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HomeMy WebLinkAboutSWG2021-00164 - SWG As-Built - 5/10/2023 Mason County ass Installation Report pg. 1 C ti MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00164 Parcel # 22018-50-00209 Applicant Name Modern Living Limited/Henning Subdivision (Name/Div/Block/Lot) Applicant Address 15414 Rose Road SW TIMBERLAKE#1 LOT: 209 City, State, Zip Lakewood, WA 98498 Installer Name Bayview Contractors, Inc Site Address 111 E Agate Dr, 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? - -{�-��]-t-(�t\q- -t1 - - - 0 N/A ❑■ YES ❑ NO >50 ft. from wells? - 15 l�J U 1i, L� - - ® ❑ ❑ Z >50 ft. from surface water? - - - y-0-2. i&23- - - 0 ❑ ❑ H Cleanout between building and tank? - ❑ X ❑ U Tank baffles present? - El El ❑ a24"access risers over each compartm _ ❑ ❑ w Effluent filter installed?- ❑■ ❑ ❑ (/) Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - j N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ Ill ❑ m- Check valves installed? ❑■❑ ❑ oa 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑� YES ❑ NO CI >100 ft. from wells?- - LI ❑ ❑ W >100 ft. from surface water? - - 0 ❑ ❑ LT >10 ft. from potable water lines?- - ❑ I ❑ Q > 5 ft. from property lines and easements?- - El 0 ❑ Q > 30 ft. from downgradient curtain/foundation drains?- - NI ❑ ❑ Drainfield level and observation ports present - - ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ it ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ NO `-r Pump tank capacity (flood) 1,000 qal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - ❑ EI ❑ a Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ I ❑ M a. Pump installed in ❑ Bucket or s On Block or ❑ Other M Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 3 ft Pump on time 1.5 min Pump off time 6 hours Daily flow set at 228 gpd Updated e.2'•20 t 3 Mason County OSS Installation Report pg. 2 Parcel# 2 2 0 B' s D- DD Zo 1 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout.Septicipump tank location.North arrow,reserve drat nfield.existing and proposed buildings.location of wells waterlines wells oeservaticn ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create addilionai delays in fins,installation approval and related permits \fi6 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that 1 installed the system in accordance with 1 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 I further certify that all information contained on this /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. I2— - 2 2_ tur Ja;eA t ri e— 17).1`01,, ✓ Printed Name of Signee MASON COUNTY PUBLIC HEALTH \h The undersigned approves this Installation Report and yq\ . Record Drawing on behalf of Mason County Public s,o aas .. r,+;'t Health: PAULA JOY JOHNSON fd r 1r b '!'GHI+tt" (6)/1 ((t. Signature of Environ ental Health Specialist Date Z re—n 3 g P (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Jpdated 812'2e15 f siopa- 1 I i &rcii ZZOI8 —50-GD20; 111E A-q a K L ' I �J , Sc,a(-e : d '-, ZG, i > i r i 1 �� 0 Id 20 3Q u( — — APP ROVED MAY 10 2023 MASON COUNTi .YENV)RONMENTAL HEALTH o , © RET N • 0 ig. El 0 \tr',11 NI A. tn \si (9) 3 ' 2( 35' FrOI)ari .f. 24' C I'QnCIN,S @ 5` d_G . c44' pl kAi ( r-Z S f 'Off i a w Z 13 R 1 { Key: I - 0 Audio-Visual Alarm -v• iN1S+ \ \ UCleanout 1 \ U NuWater BNR-500 ATU Tank 3 1,000 Gallon Pump Chamber 1 1 ----71 OValve Control Box 6/ , Tici 1 . ..... . / Is \\--- (3' , s,,e-‹ 4,1D, . . 'Is Pc ! a..., ey V lJ e l h •�, 1 -e----4.1" • � PAUTA JOY JOHNSON "� tCKltlSl413 10,04:: EXPIRE$ � `�5 a—Z8-e.3