Loading...
HomeMy WebLinkAboutSWG2022-00487 - SWG As-Built - 10/29/2024 • • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00487 Parcel# 32232-50-10104 Applicant Name Scott Gordon Subdivision (Name/Div/Block/Lot) Applicant Address 91 E Twanoh Falls Dr UNION HOOD CANAL LAND 8 IMP CO BILK: 101 City, State, Zip Beltalr,WA 98528 Installer Name South Shore Construction Site Address 440 E One Nobles Rd Union Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drenreld Only ❑Repair ❑Other System Type Shallow Pressure Intent Type NuWater BNR-500 >5 ft.from foundation? -- - -- --- - ❑ NIA ®YES ❑ NO >50 ft.from wells? - - - - - - - - ❑ ® ❑ ___ ________ Y >50 ft.from surface water? -- --- - - AG� 2&2-021 - ❑ ® ❑ Z ❑ ® ❑ r Cleanout between building and tank? - ---- ------ -- ---- El Tank baffles present? - -- ---- - -- By ❑ a 24"access risers over each compartme . ------- - ----- - - ❑ ® ❑ WEffluent filter installed?----- --- -- - - - - - - - - - - - - - -- Septic _ ❑ ❑ tank capacity(working) NUWat6r BNR gal Manufacturer Hagerman O D-box water level and speed levelers used? --------------- ❑ NIA El YES NO JEl �O Mandold/D-box accessible from surface?---- ----- - ------ ❑ M mZ Check valves installed? - - --- -�'" - = -- - '- - ' ❑ ® ❑ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - ---- ---- ---- - - ------ - -- ❑ WA ® YES ❑ No 0 >100 ft.from wells?--- - -- -------------- ---- --- -- ❑ ® ❑ W >100 ft.from surface water?- ------------------ --- - - ❑ ® ❑ M >10ft.from potable water lines?- ----- --------- - - - - -- ❑ ❑ z > 5ft. from property lines and easements?----- - - - --- - - - - ❑ ❑ W > 30 ft.from d m owngradient curtain/foundation drains?--- - - - - - -- ❑ Drainfield level and observation ports present -- -- - --- - - ---- NJ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfleld?--- - - ----- - - --- --- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- -------- - -- ❑ WA ® YES ❑ NO Y Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z 24 access riser(s)and accessible from surface?--- --- --- -- -- ❑ W ❑ aAlarm or Control Panel Installed? - -- - - - - - ------ ❑ 9 ❑❑ Control Panel equipped with Timer/ETM I Counter--- --- ---- - ❑ 0 a Pump installed in ❑ Bucket or e On Block or ❑ Other a Pump Make/Model Liberty 280 Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 5.5 ft Pump on time 1.2 min Pump off time 6 hours Daily flow set at 240 gpd g uw.�emno+e i i Mason County OSS Installation Report pg. 2 Parcel# -223 Z--50 ' O ABANDONMENTRECORD - NMra exisyry septic campolrents.abantloned as part of this Protect? ._____ -------- ❑ Yss No if yes,please desc ibe: No Were an components pumped out and pmpery abandoned Par WAC2a6-272A-03004.______. ❑ rrs ❑ RECORD DRAWING TNe x e v+m•A^•�W mm e.aceurw eea aea+puw eaw�m n.muN m ms neM a.�.m»w.+eeemu...�e ti��d.�a..rsa+m. G/.!/.P mN.h: DtmmNJ 6 mam1C aMleCma put Se�aPmP W rouEut ebN m+.verve amrfrtN.mvdq eM WW^.� tiy,dnnmm.ma,ae.ws..a enam.N..�m®ao� IimergNlPem+vradn0•�.ome.eeiwem eewf+�ew�neWGm sww+a�a�oe.+e V � Raoord 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 with the septic design stamped'APPROVED'by County Public Health and that any deviations shown Mason County Public Health and Nat any deviations here have been cleared/approved by both the designer shown here have been clearedrapprDved by both and Meson Ccunly 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 bother certify that all information contained on this 1 further certify that all intormation contained on this edR swng is a 2te Z� form and attached Record Drawing is accurate. 3Waff,e Signature of nstaller Date c � Printed Name of Signae MASON COUNTY PUBLIC HEALTH 516 141 The mce,,gned apprevas Nis lnatallation Report arM /r-`�{ PAMA JOY JOHNWN'. f Record Drawing on behalf of Mason County Public CI L t �p RK Health: p_Z4. Z`F 0 T-!�p .v�ctio�y"L �c ( lalz-y Signature of Erwironmenta/HeaIN Specdallst Date (Stamp.signature and date) THIS FORM MAY BE SCANNEDANDAVAI pW FFORPUB CV ONi EhIASONCOUNTYW BSITE � W�' p ,e to S• 9e i s' eark' 9 Ash' 14 PaC '� 32232-50- Q ,oG 1 �r5'4"r 2 4,4,D E UJycz,�r�s4 � ® �s „; W-A 9Q592 "1011 INN. w °• � �sco.r Reserve 8 s: 40' � �a. as APPR�vED NOV 13 2024 Qi Audio-ViavalAlarm 6VASOHCOUHnENRE�HMEN1AlHEA�T O2 Cleanout © NuW ester BNR-500 ATU Tank o rf n 1,000 Gall=Pump Cbanber Ux W.-N a,*C-sZP�en ?` 5 Valve Control Box t 0 NO �PAULA JOY JOMNaON'. .. W1FIEe9 /. (0-24-Z {