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HomeMy WebLinkAboutSWG2023-00309 - SWG As-Built - 11/17/2023 1 . Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/-PERMIT INFORMATION Permit Number SWG 2023-00309 Parcel # 32234-50-00006 Applicant Name Travis Ames Subdivision (Name/Div/Block/Lot) Applicant Address 6019 45th Ave NE Madrona Morningside Beach Tracts,TR 6-7 8 T.L. City, State, Zip Seattle, WA 98115 Installer Name Maples Excavating Site Address 12831 NE North Shore Rd, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 1. y ❑Tank Drainfield Only ■ Repair ❑O:her Full System Installation (s)Only ❑ ❑ System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft.from foundation' - ❑ NIA ❑YES ❑ NO >50 ft.from wells? 0 I ❑ >50 ft.from surface water? - ❑ z ■ ❑ a Cleanout between building and tank? - ❑ ❑❑ ❑ C.1 Tank baffles present? ❑ a24" access risers over each compartment? `yt=; - ❑ CI W Effluent filter installed'- I ❑ ❑ rA Septic tank capacity(working) NuWater BNR gal Manufacturer Hagerman (Traffic Rated) O D-box water level and speed levelers used? - 0 NIA El YES NO J OLL Manifold/D-box accessible from surface?- El ID El mZ Check valves installed? - ❑ LI ❑ DQ f Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 LI 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- ❑ NIA El YES LINO 0 >100 ft from wells?- . 0 ❑ ❑ W >100 ft. from surface water? - ❑ ❑ ID LL >10 ft.from potable water lines? ❑ ❑ ❑ z Q > 5 ft.from property lines and easements? ❑ ❑ 0 Q > 30 ft. from downgradient curtain/foundation drains? - PiElElDrainfield level and observation ports present - ❑ 0 —1Q--Gxatitstaiss-tha„be.c e• ❑ nor gavel user (chock ono) El cover installed over drainfield? 0 El Pump tank setbacks consistent with septic tank? ❑ N/A I5 YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman (Traffic Rated) z ElNI ❑ et 24' access risers)and accessible from surface'a.. Alarm or Control Panel Installed? - - ❑ El ❑❑ 0 0 2 Control Panel equipped with Timer!ETM /Counter- 7 a Pump installed in ❑ Bucket or • On Block or ❑ Other 0- Pump Make/Model Orenco PF 200511. 1/2hp, 20gpm 0 Floats or El Transducer 20. -- ft 7 Tank draw down 2"in 1 min in/min Pump capacity 3.8 gpm Squirt Height Pump on time 7.9 min Pump off time 1.84 hr Daily flow set at 360 gpd ` �� Mason County OSS Installation ReportParcel# 2 — SO— ABANDONMENT RECORD YES 0 NO Were existing septic components abandoned as part of this project? r r n GQPl�N ' iDN ad nI� DF If yes, please Z 01 5/IYES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING Rim Thu is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance anemias and nit ry re development ,m Oramn fold onenbM o &layout.Sept Pump tank lease Noe arrow.reserve c2o-neld.evaEng am proposed ouides.eaten of wells,waledoes. ga contain: Orefield&manifold l Record Creme may create addronal delays in Pet Pelson approval and relate permits. wells mmrnaan Dons.aaanwu,and other ma�.n:enance access posts. Incomplete b<Record Drawing Attached CERTIFICATION OF INSTALLATION 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 I 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. 7,Ejut1--- i0/I7/23 ZSignature of Installer Date i ilk Printed Name of Sfgnee :at ♦aay MASON COUNTY PUBLIC HEALTH �''t-'� �^. The undersigned approves this Installation Report and t w� 11 Record Drawing on behalf of Mason County Public t� PAIRA JOY JOHNSON Health: L A ILA OY ER" ln( `rwl t I� \75) _s S S , < . 11.45�� Signature of Environ enrol Health Specialist Date (stamp, signs core an date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBIC VIEW ON THE MASON COUNTY WEB SITE UPdmedaa1 rzNe . Ni E N o-r- S kz W ��v��� � d/ io 20 30 40 d , seucL-r © y lemi5+AMAn1okhME5 ►o 0 • -- PAQGEI#321i4 50 000Ob r 0 ___O C-kRRCT 11931 NE NoRtk SNORE RD d + o c O O TT"� a �► qA 0.000% Rz 3BRLi o {ouSE x R o4 T will aF f cA / BuiKi-iEJt I D ;-loo �p CANAL ` -�Z- G �Z/L, j C.. k \,y v il�bp xev: R® C Audio-Visual.4iarm 4,15., �UQv i V"'/'s ,,,.,p bi...;.s J Zp 3 lA U C':eanout - i.^'s"¢°' Q '.y p_ , 3 ArA at r BNR-500 Pretreatment Tank , ti , q - TC -- cP"a--. 0 1,000 Gallon Pump Chamber mr.^xc'c .- Subsurface Drip System Headw-orks ,. ' °0la TOn.K—dEco.- ei SsioseeCi Este^ ta�^�SceMis PuMp e €oc-U-n-c et\-�. s� .,pcex -2c.. �. lit `itF Z N ' \r yr ? 5+iao<s 'p`�& FAULA JOY JOHNSON i' LICE Nit ees n7rti i :: 11—A5-2,3