HomeMy WebLinkAboutSWG2024-00157 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. '1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00157 Parcel # 32127-50-00191
Applicant Name Colby Smith Subdivision (Name/Div/Block/Lot)
Applicant Address 2120 E Island Lake Dr.
LAKE LIMERICK 1 LOT: 191 S39/48
City, State; Zip Shelton, WA 98584
Installer Name House Brothers
Site Address 530 E Aycliffe Dr, Shelton Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Q Full System Installation El Tank(s) Only ❑ Drainfield Only El Repair ❑Other
System Type
Subsurface Drip Pretreatment Type NuWater BNR-500
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
E CEIRM - ❑ ❑ ❑
>50 ft. from wells? -Y >50 ft. from surface water? - ❑ • ❑• ❑
Zricbuildingtank? - - -MA-Y- $2Q 5- -�i ❑
Cleanout between and - - - ❑ ❑ ❑
U Tank baffles present? - ❑ 0 ❑
a24" access risers over each compartmen ?�y - - - _ ❑ Q
W Effluent filter installed?- _ ❑
rn 8i4 Sound Placement
Septic tank capacity (working) NuWater 500 gal Manufacturer
N/A ❑ YES 0 NO
❑ D-box water level and speed levelers used? - vo �s _ ❑ ■ ❑
—� ❑
�O Ntanifold/D-box accessible from surface?- - -�-�� ❑ ❑ ❑
mz Check valves installed?
❑Q 1„ Schedule/Class 40
E Transport Line Size
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ NIA a YES ❑ NO
>100 ft. from wells? - ❑ 0 ❑
W >100 ft. from surface water? ❑ A ❑
>10 ft. from potable water lines? ❑ Ell CI
> 5 ft. from property lines and easements?- - ❑ ❑ CI
> 30 ft. from downgradient curtain/foundation drains? ❑ ❑ ❑
en
Drainfield level and observation ports present - - ❑
Proper cover installed over drainfield?- -
Pump tank setbacks consistent with septic tank? - - ❑ N/A
El YES 0 NO
House Brothers
Pump tank capacity (flood) 1 ,000 gal Manufacturer ❑ ❑
Z
< 24" access riser(s) and accessible from surface?- - ❑ El ❑
~ Alarm or Control Panel Installed?
gControl Panel equipped with Timer/ ETM / Counter a- Pump installed in ❑ Bucket or ❑ On Block or ® Other Flow Inducer Tube
a m,1/2h 115v j Floats or ❑ Transducer
� Pump Make/Model Orenco PF200511 -20gp P.Q. Tank draw down 2" in 10 min in/min Pump capacity 3.8 gpm Squirt Height
-- ft
Q.
7.9 min Pump off time 1.84 hr. Daily flow set at 360gpd
Pump on time Updated8?212016
Parcel
2iZZ So- OO\C.l
_
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
_ 0 YES ® NO
Were existing septic components abandoned as part of this project?
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YES
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 Record
nts. Incomplete Record Draw-ngs may create additional delays in final installation approval and related permits.
Drawings contain: Dra'infie!d&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed bu idings,location of wells,waterlines.
wells,observation ports,cleancuts,and other maintenance access poi
. S-a_
..._.__
® 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 informat.o., o..tained onI further certify that all informs}rnn onr?tarred nn this
rrr} cr information o ntn o this
form aril attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Signat re of Installer Date -
r>l7 r �I
` Aft r ��
Printed Name of Signee po., • x
MASON COUNTY PUBLIC HEALTH � '' ' I, Of•
The undersigned approves this Installation Report and s'4 I •.•4
�� 51 �3n3 ;��
Record Drawing on behalf of Mason County Public 1.-�• PAULA JOY JOHNSON '.
�•.L►c s>rl�p�s,G1a..
Health: � � � CoExams ilkill
Date (stamp, signature and date)
Signature of EnviroP---17\-0Yril
Health Specialist
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updates a/212°18
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