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HomeMy WebLinkAboutSWG2023-00433 - SWG As-Built - 12/13/2024 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00433 Parcel# 22017-52-00003 Applicant Name Henley WA 12,LLC Subdivision (Name/Div/Block/Lot) Applicant Address 1537 NW Woodbine Way TIMBERLAKE#10 TR 3 S 54/122 City, State, Zip Seattle,WA 98177 Installer Name South Shore Construction Site Address 260 E Annals Way Shelton,WA Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drain(eld Only ❑Repair ❑Other System Type Shallow Pressure I�p pnPretreatment Type Nu Water BNR-500 >5 ft.from foundation? -- ------ -- �tatl-17rt� ❑ NIA ❑ Yes ❑ No >50 ft.from wells? - - - - --- --- -- _ _ _ _ 1.`-ru u 4S. ❑ 9 ❑ Z >50 ft.from surface water? ---- ---- -DEC - - ❑ N ❑ FCleanout between building and tank? -- -- ----- - --- ❑ A ❑ U Tank baffles present? - - - -- --- -- Or - - -- - --- ❑ A ❑ 6~. 24'access risers over each compartme --- - ❑ ❑ u! Effluent fitter installed?-- ------- -- - -- - -- - - - - - - - - - - ❑ ❑ A m VU Soo Septic tank capacity(working) U 8tef gal Manufacturer Infiltrator 13 D-box water level and speed levelers used? -- ------------- ❑ NIA ❑ YES ❑ NO O0 Manifold/D-box accessible from surface?- - ----------- ---- ❑ © ❑ GQCheck valves installed? -- - -a- {��`-' =�'^�-- - - - - - - 1-1 ❑� El 2 Transport Line Size 2- Schedule/Class 40 Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- -- - - - ---- - --- --- - ---- - - - ❑ NIA ® YES ❑ NO >100 ft.from wells?- ----- --------------------- -- ❑ ® ❑ W >100 ft. from surface water?-____ _ _ ____________ ____- ❑ ❑ LL >10ft.from potable water lines?- - - - -- --------------- - ❑ 0 ❑ Z Q > 5ft.from property lines and easements?- ------------ - - - ❑ ® ❑ a > 30 ft.from tlowngratlient curtain/foundation drains? ❑ ® ❑ Drainfield level and observation ports present ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - - -- -- - ----- -- Pump tank setbacks consistent with septic tank?- --- ❑ NIA ® Yes ❑ NO Y Pump tank capacity(flood) 1287 cal Manufacturer Infiltrator H24-access riser(S)and accessiole from surfaced ElK El a Ala"or Control Panel Installed? ----- ------- ------ - - - ❑ W ❑ Control Panel equipped with Timer/ETM/Counter ❑ ® ❑ o. Pump installed in ❑ Bucket or ® On Block or ❑ Other n. Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 2- in/min Pump capacity 50 gpm Squirt Height 4 ft Pump on time 1.2 min Pump off time 6 hr Daily flow set at 240 gpd umaao Ea-rzo,E Mason County OSS Installation Report pg. 2 Parcelit 22017- 52— DOflo3 ABANDONMENTRECORD Were exiscrg Septic components abandoned as part of this project? ____________ __ ❑ Ygs No If yes,please deWnbw Were ail components pumped out and properly abandoned per WAC246&272A-0300? -------' ❑ Yes ❑ NO RECORD DRAWING im r.w�F�waV 4em coca a.cc.ne.,.e e..wyu..snwyn m r.4oum m sr neea a wlnewv .caNtltlM ma tan enMmFFb Ts�^m^ psy4y¢yN: PaMN bmY[d0 MenlJM 8 Sarin.bepticqun.�F butte.NTf.anw'.rtferro @mweM.ay.NnY N VRN4v Eu1RnT.kCeFM alwelt Mtsbm. welLL eM+.a�ab.W aeerm'Ynlmaea 4®fFlNY Imo. mpYY PemO pra.Nlloi nW/eWe Wltimsl GWYSNRb IMaGM aytwd atl IdL404m�F. ® Record DrawingAttadfed • 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 accor- the septic design stamped'APPROVED-by Mason deride with the septic design stamped'APPROVED-by County Public Health and that any deviations shown Mason County Public Health and that any deviation here have been cteatedlapproved by both She designer shown here have been p/eared/approved by both and Mason County Public Hearth 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,mat all information contoured on this I ludhercertify that all information contained on this to aft ed Re rowing is a rate. form and attached Record Drawing is accurate. 04 Sgmature oflnstaller Oate Panted Nameofsfenee MASON COUNTY PUBLIC HEALTH ?1 777e undersigned anpmves this Installation Report and s10.34a Record Drawing on behalf of Mason County PublicAt " PAULA JOY JOHNSON'. C f E7t'" Health: signature of Envirarlmental H ath specialist Date (stamp,signature and date) THIS FORM MAYBE SOA,I E MDAVAIIABLE FOR PUBLICVIEWONTHE MASON CWNTYV&B SITE 6D Q 33OiD R 0 P xu jo qo O A5-bu; 64- �a © rev la wAa Lc Z�' x 4 &C E .2, W" y 2 -B9, M�k i 12 APPROVED tp I j DEC 13 20A 34 � SASON CC,t1N7f E4VIRON4ENTAL HEALTH RET 6$' (d) 3' X35 Lo 0 •C . ' I � rl•,�e Leh (eo •�S ' moo: Ol Audio-Visual Alarm O2 Cleanout1 _ QNuWater BNR-500 ATU Tank O4 1,000 Gallon Pump Chamber ` Z' PAULA JOY joH N t OS Valve Control B. 'L'ICF�i�aC 77�EelGN J E%hFeS Vs_J�SJ