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Home My WebLink AboutSWG2020-00457 - SWG As-Built - 2/22/2023 am. CC Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00457 Parcel # 22330-50-00255 Applicant Name Heather Littlejohn Subdivision (Name/Div/Block/Lot) Applicant Address 182 Northeast Lake Drive Haven Lake Lot: 255-257 City, State, Zip Tahuya, WA 98588 Installer Name Bamford Septic Repair, LLC Site Address 1301 NE Tahuya Blacksmith Rd Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair El Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ NIA 0 YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ >50 ft. from surface water? - ❑ 0 ❑ Z ■ ElH Cleanout between building and tank? - ❑ ❑ 0 Tank baffles present? - ❑ ❑ a24" access risers over each compartment?- - ❑ ❑ ❑ N ui Effluent filter installed?- 0 El Septic tank capacity (working) BNR-500 gal Manufacturer Sound Placement CI D-box water level and speed levelers used? - - © N/A ❑ YES 0 NO ❑ .-1DO Manifold/D-box accessible from surface?- ❑ ❑ CImZ Check valves installed? - ❑ oQ 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells? ❑ I ❑ J >100 ft. from surface water? - - - -- ❑ C p.W >10 ft.from potable water lines?- tJ E TiW! ' - -'-- - ❑ El ❑ Z > 5 ft. from property lines and easements? . . ,�,, 0- ❑ Q � > 30 ft. from downgradient curtainlfoundatiqtt rains? - �"' 0 � ❑o Drainfield level and observation ports present - ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - El N/A 0 YES CI NO Pump tank capacity (flood) 500/1000 gal Manufacturer Sound Placement-com©bo trash/pump❑ Z < 24" access riser(s) and accessible from surface? ❑ ❑ 0 H a Alarm or Control Panel Installed? E Control Panel equipped with Timer/ ETM /Counter - ❑ 0 ❑ n n- Pump installed in ❑ Bucket or © On Block or ❑ Other a' Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer d Tank draw down 3 in/min Pump capacity 60 gpm Squirt Height 6 ft Pump on time 1.5 minutes Pump off time 6 hours Daily flow set at 360d ,gpd Parcel# 2. 0 -50-0a2.55 Mason County OSS Installation ReABANDONMENT RECORD - D YES al NO Were existing septic components abandoned as part of this project? If yes, please describe: - ❑ YES ❑ No Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING tivities and This is a onto n: Dr record ma must be accurate &layout.Septic/Pump tank location.North arrow.gh to re4ocate in eeserve drainfield e>csbng need of maintenance cand proposed buildings,ld ngs location of welre development ls,Ical Record watedines. wells, o s contain.ports, cle ou s manifold orientation wells,observation ports,deanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5 Eig Pcr-VACk\E_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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. C / . i Si nature of Instelle Date ;(t g ( n � ty.�h. k. Printed Name of Signee '• MASON COUNTY PUBLIC HEALTH _ :,... 'o h • • 5,:,17as The undersigned approves this Installation Report and ; : ..P�.ttA�UL• A J/O�Y�JoHNSOu�{%.:-\ I_:iiCPJStb DE$IGNI�R•• Record Drawing on behalf of Mason County Public ��:�r�i�r - Health: _ g_ Z3 C041 f?:-S Signature of Environmental Health Specialist Date (stamp, signature and date) 9 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UpCated 821201a N- 70\hu a 51ca rA k" «— ?Ate( - 22330 0-00255 . 1 aim \ Key: OAu i'o-Visual Alarm OCl.anout 03 N i Water BNR-500 ATU Tank .o $p..e.- st.\ eiw.bo 0 1 000 Gallon Pump Chamber A P i. 0 alve Control Box yae_2r1 A I) IOVED Fie 2 2 2023 \o,,-*-co, I J� MASON cpUN 4VIRONMENI' � REr AL HEALTH N \` .,1,-,c, ,. ...._ 00- ...._ , . --, - .., A • ... , T. .. ..,,Q. cb _ .,., ,..0, ,,,,,,„„4 \ , • . , 4.- .4,- , -o . -1,, .j r `'' ) f oc �` s ecsa9 .5 t l�lJ c3' PAULA JOY JOHNSON "•1"'' •1 a\ D.F. .�-(<nc{n�t,S LiCFf8tt, SE8il NEi4_ •, l-�'S ► b \ hi,• W Z- 8 -23 rf5Qvv4loe.\o ' © N 11111- 1 37. � _ t - ( k I i il >5LoPE Li000l IkkH Scot (e : i 301 \4iLk' o t5 30 LI5 60 ,,,,czz.v.\.e.).--.