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Home My WebLink AboutSWG2022-00257 - SWG As-Built - 2/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00257 Parcel # 12232-10-02071 Applicant Name Gregory & Sally Weber Subdivision (Name/Div/Block/Lot) Applicant Address 1673 South Market Blvd #10057 City, State, Zip Chehalis, WA 98532 Installer Name Mason County Excavating Site Address 521 E Cronquist Rd, Allyn Designer Name Arrow Septic Designs INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - !�D YcDvS� -{� - Q N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ ❑� ❑ Z >50 ft. from surface water? - Q�; - ❑ El ❑ HCleanout between building and tank? - J,am'1° e" l� - 0 ❑ ❑ U Tank baffles present? - - ❑ 0 ❑ ~ 24" access risers over each compartment?- - ❑ 0 ❑ CI_ W Effluent filter installed?- �� - 0 ❑ ❑ co Septic tank capacity (working) NBNR-500 gal Manufacturer Hagerman D-box water level and speed levelers used? - - 0 N/A El YES ❑ NO XO Manifold/D-box accessible from surface?- - ❑ IN mZ Check valves installed? - t".,,A4.f> - ❑ ❑■ ❑ D.:( 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 LI Commercial/Other >10 ft. from foundation?- - ® N/A ❑ YES ❑ NO O >100 ft. from wells?- 3�i n ❑ Lt.! >100 ft. from surface water? - 11-�- El ti >10 ft. from potable water lines?- - ■❑ ❑ z > 5 ft. from property lines and easements?- - JAN 31 2023- ! 0 ❑ Q IX > 30 ft. from downgradient curtain/foundation rains? - - ❑ ❑ Drainfield level and observation ports present B-Y--- _ II ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A l0 YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ El H a Alarm or Control Panel Installed? - k''� . \-\"D` e - ❑ ❑ El2 Control Panel equipped with Timer/ETM /Counter- - ❑ 0 ❑ n- Pump installed in ❑ Bucket or ■❑ On Block or ❑ Other a.• Pump Make/Model Zoeller N152 ❑■ Floats or ❑ Transducer a. a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 10 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 228 gpd 'Janie::8t212018 3 i ,T ,i Parcel# I2Z3Z— tO_d2d71 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 14 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. Drainrteld&manifold orientation&layout.Septic./pump tank location.North arrow.reserve drainfield,existing 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. St9'''' k.,,d Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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 form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. , 0 7 I 0 /7..5 Signet of Installer Date 14 9 ' Printed Name of Signee °i ~ \ - MASON COUNTY PUBLIC HEALTH .i. : ♦ . l The undersigned approves this installation Report and .L' 5100349 Y�- PAULA JOY JOHN SON Record Drawing on behalf of Mason County Public 6. .. ti _ rich � a.. Health � �ExP+REs7 � i!)---- / _ 9 FCb?uj1 1- 3o-2,3 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY'NEB SITE Updated 821/2018 . , . ..,....„4... ,2: ,... „., • P 14 ----t� 70 .zo ,.• 0 FEB 0 q 2023 • _L�1- — MASON COUNTY ENVIRONMENTAL HEAL t r „„ ,t5 ctAit, '\:.. e-\3,E3r ODO ,I) ---- ? • `;ZZS - tom - o2"°I CaS ' j�� 1 'IL-------- -'E ~ i h t . J A \ \/\./ N s \`f.s• } C- i N AA.4)) . .•01 . •tor� i e`) OT sly e e Xz 111g 4c% I ' 0- .PAULA JOY JOHNSON �jek� cs4"GV-- C 3% I taikitElj-dl_ I01•ift s EXPIRES /15 `� >s\ )o-2 3 i , �s`-.. \ N\ / LOU.W.f Ober" 1'• •se.4 � 0,_5.e.,,k .A.X- q--\) S`-.3`t- '''*-\--IL---\).--i‘i-rt-.1 7 1 V Vv`A vas I 115 w fe QJ� .4__�c- � a0' X ..414 D ea-v-tip-- beA O�-C., k ST f 1 i <0" "325;'4-177.1. . Ky,• i p / , 9- Ol Audio Visual Alarm _ �' Y-��/ P k� ' 2 Cleanout . O i • �� 5 i�.o • 1 } 4 VoiX;O, ,•0 O3 NuWater BNR-500 ATU Tank _ } w; t �Y Q 01,000 Gallon Pump Chamber 1 I - ° _`Q K; ;- - a....Ac- S�Q�� sIL - . OValve Control Box s' % `ls.`p I sl71. 8 P _ i 1 a I rG S ale.