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HomeMy WebLinkAboutSWG2020-00303 - SWG As-Built - 8/3/2023 s Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION nAddress r SwG 2020-00303 Parcel# 32021-56-01037 e Stuart Simpson Subdivision (Name/Div/Slock/Lot) ress 13405 1381h Ave NW Shorec ist Terrace 3rd Addl BIk 1/Lot 37 ip GIg Harbor WA 98329Workman Contracting LLC 480 E Panorama Dr Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Drainfield OnlY ❑ Repair ❑Other Soo b•lp tmh%Mr Mbo Q Full System Installation ❑Tank(s)Only ❑ System Type Shallow Pressure Pretreatment Type NuVVater BNR-500 >Sft.from foundation? -- ----- -- - -- - - - ---- -- - - - - -- ❑ MIA YES ❑ No ® ❑ ❑ >IiO ft.from wells7 -- - - ---- -- - -- ' - - - - -- - - - --- - - ❑ Zd >5oft.from surface water? --- --- -- - - - - - - -- - - - - -- - - ® ❑ Cleanout between building and tank? ------ - ---- -- - - El ® ❑ U Tank baffles present? -- - ---- -- — ----- -- - -- - - ❑ F 24'access risers over each compartment?-- - ------ -- - - - -- ❑ ® ❑ IL ® ❑ ElW Effluent filter installed?--- ---- --- - - --- - -- - - -- - --- - N Septic tank capacity (working) 3NR-500 gal Manufacturer Sound Placement O D-box water level and speed levelers used? --- --- - -------- ® NIA ❑ YES No J ❑ e GLL — Menitold/D-box accessible from surtace?--- - ---- - -- ------ ❑ tPZ Check valves installed? - - - - - - - - --- - - - - -- -- - - - - - El ® El t]G 2' Schedule/Class 40 S Transport Line Size Bedrooms installed (check one) ❑ 2 E 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - - -`fie - - - - - - - - -- - ❑ MIA ❑ YES NO G >100 ft.from wells?------- - ------ -- - -- -- -- -- ---- ❑ ❑ W >100ft. from surface water?- - - -- - ---- - - -- -- - -- -- - -- El El li >10ft. from potable water lines?- - - - ---- - - -- - - - - - - - -- - ❑ ® ❑ z >5ft. from property lines and easements?- - -- - -- - --- -- - - - a ❑ ® ❑ C > 30 ft.from downgradient curtaindoundation drains?- - - - - -- - - - ® ❑ ❑ O Drainfield level and observation ports present - -- - - - - - - - ---- ❑ © ❑ ❑ Graveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfeld?--- - - -- --- - -- --- -- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - --- - - - - - - -- ❑ NIA 0 YES ❑ No X Pump tank capacity(flood) 1,000 at Manufacturer Sound Place -Combo w/500 ore-trash Z ❑ W ❑ 24'access risers)and accessible from surface?� - -- - - - - - - - - - H Alarm or Control Panel Installed? - - --- - - - - - -- -- - - - - - - ❑ ® El 6 ❑ O ❑ Control Panel equipped with Timer/ETM/Counter-- -- - - - - - - - ajF�uckel or ❑ On Block or ❑ Omer. fUy�e/ pua Liberty 280 ® Floats or ❑ Transducer a Tan,%, M A8� 2.5 in/min Pump capacity 45 gpm Squirt HeightF70 8 ft p on time 2 min Pump off time 6 hr Daily flow set at 360 cipd uw•,m ea,ao,e "150N COUNTY ENVIRON DJA _ 4 # Mason County OSS Installation ReAR Parcel -ol a3� AANDONMENT RECORD � Were existing septic wmponents abandoned as part of this project. -------- --- -- - - YES NO If yes, please deacnbe: Were all components pumped out and prOPeny a No bandoned Per WAG24G2t2A-0300? ' -'-- - - - Y� RECORD DRAWING TN'b.WmumM nuoN ana mwt be.«unb.M e..ce0aaa mauan m Moob In Ne nwE W mal�nan«xt'.ma NNn ewamPnnl TYOImI RKON Divneem I—n.uvmaeon a mrov sewawmo bnx ImeoM1 NeM a.W'.Taane enlMM0a.v no and PNp buiC,rKje.lopibn drslb.V.mmllinm WAs,nNemmm 0.'�m.a®srWb,YC ONN malNanan«a�'¢m WIrN. In Pm R.'ue Dn'w•nLs mq'vaate WCltloiW eMaM in M.I IioNNtien.00rwalaM NNtl«rm Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 clearedlepproved by both the designer shown here have been clearedlapproved 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 certhy that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate, form and attached Record Drawing is accurate. 5-1- 23 Signature of installer Date ' COLf<1i 2 UJ 0 r-i,- nu.� r3x Punted Name o1 signee �lA MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �y sioov� pa�fr Record Drawing on behalf of Mason County Public A PP - ' r nAI�NA.Ior dzgl6 Health: 1— °COgE51G AVG p3 �p�� i-zs Sign re of Envimnmental Health Specialist Date MAD (afa4jJ, signature and data) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC IM$A N COUNTY WEB SITE Vp«mn erz'rzms DJA Cry/ I HEAL Tit