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HomeMy WebLinkAboutSWG2020-00295 - SWG As-Built - 8/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00295 Parcel# 22029-50-90964 Applicant Name Rebecca Nutt Subdivision (Name/Div/Block/Lot) Applicant Address 8180 BE Lynch Rd City, State, Zip Shelton,WA 98584 Installer Name TJ's Excavating Site Address same Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair Other woramon P,—mac System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5ft.from foundation? ------------------ ----- --- ❑ N/A AYES NO >50ft.from wells? -- ---- - ------- -------- ---- - -- ❑ ® ❑ z >50ft.from surface wateR - - - - - ---- -- - - - -- - - - - - -- ❑ El r Cleanout between building and tank? -- --- ---- ------ --- - ❑ ❑ L) Tank baffles present? - -- - -- - - -- - --- - --- --- ---- - - ❑ ❑ a 1- 24"access risers over each compartment?-- -- - ------ - ---- El W Effluent filter installed?---- --- - --- - - - - - -- - - - - - ---- ❑ ❑ N Septic tank capacity(working) NuWater gal Manufacturer Hagerman 0 D-box water level and speed levelers used? -- --- - ------ - -- ❑ Nu ElYES ® No 00 Manifold/D-box accessible from surface?- - - - - - - -- -- --- - - - El ® ❑ mZ Check valves installed? -- - - - - - - - - - - - - - - - -- - - - - -- - ❑ ® ❑ ❑Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - ---- ----- - - ---- - - --- - -- El WA ® YES NO o >100 ft.from wells?------------------- - --------- ❑ ® ❑ w >100 ft.from surface water?-_ ----------- - -- ❑ ® ❑ LL >10ft.from potable water lines?- --- ---------------- -- ❑ ® ❑ Z > 5ft.from property lines and easements?--- ----- - ---- -- - ❑ ® ❑ ¢ > 30 ft.from downgradient curtain/foundation drains?-- --- --- - - ❑ ® ❑ Drainfield level and observation ports present - - -- - - - - - ----- IN Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - -- --- - - -- --- -- ❑ ❑ Pump tank setbacks consistent with septic tank?-- ---- - --- --- ❑ l ® Yes ❑ No Le Pump tank capacity (Flood) 1,000 at Manufacturer Hagerman Z 24'access riser(s)and accessible from surface?------- --- --- ❑ ® ❑ ~ Alarm or Control Panel Installed? ---- - ---- - ----- ------ ❑ ® ❑ a Control Panel equipped with Timer/ETM/Counter-- - - - -- -- -- ❑ ❑ 7 a Pump installed in ❑ Bucket or ® On Block or ❑ Other a- Pump Make/Model Liberty 280 ❑ Floats or ® Transducer M D Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 8 ft a Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd UgY18tl flR1201B Mason County OSS Installation Report pg. 2 Parcel# 2202q-56-9061b4 ABANDONMENTRECORD __ ❑ NO Were ezisdng septic components abandoned as part of this project? "! --- - ---- -- YEa If yea, Please desoibe. No Were all components pumPed out and pn pedy abandoned per WAC246-272A-030D? '-'-' ❑ YES RECORD DRAWING ilia e a prnt^rtt MON anC mart ea aecuw mC deacHPd'a anau9n m eNw,e in Ma nesC,_i...ecevien and Nwn Cweb . Typuil RaaC duJd'epa.brrmmaWs.vMM a, Dmwga tdYin: py�pMd6mmiM1tld aMNNmfl Wan.SapuubdmDm IM. u,M'.ramrvs ba�Rdd.e�n9 erdF NdrdmN WmM1s xeYa,oE+wavon Wa,tlwwN.W dM1rrruvranervs em+u OM'6. IrmZer n'Dlme Record tlrMnGs maY Oub eddAdiW dolya infirel lMalaum atpmia Record Drewing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certtly that I installed the system in accordance with I 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 clearedrapproved by both the designer shown here have been clearedepproved 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 alf information contained on this form and attached Re I rd Drawing is accurate. form and attached Record Drawing is accurate. sig,,tumllof Installs r Date , ,t Printed Name of Signore MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County PUNIC PAULA JOY JOHNSON . .IC�JSE rit11 R' Health: tl ` 7C7•Qnnn 0 Signature FEnvimnme al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY vES SITE uad.ua ersirsd�e ® O3 'Audjo-Visual Alai= Q 0 0 {y0 O2 CleB out Gomm 3� \ Wilt ® soo c:elloa tank 1 O4 NnWatc 13NR-500 ATL'Tames lip © 1,200 canon P=p Cva=b- (z g be CC 4 1J u ?t W"Je,. o sti -s',pv— O6 vawe C=t ' B3 Pay-off#2zo24-6o-9ogk �I r boX 6180 � �, � Sirtfer. 'N R8S84 t APPROVED PAUTA JOY JOHNSON 3� AUG 2 0 2024 qe MASON COUNTY ENVIRONMENTAL HEALTH 8 lw vt RET io00, 04� �?F tre ,CYtS ® a !A1 i`VV rZSt r� e 5 ' fit ° tcr S V� sj. / Pe C CPSS Pu5nr4 Y