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SWG2022-00289 - SWG As-Built - 6/9/2023
Mason County OSS Installation Report pg. 1 C__C__` MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00289 Parcel# 22007-50-00003 Applicant Name Scott Gradin Subdivision (Name/Div/Block/Lot) Applicant Address 28226 203rd Ave SE TIMBERLAKE#7 TR 3 City, State, Zip Kent,WA 98042 Installer Name Maples Excavating Site Address 60 E Skookum Dr, Shelton Designer Name Arrow Septic Desings INSTALLATION CHECKLIST NO Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft.from foundation? - - 0 N/A El YES ❑ NO >50 ft. from wells? - - II ❑ ❑ Z >50 ft. from surface water? - - 0 0 0 FQ- Cleanout between building and tank? - - El ❑■ 0 0 Tank baffles present? - - ❑ ® 0 I- 24" access risers over each compartment?- - ❑ ® 0 a ill Effluent filter installed?- - ❑^530 CO Septic tank capacity(working) NuWater BNR gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - >♦ N/A ❑ YES ❑ NO -' ❑ PI Elpu0 Manifold/D-box accessible from surface?- - op,.2 Check valves installed? - �c r 2 - 0 ® 0 OQ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ID 2 0 3 0 4 0 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A © YES ❑ NO G >100 ft. from wells?- - El ❑ 0 W >100 ft. from surface water? - - 0 0 0 u >10 ft. from potable water lines?- e 2v - ❑ 0 0 Z > 5 ft.from property lines and easements?- - ❑ ® 0 ct > 30 ft.from downgradient curtain/foundation drains?- - - - ® ❑ ❑ Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Infiltrator Z 4 24" access riser(s) and accessible from surface?- ❑ H d Alarm or Control Panel Installed? - - El1E 0 E Control Panel equipped with Timer/ETM /Counter- - 0 I ❑ m d Pump installed in ❑ Bucket or ® On Block or ❑ Other O. Pump Make/Model Zoeller N152 0 Floats or 0 Transducer 0. a Tank draw down 1.5 in/min Pump capacity 38 gpm Squirt Height 15 ft II Pump on time 1.5 minutes Pump off time 6 hours Daily flow set at 240 gpd Updated 8,21/2018 I Mason County OSS Installation Report pg. 2 Parcel# Z 20 0 —S O — db Ob __ ABANDONMENT RECORD NO Were existing septic components abandoned as part of this project? - 0 YES If yes, please describe: . ❑ YES r=1 No Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING This is a permanenttank location,North arrow.reserve drainfield,existing and proposed buildings,location of wells,waterlines, record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record s may create additional delays in final installation approval and related permits. well ,Drawings contain: Orts.cl d&manifold ther &layout.SeptiGpump ,,yells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawing I H 1)/V2_,,,Al Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 1 further certify that all 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. ...6/2144.-I/-- --- 0 5 72.S Z3 i ,� 4 4'Signature of Installer �`d`e Printed Name of Signee ~ MASON COUNTY PUBLIC HEALTH j 0343 y'{' P!ULA JOY JOHNSON � The undersigned approves this Installation Report and Q.: •• •LICKSS-- -N eft' Record Drawing on behalf of Mason County Public <�-sS� �� Health: EXPIRES 1 :ti LW IP \1111 6 (q f7:5 s---eR--z-3 Signature of Envirtlnmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212o18 7 . SG - •, _ �o gd AS � 0 20 3 j l2r _k___ .a.)k Z2OO1. o-oaoa� ( XS'• c)o E 5�aUo� /1 ��. �� ; 0 51 o k. CS P 1 . - ,\.k-tr Q v 1-‘v,e S ai \ s s 1 e,e\I ea.* rC 113 0 I ci ` ! � z f ? - 1© 1 1 `o ` • am- Cb � $ 1 � 1 � �9 �Q.t,J�. \ ' \ iI T 3 \ min > l l 1 Lo Q� 1 01. 0 --)k:- P . . ..4, ._..., • s1 49 .'''�' PAULA JOY JOHNSON A_ � L'tC�FlS� '�ESi ��ad r ���� � � r���-ccb Ol Audio-Visual Alarm a EcP, s� 7 J e 02 Cleanout . 5 r tS(- 7:3 0 NuWater BNR-500 ATL Tank 0 1,000 Gallon Pump Chamber OValve Control Box APPROVED MN 0 9 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET