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HomeMy WebLinkAboutSWG2021-00271 - SWG As-Built - 10/1/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00271 Parcel# 22331-52-00035 Applicant Name Jeffrey&Carmel Call Subdivision (Name/Div/Block/Lot) Applicant Address 2407 80th St E COLLINS LAKE#3 TR 35. S 50/41 City, State, Zip Tacoma WA 98404 Installer Name Bad er Excevatin 1 6 Site Address 200 NE Raintree Ln-Tahuya Designer Name Arrow Se tic Deal ins Inc. /( INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair Q Other ex gallon Pre-Trash mink System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ----- ------ - _ ___ ___ _____ ❑ NIA AYES ❑ NO >50 ft.from wells? - - - - - - - - - - �-Ug T4 TI- - --- ❑ El Y >50 ft. from surface water? - _ _ -_ __ __ ❑ ❑ z between building and tank -� �$-Z{i�¢- ---- ❑ ElF Cleanout U Tank baffles present? -- - --- - - - --- - -" -' '-- ❑ ® ❑ 0 24' access risers over each compart nt?-- - ----- - -- ❑ ❑ W Effluent filter installed?-- -- - --- - --'-'-" - ❑ Elto 8N R-660 Septic tank capacity (working) NuWater gal Manufacturer Hagerman-Traffic Rated 0 D-box water level and speed levelers used? --------------- ❑ NIA El YES NO �JEl O Manifold/D-box accessible from surface?-- ----- -- - - -- ---- ❑ iiE d?Z Check valves installed? - - -- - - - -- -- - - ---- - -- ---- -- ❑ ® El Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 §3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - - ------- ---- - ----- --- - - ❑ NIA AYES ❑ NO >100 ft.from wells?---- - ------------------------ ❑ ❑ W >100 ft.from surface water?- -- ----- ------- ---- - ---- ❑ ® ❑ a >10ft.from potable water lines?- ------ - ------- ----- -- ❑ ® ❑ Z > 5ft.from property lines and easements?- -- -- - - - ----- - - - ❑ ® ❑ K > 30 ft.from tlowngradient curtainlfountlalion tlreins?--- - - -- - -- ❑ ■ ❑ Drainfield level and observation ports present - - ---- ---- -- -- ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfeld?----- ------- --- -- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ---- ------- ❑ NIA D YES ❑ NO Y Pump tank capacity(flood) 1000 gal Manufacturer Hagerman-Traffic Rated Q24-access risers)antl accessible from surface?-- ------ ----- ❑ O ❑ ~ Alann or Control Panel Installed? ----- - ------ --- - —- -- ❑ ❑ a 2 Control Panel equipped with Timer/ETM/Counter- - - - - ---- -- ❑ � ❑ 7 g- Pump installed in ® Bucket or ❑ On Block or ❑ Other o_ Pump Make/Model Liberty FL50 ® Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 38 gpm Squid Height 3 ft Pump on time 2.33 min Pump off time 6 hr Daily flow set at 360 gpd 11pe4E PR1/At8 Mason County OSS Installation Report pg. 2 Parcel# 22351-S2-O''�OSJ ABANDONMENTRECORD Were existing septic components abandoned as part of this project? --------------- ❑ YES No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ YES ❑ NO RECORD DRAWING 1rys l..BMMTiIaOr ra[GC xa muR a.cwrta wa Ma[npyv..nougn b rNccN m N.ma-a IIYmM1nwn YtlNtlm and f Wre darv.' t Typwal ReCWa Drsimgs-cram: Draeald s mani1010 ol4aNm a 1pyeul.Sepm'N"P mM lCPPro`N..entw. ..dra aeuinIatmg VA OmpOaaC pra11s,bmlunNwWa.wnvly- walb.00Nrvmion ,a GNFNa.MEONernbNb�4Maazfa9 p00a. I n[oma.h RcaN DiPmass may UYIe aaia 0i plryain flNlIWeilat—approval aM,salw mm-a �a kJo S ee R ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with i certfy that the system has been installed in accoa 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 clearedlapproved by both the designer shown here have been clearediapproved by both and Mason County Public Health and meet all State myseff and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes 1 further certify,that all iMon iaeon 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. �-Ito-Ul- Signature ofl alley Date Panted Name of Sign9a a MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and - RecordDrawingonbehalfofMasonCountyPublic ale 'Gp t Health: PAULA JOY JOHNSON IzL LEXPI S� .. Signature Of EnYlmnment Health Sperielist Date (sta re and date THIS FORM MAY BE SCAN NED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uwsaa nux:a N CO3`,i �at {,i 27 �-52' 05C35 2.00 N DPP f°n tin � { f Zg %10 (a 0 E 1 10 orrx _+ ; APPROVED R38�4 nCT 01 2024 MASON CCUNTY E�vRCWBTAL HEALTH Pisix }' �.A ow, RET � 8 Q°j s (y) IaJ �3) 15' (6) 2b' ZaS LF `� e CkWJe 9 M m m m Ns x r? kt %0 U sco ce 2zs 3NRr500A7i-JT_=k i,ccc cry on fi..=p © Solids BasTn.� L"t41. 4�u' i o fgF1 6 PAU"JOY JOHNSON'." iC�lEk 1 1 1 rru,2� —,vim '`-'�i- Il 1� (,pI1�nS Lake �. Y , _s2- c35 n. ?ac ! 2 , n� 200 iv : +rr n -T G' , rn � ` v Y � r I (�) 10' (3) 15 (b) 2b I � .1,0 S LF l 3' wide ectmarJ vo tt+ a a �� cS•+ Audio-VirxelALxm tf rsd W� a tl Cl c eawit � /\ CS Slt+.�✓. .� U 500 C3.Z=?re-'^rash b^i[ v� Wid'M1,Y1 10 pi, ScP '�- b1 V N WeLer SNR-500 ATU Tw':k 3 1,000 Ge.iicn P—P a - ^ �= C V Valve^ca*vl 3= o1 1 ROSF pp b---e i t . � ^ -7 lw . -NE flat