HomeMy WebLinkAboutSWG2023-00433 - SWG As-Built - 12/13/2024 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 Annas Way Shelton,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 NuWater BNR-500
15 ft,from foundation? -- -------- --D
❑ N/A AYES ❑ NO
LS
>50 ft.from wel157 --- - -- -- ---- ---- —V_ ❑ 0 El
Z >50 ft.from surface water? --- -- - -- #£-} 2 ❑ ❑� El
r Cleanout between building and tank? -- ---- - -- - - ❑ ❑
V Tank baffles present? --- - -- --- - ey--- - ------ ❑ ❑
a
24"access risers over each comps ❑
WEffluent filter installed?------((-;-f,7-RSO0 —- ------ --- - ❑ El
Septic tank capacity(working) L ater gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? --------------- ❑ NIA ❑ YES NO
DO Manifold/D-box accessible from surface?-- -------- ---- --- ❑ ® El
mZ Check valves installed? - ---0- -�'- lI-- - ---- - - ❑ El
Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) B 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft. from foundation?- - - - - - - - - -- - - - - -- -- ❑ NIA ® YES El NO
0 >100 ft.from wells?---- --- - - ------- - - ----------- ❑ ❑� ❑
W >100 ft, from surface water?- -- - - - -- ----- ---- ------- ❑
M >10ft.from potable water lines?--- ----- ------- ❑ ❑f ❑
Z > 5ft.from property lines and easements?---- ------ - -- - - - ❑ ❑� ❑
a
2 > 30ft.from downgradient curtain/foundation drains?- -- - - -- --- ❑ ® ❑
0
Drainfield level and observation ports present ----- - - - - ----- ❑ ® ❑
K Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfleld?--- ------- - - ----- -- ❑ ❑
Pump tank setbacks consistent with septic tank?-- ----------- ❑ NIA ® YES ❑ No
1
Y Pump tank capacity(flood) 1287 gal Manufacturer Infiltrator
Q 24-access riser(s)and accessible Trom surface?-- - -- - --- - --- ❑ M ❑
~ Alarm or Control Panel Installed? -- - -- - -- - - - - - - - - - - - - - ❑ ® ❑
IL
E Control Panel equipped with Timer/ETM/Counter- ---- -- -- -- ❑ ❑
O- Pump installed in ❑ Bucket or E On Block or ❑ Other
a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer
:3 Tank draw down 2" in/min Pump capacity 50 apm Squirt Height 4 ft
a
Pump on time 1.2 min Pump off time 6 hr Daily flow,set at 240 gpd
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Mason County OSS Installation Report pg. 2
Parcelx Z201-(- SZ— Von 03
ABANDONMENT RECORD
Were "istng septic ramponents.abandoned as part of the pm*t7 ----- -"- ' - - ❑ YSS ® No
If yes,please desanbe:
Wets all componentscomponentspumped out and properly abandoned per WAC24&272A-03007 --'--"" ❑ Ms NO
RECORD DRAWING
IHIa r a pnMrod nmm uq nuut n accurw am acacnWw smign ro iaawaM In sw neea a mFlnroiurx+.cs.Iae av AMw drjOWP's' TMd^`pd
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,dl.,auenaFm oas.ueawve.am dnamadwre m..odds i�*ororo r<caa o�w m,ywme.eemaw am.r.��aw InaWMa appmwl aw�ddea umd+
Raootd DtawitgAttached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify mat I installed the system in accordance with I certify that the system has been installed in acorn
the septic design stamped'APPRO VED'by Mason dance with the septic design stamped'APPROVE17 by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been deara&appmved by both the designer shown here have been deared/apptoved 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 f nh rce/tify that all information contained on this I further certify that all infonnation contained on this
to n atta led Re cawing is apurate. fait and attached Record Drawing is accurate.
vSigna`lur_a,of Installer Date
Panted Name of Sign"
b�
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report an,f sro aoe
Record Drawing on behalf of Mason County Public r PAULA JOY JOHNSON �'rt`�
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Health: 77�--�p-.��� EXPIW
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Signature of Envimmantaillkath Specialist Date (stamp,signature and date)
THIS FORM MAYBE SCANNMANDANAILABLE FOR PUBLICVIEWON THE MASON COUN1WWE6 SITE ucm.�vt+rzo�a
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DEC 13 2024
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Nuwater BNR-500 ATU Tans
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O4 1,000 Gallon Pump Chamber
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JOY JUNYSON
OS Valve Control BozLtCKii3THTl