HomeMy WebLinkAboutSWG2017-00407 - SWG As-Built - 7/18/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SwG 2-6 n— D7 7 Parcel# 31904-56-00001
Applicant Name Curt Harmon Subdivision (Name/Div/Block/Lot)
Applicant Address 1281 W. Lost Lake Fid Kadoun's #1 TR1 Lot 1
City, State, Zip Shelton WA 96584 Installer Name Aaron Shumaker
Site Address 10 SE Holy PI;Shelton Designer Name Tom Weaver
INSTALLATION CHECKLIST
IN Full System installation ❑Tankm only ❑Dreinrield Only ❑Repair ❑Other
System Type Pressure Pretreatment Type NUWaterBNR500
>5ft.from foundation? - -------------- -- -------------- ---------- -- ❑wA ]YES ❑ NO
>50 ft.from wells? - - - ------------ ---- --------- ❑ ❑
Z >50ft.from surface water? - - ---------------------- ❑ �r ❑
FQ- Cleanout between building and tank? ---- --------------- ❑ ❑
V Tank baffles present? -- -- - -- - ------------- ------ ❑ ❑
1 24'access risers over eachcompartment?------------- --- ❑ ❑
W Effluent fitter installed?.--- - - ---- - --- --- - -- -- - - - - - ❑ ® ❑
Septic tank sae 1,200 oal Manufacturer NuWater BNR500 w/o trash tank
�O D-box water level and speed levelers used? ----- -----_-- -- 9 yaA ❑YES ❑ No
00 Manifold/)-box accessible from surface?------- - -- ----- - - ❑ jo El
Check valves installedv - -- - -- ---------- -- -- ----- , ❑ ❑
S Transport Line Sae z Schedule/Class SCh 40
Bedrooms installed(check one) C4 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- -- -- -- -------- - ---- --- -- , ❑wA ®YE ; ❑ No
0 >10011.1romwells?--- - - ------------------------ ❑ ❑
W -100 ft.from surface water? ---- - ---------------- --- ❑ ® ❑
2 >10ft.from potable water lines?- - - -- - ---------------- ❑ ® ❑
>5 ft.from property lines and easements?---__ -_-_ --__ ❑
0 >30 ft.from downgradient curtain/foundation drains?- -----__-- ❑ ® ❑
Drainfield level and observation ports present -- - -------- --- ❑ ❑
❑ Graveleee chambers or W Clean gravel used? (check one)
Proper cover installed over dralnfield?- -- ----- -- ---- ---- - ❑ R1 ❑
Pump tank setbacks consistent with Septic tank?- - - - -- - ------ ❑ NM YES ❑ No
z Pumptanksae 1,000 at Manufacturer Hagerman
F24'access dsegs)and accessible from surface?--- - - - - - - - - - - ❑ ❑
IL Alarm or Control Panel Installed? -- - - - -- - - - - - - - - - - - - - - ❑ ❑ ❑
jControl Panel equipped with Timer/ETM/Counter- -- --- - - - -. ❑ ® ❑
a Pump installed in ❑ Bucket or Qg On Block or ❑ Other
g Pump Make/Model Liberty 250 QJ Floats or ❑ Transducer
IL Tank draw doom .8 In/min Pump capacity 18 aPm Squirt Height 3- fl
Pump on time 2.5 Min Pump off hire 4 Hours Daily flow set at 240 apd
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Mason County DES Installation Report pg. 2 Parcel If 31904-56-00001
ABANDONMENTRECORD
Were existing septic components abandoned as pan of this prgect7 -- - --- - - - - -- - - - YES Pg NO
If yes, please describe
Were all components pumped,out and property abandoned per WAC246i272A-0300Y - -- - - - - - O Yee [A NO
RECORD DRAWING
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Uewny<i,fix, D's xild I m¢ 0i nre[asuon a kycul,SepWpuM M1'M1 bteuan Ni W" I.—vl wee+w.-,
Mb.KKYieo.Pwb.di,ii end OMo m ,i—a .MMa Ii Remrd pen,l —,—11....ii:xi I.u1.0i e —iiKd Maletl pFTiib
[Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I Installed the system in accordance with I cerMy 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 c/earedrapproved by both the designer shown here have been clearedvapproved 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 cervity that all information contained on this I further certify that aN information contained on this
form and attaehadRecrord Drawing is accurate form and attached Record Drawing is accurate.
2024
nature oflnstaller Date
Aaron Shurnaker
Pdnfed Name of Sgree
MASON COUNTY PUBLIC HEALTHr t u1
The undersignetl approves this Installation Report and 1ro33a
Record Drawing on behalf of Mason County Public �'' I : •4 ..r w�AVFR �,
Heahh: �.., 7.,5":.Y NER •,r
-7
Signatun of Environmental h6afth specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBJC VIEW ON THE MASON COUITYMS SITE uod.bdearme
Sti1 0.24'Sand loam
24.32'Grsy sand and pnvN
SU2 0.3r Sand Loam
20' $U3 0.32'Sand loam
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