HomeMy WebLinkAboutSWG2024-00296 - SWG As-Built - 8/25/2025moommummisomme
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2024-00296 Parcel # 22210-12-00071
Applicant Name Karen Green Subdivision (Name/Div/Block/Lot)
Applicant Address 5471 NE North Shore Rd.
City, State, Zip Belfair,Wa 98528 Installer Name Bamford Septic
Site Address Same Designer Name Bob Paysse
INSTALLATION CHECKLIST
UI Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type ATU-pressure Pretreatment Type NuWater BNR 750
>5 ft.from foundation? - -- -•- El N/A •YES ❑ NO
>50 ft.from wells? - n---iIce, - - ❑ ® ❑
Z >50 ft.from surface water? - - - - id 4�.2 ---- - -- 0 ® ID
• Cleanout between building and tan � --A�G�-��� -- - - ❑ ® ❑
U Tank baffles present? - '�, - ❑ ® ❑
a24"access risers over each compartment?---- - --- -- ❑ IN ❑
`W Effluent filter installed?- _._,..--- - - ® Cl Cl
Septic tank capacity(working) 1000 gal Manufacturer Sound Placement
El D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO
ow
O Manifold/D-box accessible from surface?- - II CI
QQ Check valves installed? - - ❑ ® ❑
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ® 2 ❑3 0 4 ❑ 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- ':* _ -•- ❑ N/A ® YES ❑ NO
�.
O >100 ft.from wells?- ,;,:, - ," a'j ❑ ® ❑
J >100 ft.from surface water? - - - -lilac«' '4 6- • ❑ ❑ II
LL >10 ft.from potable water lines j -
. -- �r El ® ❑
>5 ft.from property lines and e- + ants?08�--NM nt v1"— _ ❑ ® ❑
>30 ft.from downgradient curtai ' dation'�G q ❑ ❑ ❑
im
Drainfield level and observation .. �t', - 3 I$ - ❑ I ❑
0 Graveless chambers or ® `Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A a YES ❑ NO
• Pump tank capacity(flood) 1500 gal Manufacturer Sound Placement
< 24"access riser(s)and accessible from surface?- - El UI ❑
H Alarm or Control Panel Installed? ❑ II ❑
a -
• Control Panel equipped with Timer/ETM/Counter- - 0 0 ❑
fl- Pump installed in ❑ Bucket or ® On Block or 0 Other
a. Pump Make/Model ZP ell Lc" — !�i I! Floats or 0 Transducer
d Tank draw down 2.S in/min Pump capacity ?17 gpm Squirt Height 4 ft
Pump on time -9 ....... r-- Pump off time tp 1 c`S Daily flow set at lily gpd
Updated 8/2V2018
Mason County OSS Installation Report pg. 2 Parcel 22Z1.2" 12 - arpo'7/
ABANDONMENT RECORD _
Were existing septic compor,sns ab.ariioned iia part of lnia project? . - - -.- - - YES 0 NO
If yes, please desctibe: " ' '
Were all components pumped out and properly abandoned per VrAC246-272A•0300? - V S 10 NO
RECORD DRAWING
This is a permanent record and mu+t be accurate end ceetr;pdve enough to te-!o rate In the need of main•,Wane.ctivIues and future development. Typical Record
Draw,nos content Dra s.4ek&ma•rit,. ;,rien;a;:on&..yua eeaepump tank Iocato..,NJttn a.. w,a eserve da.n^%:."..e...i.ic0 And proposed b,.i:dings.Iocat cn of wells water,nes,
woisi.caservatcn pans,oled'hc,,:s arc 3.7 n•71,1tc^^a29 accost,^o.r.:;. tccc,,,pic:a Recori L'2A.iags nu.;mat:a ie tbsa:celsre in fins;rot:&iaaon s:pp'oi,il .,,d reieted perms.
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. 1414!:ii
t
1 0:1:c \ s; . .
. _ .... (Record Drawing Attached
CERTIFICATION OF INSTALLATION --
R INSTALLER
s DESIGNER/ENCitsiEER
I certify that I,nstalied the cyst-inn in aocorosnce wilt, { I certuy'that t„z system has been installed in accor-
the septic design stamped"APPROVED"by Mason: k dance with the sep!ic resign stamped'APPROVED"by
County Public Health and that any deviations shown i Mason County lsubiic Health and That any deviations
t here have been clearear'aporovac by oath the designer 1 shown her€ have been cleared/approved by both_...
and Mason County Public Heu!tn and i meet all State i myself and Mason County Public Health and meet all
3 and Mason County Cade:. :', State and Mason County Codes
1 1 further certify that ell inrcrrnsti:r,:on.'aT ed on a:'._: !further certify that at'information contained on this
form and attached Record Drawing is accureie. $ form ardatrechea Record Drawing is accurate.
