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HomeMy WebLinkAboutSWG2021-00645 - SWG As-Built - 1/24/2023 It- Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00645 Parcel # 32021-53-04046 Applicant Name Jensen Bakken Homes Subdivision (Name/Div/Block/Lot) Applicant Address 221 E Ballantrae Dr SHORECREST ADD REPLAT BLK:4 LOT: 46 City, State, Zip Shelton, WA 98584 Installer Name DB&R, Inc Site Address 50 E Bridger Ln, Shelton Designer Name At__2__-ow__S_tp_tE_Pi9L---Isi Inc INSTALLATION CHECKLIST Repair ®Othef 500 gallon Pre-Trash Tank II Full System Installation ❑Tank(s)Only El Drainfield Only ❑ NUWater BN -500 System Type Shallow Pr ure Pretreatment Type - ❑ NIA 0 YES ❑ NO >5 ft. from foundation? - ❑ ❑ >50 ft. from wells? - - - ❑ � >50 ft. from surface water? z ❑ FQ- Cleanout between building and tank? - - -RFC /L - ❑ I ❑ U Tank baffles present? - ❑ a24" access risers over each compartment? ❑ ❑ W Effluent filter installed?- N K ,�e1 0 ❑ cn Sound Placement Septic tank capacity (working) BNR-500 gal Manufacturer 0 D-box water level and speed levelers used? - - 0 NIA ❑ YES 0 NO �0 Manifold/D-box accessible from surface? - ❑ 0 ❑co, Z Check valves installed? - °- cp, ,k::. '>t<Ah ❑^ ❑ I ❑ 0Q E Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial;Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- 0 ❑ ❑ W >100 ft. from surface water? - S1e�� - El ❑ Li >10 ft. from potable water lines?- - ❑ ❑ 0 > 5 ft. from property lines and easements? - CI © ❑ cc > 30 ft. from downgradient curtain/foundation drains?- - ® ❑ ❑ 0 MI ❑ Drainfield level and observation ports present ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfleld?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES NO Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement Z ❑ < 24' access riser(s) and accessible from surface?- - - ❑ © ❑ f- Alarm or Control Panel Installed? - - ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ It ❑ o a- Pump installed in ❑ Bucket or 0 On Block or ❑ Other d Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer fa. 45 Tank draw down 2 in/min Pump capacity gpm Squirt Height 6 ft Pump on time 2 min Pump off time 6 hours Daily flow set at 360 gpd updated an1120+8 iiimimom Mason County OSS installation Report pg. 2 Parce# 32D 21-53^o4 O4 ABANDONMENT RECORD Were existing septic components abandoned as part of this protect? -• -- -- _^ " " . ❑ YES NO It yes,please describe. --- — - NO Were ail components pumped out and properly abandoned per WAC246-272A-0300'r - - - -- - - - 0 YES 0 RECORD DRAWING - --.1 -at Rowed This ys a pommy*Vetoed and must be eccurete and desertplke enough 10 re•locats In the need W maintenance aot miles and b future development.t!oo of� rfEas Omni:tot COntl in:°ratnhek I menirdd t)tentation S teyouL Sop pump twnM location,North nnow,rueenn drMNmtd,°uistrng and props r l and rk.v on"3. welt.obeervai1on ports,c eanoom.end ns+er maintenance access points. Inconteieta Record Drawings nu y eu,nle oddittcrw!detnye.in find ingtsllition appr 512Q— Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system this 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 cioared/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 f4A eson County Codes- State and Mason County Codes /further certify the!all information contained on this I further certify that all information contained on this form ttached Record Drawing is accurate form and attached Record Drawing is accurate. ( tir_1 of/oz/2z 4 Signature of instarler-- Mite jv',Arl C I I i Printed Name of S A44% ,),...,07k. 7!F � is ` MASON COUNTY PUBLIC HEALTH G;a The undersigned approves this installation Report and at, .' -,s't I. Record Drawing on behalf of Mason County Public 'r'j' 51)"`3 `� ''' PAUI.A JOY JOHNSON y Health: �'1'ic;a'VS.ta, affa0gA Civ/A ` kV/ fZ5 - ^ N. EXPIRES ,N_1 ►'f — Signature of t nlltr enta!Health Specialist Date (stamp, signature and date) THIS.FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEA S1TE tiol1`1i0 t11F :5 e E S\.A.,:we c.re s r r --- _ � � --rD Sole . 1 ' 2.0 1 S, G% Slope b iCo Zo 30 40 f5 f �,Sbu 'sl'... 1 /A A 1A-/ -°' ,� f —i ;-O g v'1 alc3ev L Nejssr 1 ii 1-- ___—__ 5 '1,e,40,-.t WA- cf 658'1 5\121 I © (4) 3 x s.p p `' ° ►"'`o..''.t D. 8� LP -{� Y e 5€✓ e •t y\ I p -}-vJ e 2h b e- I m ® © gm N � 0 3 Z'k 0Audio-Visual Alarm \\ /11 2 Cleanout Mama-�cCkuc.veoF 0 w\e_ 0 500 Gallon Pre-Trash tank SZ O NuWater BNR-500 ATU Tank 1 O 1,2.50 Gallon Pump Chamber dv ; .)e_u....)ay /fax"(4 1.-,] G Valve Control Box 414 -....4$ '1/4—F.----ie _ �i^. S106349 - 4 b PAULA JOY JOHNSON .?_