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HomeMy WebLinkAboutSWG2023-00032 TANK ONLY - SWG Application / Design - 2/7/2023 • OFFICIAL USE ONLY MASON COUNTY DATERECEIVED•. _1 ` `3 COMMUNITY SERVICES AMOUNT CENE • RECErV r: in v m --� Public Health(Community Health/Environmental Health) C 41S N.6th Street Shelto400 or n .or.400 SING .2( )3 _ C��3� 475 N.6th Street•Shekon WA 98584 0 N 0 Z fn ON-SITE SEWAGE TANK ONLY APPLICATION D m APPLICA PHONE mr JJJck r r( w z c MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE m, �" � a � 1�-'� � ;-4-11 CD X SITE ADDR SS-STR T,CITY,ZIP CODE _ C , 6 c�p. C? ) I N NAME OF DESIGNER PHONE P Ot tItht 1c 45 or) 0 -8q(6- zzs3-- I r) NAME OF INSTALLER PHONE TYPE OF WORK(select ne) DRINKING WATER SOURCE N I ❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I COMPONENT(S)TO BE REPLACED/INSTALLED t)LPUBLIC WATER SYSTEM t ❑ SEPTIC TANK r PUMP TANK RV HOLDING TANK BEDROOMS LOTSIZE ^ 0 I t R LT�W 5 l-„ W ter/ OTHER DETAILS(select all that ap y) TANK(S)SETBACK CHECKLIST r t SUBMITTALS L ❑ SURFACING SEWAGE CI EXISTING FAILURE 0 SHORELINE E 1 100FT+PUBLIC/COMMUNITY WELLS n I 1Lp 50FT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS *PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I 2 IDPUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS G PLOT PLAN CHECKLIST r o I❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES ❑ EXISTING/PROPOSED OSS COMPONENTS AND LINES -4 ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES CIDRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I Vi 1 ❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate) OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(tor reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER. COMMENTS/CONDITIONS \c":7)mi)ci,A r alr\p- -1 -ekA SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED WITH RISERS AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE Zito 1 zL1 r y(6W\ NiaZ5 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 7/9/2019 w�, UPDP� 0t(iTai- I via.) 20t4 _ ook-1ici Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG r?,OZ??-- 00cY-L. Parcel # 22331-51-00057 Applicant Name John Brusco Subdivision (Name/Div/Block/Lot) Applicant Address 61 NE D &J Trail Collins Lake, Div 2, Lot 57 City, State, Zip Tahuya, WA 98588 Installer Name Maples Excavating (repaired DF) Site Address 1220 NE Collins Lake Dr., Tahuya Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s) Only ❑ Drainfield Only 0 Repair ❑Other 500 Gal Pre-Trash Tank System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A El YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - ❑ ❑■ ❑ HCleanout between building and tank? - - ❑ El U Tank baffles present? - - ❑ 0 ❑ a24" access risers over each compartment?- - ❑ 00 W Effluent filter installe ?- ❑ ❑ ❑ V) r6 tS(Z-5'0fl Septic tank size NuWater gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ■❑ N/A ❑ YES ElNO (:)O Manifold/D-box accessible from surface'?- - - --\..e.-0.Xvotri- - ❑ ■❑ ❑ mZ Check valves installed? - - ❑ El ❑ oQ 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - N/A 0 YES ❑ NO >100 ft. from wells? - {� [� 0 ❑ -J >100 ft. from surface water? - 5 2 2 Il U 0 El LL >10 ft. from potable water lines?- -Ff-8-9 3-2623- ❑■ ❑ Z > 5 ft. from property lines and easements?- - - - - 0ElQ 0 > 30 ft. from downgradient curtain/foundation dra ? - - 0 El'Drainfield level and observation ports present - - - 0 ❑ ❑ Graveless chambers or ❑ Clcoil gravel uacd? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑■ YES ❑ NO Pump tank size 1,060 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ F- a Alarm or Control Panel Installed? - - ❑ 0 CI 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑ m n- Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank a Pump Make/Model Orenco PF200511, 20gpm, 115v, 1/2hp ❑D Floats or ❑ Transducer a Tank draw down 1.5/10 min in/min Pump capacity 3.75 gpm Squirt Height -- ft Pump on time 8 min Pump off time 1.84 hr Daily flow set at 360 gpd Updated 8/2120'8 Mason County OSS Installation Report pg. 2 Parcel# 22 33 `5 0 0 7 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 2 YES ❑ NO If yes, please describe: brOKC 11 3rR;n=h1 co y raKtntc ref IQ C{d 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 onentation&layout.Sento'pump tank location,North arrow,reserve Grainfield,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 instalation approval and related permits. UpC\C,t-t AS - bv, ‘ jiG (1 Zoz3 - or crctiv\ ffeId feea r Jue fa of e 5 f'r u Cftdh by I O h aI 5C qV r. See kit d ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. I- 2-(P-23 /Signature of Installer Date (4c^•(i t 5 Printed Name of Signee 9�(�r • MASON COUNTY PUBLIC HEALTH l �`r The undersigned approves this Installation Report and : .�. !`t c,ic`oa4s •4,'414 Record Drawing on behalf of Mason County Public PAULA JOY Joi-NSow Health: U►C tSG0tb£aiG tf .L6nit_vvycal, q(011-3 - 3I-- z3 Signature of Environmental Health Specialist Date (stamp, signature and date) updated 82172018 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Ju A rfvo6f. ct1023 cufCra\ Y�-h�e ' d _o Scs1,:S2,=:_i_o' dP.S vC.-1s0ti b , NI . �� . )hhr .ruSrO ` 0_,rai 2. .$si.51-0005-1 t .;-o t Collins tRk.-e Dr .oF\,-d- 2A" S t,.- 0 S goo spDry P /(701° •� 3 ^' (�'2Z''S .'��-04��L �t Srrvf . 1�, :12. S v el _ O - . s oa c4 cl.-12(;10 t,Ale° CI ��- Its a 0 Audio-Visual Alarm a� 1 0 @ Cleanout 4 C3 500 Gallon Pre-Trash Tank e. • '1J,g'Q.�4r5 0 NuWater BNR-500 Pretreatment Tank v' fig.-. ® 1,000 Gallon Pump Chamber f ' - l�.-.• „to WA O Subsurface Drip System Headworks r - © or 3 .I •• I6. L,T. E 01 tr54. 4z1 f reS{tvf tS tv{r Xis, Ot;f , 1uddfd , d; +kteugl, :II 1 46 ‘'n-t 0 Y\od-i Ve SO i 1. J t /1 ill .f --. ' , Ns 1- pi.4.A.,. ,.;4. 4 . . a -n� -�;,,,�' war,, jV APPROVED ;- .1 FEB 10 2023 ,-( PAULA 5108349 y JCY JOHNSON N1''*1) MASON COUNTY ENVIRONMENTAL HEALTt. �f m,.$ i )e5_iGNrie Fes ail -;�� E. I - 31-23