HomeMy WebLinkAboutSWG2024-00090 - SWG As-Built - 12/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00090 Parcel# 32127-50-00147
Applicant Name Gary White Subdivision (Name/Div/Block/Lot)
Applicant Address 5820 Kinney Rd SW LAKE LIMERICK 1 LOT: 147 S541206
City, State, Zip Olympia,WA 98512 Installer Name Dotl a Excavatin
Site Address 31 E Aycliffe Dr, Shelton Designer Name Arrow Septic Desi s Inc
INSTALLATION CHECKLIST
W Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Subsufacs Drip Pretreatment Type NUWater BNR-500
>5 ft.from foundation? - Iy��1FI�� flit�\1Y.r/�I��s ❑ WA W YES ❑ No
>50 ft.from wells? --- ---- ---- qs- -,
MEP ❑ W ❑Z >50ft.fromsurfacewater? -- -- --- -- - 2 - -- ❑ x ❑Cleanout between building antl tank? -} --- - ❑ ❑ ❑
c1 Tank baffles present? - - --- --- --I.------ ❑
I— 24"access users over each compartmehy-.=. _f El El- .a
W Effluent filter installed?- - -- - -- - -- - - - - - - - -- - - - ----- ❑ ❑
N
Septic tank rapacity(working) NUWater 500 gal Manufacturer Sound Placement
r3 D-box water level and speed levelers used? ------ ---- - -- -- ❑ WA E] YES I! NO
DJ
O Manifold/D-box accessible from surface9---k4UOOCIA - -- -- ❑ ® ❑
00z Check valves installed? -- - - - - --- -- - ---- - - - - ---- -- ❑ ® ❑
02 Transport Line Size 1 inch Schedule/Class 40
Bedrooms installed(check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑CommereiallOther
>10ft.from foundation?------ - ----- - - --- -- - ------ El WA ® YES El NO
>100 ft,from wells?----- --------- ---- -- ❑ W ❑
w >100 ft.from surface wateR- - - - ---- - - ❑ 0 ❑
E >10ft.from potable water lines?-- ---- - --------------- ❑ W ❑
Z > 5ft.from property lines and easements?---- - -- --- ------ ❑ ® ❑
IX > 30 ft.from downgradient curtainifoundation drains? ❑ W ❑
Drainfield level and observation ports present --- - -- - - - ---- - ❑ 0 ❑
Proper cover installed over drainfieW--- - - --- -- - - -- --- - - ❑ W ❑
Pump tank setbacks consistent with septic tank?- ❑ NA W YES ❑ NO
`S Pump tank capacity(flood) 1,250 gal Manufacturer Sound Placement
Q24"access risers) and accessible from surface?-------- - - - - - ❑ ® ❑
~ Alarm or Control Panel Installed? - ❑ ❑
Control Panel equipped with Timer/ETM/Counter-- --- -- - - - - ❑ 0 ❑
a Pump installed in ❑ Bucket or B On Block or ❑ Other
rl Pump Make/Model Zoeller 5031-0005 19glam, 1/2hp, 115v ® Floats or ❑ Transducer
D Tank draw down 1"In 10 min in/min Pump capacity 2.2 gpm Squirt Height — ft
a
Pump on time 12 min Pump off time 1.84 hours Daily flow set at 360 god
ues.rca Wlmla
Mason County OSS Installation Report pg. 2 Parcel# 712IZ1- 50 —001 lcl
ABANDONMENT RECORD �-�r
Were existing septic components abandoned as part of this project? ---- -- ----- -- - ' ❑ YES / NO
If yes, please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? -- --- -- - ❑ YES ❑ NO
RECORD DRAWING
This is a wrm➢nart neond and must be accurab and deetrati➢e enough to Meub In the new M malnurenre edNives and IWun dwdkaan.nt Typical Rerord
prew.nga WnGm: Drarrfi¢IE 6 manReb cnenreYon 8layput Septlr/pump bnk Illation,Ni oralia'i d enos waRRmes.
—11. onse—Ion paY,tlunouts,ell dnm mains nerve a.P.... In.Iwd sd pd D..,,may rreara addluaml delays In final new,..approval➢nd Mabel permit.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that l installed the system in accordance with I 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 cleared/appr ved 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.
LSiggatum of Ins taller Dat 1
Tessa J. Nelt '
Printed Name of Signee H
MASON COUNTY PUBLIC HEALTH f},
The undersigned approves this Installation Report and
SON
Record Drawing on behalf of Mason County Public ' PAUL S JOYY JO"DKSi I:N l t: (SE Ft "
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Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Vn'sted QL1ma
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O3 �400 G-N—Pre-Trash Tank—n.+ v
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O4 NuWater BNR-500 Pretreatment Tank 8c)
O5 1,000 Gallon Pump Cbamber
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O6 Subsurface Drip System Headworks
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