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HomeMy WebLinkAboutSWG2021-00103 - SWG As-Built - 7/27/2023 JUL 2 7 2023 LT H Mason County OSS Installation Report pg. 1 MASON APPLICANT! PERMIT INFORMATION Permit Number SWG 2021-00103 Parcel# 22018-33-00118 Applicant Name Pin Subdivision (Name/Div/Block/Lot ) Pinnacle Constr uction TIMBERLAKE#5 LOT: 118 Applicant Address 10718 Crescent Valle Dr in Solutions City, State, Zip Gi Harbor,WA 9832 Installer Name B& C Build Site Address 150 E Designer Name Arrow Se tic Desi ns, Inc INSTALLATION CHECKLIST 500 Gal Pre Trash Tanks Only 0 Drainfield Only 0 Repair alOther ® Full System Installation 0 � % Pretreatment Type NuWater BNR-500 System Type Pressure Bed - - ❑ NIA �YES ❑ NO >5 ft.from foundation? - - - - - - - - - _ _ _ _ _ _ _ _ Q 0 0 - - - - - - ❑ 0 >SCft. fromwells? - - - - - - - - - - - _ _ _ _ 0 • >5O ft.from surface water? - - - - - - - - _ _ • 0 El z - - - - - - - - 0 0 ❑ < Cleanout between building and tank? - - - - - ❑ Tank baffles present? - - - - - - - - - - - ❑ ❑� U 0 ❑ a24" access risers over each compartment?- - _ _ - - - - - - - _ a W Effluent filter installed? - - - - 3N ck- Sao Ha erman N (working) NuWater gal Manufacturer Septic tank capacity ( 9� � `S ❑ NO o D box water level and speed levelers used? -yve tooX - - _ _ _ 0- - - - - - - - - - - - - _ 0 NIA ❑ll YF 0 00 Manifold/D box accessible from surface?- -p - - _ - - ❑ a ❑ 092 Check valves installed? - - - - '�_ -r O Q " Schedule/Class 40 � Transport Line Size Bedrooms installed (check one) 0 2 ■❑ 3 04 ❑ 5 06 0 Commercial/Other 0 NIA � YES 0 NO >10 ft.from foundation?- -- i 0 0 >100 ft. from wells?-El - a 0 0 0 >100 ft.from surface water? - - 0 ❑ LL, >10 ft.from potable water lines?• ❑ 0 0 Z > 5 ft. from property lines and easements?- El 0 Ce > 30 ft. from downgradient curtain/foundation drains? a 0 Al EY. - ❑ a Drainfield level and observation ports present •❑ Graveless chambers or © Clean gravel used?-(check one) - El a El cover installed over drainfield?-- - - El N/A 0 YES 0 NO Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -1 000__al Manufacturer Ha erman Pump tank capacity (flood) . _ _ _ _ � ❑ ID Q24" access riser(s) and accessible from surfaces _______ - - _ - 0 Q ~ Alarm or Control Panel Installed? - - 0 ® ❑ awithTimer/ ETM /Counter- - - - - - - - � Control Panel equipped CI ❑ Other Pump installed in 0 Bucket or Q On Block or ❑ Transducer Libe 253 ■l Floats or a Pump Make/Modelh R '� F�<ti it 30 90 i Tank draw down 1.75' in/min Pump capacity�— pui sit a>' _g60 gpd �' Pump off time 6 hr 3 min � ,aceoa�1rzo1s Pump on time AUG 1 1 2023 MASON COUNTY ENVIRONMENTAL HEALTH ,J B PaC2 _� o ^�1 4 ABANDONMENT RECORD 0 so Mason County OSS InstallationReport _ AB _ _ �� „n" ❑ No this otoiecr �- YES abandoned as Dar` of _ _ _ _ - mponents �� � AC2d6 272A 0300? IWeref ye , plea e septic t--- ndoned Per tN, If yes.all dencns pumped properly aba �e r all components Iw DRAWING and+ QeY`t �,y ems.N�psSRes Were RECORD o� ,n dx of tsuinenan�a P 'cd p bides ,a and ra�'tea vim^ra. descriptive North ar*a^ 3ra n�add7t+�a'3elaY5 in final in51a109� ve enou9� reSeM Drav must be accurate and Septa/pump as.II 1c:atioR. nys may anent record and .ion S Woo:,Ste' G. Incomplete Re dosd weltDraw naaxrvalaan tom,cleano J� and of mantenance access;iam welts. AROV ;1.t' AUG 1 1 2023 i.: MASON COUNTY ENVIRONMENTAL HEALTH21 ReCQTd Drawing Attached JBW INSTALLATION CERTIFICATION OF SNEER pES1GNER1 ENGINEER system has been installed in accor- thaf the ed"APPROVED"by !certify septic design stamp ance with with the any deviations INSTALLER septicpDER the system O accorddance' Health and that both that i installed "APPROVED"by Mason Public, rov.. by certify ed"APPRO Mason County design stamp thatan deviations shown here have been cleared/approved and meet ail the shown �, County red/Public H County Public Health and Y both the designer myself and Mason t Codes n cleared/approved by County and meet all State State andcontained on this here have niC public Health certify Mason that C u information ,S accurate and Mason County I further Record Drawing Codes. form and attached alt information contained ,r fhis and Mason County I further certify that Drawing is accurate. form and attached Record D� Date A ..,t, Installer___. �` . ��'fA� g{gna re of to o ,a . F , , , ,_, . „,..„ e of Signee Printed Na•r �� ' s,�u:, a "� ��. pUBLtC HEALTH nd 4 PAULA JONtd60N ! , MASON COUNN this tnTterieuor, Report a LiC4 :,�b'0�$i'r1vt=li_ J. s Dues Public ��CS'�1 The undersigned d wing PPr half of Mason County r-i,e A JOY �7 `' Rece d Drawing on be _ (-?j `l,-� (stamp,u.,-u- une and date) ,\ THE uoar.•.�aaz1 � COUNTY WE6 SITE .. I • Date MASON CORN 11).4 Specialist��� eRT: Health SP FOR PUBLIC VIEW ON / nvironrn AVAILABLE Sig,r � BE SCANNED AND ';ti15 FORT' MAY • 56 x 2:7 38R DC ;\/ewa� 43ta ba m,Tck 1 Q- ox.houSe cxlSfl 1II '1 2 c cr ,c vs- NI r , 1-- --- ' \ -j-- Si ':7---) 11 o 1 x 1,S t �, l i--t 5 I\ (: .\ min o © r ro o — � y jot O o 0 �"Co 0 -- PCO�� r ' 1xi' ' ,La tag. Vi ``�' s`` Sto4' L 112•1-i7 tiS{-; tank EyoS-F n9 Shed tc be d.ecom;ssCovu,d ASbu +- MJS+ be removed . or rt.w,o+ed. b be a balo 0►d F. nc ,d . �i n n ac l-e GohShCu C.��ah Par C.e( #220 l? 53-60 i ( xer: (SO a Vc U h �, O Audio-Visual Alarm 2 Clear_out 4. tt 20' C Se ct 1 i U 500 Galion Pre-Trash tank ppRO [O 2 0 30 Lid O NuWater BNR-500 ATU Tank O 1/ Chamber AUG E ,,, .A. Q= Te S. —aft n 1,000 Gallon Pump MASON UG ' 1 �023 Li c �/ Cam- ` $ax OUNTV FNVIR t ` 4-0# �' 0 uU GO C r (2 )3, Q?°�Nre-s stir/W NTAL HEALTy 42A, 0- 2'4 " LS ' N i i. l �7 cD� Jy� : �. 51L0149 r�} ,-' PAULA JOY JOHNSON .?y eO.. l:iC�iS�����iGN�.�.b _,, ExPIR1 9rib'i