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HomeMy WebLinkAboutSWG2024-00051 - SWG As-Built - 4/16/2024 Mason County OSS Installation Report pg. 1 MASO TY PUBLIC HEALTH APPLICANT/PERMIT INFORMATIONPermit Number SWG Parcel# 22017-5 -000; Applicant Name Ronald Poole Subdivision (Name iv/B at) 4 Applicant Address 38215 42nd Ave South Timberlake Div 2 L �E/VFD City, State, Zip Auburn WA 98001 Installer Name Shale Oien If Site Address 360 E Lakeshore Dr E;Shelton Designer Name Tom Weaver INSTALLATION CHECKLIST [9 Full System Installation ❑Tank(s)Only ❑Drainneld Only W]Repair ❑Other system Type Pretreatment to pressure beds Pretreatment Type Nu WaterBNR600 >5 ft from foundation? --- ------ ----- --- - --- E]WA K)YES ❑ No >50 ft.from wells? ----- __ Trash Tank Before NuWater . ❑ II ❑ A Z >50 ft.from surface water? ---- ------- --- - ------ - -- ❑ K I El C Cleanout between building and tank7 ---------------:-- ❑ KII ❑ Z Tankbafflespresent? ---- ------------- -------- -- ❑ 91 ❑ 24'access risers over each compartment?---------------- ❑ 91 ❑ Effluent fifter installed?- ---- ------ ------- ------- ❑ ❑ El Tepattank size 500 Manufacturer Infiltrator Poly 0 D-box water level and speed lev s �- - - - --- jo WA ❑YES ❑ NO 0116 0 Manifold/D-box accessible fro o-- - - ®-{f- ❑ �] ❑ s?= Check valves installed? ----AM -_APR- _ �-r - ❑ El �( O22 Transport Line Size 2„ COI/ r XIS h 40 Bedrooms Installed(check one) 502 T 8 ❑Commercial/Other >10 ft.from foundation?--XPIN VAjveL_ __W__ -__Spq/TF_- ❑ rae ❑YES No >100 ft.fromwelis?---- ---------------- --------- ❑ IN ❑ W >100 ft.from surfacewater? --------------- --------- ❑ ® ❑ ti >10ft.from potable water lines?----------- -- --------- ❑ ❑ aZ >5 ft.from property lines and easements?- -per waiver-- --- ❑ ❑ K >30 ft.from downgradient curtaintfoundation drains?---- -----• ® ❑ ❑ 13 Dminfield level and observation ports present - - - -- ------- - - ❑ 91 ❑ ❑ Graveless chambers or W Clean gravel used? (check one) Proper cover installed over drainfield?--- ---- - ---- ------- ❑ ® ❑ Pump tank setback$consistent with septic tank?-- --- ------ -- ❑ NrA I$) YES No Z Pumptanksae 1,000 gal Manufacturer Infilrator H 24'access risers)and accessible from surface?---- -- ------- ❑ 1:1 ❑ C Alarm or Control Panel Installed? ---- - -- -- -- ---- --- - - ❑ F] ❑ Coned Panel equipped with Timer I ETM/Counter----- --- - -- ❑ ] ❑ a Pump installed in ❑ Bucket or n On Block or ❑ Other Pump Make/Model Liberty 280 91 Floats or ❑ Transducer a Tank draw down 1.8 iWmin Pump cspacdy 36 Opm Squirt Height 6 ft a Pump on time 1 Min 6 seconds Pump off time 4 hours Daily flow set at 240 opd urawseawois 22017-50-00079 Mason County OSS Installation Report pg. 2 Parcel If ABANDONMENT RECORD Were existing septic components abandoned as pan of ous project? -- - ----- -- --- -- n YES NO It yes, please describe: Were all comporents pumped out and property abandoned per WAC246-272A-03007 - -- -- - -- YES NO RECORD DRAWING Tnl.u<PrmN.nr n<oN.na mu.l e.--no..ntt an.Ma'.—I w n.lx.0 In N.n.w M n.u........I',-uM Nwn ar.l^P^.nt T"'XmrE w.w+w<<.u..r. o,.�.neaam.nnoa wm.nonsawtsromwimwm crew..NaN.nw.,�..nwe,nnela..mme.m enwe.a wwme..Ipu�lan a..11....enm... w.n<.oe..mmn eoti,a..iww<,.ne omrm.'nun.�.mu polnu. rmnwn A.wa a.Mne<m.r ww.aauwl eaq.in nnN:we.uon Tow+N•M.a•ua p.1wx.. Septic Tank had been pumped for sale and was also a leaker. Tank was removed from the lot !7 sov pp�OVF CDONT��RolviV, w HPALTy 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 stemped 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 cleamd/approved by both the designer shown here have been cleareclapproved 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 1 further certify that all information contained on this form and attached Record Drawing is accurate. Apron and attached Record Drawing is accurate. &- 4111/202a Sgnafum of Installer Data Shae Oien ������� Ponied Name of Sgme o+r MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �/ 's1m01A MOAVa E.VFAVER Record Drawing on behalf of Mason County Public He fh �1a S' of✓re vimnmenlaI Healx Specialist Dale (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UW.w en�m+e � © E \ m � r $ if E ` g � - / ■ a k ■ , | @ ! ! � / / Lu , k ui ( \ ke } ® iLco ` ° f ! u / � cc @ ©