HomeMy WebLinkAboutSWG2023-00505 - SWG As-Built - 2/27/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWIG 2023-00505 Parcel# 22116-77-00090
Applicant Name Stephen &Debbie Byron Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 854 TR 9 OF SURV 151194 S 16/64, S 53130
City, State, Zip Allyn WA 98524 Installer Name South Shore Construction
Site Address E Mossflower Ln Gr4peview Designer Name Arrow Septic Designs
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair Other
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System Type Shallow Pressure Pretreatment Type NuWater BNR-500
15 ft,from foundation? -- --�0_ �w__'4 ! Y -- - - - -- ❑ ara ®rE5 NO
>50 ft.from wells? ----------- - -- �(r51 (r(JI� ❑
Z >50 ft.from surface water? --- -- --- - - j�r�LSU �rf �C ❑
F Cleanoul between building and tank? - -- --� - - - - - ❑
EE&1]_2025 -
O Tank baffles present? --- - --- - ----- - � ❑
~a 24'access risers over each compartment?-- --- ❑ ❑
w Effluent fitter installetl?--- - - - - - - -- - - El
rn "a mile.
Septic tank capacity(working) NUWater 0 pal Manufacturer
o D-box water level and speed levelers used? ---- -------- --- ❑ NIA El YES NO
QO Manifold/D-box accessible from surface?-- -- -- ----- ----- ❑ ® ❑
o?Z Check valves installed? -- P--'Qjk s r ❑ ® ❑
04 Transport Line Size 21nch Schedule/Class 40
Bedrooms installed(check one) ❑ 2 ❑3 �,M 4-- ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- -4-M-��Q--ry---- - ---- El MIA ® YES NO
>100 ft.from wells?--------- -------------------- ❑ N ❑
W >100 ft.from surface water?-- - - - -------------- ----- ❑ 0 El
LL >10ft.from potablewater lines?- - - - -- ---------------- ❑ ❑
Z >5ft.from property lines and easements?------ -- ----- - -- ❑ ® ❑
a
K > 30 ft.from downgradient curtain/foundation drains?--- - - -- - - -
In Dramield level and observation ports present - - ---- -- ---- - - ❑ ❑
N Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-- - - -- ----- - -- ---- ❑ ® ❑
Pump tank setbacks consistent with septic tank?-- ---- - ---- -- ❑ NIA YES ❑ No
Y Pump tank capacity(flood) 1,250 pal Manufacturer Hagerman
Q ❑ ® ❑
24'access riser(s)and accessible from surface?-- --- ----- ---
~ Alan or Control Panel installetl? - ----- -- ---- -- - - - ---- ❑ ® ❑
2 Control Panel equipped with Timer/ETM/Counter-- -- - --- - - - ❑ ® ❑
7
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
n. Pump Make/Model Liberty 290 E Floats or ❑ Transducer
23 Tank draw down 2.5 in/min Pump capacity 55 ppm Squirt Heigh 3 ft
a
Pump on time 2 min Pump off time 6 hours Daily now,set at 480 ppd
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Mason County OSS Installation Report pg. 2
Parcel# 2Z`` 6— I1 — )00 V0
ASANDONMENTRECORD
NO
V*, e,I t g septic components,abandoned as part of this project! -_____
YES
If yes,please descnbe: NO
WMe all components pumped out and property abandoned perwAC24S272"Z 300? -------- YES
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Record DraotingAttached
;.CER7IFlCATION OF INSTALLATION ::_-. .
INSTALLER DESIGNER/ENGINEER
I certiry that 1 installed th system in accordance with I certify that the system has been installed in axon-
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 c1ear6&aPProved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myseHand Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
fo/may/�n�att R swing is a wrate. form and attached Record Drawing is accurate.
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signature of Installer Date t
Printed Name of S'gnes a 0
MASON COUNTY PUBLIC HEALT* lT
The undersigned aPpmves this InshO and
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Record Drawing on behalf of Mason JOY,WHMBDN .
Health
Signature OFEnvironmartat Heath Speaasst Date �`2T9 (stamp,signature and date)
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