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HomeMy WebLinkAboutSWG2023-00178 - SWG As-Built - 5/7/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2023-00178 Parcel # 22221-31-90000 Applicant Name Seam Sem Subdivision (Name/Div/Block/Lot) Applicant Address 10848 SE 228th St City, State, Zip Kent, WA 98031 Installer Name Bayshore Construction Site Address 13790 E State Route 106, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST I. Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other 500 Gallon Pre-Trash Tank System Type Subsurface Drip Drainfield Pretreatment Type NuWater BNR-600 >5 ft. from foundation? - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - �� ❑�❑ ❑ Y >50 ft.from surface water? - � • 0 ❑ Q Cleanout between building and tank? - - - - A -\�- I ❑■ ❑ UTank baffles present? - `` M - II ■❑ ❑ P.: 24" access risers over each compartment?- - - - % ❑� ❑ `W Effluent filter installed?- g - - - - - ❑ ❑ 0 Septic tank capacity (working) NuWater 60i gal Manufacturer Infiltrator D-box water level and speed levelers used? - - ❑ N/A El YES ■❑ NO XOManifold/D-box accessible from surface?- ems - ❑ © ❑ m Z Check valves installed? - - ' - ❑ I ❑ ❑Q 2 Transport Line Size 1.25" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial;Other >10 ft. from foundation?- - ❑ N/A I YES ❑ NO >100 ft. from wells?- - ❑ U ❑ W >100 ft. from surface water? - - ❑ ❑Q CI u. >10 ft. from potable water lines?- - ❑ I El Z > 5 ft. from property lines and easements?- - ❑ . ❑ Q re > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ o Drainfield level and observation ports present - - Cl ® ❑ ❑ Crovciccc chambers or ❑ Clcon grovel uocd? (chcck onc) Proper cover installed over drainfield?- - ❑ . ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator Q24" access riser(s) and accessible from surface?- - ❑ I. El ~ a Alarm or Control Panel Installed? - - ElI CI 2 Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ m a- Pump installed in ❑ Bucket or 0 On Block or ❑ Other a. Pump Make/Model Orenco PF201012 -20gpm, 1hp, 240v ❑ Floats or ❑ Transducer a Tank draw down 2.5" in 10 min in/min Pump capacity 6.25 gpm Squirt Height -- ft Pump on time 4.8 min Pump off time 1.84 hr Daily flow set at 360 gpd Updated.:21!20t3 Mason County OSS Installation Report pg. 2 Parcel# 2222-�- Si - 1 a000 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES ® NO if yes, please describe. Were all components pumped out and properly abandoned per WAC246-272A-030C? - - ❑ 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 development_ Typical Retard Drawings contain: Drainfeld&manifold orientation&layout,Septcfpump tank Iocation_North arrow,reset ve oratriela.existing and proposed ouiltings,:oceton of wets,vraterthes, wells.observation ports.deanouts.anti other maintenance arrAss points, incomplete Record Drawings may aeate additional delays in 1irt installation approval and related permits • 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 Heal and meet all State myself and Mason County Public Health and meet all and Mason County Code . State and Mason County Codes 1 further certify that information contained on this I further certify that all information contained on this form a1r de Record Drawing is accurate. form and attached Record Drawing is accurate. • firs 4-18-LS • Signatu of I stetlerzce Date ' ' /,' If ,J .1 biC(,i1(14P.t. 71-tY -I- ' 2 r( '''( Ai : . of �Printed Name of Signee a rf, MASON COUNTY PUBLIC HEALTH '`�.' Q� ^ �. The undersigned approves this Installation Report and �y(,�. ig ;.,- • Record Drawing on behalf of Mason County Public t f� 51;i0t49 .i:1) cis PAULA JOY JOHhfSC f! :.r�l Health 1 i „� /1 C. I7, -c-c s 3 I `iris . . ��\\J� i' W ►n/t ,�/!� -6 y� I � E�w;FtES r��T�-S3��1..b Si nature of Environmental!- ith Datese an date) Specialist (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Undutea 3r2t:2ot8 E Stq}p Rot �--- o zo yo �� Seam Sc1nn to6 q 41376t / $arct#'Z22213j- 100oU ` i*«7 8j t3757 ►r% "v' 2 13790 E Si. M . I Co , 1> iii4tr'514- . -1''''-uLkc..1.74.3 7:IL tip k., 6 Z5 ` $ or f — o� I oo) #(3to c.c •,tj38 * 4)* 3 ►3, _., 0(--- .0 _, I AF k sit . Nt;\ 8--r\--: / e \V.5 gA're it's,,,,,, t . - 1 glito,o.s. 4 / s-Q, / -r• .o 97= / hP V V V v ; • . I Weli — *3,40 `0 .e, . � . -138o1 `' D • >YouseI. PROVE 1 • 2-p Mg 20MENSAL HEA ' MASON COUNTY EN�RON 1 . RET cif L� We+land , cf. , . . 7 a. _ "` �r�., 0651' a8 • Z NC'1 • `• 5'00349 9 O �� ' - o-'.PAULA JOY JOINSGN 3'i p 1 �y N•P ` . g. I:fC t4f 1.1 Iztt•• -C.--C- --. ..S. 1 --S ,'"'S_, 4 , , . { .. 5-40 S • OAutho-Visuaa: ix= 1` ' t N(0. - O clean 1 • �3 50C Con?e-re • t ONuWa:er 3N'2-6C0?:et al=ey:^�i I,l A \� t C 1,000 C :on?ump Cabe Y ! O Sub51:-fP�anp Sys*,e :?C2.CG.•C_l s /•u- 0C9 \ 4 s� / Ot-zaf,c� • i N , ,,, • �'k •,�' / OO. S\cQ •