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HomeMy WebLinkAboutSWG2023-00017 - SWG As-Built - 3/30/2023 Mason County OSS Installation Report pg. 1 C, . C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00017 Parcel # 31904-51-00099 Applicant Name Dean & Sherril Pustek Subdivision (Name/Div/Block/Lot) Applicant Address 1330 SE Crescent Drive Fawn Lake Division:2 Lot:99 City, State, Zip Shelton, WA 98584 Installer Name Maples Excavating Site Address Same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑■ Repair ❑ Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - (t t-Tii- tiJ - ❑ ❑ z >50 ft. from surface water? - i�� t� ❑ Q El HCleanout between building and tank? - - -MAR.-2 2-2.023- - II - ❑ 0 ❑ U Tank baffles present? - U - ❑ 0 ❑ a24" access risers over each compartment By - ❑ I W Effluent filter installed?- - - • ❑ ❑ tf) t•fikkO of e�(` Septic tank capacity (working)__ BNR-500 gal Manufacturer Infiltrator O D-box water level and speed levelers used? - - Q N/A ❑ YES ❑ NO O0 Manifold/D-box accessible from surface- - ❑ ❑■ ❑ m— Check valves installed? - - " L""`"^e K ❑ 00 aQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 0 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - ❑■ ❑ ❑ J >100 ft. from surface water? - ❑ ❑ ❑�w u. >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑ Q Q > 30 ft. from downgradient curtain/foundation drains?- - Mg El El Drainfield level and observation ports present - - ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A I YES ❑ NO Y Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z < 24" access riser(s) and accessible from surface?- - ❑ © ❑ I— a. Alarm or Control Panel Installed? - - ❑ El ❑ Control Panel equipped with Timer/ ETM/Counter- - ❑ it ❑ CI Pump installed in ❑ Bucket or © On Block or ❑ Other mPump Make/Model Zoeller N152 ■❑ Floats or ❑ Transducer d Tank draw down 2" in/min Pump capacity 50 gpm Squirt Height 10 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd :;ecaced 8.2'I'2C'3 1 Parcel# 31gCA- 5k"000(31c1 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - YES NO If yes, please describe: OR MtrliitAd vkbarvioned NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - ® YES 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: Grainfield F.manifold orientation 8 layout.Septic/pump tank location,North arrow,reserve drainfield,ebsting 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. k __,,,k.,, ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that 1 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 l further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. /t `1 L 3-tL -23 �gnature of Installer Date , } ��2‹��� ��4 1� 5 r ,,, w ii-. Printed Name of Signee c 's. : h MASON COUNTY PUBLIC HEALTH -'7,.• p' 1 s i c,J34 3 :�'�,'f The undersigned approves this Installation Report and ' �,`� PAULA J0Y tp}{NSON ' C Record Drawing on behalf of Mason County Public � � L�'_ctit,51= Ul_SiONM'' AREA -igh.\-` N, Health: ��5 '�'`,� �, �317 7 3-7A-2 3 Signature of Environrhental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uaoatec 812112o18 �wN SGPLE.b \„_3 0, t kDk.53' AS-Qj AIL-f DEN P AS1 — PAgce.Lit 3R 04-5t-000 01c V57)0 SE CxQESC ENT DR. •NS3h w otc N\c2 1 _. (2 i,) 2.07 1 , 7 N ' T59G Siefe ' • . _ 14 .a cvlo block Wall 4 PP:O VE D �'l So SF DL c P _ � T _ ._..1. MAR 3d 2023 Rese MASON COUN1YEhV1RpNMENTAL HEto ALTH EALTN c-e .J ���F 0 - :Protec+ (�) 3 x5t' ptZMF�\z\( Agpcticbtv£- 9 4 . tahks {-fom �. O.G \lChi clt a C.lt' ,_________c(7 Kew 4.-44) . 0 Audio Visual Alarm Ex:Sfi tv) Q:. JJ ..., ,��ah•' 3 Cleanout 3 B R '^� ti �x�s-rl N RCVS t r• :( k 3 t 20 o Gallon rare-Trash tank O ADvEV RtSF•CL5 .-L-\P5 J'�+" 5,00349 Vs. O huWater BNR-500 ATU Tank r ''*'�' PAUTA JOY JOHNSON ( es.. \\ T a'L'iC iS� -onf xg•• i f exaiaes ThZ� C 1,000 Gallon Pump Chamber w/ at of j `J Q, . 2`f s t film Q( `�vyq}Lt --Zl---- ,`s 06 Valve Control Box 0,