HomeMy WebLinkAboutSWG2022-00273 - SWG As-Built - 9/27/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00273 Parcel# 12118-50-00034
Applicant Name James&Patricia Jevec Subdivision (Name/Div/Block/Lot)
Applicant Address 4202 Jessica Ln MT SHORES TR 34&1/801NT TR 41 S 52/225, S 53142
City, State, Zip Carrollton.TX 75010 Installer Name South Shore Construction
Site Address 40 E Mountain PI Grapeview Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
M Pull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other SW gantltl cane-wehta
System Type Subsurface Dnp Pretreatment Type NuWater BNR-500
>5 ft.from foundation? -- - -- --- - -- -- - - - - - - --- -- -- - ❑ NIA Eves NO
>50 ft.from wells? -- - - ❑ M ❑
Z >50 ft.from surface water? - - E] E El
Cleanout between building and tank? - - -- - -- - - -- --- -- - -- ❑ E ❑
U Tank baffles present? -- - - -- - -- - - - - - - ❑ M ❑
d24"access risers over each compartment?- ---- - - - - ------- ❑ E ❑
u1 Effluent filter installed?------ SN K - - - - - - - ---- El E] E
CO)
Septic tank capacity (working) NuWater 500 gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? - ❑ WA ❑ YES N NO
QO Manifold/0-box accessible from surface?--h¢AAw°+'KS - ---- ❑ M ❑
OZ Check valves installed? - - - - - - - >a'a'aPi- - - -- - - - ❑ E ❑
2 Transport Line Size 1 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation? ❑ NIA M YES NO
>100ft.from wells? ---- -- - - - - ❑ E ❑
W >100 ft. from surface water?- ❑ M ❑
u >10ft.from potablewater lines?- - - - ---- - - - -------- - - - ❑ M ❑
QZ > 5 ft. from property lines and easements?- -- -- --- - -- -- - - - ❑ M ❑
C > 30 ft.from downgradient curtain/foundation drains? - - ❑ N ❑
Drainfield level and observation ports present - - - -- - - - - - - - - - ❑ ❑
Proper cover installed over drainfeld?- -- - - - ----- ❑ ® ❑
Pump tank setbacks consistent with septic tank? ❑ NIA ® YES ❑ NO
Y Pump tank capacity (flood) 1,287 oat Manufacturer Infiltrator
24^accessriser(e) end accessible from surface?-- -------- -- -
❑ ® ❑
a All or Control Panel Installed? ----- - - - - - -------
- - - - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - --- - - ❑ E ❑
a Pump installed in ❑ Bucket or ❑ On Block or M Other tube
o- Pump Make/Model Stayrte Step 20-03 E Floats or ❑ Transducer
a
Tank draw down 1.5'in 10 min.in/min Pump capacity 3.75 gpm Squirt Height — ft
Pump on time 8 min Pump oft time 1.84 hours Daily flow,set at 360 gold
Op[a:etl FY1R0'.d
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Mason County OSS Installation Report pg. 2 Parcel# ICI 1 — �i �COc��'
ABANDONMENT RECORD
Were existing septic components.abandoned as part of this project? ._____________- Yu NO
If yes,please describe:
Ware all components pumped out and property abandoned per WAC246i272A-0300? ❑T9 ❑ NO
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION;OFINSTALLATION
INSTALLER DESIGNER/ENGINEER
i cerdly that I installed the system in accordance with- l certtly that the system has been installed in accor-
the septic design stamped`APPROVED'by Mason dance with life septic design stamped'APPROVED'by
County Public Health and that any deviations Shawn Meson County Public Health and that any deviations
here have been cleareWapproved by both the designer shown here have been clears aVapproved 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
-
f further certify that all information contained on this I furthercenl y that all information contained on this
Xfoata ed Rec 2wing is a^cu2teform and attached Record Drawing is accurate.
a a .�°��`Bl�9
Signature of Installer Date
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Printed Name ofSigrw ,, ••
MASON COUNTY PUBLIC HEALTH The undctsigned approves this Installation Repost and stooa•s
Record Drawing on beha/fofMason County Public PPAUU JOY Ns1.
it w
Health:
Signewm&EW/ronmamw Hearn Spedallst Date (stamp,signature and date)
THIS FORM MAY BE SCANNEDAND AVARABLE FOR PUSUC MI ON THE MASON COUMY WEB SITE uwY.e env�a
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Q3 500 Gallon Pre-Try Tank S EP 27 2024
4O Nuwater BNR-500 Preteatmemt Tank MASON COUNTY ENVIRO NTgk HEALTH
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