HomeMy WebLinkAboutSWG2023-00528 - SWG As-Built - 1/15/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 2023-00528 Parcel # 32220-75-00040
Applicant Name Van 8 Lisa Jeppesen Subdivision (Name/Div/Block/Lot)
Applicant Address 16401 BE 352nd Street
City, State, Zip Auburn,WA 98092 Installer Name TNT Excavating
Site Address 951 NE Patton Dr, Tahuya Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair i Other 500 xenon Pre-Treeh Tank
System Type Shallow Pressure Pretreatment Type Nu Water BNR-500
>5 ft from fountlation? B Il"lVl'L�"ll- V�� ❑❑ N/A YES NO
>50ft. from wells? - - - -- - - _ _ _ _ - - L}`s�l�`}��L}S{�Y\V�(-
Z >50 ft. from surface water? - - - - - - -- - ❑ ® ❑
Cleanout between building and tank? - -- _ �AN-� --25 ❑ ® ❑
V Tank baffles present? -- - - - - - - - - - ❑ ❑W ❑
IL 24"access risers over each compartment. By ❑ ® ❑
LU N Effluent filter installed? BQk--EaO ❑ El
Septic tank capacity (working) NUWater gal Manufacturer Hagerman
0 D-box water level and speed levelers used? - -- - - - - ❑ N/A ❑ YES No
0J
0 Manifold/D-box accessible from surface? -- - - - -- - - - ❑ ® ❑
0°Z Check valves installed? - - - - - - - - -- - - - -- - - - ❑ ® ❑
❑Q
2 Transport Line Size 2- Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther
>10ft. from fountlation?- - - - - - - - -- - - - - - - - - - - - - - - - - ❑ WA ® YES ❑ NO
>100 ft. from wells?- -- - - - - - - - - -- - - - -- - - - - ❑ ® ❑
W >100 ft. from surface wateR - - - - - - - _ -- - - - - ❑ ® ❑
Z110 ft. from potable water lines?-- - - -- ❑ 0 ❑
> 5ft. from property lines and easements?- - - - - - - - - - - -- - - - ❑ W ❑
> 30 ft. from downgradient curtain/foundation chins?- - - - - - - - - - ❑ W ❑
O Drainfeld level and observation ports present - - - - - - - Cl ® ❑
❑ Graveless chambers or Q Clean gravel used? (check one)
Proper cover installed over drainfield? -- ❑ ® ❑
Pump tank setbacks consistent with septic tank? ❑ N/A W YES ❑ NO
Y Pump tank capacity (flood) 1,000 oal Manufacturer Hagerman
Q24"access riser(s)and accessible from surface?-- - - -- - -- - - -- ❑ ® ❑
aAlarm or Control Panel Installed? - - - - - - - - -- - - - - - - - - - - - ❑ ® ❑
jControl Panel equipped with Timer/ETM/Counter- - - - - - - - - - - ❑ 0 ❑
d Pump installed in IM Bucket or ❑ On Block or ❑ Other
IL Pump Make/Model Liberty,280 N Floats or ❑ Transducer
y Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 6 ft
Pump on time 1.9 min Pump off lime 6 hr Daily flow set at 360 gpd
Vpaa!a�8!fl201B
Mason County OSS Installation Report pg. 2
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ABANDONMENT RECORD
Were aY'SjOQ 32PSry wT,OC^:20Sa -v'GdndOted d5 pE C '':9 J912C.` _ _ ____ _ _ _ _ _ _ _ _
_ YES �y NO
if Yes, ^y!22se describe: NO
Ws2 all car:porxcs pupped pit anc properW abd^dored per VJAC24a-2-?%.-.3_7r _ _ __ _ __ . j YES
RECORD DRAWING
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ilia rc a Oarma t ncM u�nun]a
p'r::n6sEe/S:: O:a.Y-"3r,�rYJ.arrala.brycv:tea __ ,_-,. Y ,^a:•JWYa. ra.a.,. e. roe anC r�aEt..zni:x.
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4 � ftecorJ 72w:nq Aitaened
CERTIFlCATION DF INSTALLATION
,INSTALLER DESIGNER!ENGINEER
art nai he system has been!nstailed in sccor-
f car*rout!installed stall the sys sn - ^ fl
the septic design stamped Ar ^✓c as � e ^e r"h he septic design stamped-aPP'YJ✓e0'by
County Public Health and.nst am der a o $ 3Il1 is on County Pubic Hearth and that any deviations
here have been deared1aPPMW6d qv h" a _ Pne i hc^ "are have bean clearedxPpmv d by both
and thason County Pubric Health end•=ear a::S: ! -as and R9aSo, County Public.'fee th and meet a!!
and Mason County Cods a M1FssP ^Puny Co es
!further cerr'fy That all jntO!M3SfiOn.Antai eo.. ._S 4 4^ar e'y t atl.hfo.nT!aton cdntanec or, this
form and attached Record Crawfng is accurata. ;bm an:aractrad Record Dransng is ScCvrate.
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Signature oP-Insteffer Gars
Awg
Printed Na.^e 0r5:9re= ^
NIA80N COUNTY PUBLIC HEALTH t
The undersigned SPProees',.!s ins:2!ta:!on Repo:uric xf im 349 '
Record Drawing on benaS Of M8SOri CcunM pub';c PAULA JOY JOMN60N
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signs" rc p,`Envr n:-a-r--;.,aa:.'Sa2=ra:s! .=.a :siemF. s!gnaWm and date;
-iS FdRU fnv 3E SOAtiN_J 4uO.:.u:A3-_-F 3 T 6_:d�, �-=JAS u.,OI:N^":'F_a SITE
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APPROVED
h / JAN 15 2025
MASON COUNTY ENVIRONMENTAL HEALTH
O Ati3o-Visttzl A;-*+�
RET
22 01r out
_ 500 Gaoa P-e-Taza'x tank
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O NUWatc Bh_2500 ATU Tank
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O 1,000 QaLon P.Lmp Chamber
1 O6 valve Control Boa _
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' PFULN JOYY JO JONNSON .
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