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HomeMy WebLinkAboutSWG2025-00030 - SWG As-Built - 3/17/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWO 2025-00030 Parcel# 321045200124 Applicant Name BCS Development LLC Subdivision (Name/Div/Block/Lot) Applicant Address 8830 Erie Ave NW Alderbrook G&Y 02 TR 124 Div 2 City, State, Zip Silverdale,WA 98383 Installer Name BCS Development LLC Site Address 1070 E Vine Maple Ln,Union 9859 Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ■TS k(S)only ❑ominrield only ❑Repair ❑oth r System Type Gwty Preffeaurlant Type >5 ft.from foundation? ---------------------------- ❑WA yEll, ❑M Y >50ft.from wells? -____________________________ ■ ,,,y O Z >50ft.from surface water./ --- -- ------------------- ❑ FCleanout between building and lank? ------------------ - ❑ '�tt�°' ❑ U Tank baffles Present? -- -- -- --------------------- ❑ ■ 5 ❑ 3 a24"access risers over each compgaren(?---------------- ❑ ■ ❑ rW Effluent fiber installed?-- - --______________________ ❑ ■ ❑ r Septic tank capacity(working) 1250 nal 1gerM/eGlew Infiltrator N �o D!>a><water level and speed levelsrs used? --------------- ❑" ■YES NO O0 Manlfold/D-0ox accessible from surface?---------------- . ❑ ■ ❑ GQCheck valves installed? ------ ------------ ■ ❑ ❑ M Transport Line Size existing 4' ScheduledClass; ADS smooth wag Bedrooms installed(check one) ❑2 ❑3 ❑4 ❑5 ❑6 ❑CcmmerciaVOther 110ft.from foundaton?------------------------- - ❑ wA ❑ YES ❑ NO 0 >100ft.fromwells?. -----__- _-- -. ❑ ❑ ❑ J 1100 ft.from surface water?-______________________- ❑ ❑ ElW _ 110ft.from potable water flees?-------- ____--_. ❑ ❑ El >5 ft.from property lines and easements?-______________ . ❑ ❑ ❑ C >30 ft.from downgradient curtainPloundation drains?-----___-. ❑ ❑ ❑ Orainfreid level and observation ports present --- ----__-__-. ❑ ❑ ❑ ❑ Gmveless chambers or ❑ Clean gravel used? (deck one) Proper cover installed over dramfield?------------------ - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank?------___-__- ■ NIA ❑ YES ❑ NO = Pump lank capacity(flood) Oat Manulackm 24"access dseds)and accessible from surface?----------- - - El ❑ y Alarm or Control Panel Installed? - -------- __ ❑ ❑ ❑ 7 Control Panel equipped with Timer/ETM/Counter------ --___ ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Cow 3EPump Make/Model � ❑flats or ❑ Transducer IL Tank draw down indmin Pump capacity Darr Squid Height ft Pump on Urns Pump off time Daily lbw set at opd wa.aeeawo,e Mason County OSS Installation Report pg. 2 parcel a 321045200124 ABANDONMENTRECORD Were exiSmg septic compensms abandoned as part of mis pmled? ------------ -- - DYES El No If yes, please describe:Replaced Existing Septic tank. Pumped and removed old tank Disposed of Ware all components pumped Out and pmpady abandoned per WAC246-272A-0300? ------- - © YES NO RECORD DRAWING 1N•ro.wuw�n..w.e..e e..�n,..e...a a...rvw.,wm m�+o.+o a w M.a a<.m.u"......e.iu.w w..a.aoaa.a Troy a®x ore.nas w,um: ae.rtae a m.n�mu urwm a e>aa s.pr�vmmia aum.wm..o.,.m.e.e aanru...aN,o.m nw..dl.aaq.asa�a..r,.reaA o: o'+ eaa x.i.a,ro.wm..�mrc,wv uam wra. e�•azro aema o.z.v.�m.r aese mcrvl u+m n4r rrsswawl.rrarra.r ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER I certify that I installed the system in accordance with 1 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/approwd by both the designer shown here have been cleafed/appmved 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 certify that all information cwtlamed on this I further ceddi,that all edonnaNan contained on this to"and aattttached Record Drawing is accurate foal and attached Record Omwhng is accurate. ' 3112t2025 Signature of Installer Data Bill BumbW22gh Printed Name of Signae MASON COUNTY PUBLIC HEALTH The undersigned appmvas this Installation Report and Record Drawing on behalf of Mason County Public Health: —jtNe4cM 3�nf Signature W Enveonmavital Health Specialist Data (stamp, signature and date) THIS FCftM IMY BE SCANNED AND AVAd-A FORD IC VIEW ON THE NASE0N COUNTY WEB SITE �»neavmre AooaesS ' 1990 E �wi mAH a zl✓ UNlar/, WA 955' 92 i PAP<6L Jt 32i045z oo Iz4 _ - �ZL ' ,K uta lu• rww simc EXIfTr,✓4 � pw if NEa D•4.x �'� - cr.c • sgru • r fPwP 1. 4' 'F•CIGJw! r I •APPROVED w , a MAR 11 2025 MASON COUNTY ENVIRONMENTAL HEALTH Or RET I � �R ASBuI�t roe 4 "fi1.JL' I.aS'raiL V f. pa,�„griw _ ,tiaw�P. >✓ u� exlsn,a, �, SJfi got$ • Onoj0