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HomeMy WebLinkAboutSWG2020-00167 - SWG As-Built - 3/6/2023 CC Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00167 Parcel # 12018-50-00002 Applicant Name Daniel & Elizabeth Yost Subdivision (Name/Div/Block/Lot) Applicant Address 451 Hamptoncrest Circle Island Shores Tr 2 &T.L. City, State, Zip Heathrow, Florida 32746 Installer Name Bamford Septic Repair, LLC Site Address 232 E Leaf Ln, Shelton, WA Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST I. Full System installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ® Other 500 Gal Pre-Trash Tank System Type Shallow Pressure Trench Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - El ❑■ El Z >50 ft. from surface water? - - ❑ ❑■ ❑ H Cleanout between building and tank? - - GI ❑■ ❑ U Tank baffles present? - - ❑ 0 ❑ 2 24" access risers over each compartment?- - ❑ 00 W Effluent filter installed?- �� - � ❑ ❑ Septic tank capacity(working) BNR-500 gal Manufacturer Infiltrator D-box water level and speed levelers used? - - g N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ rt ❑ QQCheck valves installed? - - ❑ ❑■ ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ■❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO O >100 ft. from wells?- qt -1E1-1Frit N ❑ W >100 ft. from surface water'? - u U NI . (1 0 ❑ u. >10 ft.from potable water lines?- 4M�-f } ;[u23- ,If ■❑ ❑ - > 5 ft. from property lines and easements?- f > 30 ft. from downgradient curtain/foundation gains?- -ilk - 0 ❑ ❑ o Drainfield level and observation ports present - "----M=----- ] © ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator • 24" access riser(s) and accessible from surface?- - ❑ El ❑ a. Alarm or Control Panel Installed? - - ❑ Q ❑ E Control Panel equipped with Timer/ ETM/Counter- - ❑ El ❑ - Pump installed in ❑ Bucket or ■❑ On Block or ❑ Other 0- Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer O. Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 5 ft Pump on time 1.1 min Pump off time 6 hr Daily flow set at 220 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# \aO 50'00002 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - D YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 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 8 manifold orientation 8 layout.Septicipump tank location,North arrow.reserve drainfield,existing and proposed bu.ldings,location of wells,waterlines. wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final instatation approval and related permits. °)/(5—.1 J ctrjr?\ut ® 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. Z—g— 2 3 Signature of lnstalle Date Printed Name of Signee 'Es • MASON COUNTY PUBLIC HEALTH a '• 1 (%,(1. • The undersigned approves this Installation Report and `�: r `f=� } Record Drawing on behalf of Mason County Public f� 51o0349 ct PAULA JOY JOHNSON• .r Health: _ (7. �(6 � • 2 2 —3 Signature Environme al Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated erztrzota ' , C9-se- ')' .. . (11'.\\III), 1 1 11 1 I o t5 30 :45 t►o \\\\\ PPR0VE.D AS-3UL7MAR 062023 l�O ^501OOoMASON COUNTYENRONMENTAL HEALTH a`5� LCaF L .REt ° NEtGt'toRLL Y PAYv • A'Attx so . A Ito,-,'S. ' ' V-1.,61, tt.j ' diet , 0 -- I' 1)-',6, r' 3 '.`,,�' 3n! 'y i t!•• )-�vb MPcR\4 S Audival Alarm Clea0n Pre-Trash tank BNR-500 ATU Tank Chamber RESE'1,0llon Pump• �«Valntrol Box 100 1 _w