HomeMy WebLinkAboutSWG2020-00304 - SWG As-Built - 1/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00304 Parcel u 32021-56-01038
Applicant Name Stuart Simpson Subdivision (Name/Div/Block/Lot)
Applicant Address 13405 138th AVE KPN SHORECREST TERRACE 3RD ADD BILK: 1 LOT: 38
City, State, Zip Gig Harbor,WA 98329 Installer Name Northwest Cascade Inc.
Site Address 330 E Parkway Blvd Shelton, WA Designer Name Arrow Septic Designs Inc.
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other sos oailonF ..h
System Type Shallow pressure Pretreatment Type NuWater BNR-500
>5 ft.from foundation? ------ -- - -- --- - - -- - ----- --- ❑NIA EYES ❑ No
>50 ft.from wells? ---- -- ❑ ® ❑
Z >50 ft.from surface water9 -- - --- - - - -- - - - - -- - - -- - -- E] ❑
F Cleanout between building and tank? ---- --- - - ------- - --
Tank baffles present? - __ _ _ ___- ❑ E ❑
1-0. 24'access risers over each compartment? ❑ E ❑
W Effluent filter installed? lz-5 _ _ ___ _ _ _ _ ____ ❑ Elrn WDo
Septic tank capacity(working) NuWater gal Manufacturer Infiltrator
o D-box water level and speed levelers used? -- ❑ NIA ❑ YES No
00 Manifold/D-box accessible from surface?------------------- - - - ❑ IN ❑
13�1O Q Check valves installed? - ________ . ❑ E ❑
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed(check one) ❑2 E 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - -- - - ------ --- -- --- - -- - -- ❑ WA EYES ❑ NO
CI >100 ft.from"Its?---- --------------------- -- -- ❑ E ❑
W >100 ft. from surface water?- - ----------- ----- ❑ E ❑
EZ >10 ft.from potable water lines?- - LJ4�'N'a=_��3L�s-- ❑ ❑
Z
Q > 5 ft.from property lines and easements? ❑ E ❑
Of > 30 ft.from down9radienl curtainRountlation tlreins?--- - - - -- -- ❑ � ❑
Drainfield level and observation ports present - - --- --------- ❑ ® ❑
IN Greveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield? -------- -- ❑ ❑
Pump tank setbacks consistent with septic tank?------ - ------ ❑ NIA a YES ❑ No
ZPump lank capacity(flood) 1,287 gal Manufacturer Infiltrator
Q 24'access nser(s)and accessible from surface?-- ----------- ElW ❑
a. Alarm or Control Panel installed? ❑ 1E ❑
Control Panel equipped with Timer/ETM/Counter -- - - - - -- -- ❑ E ❑
a Pump installed in E Bucket or ❑ On Block or ❑ Other
rL Pump Make/Model Liberty oats or 280 E Floats ❑ Transducer
y Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 5 ft
Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 apd
Mason County OSS Installation Report pg. 2 parcel# 3?A 2-
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? ------ - ------- - YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YES No
RECORD DRAWING
Thb H a pamunnnl nand and molt M ueun o add WaeXpWe enough m mleun In Ne naM of radmamance actlMlai and M1rtun Xvyelopmnt Typlal Reconl
02wlnpa anlein: OnrfiNtl 6 manlfoN nmla4on 6layom aepti'Ipump lank IrcdOtli.NOM arfow eBeMe tlrainfield,eYiNre and pNpp60tl WIIdIMj,IpCa11M N W We,Wvlemx;
welb,oC%rvadm po�6,Wamu4 and oUer meiMenonce Mcesa gMnIS. IMpmplele Rtt tmwings may cwte addilimnal delap in(I imnallaum epprov&and alaled pertnds.
Er Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I ceIffiy 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 clearad/approved by both the designer shown here have been cleared/approved 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 further Ceti*that all information contained on this I further certify that all information contained on this
form and had Record/Drawing-is-accurate. form and attached Record Drawing is accurate.
�i✓�1is 11 -4-24
Signature oflnstaher Date
printed Name o/S4ne9 �
MASON COUNTY PUBLIC HEALTH qq ?ee
The undersignedappmves this lnstallaf eportvl�
Record Drawing on behalf Of Mason Coun IC y"'2' PAULA t .3JJOY DNNSOry . �
Health: F,/y�q OZs. 'IC SE n
Signature of Envhonmental Health Specialist Date ��i� signature
-re an `
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upda.,I.I.la
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