HomeMy WebLinkAboutSWG2021-00423 - SWG As-Built - 2/1/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION ---..........._
Permit Number SWG tat ( -CO 115 Parcel # 32127-53-00181
Applicant Name Solid Homes Subdivision (Name/Div/Block/Lot) 4N2 S?02‘
Applicant Address PO Box 4881 RE -
City, State, Zip South Colby, WA 98384 Installer Name Mike Skinner `✓
Site Address 100 E. Olde Lyme Rd, Shelton, WA Designer Name Rod Left
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type --_ Pretreatment to Pressure Pretreatment Type Nuwater BNR500
>5 ft. from foundation? - - ❑ N/A 0 YES El NO
>50 ft.from wells? - - ❑ 0 ❑
• >50 ft.from surface water? - - ❑ 0 ❑
Z
Q• Cleanout between building and tank? - - ❑ ❑ 0
U Tank baffles present? - - ❑ 0 ❑
F-- 24"access risers over each compartment?- - ❑ 0 ❑
a_
IA Effluent filter installed?- - ❑ ❑ 0
rn
Septic tank size 1250 gal Manufacturer _ Hagerman
O D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
O Manifold/D-box accessible from surface?- -- - - 0 ❑ ❑
a?-2 Check valves installed? - - 0 El ❑
❑<
Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 20 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
>100 ft.from wells?- - ❑ 0 ❑
W >100 ft. from surface water? - - ElEl0
LT_ >10 ft.from potable water lines?- - ❑ 0 ❑
Z > 5 ft.from property lines and easements?- - ❑ 0 ❑
Q
tY > 30 ft.from downgradient curtain/foundation drains? - - ❑ ii ❑
0
Drainfield level and observation ports present - - ❑ El ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES ❑ NO
• Pump tank size 1250 gal Manufacturer Hagerman
< 24"access riser(s)and accessible from surface?- - ❑ 0 ❑
1--
P. Alarm or Control Panel Installed? ❑ El 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑
D
a- Pump installed in ❑ Bucket or /❑ On Block or ❑ Other
a• Pump Make/Model Liberty 280 0 Floats or El Transducer
a.
a. Tank draw down 2 in/min Pump capacity 52 gpm Squirt Height 6+ ft
Pump on time 51.9sec Pump off time_ 3hr Daily flow set at 359.8 gpd
Updated 8/212018
4
Parcel# S -- 0447,-r -
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD •
. f__1 YES 'NO
•
Were existing septic components abandoned as pact of this project? - TTT-
if yes.please describe:_ NO
Were all components pumped out and properly abandoned per WAC246.272A-0300' ❑ YES •
V.
RECORD DRAWING ."
ivities and future development
mh k a psrtnanant.wcnrd and must'be accurate and descriptive ]ank9h to w:,at on North arrow,fca¢r .'d�axr<in the need of rntenance eld.exrslntg atnd D Wo'ed rankings o:.z>•Ce n:wells.Typical
vva�Cd'^e` -"'—
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Ii ob mnnn p(sinfiNC 6.,,eMWd onercyl,on X tayow.Sri'{'xa^G scale wJdrriaul delays m final instaL'auM aUPwal and telaled[+e^1R5 :. k
rkanwn..ne other rnaenan r access P"n�.k,compkre Resod Drawings may �,<4,7c3' ,4
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Or Record Drawing Attached
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CERTIFICATION OF INSTALLATION
1";-. INSTALLER DESIGNER/ENGINEER
L1 certify that I installed the system in accordance with I certify that the system has been installed in accor-
f - the septic design stamped APPROVED"by.Mason dance with the septic design stamped'APPROVED"by
ICounty 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 f urthercertify that all information contained on this 1 further certify that all information contained on this
•
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature of Installer Date =.
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I_A (Ke SKri✓rr_er-
'* Printed Name ofSignee y p,
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- MASON COUNTY PUBLIC HEALTH '� Pp f`� � 1 _.
The undersigned approves this Installation Report and 1_I 0 V ;q' r 1�:.
Record Drawing on.behalf of Mason County Public *Q 9 RaFr '�.
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MASON 2024 c,t l 12r1s12
"" -'� �_ ,,. =ofFnvirnnnmenta'Health Specialist Date b JA NMENTAL lick*. p,signature and date) T.,
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