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HomeMy WebLinkAboutSWG2024-00395 - SWG As-Built - 10/30/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2024-00395 Parcel# 122063490034 Applicant Name CCM Financial, Inc Subdivision (Name/Div/Block/Lot) Applicant Address 804 SW 148th Street City, State, Zip Seattle, WA 98166-1861 Installer Name BCS Construction - B.Bumbolough Site Address 151 E Hemingway Designer Name Caliber Design - R.Bazzell INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type Alternative- Pressure (ATU) Pr reatment Type NuWater BNR500 .• --t >5 ft. from foundation? - ❑ N/A 0 YES ❑ NO >50 ft. from wells'? - { irG rt--- - ❑ • ❑ • >50ft. from surface water? - - - - � �7 __t - ❑ 00 Q Cleanout between building and tank? - 1 -aC - ❑ ® ❑ H 0 Tank baffles present? - - - - - ❑ LI ❑ a24"access risers over each compartme 1t y--- ---- - ❑ 0 ❑ W Effluent filter installed?- - ❑ X ❑ Cl) Septic tank capacity (working) 1250 gal Manufacturer Infiltrator IM1250 9 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ N ❑ mz Check valves installed? - - ❑ 0 ❑ OQ E Transport Line Size 2" Schedule/Class SCH40/3034 Bedrooms installed (check one) ❑ 2 1113 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO o >100 ft. from wells?- ❑ 0 ❑ J >100 ft. from surface water? - - ❑ It ❑ tit u. >10 ft. from potable water lines?- - ❑ ® ❑ QQz > 5 ft. from property lines and easements?- - ❑ • ❑ d > 30 ft. from downgradient curtain/foundation drains? - - ❑ © ❑ Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ii YES ❑ NO • Pump tank capacity (flood) 1250 gal Manufacturer Infiltrator IM1250 Q • 24" access riser(s)and accessible from surface?- - ❑ I ❑ a `. Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ m a`:• Pump installed in ® Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model Liberty 280 II Floats or ❑ Transducer a Tank draw down 1.375 in/min Pump capacity 30 gpm Squirt Height 5 ft Pump on time 1 minute Pump off time 2 hours Daily flow set at 360 gpd Updated 6/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 122063490034 ABANDONMENT RECORD Were existing septic components abandoned as pars of this project? - - 0 YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES NO RECORD DRAWING This Is a permanent record and must bo accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&maniloid orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER] ENGINEER I certify that 1 installed the system in accordance with 1 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 form and attached Record Drawin is accurate. form and attached Record Drawing is accurate. ,5LIeSignature ofinstaller g;1( ��,b��U�L Printed Name of Signee MASON COUNTY PUBLIC HEALTH 4:`4 .4 i�3 The undersigned approves this Installation Report and 037126 Record Drawingon behalf of Mason CountyPublic 21 D SA RICHARD l BAzzEt Health: LICENSED i)FSIGNER `0(5o( 10/23/2025 Signature of Environme al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated8f2t/20t8 0 c::::?'"-ki-..4 i‘ m Q - - - - - - -- 131.00' -- -- -- -- - � �'. � A z IIv I y \ r-7 10A X• s' T \ y�MM41t iv 44),.4.44. (q I I I Iv n I I Z I H T V0 Z © V n m I z w 73 O 1V Z co N 1 0- tJ1 1 "I )y_... 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