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HomeMy WebLinkAboutSWG2023-00245 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00245 Parcel If 32104-54-00105 Applicant Name PW W Developments Subdivision (Name/Div/Block/Lot) Applicant Address 521 W B St ALDERBROOK G&Y#4 TRACT 105 DIV.4 City, State,Zip Shelton WA 98584 Installer Name Schce Ina Excavating Site Address 160 E County Club Dr N Union Designer Name Arrow se.tic Designs INSTALLATION CHECKLIST Full System Installa5on ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Shallow Pressure Bed Pretreatment Type NuWater BNR-500 >5ft.from foundation? ---------------—---------- ❑NIA AYES El No >50ft.from wells? ----------------------------- ❑ © ❑ Z >50ft.from surface water? ------------------ ------ ❑ ❑ F Cleanout between building and tank? ------------------- ❑ ❑ d Tank bathes present? ------------------ --------- ❑ ® ❑ 1- 24"access risers over each compartment?---------------- ❑ ❑ Q. ❑ El Effluent flier installed?------- N -- BNR-5ev Hagerman Septic tank capacity(working) BNR-500 gal Manufacturer O D-box water level and speed levelers ueetl? --------------- ❑ WA ❑YES NO 0J DO Manifold/D-box accessible from surface?----------------- ❑ ❑ mZ Check valves installed? -----L4 -- ---- -- ❑ ® ❑ 04 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) 02 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?---------- -- --- ------ ----- ❑ NIA ® YES El NO o >loanfromwells?-------------- -----' ---I ,")4 ❑ m >100 ft.from surface water?------------------------ ® ❑ g- >10 ft.from potable water lines?---------t------------ n� ® ❑ QZ >5ft.from property lines and easements?------ ---- ----• ® ❑ C >30 ft.from downgradient curtain[foundation drains?- --- ------ ❑ IM ❑ in Drainfield level and observaton ports present -------------- ❑ 0 ❑ ❑ Graveless chambers or E Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------- ❑ WA ® YES ❑ No 1' Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman ZEl � 24"access risers)and accessible from surface?------------- ❑ a Alarm or Control Panel Installed? --------- -- ❑ f Control Panel equipped with Timer/ETM/Counter----------- ❑ ® ❑ a Pump installed in ® Bucket or ❑ On Block or ❑ Other a Pump Make/Model Uberty 290 ■ Flosta or ❑Transducer � Tank draw down 1.25 iNmin Pump rapacity 24 gpm Squirt Height 20 ft a Pump on time 2.5 Pump oft time 6 hours Daily flow set at 240 antl ugnw envzoia Mason County OSS Installation Report pg. Z Parcel# 32104-S4'061OS ABANDONMENT RECORD ( No _ __ _ - YES f" Were existing sepsepticcomponents abandoned as part of this pro 1ect? - _ _ ____ ___ If yes, please describe: _ __ __ __. YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300 RECORD DRAWING .maa..+ne mv.env.ml.n•nr. Trw�l a.wm Tnb Ie.permanent rtcoN and mua he eecunn ena aescnPew°enough g o rearm.-�r.n eee W iufi ld mce 5 oaw�.yswnum: ommaae a m.neaa vaeni.upn s uy.m,snonuo n e.it nx m hem,NOM e n'e erannea,ea.uns anoomvpsea pmumq.,i.oem ois.cp—.e-note,nee,cus,end nma mNmmenre—ge otims. ImomPlelz aewe O1evinps mar��•aeammzi aNaya m nnm InbIDa.um epprwN°^a'Weed P.n^s. Record Drawing Attached CERTIFICATION I INSTALLATION INSTALLER DESIGNERI ENGINEER 1 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 cleare&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.^^rr form and attached Record Drawing is accurate. S, _qlyure of Installer Brayden Schoenino Q Printed Name of Signee 49iA MASON COUNTY PUBLIC HEALTHThe undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: V —n-Y. h signaaiu're off kn nme tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTYVVEB SITE Uvemea eavzme Kew A5 rry ro ,V•1 L', 0Audio-Visual Alai- O2 Cleanout r r NuWater BNR-500 ATU Tank A,rr tZgMit- 4.0010E far col, 4 Clvb 9 N I O 1,000 Gallon Pump Chamber Scale: t'° a io 20 30 40 WATER P , a Z 03 `y5 c APPROVED . APR 03 2024 PAULA JOT OHNSCN yl m_�r_as_r brit wia.. . MASON COUNTY ENVIRONMENTAL HEALTH s RET