HomeMy WebLinkAboutSWG2020-00566 - SWG As-Built - 1/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00566 Parcel # 32021-55-01014
Applicant Name Sasja Dekoker Subdivision (Name/Div/Block/Lot)
Applicant Address 320 E Fox Run Ln SHORECREST TERRACE 2ND ADD BLK: 1 LOT: 14
City, State, Zip Grapeview, WA 98546 Installer Name Five Guys Enterprise
Site Address 101 E Ashwood Ln, Shelton Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type Shallow Pressure Pretreatment Type NuWater BNR-500
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - - - ® ❑ ❑
Z >50 ft. from surface water? - - - - ❑■ El
H Cleanout between building and tank. ict- % - ❑ ❑■ ❑
o Tank baffles present? 1 N 2 6 ZQ`L3- - _ ❑ ❑� ❑
n~. tm
24" access risers over each compar : AN Li ❑■ El
W Effluent filter installed?- t 0. �sc- - ElEl El
1�+
Gi
Septic tank capacity (working) BN- +t i_.....e-' ,anufacturer Infiltrrator
o D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
(Du_
Manifold/D-box accessible from surface?- - ❑ 0 ❑
co Check valves installed? - 0..--\- u`' ---f, "— - El0 ❑
�
❑<
2 Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) 0 2 P[I— ❑ 5 El ❑Commercial/Other
>10 ft. from foundation? 4 0-pf- -.i . ❑ N/A El YES ❑ NO
>100 ft. from wells?
44SQ - 1 ❑ ❑
a -
W >100 ft. from surface water? � Ali/ 3 Nry i(j - - J ❑ ❑
T. >10 ft. from potable water lines?- E��/R� , 1 0 ❑
Z
> 5 ft. from property lines and easements?- - - - ✓$ NMFN�4t-gE}- r. ❑ 0 ❑
Ce > 30 ft. from downgradient curtain/foundation drains? A�` ® ❑ ❑
a
Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑■ YES ❑ NO
Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator
< 24" access riser(s) and accessible from surface? ❑ 0 ❑
1--
Alarm or Control Panel Installed? ❑ ® ❑
a
2 Control Panel equipped with Timer/ETM /Counter- ❑ 0 ❑
m
a Pump installed in ❑ Bucket or IN On Block or ❑ Other
a' Pump Make/Model Zoeller N152 ■❑ Floats or ❑ Transducer
a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 2 ft
Pump on time 1.2 min Pump off time 6 hours Daily flow set at 240 gpd
eat,',. :?^........
Mason County OSS Installation Report pg. 2
Parcel it 50'02, --SS-O l o t 4
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project?
- El YES )4 NO
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? - YES
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough
to re-locate
eel catte in anowe.neede of
mainteetd,nance
and activities nd development.
of wTypical axecord
Drawings contain: O:dinfield 8 manifold orienlaeon&layout.Sep P P s:,: ihonal delays in a11aeon approval and related permits.
wells.observation ports.cleanouts,and other maintenance access points. Incomplete Record r. T.p ma t.
1,., .. ROvED
... :.
ad
;�SOvCOUNT,JAN 3 0
2023
rENVIRO
Jew MENTAL yEALry
*Record Drawing Attached
CERTIF1CArTION4F LNSTALLATI
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
1 further certify that ail information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature of4FZIler Date
11ra 1 L elf 1) .9.5
Printed Nage of Signee •
it `(
MASON COUNTY PUBLIC HEALTH ',.
The undersigned approves t4his Installation Report and '' .:`/ 'AP •
Record Drawing on behalf of Mason County Public _ s,oosae i�}'o
va PAULA JOY JOHNSOM .7�� `F�
t.,), ,„.,9,
Heath g LtCEFd c.W'b IGNf4''f'
'PitsOYY JO/ '
Sign ure o Environmental Health Specialist Date (stamp, signature and date) +
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upd"'d a2nl2O18
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jc c e 1. *t32021-55-0101 3 Audio-Visual Alarm
l 01 a Ash Auood' Lh n Cleanout
3 NuWater BNR-500 ATU Tank
3 1,000 Gallon Pump Chamber
OValve Control Box
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