HomeMy WebLinkAboutSWG2021-00620 - SWG As-Built - 9/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY P LIC TH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00620 Parcel# 22104-75.90012 SZOk
Applicant Name David Lawrence Subdivision (Name/Div/Block/Lot) /�Fp
Applicant Address 1360 E Mason Lake Dr E TR 3 OF SP#1131 AF#402555 PIN OF SE NE S 7/1
City, State, Zip Grapeview, WA 98546 Installer Name Maples Excavating
Site Address 350 E Roos Ct Grapeview,WA Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ®Other —qw.o,e-12 Bank
System Type Shallow Pressure Pretreatment Type NuWater BNR-500
>5 ft. from foundation? --- - -- - - - - - -- - --- - - - - ---- - - ❑ N/A ®YES E] NO
>50 ft. from wells? -- - -- - -- --- -
El
2 >50 ft. from surface water? - - - - - - �� � E ® ❑
H Cleanout between building antl tank? - 2024 ® ❑
V Tank baffles present? -- - - - - - - - - - -SEPZ--- -- _ _ ❑
a
24"access risers over each compartmwp90"UNTYF1Ni laONMENTAL HEALT� ® ❑
W Effluent fitter installed?- - - - --- - -- - - - - - - -J13W-- - - - - ❑ ❑
Septic tank size NuWater BNR gal Manufacturer Hagerman
o D-box water level and speed levelers used? - - - - - - - - - - - - -- - ❑ N/A ❑ Yes ❑� NO
C0 Manifold/D-box accessible from surface?- - - - - - --- - - - - - - - - ❑ ® ❑
TZ Check valves installed? -- -- - - -- - - - - - - - ❑ ® ❑
oQ
g Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - - - - - - - - - - - ❑ wA ® YES ❑ NO
>100 ft. from wells?---- - -- - - - -- - -- -- - -- - - - ❑� ❑
W >100 ft.from surface water? - - --- - -- - - -- - - -- - - ❑� ❑
a >10 ft. from potable water lines?-- - - -- -- -- -- -- SF��- ❑��y (] ❑
Z �Y- y
> 5ft.from property lines and easements?- ----- - ---�`--- - ��. � ❑ ❑
> 30 ft. from downgradient curtain/foundation drains?- - - -- ���- - - [j ❑
Drainfield level and observation ports present - - - -- - - - - -- --�.�❑ ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfeld?--- -- - - - --- - -- - - --- ❑ ❑
Pump tank setbacks consistant with septic tank? -- -- -- - - ---- - ❑ wA ® YES ❑ NO
Se Pump tank size 1,000 pal Manufacturer Hagerman
Q24"access risers)and accessible from surface?-- - - - - - -- - - - - ❑ ❑
f
y Alarm or Control Panel Installed? - -- - - - -- - -- - - - -- - - - - - ❑ ® ❑
`d Control Panel equipped with Timer/ETM I Counter- - - - - --- - - - ❑ ® ❑
d- Pump installed in ❑ Bucket or E On Block or ❑ Other
a Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer
a
Tank draw down 2.25" in/min Pump capacity 43 gpm Squirt Height 6 ft
Pump on time 2 min Pump off flme 6 hr Daily flow set at 360 gptl
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Mason County OSS Installation Report pg. 2
Parcel# 2Zi�h -�5
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? ---
❑ YES NO
If yes, please describe'. NO
Were all components pumped out and propedy abandoned per WAC246-272A-0300p -------- ❑ YES ❑
----------------
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MASON COUNTY ENVIRONMENTAL HEALTH
JBWRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with /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 have been cteared/approved 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
l further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
� ��� � o4li 4l zz �
Signature oflnstaller I ate .
Punted Name of Stgnee
d,
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report and 1
Record Drawing on behalf of Mason County Public s PAUTA JO JOY JUOHNSON';,
Hed
I I 126%) `1- I -Z"t
Sign he ironmentaf Health Specialist Date (stamp, signature and date)
THISFORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE °wnw arz'rzme
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