HomeMy WebLinkAboutSWG2021-00551 - SWG As-Built - 12/26/2024 f
Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PER INFORMATION
Permit Number SWG 2021-00551 Parcel 32021-59-03041
Applicant Name CMH Homes Inc Subdivision (Name/Div/81ocWLot)
Applicant Address 6312 Martin Way E Shorecrest Beach Estates Division:2 Block:3 Lot:41
City, State, Zip Lacey WA 98503 _ Installer Name Skinner Construction
Site Address 101 E Cedarorove Ln Shelton Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only [IRepair OtherNUWater BNR-500
System Type Shallow Pressure Pretreatment Type
❑ YES NO
>5 ft.from foundation? ® ❑
>SOft.from wells? -_ _ ___________ ______________ . ❑
Y >50ft.from surface water? -- - -- - - - -- - - -- - --- - ----- ❑ ❑
Z ❑
F Cleanout between building and tank? - --- - -- - --________- ❑ ❑ ❑
O Tank baffles present? ---- - -- ----- - - - -- - ❑
f- 24"access risers over each compartment?- - ----- - ------ - ❑ ❑
Q. ❑ ❑
W Effluent filter installed?-- ---- - - - - - - - - ----
rn Evergreen Precast
Septic tank capacity(working) BNR-500 gal Manufacturer
C3 D-box water level and speed levelers used? ------ --- --- - -- ❑ NIA ❑ YEs NO
J Q ❑
0O Manifold/D-box accessible from surface?---- --- --- - - - --: ❑
g1Z Check valves installed? - - -- .per- '� -- - --- ❑ ® ❑
�2 Transport Line Size 2" 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?-------- ---- --- f./ ___ ___ . ❑ ❑
W >100 ft.from surface water'- ----- - - -- �1 I?fi=�� 1y/ IS O ❑
LL >10 ft.from potable water lines?. - —-- - - J/ ILLS SS S:L -17 lea
> 5 ft. from property lines and easements?- - -DEC 2TMU ❑
W > 30 ft.from downgradient curtaintfoundation s?--- - - - -- ❑
Cl Drainfield level and observation ports present -By -- - - - - -- --- ❑
® Graveless chambers or ❑ Clean grav ® ❑
Proper cover installed over drainfield?--- --- --- - -- --- ' - -- El
Pump tank setbacks consistent with septic tank?------ - ------ ❑ WA ® YES ❑ NO
Y Pump tank capacity(flood) 1.200 gal Manufacturer Evergreen Precast
Z 24- access riser(s)and accessible from surface?---- --- ------ ❑ 0 ❑
F- Alan or Control Panel Installed? --- - - - - - - - - - - " ' - - --- ❑ IN ❑
IL ❑ ®
`� Control Panel equipped with Timer/ETM/Counter- ---- -- - - --
❑
7
a Pump installed in ❑ Bucket or 0 On Block or El Other
0- Pump Make/Model Liberty 250 ® Floats or ❑Transducer
Z) Tank draw tlown 2 in/min Pump capacity 40 qpm Squirt Heigh 3 ft
a
Pump on lime 2 min Pump or'time Shia, Daily flow set at 3al'mpd
Mason County OSS Installation Repoli pg. 2 PgCB
I# 320215903041 I
ABANDONMENT RECORD
Were existing septic components abandoned as part of this arpiect? �--------- ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC24fi272A-03007 -------- ❑ YE$ NO
RECORD DRAWING
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See-
Remrd Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNERI ENGINEER
I certify that 1 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 Me designer shown here have been cleared/approved by both
and Mason County Public Health and meet at State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that alt Information contained on this 1 further certify that at information contained on this
found attached Record Drawing is accurate- form and attached Record Drawing is accurate.
AS4natue of installerDate 2024 2y�
Dare
SAMUELSKINNER r _
Printed Name of Sign"
MASON COUNTY PUBLIC HEALTH e
The undersigned approves this Installation Report and
PAULA JOV JOHNSDN 'C
Record Drawing on behalf of Mason County Public L IS@ ri i W t"
Health: a(mes t
17� 121 1
Signature of Environmental Health SpeCIslud Data (stamp,signature and date)
THIS FORM MAY SE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UlNard bzhrmle
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i GAULAJOY JOHNS°N ;, Gcd pYQre
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DEC 2 6 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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