HomeMy WebLinkAboutSWG2023-00051 - SWG As-Built - 12/13/2024 Mason County OSS Installation Report pg.t MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2023.00051 Parcel# 32333-22-00030
Applicant Name NW Lopping Comany LLC Subdivision(Name/Div/SlocWt-or N�
Applicant Address 2522 N Prodor#15 VT1 '204
City,State,Zip Tamura We 98406 Installer Name Shumaker Construct RF
Site Address 26130 No North Shore Rd Taming Designer Name Advantage Per--Oesign
INSTALLATION CHECKLIST
■Fuk System installation ❑Tanklst OnN ❑Dmio9esf Only ❑Repair ❑Other
System Type Oscar X02 Pretreatment Type Oscar X02
>5 ft.from fmndation? ----------- - - --- --- -- - ---- ❑WA ■YES ❑ No
150 ft.Yonl Wetly? ----------_ ---------- -- -- --- - ❑ ■ ❑
_ >50 ft.from surface water? ---------------------- - ❑ ■ ❑
F Cleenmt between budding and tank? ------------------ -
❑ ■ ❑
O Tank baffles present? --- - --------- -- ------------ ❑ ■ ❑
24'access risers over each compartment'---------------
Effluent fifterineCalled?------- ----------_.____- ..-._ . ■ ❑ ❑
N Septic tank capacity(workirg) 1250 gel Marufatfura Hanemann's
.�1 D-box water level and speed levelers used? .__-__________ . ■WA ❑YES ❑No
QUQO Man#oWD�tox accessible from surface?--------.--------- ■ ❑ ❑
girt Check valves Installed? ------------------------- - ■ ❑ ❑
G
Transport Line Size 1' Sch9dub7Class M
Bedrooms installed(check ons) ❑ 2 ■3 ❑4 ❑5 ❑6 ❑Comrnaim.110ther
>101L from foundation?----------------- ---- - ❑ NIA ■YES ❑ NO
Q >iooft.fromwelis?.- ---------------------______ ❑ ❑ ❑
W >100 ft.from surface water?------------------------ . ❑ ■ ❑
LL 110ft.from potable water lines?------------------ ---- ❑ ■ ❑
Z >5ft.from property lines and easements?--------------- - ❑ ■ ❑
a >30 n.from dowrgradient cunainnounaatbn drains?---------- ❑ ■ ❑
Drain6dd level and observation ❑ ■ ❑Pons Present----- ---------
❑ Greveless chambers or ❑ Clean gravel used? (ohedf one)
Proper cover installed over drainfieki?------------------ -
❑ ■ ❑
Pump tank setbacks consistent On septic tank?------------ ❑ WA WYEs ❑ NO
X Pump tank capacity(flood)12N gal Manufacturer Hegamens
24-access riser(s)and accessible from surface?------------ - ❑ 8 ❑
~ Alarm or Control Panel Installed ❑ a ❑
Control Panel equipped with Timer I ETM/Counter-- - -- - - --� ❑ JR ❑
Pump installed in ❑ Bucket or ❑ On Block or a Other kan,sC-
�1 7 —
Punp MakeNodal �.li i - J O 8-Fbas or ❑Transducer
Tank draw down �� /min pump
� � m p rspsctry Squirt tMigM ft
Pump on time Pump of bme 3,41,k1 3"&(5 D-IY flow eat gl 27T} gptl
,m 'ikn,rare
Mason County OSS Installation Report pg.2 Parcel s 32333.22-=30
ABANDONMENT RECORD
were severe while mmponenta abandoned as pan of this pawl ______________ _ yES ® NO
If yes,please d tacnbe: ._.
Were all components pumped ourand properly abandoned per WAC246-27M.09W? '--- - El 'El Q no
RECORD DIIAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER]ENGINEER
I certily that I fnaralmd the syatam in accoNanpa with I contrary(het the system has been instatled In actor.
the septic design shithead"APPROVED"by Mason dance with are aspic,design cramped"APPROVED"by
County Public Heath and that any deviations shown Mason County Public Healh and that any deviations
here have been ciearedlapproved by both the designer shown here hem been cmamompproved by both
and Mason County Public Health and moo,aft State myself and Mason County Public Herald,and meat all
and Mason County Codes. State and Mason Counly Codes
I fuMrer courtly that aN inhvnetion contained on this I I.,#w oe(dythat as inlornalion contained on this
form and a r Drawing is accurate, term and attached Receed Drawing is acuurate.
SgrwNm/�o/r.N aranar�(�.j// bare
Name or Sainte
MASON COUNTY PUBLIC HEALTH ?J
rho undersigned spprovea this Installation Report and {/
Record Drawing on behalf of Mason County Public
Health CMn I�I3IZ \ /0
s g,a ae,a t4pitna Swcaca dot patent.signatune and date)
THIS FORM MY SE SCANNFO An)AVAIL W E FOR PUBLIC V&W t)H THE MASON COUMY WI SITE
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