HomeMy WebLinkAboutSWG2023-00050 - SWG As-Built - 11/26/2024 A
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2023.00050 Parcel# 323332300020 n
Applicant Name NW Lodges;Company LLC Subdivision(NamelDiv/Slock/Lot)
Applicant Address 2522 N Proctor#15 61iys
City,State,Zip Tacoma.We 98406 Installer Name Shumaker Comtrudbn F/
Site Address 2613aNE North Shore Rd. Designer Name Advari Pac a DOWCO,
INSTALLATION CHECKLIST
■Full System lnehsho m ❑rank(.)cw ❑Oranaekr only ❑Repair ❑offer
System Type W Pretreatment Type
>5ft.from foundation? _________________'_ _______ _ ❑WA EYES ❑No
>50 ft.from wells? . --------------- - ❑ ■ ❑
_ >50ft.from surface water? -----------------------_ ❑ ■ ❑
FClasmoul between building and tank? __________________ _ ❑ ■ ❑
f.1 Tank baffles present? ._ _________________ _ ______- ❑ ■ ❑
a24'access nears over each companim®m?_____ ____ _ ______ ❑ ■ ❑
WW Effluent f8er installed?- _ -- -- ------ -.. - ---- - _ _ __ _ _ - ❑ ■ ❑
Septic tank capacity(working)1250 gal Manufacturer Hagemien's
D-box water level and speed levelers used? ---- ---- ------ - EWA El YES Not
OLL ManlfoWD-ho.accessiblefromsurface?�-- - ------------- ❑ E ❑
og Check valvesmstaned? _ ---- ---- ---- ------------
Transport Line Size 2' SchdduWClass_ 40
Bedrooms installed(dreck one) ❑2 ■3 ❑4 ❑5 ❑6 ❑CommercisUOther
-10 n from foundation?------------- ----- --- - --- - ❑WA EYES NO
>1 DO ft.from waft?---------------- ---------- - -- ❑ ■ ❑
W >100 M from wrface water?- ❑ ■ ❑
X >10 ft.from potable water lines?___ ❑ ■ ❑
Z >5ft,from prop"p party line and easements? - 0 E ❑
>30 ft,from downgradienl curtain/foundation drake?---------- ❑ E ❑
DMinaaw level aM ohsen adon cede present - _____ ,. ❑ ■ ❑
[I Grainless chambers or E Clean gravel used? (check are)
Proper cover installed over dmirdmNl?-- _, _____ ❑ ■ ❑
Pump tank setbacks consistent with Septic tank?.__________-- - ❑ WA ■ YES ❑ NO,
zY Pump tank capacity(food} 1250 gal Manufacturer Heaaman's
F24'access Maestri and accessible fromsurtace?------------ - ❑ E ❑
C Alarm or Control Panel installee? -- -------------- ----- ❑ ■ ❑
Control Panel equipped with Timor/ETM I Counter.- ------ ❑ ❑ ❑
LL Pump installed in E Bucket or ❑ On Bkx* or ❑ Other
PUMP Maked+lodel Liberty 2B0 ❑Floats or ❑Transducer
y� Tank draw down 1.5 iNmin Pump capadfy 50 gpm 6gmrt Height 10 f
Pump on bme r--- J .0 IO1) Pump of time Daily flew set at V1 0 god
Mason County IDES Installation Report pg.2 Psmel a 323332300020
ABANDONM TRECORD
Ware eflsung septic comparisons seas doned as can of Nis project- -------------- - L3 YES ® rb
If yes,peace deaaiba'
Wen acomponents Pumped out arW pmpeny abandone".per WAC24E42T2A-03007 •---- --_One ® NO
RECORD PPVANG
.nYt.aiwvrvm NY.d.mmuMaov«er. arce soma a bw ve,..X Va- w nsi.ays4,: XmI,wBYu.A'Y,rY vq,b'ot✓rvnr
f
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certity that I installed the system in accordance with I Costly that the System has bean installed in aba0r-
me septic design stamped"APPROVED"by Mason dance with the septic design stamped`APPROVED"by
County Pubic Health and that any deviations shown Mason County Public Health and that any deviations
'.'nave bean obareaVopp,m e i by both the desetrrer, shown ham have bean cleared/approved by both
any Meson County Public Health and meat aN State myself and Mason County Public Health and meet all
and Mason County Codes, State and Mason County Codes
I farmer comfy that 00 information contained on ft., I Further cemly oat all infamaeion contained on this
form and attache p�rd Drawing 9��abe, form and allwhad Record Drawing is accuratn,.
et4
u/B ellnataller / oafs
Printed Name of sgnea
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report and
Recant Orewing on behalf of Mason County Public
Health'
R �-I + f7, 1
Sip: rze:a ar Envimnmrnra/ an spee�wwn Dote fstamp.signature and date)
THIS FORM MAY HE SCANaEDeNOAVAILAH� 6FORNIBLIC VIEWONTHE MASON COUNTY WEB SITE
o u atlols JO db1 \\��
D
3
A �
m a S
0
3 co C
� � b
1 G
APPROVED
DEC 0 4 2024
r a MASON COUNTY ENYIRONMENTALHEALTH
o � m
RET
y , m
94
c � m
, s S
w
'-------#---------------------Water AaAvter-----
N
n w O w mzOz v >
m � �
w w w Ab4S � v_
� l
E
3
o a o b
A �
4)