HomeMy WebLinkAboutSWG2023-00100 - SWG As-Built - 2/2/2026 r I
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2023-00100 Parcel# 22017-50-00008
Applicant Name Jack&Carol Kuusisto Subdivision (Name/Div/Block/Lot)
Applicant Address 832 21st Street SE TIMBERLAKE#2 LOT: 8
City, State, Zip Auburn, WA 98002 Installer Name Mason County Excavating
Site Address 271 E Lakeshore Dr. E, Shelton Designer Name Arrow Septic Designs Inc.
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ...,❑ Repair IT Other Old Tank for Pre-Trash
System Type Shallow Pressure /P. etreatment Type NuWater BNR-500
./p, .y
>5 ft. from foundation? - /T"`--,'- - 0 N/A 0 YES O NO
>50 ft.from wells? - /- "'- 0 O
~~w
>50 ft.from surface water? - ' "`r O i 0 ❑
H2,>_:1 between building and tank? - - - U '- /2,>_:� �`,- - 0 ❑
U Tank baffles present? - - - 0 ❑
H 24" access risers over each compartment?- - - - - - - - - 0 ❑
W Effluent filter installed?- iwa- - -- . - - - ❑ 0
co
Septic tank capacity (working) NuWater 500 gal Manu rQp Hagerman
0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO
oO Manifold/D-box accessible from surface?- 1 - ❑ 0 ❑
c9-±- Check valves installed? - - - _a. -v�` -L-44.A.1/4' - ❑ 0 ❑
aQ 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) 02 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
>100 ft. from wells?- - ❑ 0 ❑
0 >100 ft. from surface water?- 1O'4' ( ii'r, ) - ❑ ❑ 0
W
u. >10 ft.from potable water lines?- - ❑ 0 ❑
Z > 5 ft. from property lines and easements?- - ❑ 0 O
Q ❑ It ❑
a > 30 ft. from downgradient curtain/foundation drains? - -
Drainfield level and observation ports present. ❑ 0 O
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ■❑ ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
< 24"access riser(s)and accessible from surface?- - ❑ 0 ❑
H
a Alarm or Control Panel Installed? - - ❑ ® ❑
• Control Panel equipped with Timer/ETM/Counter- - O 0 O
a Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other
a• Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer
a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 8 ft
Pump on time 1.5 min. Pump off time 6 hr. Daily flow set at 240 gpd
Updated 8/21/2018
22.8 (1-St- OOOOB
Mason County OSS Installation Report pg. 2
Parcel#
ABANDONMENT RECORD
NO
Were e existing septic components abandoned 4�of�this project?,t (0Y1
"1)If yes, please describe: Q 8 •' �u.►i��+ , ❑
Were all components pumped out and properly abandoned per WAC246-272A-0300? - YES
NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record
Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wets,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
,S-SL >4144 C -I yam,
■ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that l 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
form and atta hed Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer Date ,� t
F'c' ax\ V \ % .
Printed Name of Signee sZt
1 ars• `t
,.
MASON COUNTY PUBLIC HEALTH . . y_.
The undersigned approves this Installation Report and • `'. ' \i',
Record
.4,;:p.• 5100349 •` �
Record Drawing on behalf of Mason County Public 't: PAULA JOY J0HNS0N..1
Health: fr/i//k,
•L'iC�SI f0N��t•
- 1-2'L (o
Signaturi fnv mental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/21/2018
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ONuWater BNR-500 ATU Tank _
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• APPROVED
-FEB 0 2 2026
MASON COUNTY ENVIRONMENTAL HEALTH
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