HomeMy WebLinkAboutSWG2024-00401 - SWG As-Built - 12/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00401 Parcel# 22221-54-00019
Applicant Name Christian &Lisa Richardson Subdivision (Name/Div/Block/Lot)
Applicant Address 23625 253rd Ave SE TWANOH FALLS ADD#2 TR 19
City, State, Zip Maple Valley, WA 98038 Installer Name Bamford Septic Repair
Site Address 40 E Creekside Dr. Belfair, WA Designer Name Arrow Septic Designs Inc.
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ■Repair ❑Other
System Type Shallow Pressure Pretreatment Type Nu Water BNR-500
>5ft. from foundation? - --- ----- --- --------- - - - - - - ❑N/A YES NO
>50ft. from wells? -- --- --- - - - -- --- - --- ----- --- - ❑ ® ❑
_ >50 ft. from surface water? -- - - - - --------- --------- ❑ ® ❑
F Cleanout between building and tank? - --- ------------ ❑ El_-
U Tank baffles present? -- -- - - - - - - - -- ----- -- -- - -- - - ❑ ❑� ❑
24'access risers over each compartment?--------- -- -- - - - ❑ ® ❑
W Effluent filter installed?- - - - - - --St�- -- - - -- - -- -- - - ❑ ❑
Septic tank capacity (working) NUWatef gal Manufacturer Sound Placement
O D-box water level and speed levelers used? - - - - - - - - --- - -- - ❑ WA ❑YES 0 NO
Cu Manifold/0-box accessible from surface?- - -- - - -- - ----- - - - ❑ ® ❑
°P2 Check valves installed? -- - P-A" p14'^-X-- -- - -- - - - ❑ ■ ❑
0
Transport Line Size 2' Schedule/Clan 40
Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Comnrercial/Other
>10ft. from foundation?-- - - -- - ----- ------ - - - - - - - - ❑ WA ® YES ❑ NO
>100 ft. from wells?------ ---- ---- --- ------ - - ---- ❑ Q ❑
W >100 ft.from surface wateR- _ �tgl iC- - - - - -- ------- - -- ❑ ❑ IN
W >10 ft.from potable water lines? - ---- --- -- - ❑ IN ❑
K >5ft.from property lines and easements?- gtle'L`- -- - ---- --: E] ❑ 0
ft>30 . from downgradient curtain/foundation drains?- -- -- - --- ❑ ® ❑
Drainfeld level and observation ports present -- - -- -- - ---- -- ❑ ❑
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield? ---- - --- - - - ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- - - --- ----- - ❑ wA o YES ❑ NO
2 Pump tank capacity(flood) 1200 at Manufacturer Sound Placement
Q 24"access nser(s)and accessible tram surface?--- - ----- ---- ❑ ® ❑
aAlarm or Control Panel Installed? - - --- ------ -- - ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter- - - - - -- -- - - ❑ ® ❑
S Pump installed in ❑ Bucket or E On Block or ❑ Other
Pump Make/Model Zoeller N152 ■ Floats or ❑ Transducer
d Tank draw down 2' in/min Pump capacity 42 opm Squirt Height 10 ft
Pump on time 1.4 min. Pump off lime 6 hr. Daily flow set at 240 gpd
Um uoen_iaooe
Mason County OSS Installation Report pg. 2
Parcel# Z2221 - '$�'DeCIS
ABANDONMENT RECORD
NO
Were existing septic components a.b��annndoned- as�p,,art of�thi�s�p1ro1ject? -� '����
If yes, please desmbe'. Off- T°"""" IOW` Q 3071 -- NO
Were all components pumped out and propedy abandoned per WAC246-2I2A-03009 --" -' ® YFS
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in actor-
the septic design stamped-APPROVED'by Mason dance weh 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 cleamd/approved by both the designer shown hem have been cleared/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
I 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.
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Signature of Inatalle Date
Printed Name of Signae
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and "rN�
Record Drawing on behalf of Mason County Public .P`U(AJIn
OY JpNNSON fr
Health`^^^ �_ lY(. e,t
Stgneture of Environmental HealthSpeaa/isf Date (stamp, signatuB a)date)
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APPROVED 0o • a 'Draln Meld
DEC 05 2024 aban doped
MASON COUNTY ENVIRONMENTAL HEALTh
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