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HomeMy WebLinkAboutSWG2023-00346 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00346 Parcel # 32021-56-03015 Applicant Name Henley WA 16 LLC Subdivision (Name/Div/Block/Lot) Applicant Address 1537 NW Woodbine Way SHORECREST TERRACE 3RD ADD BLK: 3 LOT: 15 City; State. Zip Seattle, WA 98177 Installer Name South Shore Construction • Site Address 470 E Wood Ln Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only E Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - 27,4CM--7-- - ❑ N/A U] YES ❑ NO >50 ft. from wells? - ❑ U ❑ z >50 ft. from surface water? - -Al 9_4i-2025- - - ❑ 'U] ❑ Cleanout between building and tank? - A ❑ ■ ❑ o Tank baffles present? - -BY;...................... ❑ El ❑ 17- 24" access risers over each compartment?- - ❑ El ❑ a W Effluent filter installed?- - ❑ I ❑ cn 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?- - ❑ U ❑ OOz Check valves installed? - - ❑ ❑■ ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A U] YES ❑ NO o >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ D ❑ it >10 ft. from potable water lines?- - ❑ C ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ a cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ [U El ro Drainfield level and observation ports present - - ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A © YES ❑ NO Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator Q24" access riser(s) and accessible from surface?- - ❑ ® ❑ H a Alarm or Control Panel Installed? - - ❑ U] ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ • ❑ D - Pump installed in ❑ Bucket or ® On Block or ❑ Other 4. Pump Make/Model Liberty 280 ❑ Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 62 gpm Squirt Height 7 ft Pump on time 1.4 min Pump off time 6hr Daily flow set at 360 gpd , ..�tla!?d E:2--?G73 1 Mason County OSS Installation Report pg. 2 Parcel# 3 2- 2\ - - 030\-J . , ABANDONMENT RECORD Were existing septic components,abandoned as part of this protect? - YES II NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES 0 NO RECORD DRAWING - • d.Is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Triad Record Drawings write n: Dr e d&manifold orfentaaon&layout.Septic/pump tank location.Now arrow,reserve drsnfield.existing end proposed D:u:wings.location of weds,waterfnes. rails.obsefvabOn 9OrtS,deenou s,aid otter maintenance aoaess points. Incomplete Record Drawings may create additional delays in final instadation approval and related Demos• • Record Drawing Attached •.. CERTIFICATION OF INSTALLATION . x.. •..- INSTALLER DESIGNER/ENGINEER /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 information contained on this I further certify that all information contained on this f n atta ed R rawing is a rate. form and attached Record Drawing is accurate. 5-lS-ZS Signature of Installer Date Z��-._ f ...4», Printed Name of Signee MASON COUNTY PUBLIC HEALTH ; The undersigned approves this Installation Report and r, .,;g • : Record Drawing on behalf of Mason County Public � PAUL.A JOY JOHNSON '•. Health: lac;_ SE Yi�� Expires 'SiGNt:tf' r , c ‘IU `�' Signature of Environmental Health Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE Updated Br214018 1 SS ( . -s z j — r cs-> i '] 1 _ ate ' 2 ,Slope A -\--cs - - \ er) ;.-',\ _ GI El' -.4 _ c_ - t.(,)-A-c,-c-- 7 _\ ,.. O ._L `i G-L--sLi. f (z-t-c 33R 4.„, Core,-fes-r_,4c-7 . xev: 2 i` X' Ua I 0 Audio-Visual Alarm h 0 Cleanout 1 / O3 1200 Gallon Septic Tank 2-Compa=t eSnet with / / 15` Effluent Filter / • C` U' O 1000 Gallon Pump Chamber \ 7 .(\--\Te--‘'D°`"Z 5^ Valve Control Box Cog, r- c s-0\\ d .%y 5c e. : (L' = 20` PROVED 1 D 'o I a zo 3a i+a SEP 12 2025 � ,`s�.7 .',�ti A:.\•.,':A,tii S - ENVIRONMENZ . - � '' &i s� 1MASON COON _ ) , `;;r\--ScPyL`�. t. `P , iLC ooana�`JJ �� PAULA JOY JCHNSnN �Jl+C�fS��ib�SiGN�a. .i). Pci,-c2.5, 3 2oz-k—S(0- 03 0 I E mow, .8 1 s_s-: b Q