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Signature of Installer D to `4$
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tit c,
S Printed idame of Signee
MASON COUNTY PUi3Lt: H EALT!' i �1 , ` 1'' '
t ►:'
The undersigned approves '- , + ;+ ►. s
d s this Ms,a►ation rte pr. . ., .6 pl✓ 7 I '�
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Record Drawing on b2.ra�r".�. Mason County
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EXPIRES
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Si ;9 ntaronmentai liei.:.r :,c%a: : . (sr.lmp, signature and date)
THIS FORM Mn."SE SCANNED A\D:V At_ASL==CR r=:.BLl;V;Ew ON THE MASON COUNT?WEB SITE Updated8/211018
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�� PROPOSED 2-BED
/' / • EXISTING '� 1 TABLE-9 REPAIR.
// j HOME _ 10'X 50' BED SYS.
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PUM P OUT& 'I ��
ABANDON EXIST. - ,�' ,.
TAN K(S), INSTALL I �\�r/" \ I APPROXIMATE
TRASH, NUWATER 1 \\ I BULKHEAD
& PUMP TANK I
I /^\ HOOD
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300 SOFT \ -vA I
TABLE- IN 9
RESERVE AREA 0$1%,
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,� M1G 25 2025
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MASON COUNTY�NVIRONMENTA HEAT// ti
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EXF L5
AN ASBUILT/INSTALL SIGNOFF FEE WILL/
BE CHARGED AT TIME OF INSTALLATION
I
CUSTOMER IUREN GREEN TEST HOLE I: TEST HOLE 2
PIONEER DIGGING, INC. PARCEL Zz2,o-,2-000„ 0-5I GMS
51+NO RES 38 38+SIGNIGN
SOF
SEPTIC DESIGNS ADDRESS: 5471 NORTH SI TORE RD LAYER TIDEWATERS
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT I L PAYSSE °ag'RT TM"MrarAwmr.nvam¢mskuixwrawmoa�+nne192
PunoatuPURPOSES O&Y.rdn a'OSW NnuoE VGI6 oEx++wreom O OTi lC
OFFICE 360 4261803 FAX 360 427 2353REVIEW DEVELOPMENT rar nesvn�E FOR w MAY BE Aw uimw�TO
SHEET: SITE PLAN SCALD I"=30' «WO•NO Ta
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600-GALBNR500 TRASH
NUWATER - , _ - ,\� �Q OB PORT
—
1500 PUMP TANK \ & C/O (X4)
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...�- ' s ,�.' BULKHEAD ---\ I
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BA-tL ',, — HOOD
�-r/ALVE \ CANAL
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`;�� —'-.' OB PORT
ORIGINAL FINISHED GRADE & C/O
GRADE (b"+ COVER MATERIAL)
_ = _____ T
:4, sa . fit
_ , .',� - .f 7 r .•1- - _1___;
15 - 30" — 12" C-33 SAND ri
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THREADED RESTRICTIVE
CAP LAYER `• .
I It"ORIFICES @ 12:00 ` � ^ pKdg•.,,,.1
W/ SHIELDS �. h'��`
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SWEEP •EE. " '� E \I\ F ai_s
�'�" CO\ W 1BUILT1 INSTALL SIGNOFF FEE WILL
�— GLUED TEE w,aS� �� ..__..ARGED AT TIME OF INSTALLATION
CUSTOMER: 1CARFN GREEN �ESI H` I: TEST HOAt; 2
PIONEER DIGGING, INC. 15'``�" `8+ ``;NI PARCEL# 2: KAR-00071 51+N MS. 38+�IC:IaS OF
SEPTIC DESIGNS ADDRESS 5471 NORTH SHORE RD I.\,I.It. ,1)1.\V'.\HR; ,
...CLAIMER:Tat M NOT A SURVEY.REFERENCES COUNTY CUS APPLICANT/COUNTY Y PROVIDED
3083 E.MASON BE SON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PRIME ONLY NOPROPOSED
A Po D DEVELOPMENTFiNLU S PLICA T/TIEE Dro SEPTIC
OFFICE 36l}4261803 FAX•360 427 2353 SHEET: DF DETAIL SCALE I"=IO' DEPRRTMENTIA3ENDY REVIEW DESIGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COMPONENTS.