HomeMy WebLinkAboutSWG2022-00126 - SWG As-Built - 5/23/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00126 Parcel# 31904-54-00015
Applicant Name Zenith Group NW LLC Subdivision (Name/Div/Block/Lot)
Applicant Address 3190 Harris Rd SE FAWN LAKE#5 TR. 15
City, State, Zip Port Orchard,WA 98366 Installer Name Bamford Septic Repair
Site Address 30 BE Fuchsia Ave,Shelton Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure Trench Pretreatment Type NuWater BNR-500
>5 ft, from foundation? ---- ❑NIA ®yes ❑ NO
>50 ft.from wells? - - - - ^ ❑ ® ❑
Z150 ft.from surface water? - - -- - - - - g ({� t{(� ❑ ❑
H Cleanout between building and tank? - -- D L5 "' - -- Ilry1L'IF'IJII ❑ ® ❑
v Tankbaf�espresent? -- ---- - - - - - - - mayfir}, ?G?4- ❑ ® ❑
a24"access risers over each compartment?- - - ----- - - ---- ❑ ® ❑
rW Effluent filter installetl?----------- - - - -- ------ - - - ❑ ❑
Septic tank capacity(working) NUWater anufacturer Sound Placement
0 D-box water level and speed levelers used? - -- -- ❑ WA ❑YES ❑� NO
0J
O Manifold/D-box accessible from surface?-- - - -- - - - - - - - ---- ❑ e ❑
ail!L
Q¢ Check valves installed? - - - - -— - - — - - - - - - -- - - - - -- - ❑ ® ❑
2 Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation? ------- ------ ❑ NIA ® YES ❑ NO
0 >100 ft.from wells?----- - ------------ ❑ 0 ❑
w >100 ft.from surface water?--- - ---- ❑ ❑
LL >10ft.from potable water lines?- - - - ------------------ ❑ ❑� ❑
Z >5 ft. from pr
operty perty lines and easements?--- -- --- -------- ❑ W El
K > 30 ft.from downgradientcurtaintfoundation drains?----- - ---- ❑ ® ❑
DrainBeld level and observation ports present ----- ❑ W ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield? --- ❑ 0 ❑
Pump tank setbacks consistent with septic tank?-- ---- ------- ❑ wA ® YES ❑ NO
Y Pump tank capacity(flood) 500/1000 pal Manufacturer Sound Place pre-trash/pump combo
2
F24"access riser(,)and accessible from surface?-- --- ---- -- -- ❑ 0 ❑
a Alarm or Control Panel Installed? ❑ 0 ❑
jControl Panel equipped with Timer/ETM/Counter- - -- - -- ----
Pump installed in ❑ Bucket or ® On Block or ❑ Other
a Pump Make/Model Zoeller N-152 ® Floats or ❑ Transducer
y Tank draw down 2 in/min Pump capacity 42 apm Squirt Height 3 ft
Pump on time 2 minutes Pump off time 6 hours Daily flow set at 360 gpd
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Mason County OSS installation Report pg. 2 Parcel s-l1-WA(— 67' 606/Jr
A_SANOONMENT RECORD
Were existingse components
Sc P abandoned as FaM1 of this :roac:% - ---.---- - - - -- -- E3 YES NO
It yes, please describe.
Were all components pumped out and prcper!y abandon_per 9uAC24E-272A-03007 - ❑ YES ❑ NO
RECORD DRAWING
This 1a a Permanent moan and must be accu ne and desmy0e enosn!...JC.a.,:.m.nesC ef mz bne.en ac4.hl.a.nd Iueire axelopneo. Typ¢ai ReccrG
0' -ern-": DTMBYSma:Se.aKnWtioc n,,rc To N .rcrv.,.ueve . ann.mpaaab bw,jnpb J. ells w !edlves.
'xC lS o�aCa O0 p0'4. ei80Nv.aaE Clbal Te nFree[HVvea pC s vaT{es orCCax gs. ee .a ade:Cnal M'Hy (nel:M1Si IBHa'.appCwlam:da".nn",.
1
I
gK Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
1 certify that i installed the system in accordance with I certify that the system has been installed in Sol
the septic design stamped APPROVED"by Mason dance with the septic design stamped`APPRROVED"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 Stare 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 c¢dXy Ntat all information contained on this
to, and attached Record Drawing is accurate form and attac^ad F'o.1 'D awir;: is acc.rrsts.
6+1_X 3hrbl
Signature of Installer Date
Pnhfed Name cf Signeaa.�a
MASON COUNTY PUBLIC HEALTH an
The undersigned approves this Instafiatior:Report an4
Record Drawing on behaHefMason County Public `r PAULA JtDYaJONN5IN 3'Y
Health, �n� j UC 1) NER
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Signature cf Enrvonmental 14..In Specialist Date ^. a gnature and daiei
THIS FORM MAY BE SCANNED AND AVAILAELE FOR PUBLIC VZViDN 7HF MASON COUNTY WEB SITE uShe m.Ilhle
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