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HomeMy WebLinkAboutswg2024-00305 - SWG As-Built - 4/21/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00305 Parcel # 32021-56-01014 Applicant Name Habitat For Humanity Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 1549 Shorecrest Terrace 3rd Add/ Blk 1/Lot 14 City; State; Zip Shelton, WA 98584 Installer Name Mason County Excavating Site Address 190 E Panorama Dr, Shelton Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure - - i ent Type NuWater BNR-500 >5 ft. from foundation? - { tatVj ❑ N/A El YES El NO >50 ft. from wells? - 1 El I ❑ z >50 ft. from surface water? - ' , - A9R 2._2 25 - ❑ 0 ❑ HCleanout between building and tank? - - - ` p - - . CI ❑ U Tank baffles present? - By- - - -1i4-410— - • 0 ❑ a24" access risers over each compartment? - ❑ 4 ❑ W Effluent filter installed?- ❑ ❑ 0 COg�e- Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO �O Manifold/D-box accessible from surface?. - ��� ❑ 0 ❑ LL m2 Check valves installed? - a 4p�' ❑ 0 ❑ CS Q 2" Schedule/Class 40 E Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- Ste" �G`�` � — 1 �b N/A 0 YES 0 NO 0 >100 ft. from wells?- - ❑ ■❑ ❑ J >100 ft. from surface water? - - ❑ I ❑ W ❑ Cr. >10 ft. from potable water lines?- - ❑ Q > 5 ft. from property lines and easements?- - ❑ El ❑ CC > 30 ft. from downgradient curtain/foundation drains? - ❑ IC ❑ Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A El YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ *I CI H - a Alarm or Control Panel Installed? ❑ VI ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- ❑ d Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Liberty 280 0 Floats or ❑ Transducer a. Tank Tank draw down 2.25 in/min Pump capacity gpm Squirt Height 6 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd Updated 9121/2018 � - o� ��� Mason County OSS Installation Report pg. 2 Parcel# 32ssaZ.�— — ABANDONMENT RECORD El YES ® NO Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING need of maintenance activities and future pical This is a permanent record and old onertatio&layouteppGp must be accurate and descriptive enough to re-locate in Sump tank location.North arrow. ereserve dra field.existing and proposed buildings,location otwell�s..waterlines, D ngs contain: Oral^field&mar .. rawmay n final installation approval and related permits• wetl s s,observation ports.deacons,and other maintenance access points. Incomplete Record Drawings create additional delays 4 . A \ & gi 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 cleared/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 certify that all information contained on this 1 further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. I Signature of Installer Date \ • h. P.C .1', 1 \ r tF+ i, of +y +�l Printed Name of Signee 't N MASON COUNTY PUBLIC HEALTH stoo 49r� The undersigned approves this Installation Report and y: : PAULA JOY JOHNSON . �Record Drawing on behalf of Mason County Public f LiCeus= •n�S�asiol'• v Health: EXPIRES f1 r yA4' 9c !ZS— -u-z s 9 Si nature of Environmentd1 Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UpdateC 8212018 ✓ C A_ } • • 1 ; < 2 0 - E_ : `fib•�D L7 zv rs 0 �! V l'� -0 { { t} 43 / �v' �cC=} 15E O Y �� � K"l �- s HS 1 0 t t ^ v L/l \'� \�� 4 SGE�.�,� © s APPROVED ?occti O;,c I -----1 _ APR 2 9 2025 } ; ,� MASON COUNTY EhV1RQN,MENTAI HEALTh _ `y RET _ (-- 13 J C.f.:,`s OE��-cJas • i'.. y- ti,c 5 S 30 Aev3A6 / ' i Key: • l ��� 1 01 \ Audio Visual Alarm \ ` f l ` • r 1 O Cleanout -. V..)-6-4 0 NuWater BNR-500 ATU Tank 1-/, Q-- 0 1,000 Gallon Pump Chamber OValve Control Box Nk ' 'o, *4 `• }• e h • 5100349 • < r `•:0Z' PAULA JOY JOHNSON ufaki I= U 5(GN " i. o'-cS�c-s.N s i 3r _ Le-2(-ZS