HomeMy WebLinkAboutSWG2024-00286 - SWG As-Built - 9/18/2024 Mason County OSS Installation Report pg. t MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number 8WG 2024-00286 Parcel # 32224-50-00095
Applicant Name ADELE LARSEN Subdivision (Name/Div/Slock/Lot)
Applicant Address 11403 N E NORTH SHORE RE) //11
City, State, Zip BELFAIR, WA. 98528 Installer Name JA(X-7dhf'�-SINS
Site Address 11403 N E NORTH SHORE RD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type PRESSURE Pretreatment Type BNR 500
>5 ft. from foundation? --- - - - ---- - -- - -- - --- - - - -- - - El NIA 01YES NO
>50ft. from wells? - - - -- -- - -- - - - - - - - - - - - - - ❑ ❑ ❑
Z >50ft. from surface water? - - - --L
- - - - - -
(7- - ❑
F Cleanout between building and tank 0 .� ❑ �"
V Tank baffles present? - - - - - - - - �^ ❑
24"access risers over each compart -Rk ;'% IRA- ❑
yEffluent filter installed?- - - - - - - - - - - - -- - - ❑ ❑ .01
Septic tank capacity(working) gN w a .0 D
G D-box water level and speed levelers used? - - - - - - - - - -- - - - - 'NIA ❑ YES ❑ NO
�O Manifold/D-box accessible from surface?-- - - - - - - - - - - - - - -- ❑ ❑
LL
, = Check valves installed? - - - - - - - - - - - - - -- - - - - - - - - - - - ❑ 8- ❑
O
Transport Line Size _ .2 " Schedule/Class
Bedrooms installed (check one) pZ 1p 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>I0ft.from foundation?- - - - - - - - -- - - - - - - - - - - - - - - - - E] WA �Ea NO
G >100 ft from wells?- -- -- -- - - - -- -- - - - - - - - - - - - - - - . ❑ ,0'
W >100 ft. from surface water? - - - - - - - - - - -- - - - - - - - - - - -- ❑ ❑
LL >10ft. from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑
Q_ >5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑
C > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ 8 ❑
Drainfield level and observation ports present - - - - -- - - - -- - - - ❑ JRr ❑
❑ Graveless chambers or ❑'Clean gravel used? (check one)
Proper cover installed over drainfield?- - -- - - - - - - - - -- - - - - - ❑ ,ET ❑
Pump tank setbacks consistent with septic tank?- - - - - ----- --- ❑ NIA+ La-YES ❑ NO
C
YY Pump tank capacity (flood) 12-40 gal Manufacturer e,rl,.,r
a 24"access riser(s)and accessible from surface?- - - - - - -- - -- -- ❑
aAlarm or Control Panel Installed? - - - - - - - - - - - - - -- - - - - - - ❑ ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ 0 ❑
,,//Pump installed in [I Bucket or ❑ On Block or ❑ Other �15
%Ax ump Make/Model Lr� Ly '2Ss ❑ Floats or ❑ Transducer
'Tank draw down H-g"' in/min Pump capacity 3'd cpm Squirt Height J7 ft
*Pump on time Pump off time nM" Daily flow set at gpd
/ upa.iea ea,aaie
Set L.rti
Mason County OSS Installation Report pg. 2 Parcel a 32224-50-00095
ABANDONMENT RECORD
Were existing sepdc components abandoned as pert of this project? . - - -- -------- -� ❑ YES NO
If YES, pease describe:
Ware all components pumped out and properly abandoned per WAC246.272A.0300?--- --- -- ❑ YES ❑ NO
RECORD DRAWING
This is.onmenent roam AM must Xe sauna snd daeedpdve mdden m ma Ixxa N m.nap 1 MOM.ma adavNu and Xdun deeeldpmedt. tYpxsl Revd
arevdnpa danw n', carried&m narrow elenlslldn B NyduL s.plk/, Mk Ieuuon.wo.row,msa s dNAT AM mlelMls am p.",whass.XNa s,or wash,wsNrdvss.
MIN.dUe MNara,dssrouls,and sae mstrunesce eaase pa,o Ilwom{asls Roww arswage mw emas sessions doors In Mal lnesudan Masawl eM MSHd pari
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Record Drawing Atteched
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I 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 hove been cleared/epproved by both
and Meson County Public Health and meet all State myself and Megan County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further cerlify that all Information Contained on thus I further certify that all Information contained on this
fo end Bit ed Record Drawing Is accurate. form and attached Record wing is accurate.
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Sig reoflnsts/ler Date 4-
c(. Je tntn SEMI -- - a
Printed Name of Signee {
MASON COUNTY PUBLIC HEALTH 9 e nave -F
The undersigned approves this Installation Report and LICENSED DESIGNER ;
Record Drawing on behalf of Meson County Public Z
Ln.nik6.aa1
Health:
Signature ofEnNronmen a/Health Specialist Dale (stamp,signature and date)
THIS FORM MAY BE SCANNED ANO AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UN.Aa.,nole
APPROVED
SEP 18 2024
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APPROVED
SEP 18 2024
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