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HomeMy WebLinkAboutSWG2020-00352 - SWG As-Built - 4/6/2023 Mason County OSS installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00352 Parcel # 32031-14-90020 Applicant Name Roderic Dohleman & Ryan Finn Subdivision (Name/Div/Block/Lot) Applicant Address 103 W Story Rd City. State. Zip Shelton, WA 98584 Installer Name H2F, LLC Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Dranfield Only ❑ Repair al Other 50C ga,.on p+e-trash lank System Type Oscar Mound Pretreatment Type NjWater BNR-500 >5 ft. from foundation? - - ❑ N/A il YES ❑ NO >50 ft. from wells? - -' - - - - ❑ Ix ❑ • >50 ft. from surface water? - - - - U' g-U -IL 1--L- %1 - - - - ❑ U] ❑ Z ❑ � ❑ Q Cleanout between building and tan• ,....7 �, - - - - 1-. a - MA3c-- U Tank baffles present? - - - - - ❑ 11 ❑ I`- 24' access risers over each compa ment?• - - ❑ j ❑ a. Lu Effluent filter installed cn �ox-\e,f` By - - - - - 0 J ❑ Septic tank size BNR-500 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ® NiA ❑ YES ❑ NO �J 0 NI ❑ O Manifold/D-box accessible from surface"- - u. m z Check valves installed? - - 0 ® 0 OQ 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑■ 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- • ❑ N/A [. YES ❑ NO CI >100 ft. from wells?- - ❑ Eil ