HomeMy WebLinkAboutSWG2020-00542 - SWG As-Built - 2/9/2023 i
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00542 Parcel # 32104-58-00049
Applicant Name Nick Bulubenchi Subdivision (Name/Div/Block/Lot)
Applicant Address 1431 El Mirador Drive Alderbrook G&Y Division 9 Lot 40
City, State, Zip Fullerton, CA 92835 Installer Name Mason County Excavating
Site Address 201 E Susan Ln, Union Designer Name Arrow Setpic Designs, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only Li Repair ®Other 500 pre-trash tank
System Type Subsurface Drip Pretreatment Type NuWater BNR-500
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - - 0 ❑ ❑
Z >50 ft. from surface water? - - 0 ❑
Q Cleanout between building and tank? - - ❑ 0 ❑
1-- - ❑ 0 ❑
U Tank baffles present?
P 24" access risers over each compartment?- - ❑ 0 ❑
a
fW Effluent filter installed?- N.�.�a'�� - ❑■ ❑
Septic tank capacity (working) BNR-500 gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO
O 4eabL
O Manifold/D-box accessible from surface? - v�orks
❑ II ❑
m Z Check valves installed? - - ❑ UI ❑
0Q 1" Schedule/Class 40
E Transport Line Size
Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A n YES ❑ NO
0 >100 ft. from wells?- - 0 ❑ ❑
-I >100 Q ft. from surface water? - - 0 ❑ ❑
IIIu., >10 ft. from potable water lines?- - - ❑ ❑
Q > 5 ft. from property lines and easen,e{it ?- - �, - - _ - ❑ I CI
f > 30 ft. from downgradient curtain/f I-y � ns? [U ❑ ❑
CI
Drainfield level and observation po re- - ❑ IN
❑ Gravelecc chombcrs or ❑ CilE -f .jp i� " )
Proper cover installed over drainfield? - - - - - - - - - - ❑ 0 ❑
v — i
Pump tank setbacks consistent Witt, eptiu tank?- - ❑ N/A ❑■ YES ❑ NO
• Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator
Z ❑
< 24" access riser(s) and accessible from surface?- ❑ • ❑
~ Alarm or Control Panel Installed? - - ❑ E
5 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0
m On bottom
n- Pump installed in ❑ Bucket or ❑ On Block or ® Other
a Pump Make/Model Orenco PF200511-20gpm,1/2hp, 115v 0 Floats or ❑ Transducer
d Tank draw down 1" in 10 min in/min Pump capacity 2.5 gpm Squirt Height
-- ft
Pump on time 10 min Pump off time 1.84 hr Daily flow set at 360 gpd
Updated 8/2112018
Mason County OSS Installation Report pg. 2
Parcel# 1)),\0Z+ — 58 0004 0\
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - YES
Ei ® NO
If yes, please describe: NO
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES
El 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: Drairtiead&manifold onenation&layout.Septic/pump tank location,North arrow.reserve drainfield,existing and proposed buildings,location of wets,waterlines,
wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in:final installation approval and related perm
its.
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® 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.
101D.c /
Signature of Installer Date s t
Printed Name of Signee '`r.� •'5t.MASON COUNTY PUBLIC HEALTH 4k I / `
The undersigned approves this Installation Report and `'! r !�' 1
9 PP P �s,� s+obaa� •. .f
PAULA JOY JOHNS
Record Drawing on behalf of Mason County Public t-.4. , � ON '�
Health exrsSiGMWI 3i''
Ma 7-61_2:5 1- c7 - z3
Signatu e n ironmentai Health Specialist Date (stamp, signature and date)
ITHIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8/2:RC18
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Key:
-'74O Audio-Visual Alarm i
O2 Cleanout 14. tb,
3 500 Gallon Pre-Trash Tank O1•w :h
• • O4 NuWater BNR-500 Pretreatment Tank jh'• - `.
51C J349 •'F''''
���PAULA JOY JOHNSON '•. ��i}�
5 1,000 Gallon Pump Chamber �PAULA� .MI Nfl:: .
O Subsurface Drip System Headworks
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