HomeMy WebLinkAboutSWG2023-00250 - SWG As-Built - 4/22/2026 r �
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2023-00250 Parcel# 32122-50-00453
Applicant Name David&Angel Sullivan Subdivision (Name/Div/Block/Lot)
Applicant Address 410 Capitol Way N,Apt 211 LAKE LIMERICK 3 LOT:453 S 53/54
City, State, Zip Olympia,WA 98501 Installer Name Mason County Ecavating
Site Address 1561 E St Andrew Dr N, Shelton Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure Bed Pretreatment Type NuWater BNR-500
>5ft. from foundation? ------ --- -- - ( ❑ N/A KYES NO
>50ft. fromwells? - - - - - - - - - - j} � ❑ 0 ❑
>50ft. fromsurfacewater? - - - - - - - 1-9 - - - - ��� - ,� ❑ EMI ❑
Cleanout between building and tank? - -\- \ - -A�� 6--- - - --� ❑ M ❑
Tank baffles present? - - --- - - -- - -I- -- -- - - --- ❑ ❑■ ❑
24"access risers over each compartment -- - r� ❑ I ❑
tL
W Effluent filter installed?- -- -- --- ---�—_-- - - - -- - - ❑ ❑ IN
Septic tank capacity(working) NuWater 500 gal Manufacturer Hagerman
t1 D-box water level and speed levelers used? ------ -- - - - ---- ❑ N/A ❑YES Q NO
` Manifold/D-box accessible from surface? -- - - - -- - -- -- - - -- O ® ❑
��H Check valves installed? - - - -- - - --- - - ❑ 0 ❑
• Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) 0 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?-- -- - - - - -- - - - - - - - -- - ----- - N/A IYEs NO
>100ft. fromwells?-- ---- -- - ------- - - -- -------- - ❑ P1 ❑
>100ft.fromsurfacewater?- - - - - - -- ---- - -- - ------ - - ❑ R ❑
ILI_ >10ft.frompotablewaterlines?- - - - ---- - - - -- - - - - - -- -- ❑ P1 ❑
> 5ft.frompropertylinesandeasements?- -- - - - - - - --- - - - - ❑ II D
> 30 ft.from downgradient curtain/foundation drains?- -- - - - - - - - ❑ 0 ❑
Drainfield level and observation ports present - -- - - - - - - ---- - ❑ ® ❑
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- -- - - -- ---- - -- --- - - ❑ ■❑ ❑
Pump tank setbacks consistent with septic₹ank?-- -- -- - -- -- -- ❑ N/A ❑Q YES ❑ NO
Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
°y q 24"access riser(s) and accessible from surface?-- --- -- - - ---- ❑ ® ❑
sa
Alarm or Control Panel Installed? -- -- - - - - - - - - - - - - - - - -- ❑ ® ❑
Control Panel equipped with Timer/ETM/Counter- - - - - - -- - -- ❑ ❑
Pump installed in ❑ Bucket or On Block or ❑ Other
Pump Make/Model Zoeller N152 M Floats or ❑ Transducer
Tank draw down 2.25 in/min Pump capacity 56 gpm Squirt Height 11 ft
Pump on time 1 min Pump off time 6 hours Daily flow set at 240 gpd
Updated 8/21/2018
Mason County 0SS Installation Report pg. 2 Parcel# 3Zl -SC- cDO 1E3 RECORD
Were existing septic components abandoned as part of this project? --------------- ❑ YES NO
if yes, please describe:
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,eadsting and proposed buildings,location of wells,waterlines,
wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.•NtRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
/certify that i installed the system in accordance with /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 /further certify that all information contained on this
form and atta fled Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of Installer • Date
Printed Name of Signee x'09 •
MASON COUNTY PUBLIC HEALTH
The undersigned approves this installation Report an
ooaas Sri
Record Dra ing on behalf of Mason C r O snty Public G�• PAULA JOY JOHNSON
Health: � IL•�iJStj9i�;titiiR
Y ZZ Z
Signaf a of Environmental Health Specialist Date O ry
✓ �.$j (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR jC VIEW ON THE MASON COUNTY WEB SITE Updated e,t2oia
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Audio-visual Alarm
`c 20 14 0 • Cleanout
• NuWater BNR-500 ATU Tank
1,000 Gallon Pump Chamber cT)T• I
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PAULA JOY JOHNSON ' ' O
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