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HomeMy WebLinkAboutSWG2022-00094 - SWG As-Built - 1/4/2024 / k9, 1q/��// Mason County OSS Installation Report pg. 1 MASON COUNTY PUr LIC HEAET 422 / APPLICANT/ PERMIT INFORMATION °' �!-�" Permit Number SWG 2022-00094 Parcel # 22017-51-00152 --"�.• y.` Applicant Name Kristine Anderson &Jesse Laird Subdivision (Name/Div/Block/Lot) Applicant Address 625 W Railroad Ave#200 TIMBERLAKE#9 , Lot 152 City, State. Zip Shelton, WA 98584 Installer Name DB&R, Inc Site Address 131 E Willopa Rd, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Bed Pretreatment Type NuWater BNR-500 >5 ft. from foundation'? - - ❑ N/A j YES ❑ NO >50 ft. from wells'? - ❑ ® ❑ >50 ft. from surface water? - ❑ 0 ❑ Z 1-- • Cleanout between building and tank? - - II] 00 U Tank baffles present? - - ❑ ■❑ ❑ P. 24" access risers over each compartment?- - ❑ 00 W Effluent filter installed?- - El ❑ ❑■ rn Septic tank capacity (working) NuWater BNR gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - ElN/A ElYES ❑■ NO DO Manifold/D-box accessible from surface?- - ❑ ❑ 0 co.,Z Check valves installed? - -- - ❑ ❑■ ❑ < 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO CI >100 ft. from wells?- ❑ ❑■ ❑ —1 >100 ft. from surface water? - -�Sfl I�'j - - ❑ ❑W � Y. >10 ft. from potable water lines?- LiEU CI Z > 5 ft. from property lines and easements?- -1 ` ��� -'4- Pi o• > 30 ft. from downgradient curtain/foundation . - s?- - - - II ❑ Drainfield level and observation ports present -w i'' - ' IF ❑ ❑ Graveless chambers or ® Clean gravel used?-( eck one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - El N/A IN YES ❑ NO Pump tank capacity(flood) 1,250 gal Manufacturer Sound Placement Z < 24' access riser(s) and accessible from surface?- - ❑ © ❑ a Alarm or Control Panel Installed? - - El • ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ U ❑ n - Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other a' PumpMake/Model Gould PE51 m � 0 Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 10 ft Pump on time 1.36 minutes Pump off time 6 hours Daily flow set at 240 gpd Updated 8/21/2018 parcel# fl o V1 c5 CO y 'l MesonCounty OSS Installation Report pg. 2 . — BANDONMENT RECORD — , Were @gigtirg peptic som orients etiantidned as pdft of iNe ptt3)eetV - - - - - -• - •- - - - - 0 YEa 131 NO It yee, Tessa detj6riba; -- ------_. — — — — Were all convene*pumped ett and properly abandoned pet W C 46--VV2A-A3Q69 -__===_° 0 YE8 —0 NO RECORD DRAWING {pis is a @@neage it ffgPfa_an (Rust be;pcufate an4 fleseriptive enough to to,l©sato in the Reed ofami aint n e settles aned oto)tto0OPR1 cf Twig.algoopf0 @WON§9snt !; Qaifib�4 TL31 4 erientatign 8 layeyt,Wto/wmp tank tosaton,t affpN,faaew® .._epf+l , 9_.-e eees g., Ylfltt§,@9fe444140 @@A§,ds af',aofs,PO @VW(Batmen@sts@ 4%e§5 POW In +ets aftftRIO rN40,1ng§rtlfq ofgate additional cjelays-iR fpai instatleliae appfaval wilt tplatad pefffets- ' • @cgfd Orawing Attached ._AF:i -- CERTIFICATION OF INSTALLATION INSTALLER UNSIr NER! ENGINEER I gef ify that I installed the system in aoeardanne with I certify that the system has been installed in aGenr= 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 rei pprove_d by both the designer shown here have been cleared/approved by both and Mason Goofy Public Health end 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 ell information contained on this form and-atteched Record Drawing is accurate- form and attached Record Drawing is ece_urate. C(Z __ _ i z- - 2_3 Signature of installer Bate a -N 14,-A94, 13rinted Narrle©f Signee a .. ' Aik..:•47t. MASON COUNTY PUBLIC HEALTH `�..' i$11.:. 1. .'» • nod this Installation Report and �":�1 ; `� 1 The fa..d+�rslg approves . 51:'o349 ` 4:1 ' PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public �' •Main•U i�iV� c_{�, DCPIfiES s � r �' " ±P- -r' 12- t a- 23 sigsatura cif Environivenfe!Health Specialist Date (sfariip, signolure and date) THIS FORM MAY BE SEANNgD AND AVAILABLE FOR PUBLIC VIEW ON THE MASON eouNTY WEB SITE 47d1"8f21i2O 5 AS n1 � ,l ® _ r�� Fig e,s5-6.0H4 rf nf; 15 4z ,a. SCC414 g I - 2 o r. 2,-7 33 4� . '� t 5 6Lio.):1: K • • / /..,\ s _..7 / O Audio-Visual Alarm _ z 2 Cleanout l`yt" • _ /\\NNN\t,(e- O ed., 0 NuWater BNR-500 ATU Tank VC �--- b.,- S -- f 0 1,000 Gallon Pump Chamber {)iST - flxZoi } a l ?� x 3a ?��' 's / ,). 018'i D ..`t.fiS cCri ° O 4..A. : l' \ .- 40' . APPROVED . --11- z23 4 - ANo4 - MASON COUNTY '�'JIRO '�ENIM.HEA NN �.S `j " ` i6' T RE C IN 2, 1' x uous�c -3S PA N . • - PAUTA JOY JONNSON !�?, \ 17,--c 9 J1.3