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HomeMy WebLinkAboutSWG2025-00322 - SWG As-Built - 10/1/2025 Mason County OSS Inst allation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SNG 2025-00322 Parcel # 22017-50-00012 Applicant Name Brian & Dian Subdivision (Name/Div/Block/Lot) ne Clark TIMBERLAKE#2 LOT: 12 Applicant Address PO Box 683 City, State, Zip Installer Name Bamford Septic Repair Shelton,WA, 98584 pesi ner Name Arrow Septic Designs, Inc. Site Address 321 E Lakeshore Dr E, Shelton 9 INSTALLATION CHECKLIST Repair ❑Other 0 Tank(s)Only ❑ Drainfield 0, NuWater BNR- 00 ❑ Full System Installation Pretreatment Type System Type Shallow Pressure-= rn� NO „ t% ` 1_- -\ _- El NIA L YES ❑ >5 ft. from foundation? ❑ ❑ - -n-0�5- - - ❑ o ❑ >50 ft. from wells? a - - -� >50 ft.from surface water? - - - - - _gyp ❑ ❑ z ❑ Cleanout between building and tan • - ❑ 0 U Tank baffles present? - \ - - El P 24" access risers over each compartm nt?`!-� El W Effluent filter installed? -4j,_ � Infiltrator Septic tank capacity (working) NuWater 500 gal Manufacturer - CI NIA El YES 0 NO L1 D-box water level and speed levelers used? - �CZS+ � ❑ Cl 0 J XO Manifold/D-box accessible from surface. - El o02 Check valves installed? - 40 pQ 2, Schedule/Class 2 Transport Line Size 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other Bedrooms installed (check one) El NIA II YES ❑ Ne >10 ft. from foundation?- El El El >100 ft. from wells?- ❑ 0 ❑ >100 ft. from surface water? - ❑ u. >10 ft. from potable water lines?- - - - a ❑ z > 5 ft. from property lines and easements?- ❑ El Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ El !Y vim- ❑ NE �] Drainfield level and observation ports present - �� El Graveless chambers or pi Clean gravel used? (check one) El ❑ El cover installed over drainfield? NIA � YES CI NO Pump tank setbacks consistent with septic tank? ❑Pump tank capacity (flood) Infiltrator 1 060_gal Manufacturer � 24" access riser(s) and accessible from surface?- ❑ < - El El a. Alarm or Control Panel Installed? ❑ © ❑ Control Panel equipped with Timer/ ETM /Counter- Pump installed in El Bucket or El On Block or El Other Transducer Zoeller N152 0 Floats or ❑ n- Pump Make/Model a Tank draw down 1.5 in/min Pump capacity 38_ gpm Squirt Height 10 + ft 1.5 min Pump off time 6 hr. Daily flow set at 240 gpd Pump on time Updated 8/21/2018 2.201"t- 50- CI"DO Mason County OSS Installation Report pg. 2 Parcel#ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - - - - - - - - - ® YES ❑ NO _ _ ® YES NO If yes; please describe: Were all components pumped out and properly abandoned per WAC24E-27 A-0300? - - - - - RECORD DRAWING WI Record in final installation approval and wells, wd eeines. Dra e tiG ump tank location,North arrow.reserve dra;nfielC,existing and proposed buildings,Iccatior.of wells,waterlines, This is a permanent record and must be accurate and descriptiveenough to relocate in the need of maintenance activities and future development well .o s observation Drainfield e 8 manifold orientation 8 layout. D wells.observation ports.deanouts,and other maintenance access points. Incomplete Record Drawings may ceate additionaldelays Ill Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ ENGINEER INSTALLER i certify that the system has been installed in accor- 1 certify that 1 installed the system in accordance with dance with the septic design stamped"APPROVED"by the septic design stamped"APPROVED"by Mason County Public Health and that any deviations shown Mason County Public Health and that any deviations both the designer shown here have been cleared/approved by both here have been cleared/approved by myself and Mason County Public Health and meet all and Mason County Public Health and meet all State State and Mason County Codes and Mason County Codes. I further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. -, Jafe Signature of lnstalle � �' )�• �\ &w van Noy w "r s Printed Name of Signee •i� MASON COUNTY PUBLIC HEALTH • J�U a� approves this Installation Report.and. pAULA JOY JOHNSOP4 The undersigned011 ; �S;NS Record Drawing on behalf of Mason.County Public f��a __ r1 Health: l o t. '._ l I ?OZ: y / l — 23—ZS signature Signature o Environmental Health Specialist Ds 00 ,_ and date) Updated 82t20'8 THIS FORM MAY BE SCANNED AND AVAILABLE FSm�,PUBLIC VIEW ON THE MASON COUNTY WEB SITE .�, '<Ij, �,L Tr-LE - f N c..A.K E ............:2\...3:=2.- BuL.<< D I n � ' . ee.e,Vit ? 5ALE � = 2 '1't ri io Z 40 I 1 53`(5°T ! INA,-,,A) 'b AA i 1 A-(ZC_c_c_# 22,D11 - c0 - C'OcEZ 4,LtPe s2; E L1LE5 �� DR E © - ® LT° v qS S8 4 �.; oco o � , �. eQ9.�. Cou&QEO l'a ec+t 6` Key: OAudio-Visual Alarm O Cleanout E -'Sr,Nv 2 Q K. O NuWater BNR-500 ATU Tank 4 1,000 Gallon Pump Chamber ....... / L,..7..-k) 0.-......-A-c- s r.,ek O Valve Cor_trol Box I:). \ I - .9 E - -1ZA-Kec.\--r- 4.+ -feo ''. (vAt..L.a rt Q0 µ� -rR -. Vave- oP� 11- j — b eel" P.9_,c,e sv —_ nil 1 N‘IL W ,� hoc — __. 1"1111 1 ozs-u, 1 , ,444+,,ii 444bq' :45).1 S . . 007 z 6 coUNry /gyp a `,• �rojor4 .t �k���' Q��O4:ke ' 2 PAULA JOY 3JOHNSON 61 -2 3-2S-