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HomeMy WebLinkAboutSWG2023-00522 - SWG As-Built - 4/23/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00522 Parcel # 31904-55-00041 Applicant Name Henley WA 17, LLC Subdivision (Name/Div/Block/Lot) Applicant Address 1537 NW Woodbine Way FAWN LAKE#6 TR.41 City, State, Zip Seattle, WA, 98177 Installer Name South Shore Construction Site Address 41 SE Azalea PI, Shelton Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pressure Bed Pre ___,-maType >5 ft. from foundation? I.- It ❑ N/A YES ❑ NO >50 ft. from wells? ❑ ❑■ ❑• >50 ft. from surface water? -• Cleanout between building and tank? - - -1%tel- - f�+R - II ❑■ ❑ U Tank baffles present? - ` - 0 ❑ a24' access risers over each compartment?- - -,web- - - - ❑ 0 ❑ W Effluent filter installed?- ey - ❑ 0 ❑ N Septic tank capacity (working) 1,250 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ■❑ NO oO Manifold/D-box accessible from surface?- 1D s - CI0 ❑ OQCheck valves installed? `Fu.A^"e -seK ❑ ❑■ ❑ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 I113 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑ El ❑ W >100 ft. from surface water? - ❑ j El LL >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q a > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ o Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or I. Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A El YES ❑ NO ZPump tank capacity (flood) 1,060 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ • ❑ ~ Alarm or Control Panel Installed? a ❑ I. El • Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other n'• Pump Make/Model Liberty 280 0 Floats or 0 Transducer a 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 gpd mate"8/2"?J^.8 Parcel Mason County OSS installation Report pg. 2 3( oaf-5 oo044 ABANDONMENT RECORD Were existing septic components.abandoned as part of this project? - - ❑ YES 111 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES [] NO RECORD DRAWING . - This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future davabpment- Typical Record Drawings : Drainseid&manifold orientation&layout,Sepik/pump tank tocation.Month arrow.reserve drsmfietd.existing and proposed bufd>ngs,location dwel%w5tarnos, wells,obsen anon ports,eleencuis.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 3ee- • • • • • • 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 1 further certify that all information contained on this I further certify that all information contained on this fo n atta ed R rawing is a curate. form and attached Record Drawing is accurate. Signature of Installer Date Printed Name of Signee . MASON COUNTY PUBLIC HEALTH 0 �� The undersigned approves this Installation Report and r % �I 5100349 Record Drawing on behalf of Mason County Public Ltis:LA JOY JOHNSON Health: ,t 1, ( -�.3-zs Signature of Environ i Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE 11Pdated 81214018 GP\Lt a + 1 ! ! AS - ��1i 1 aNk--"-NI,'1"11 1--`--C, . ' 'aRc-EL 3Ig06t-55-0Cc4 3 1 3/• ' (t) ! x 36` • I— ` $l `,f) l 0'z 15' av:renairy to �30 L_ ..... ovain-Fie14 beds j :j witk +^tservt lG Yts '9 1 p xl5 d Cr' n t .4. tj 0 kfl co i_ r Ati If eE Bo ,, .�1 APPROVED q.\ 27 x4`1r / '. b100348 • 1� 36R ir APR 30 2025 ,Q PAUTA JOY JOHNSON' -i ttGC�ts u_si.,Nita" Rousec MASON COUNTY ENVIRONMENTAL HEAT( cs ,m• ''a it RET ti -Z.3-zs ` '' t Q Audio-Visual Alarm � S - i 3r.Cleao ut 1 Q� /44,‘p 3 1200 Callon Septic Tank _'__ 2-Corapar :gent with Effluent Filter 5�� �`' 0 1000 Gallon Pump Chamber /`J< �1\- c-1M, a i-' rPbova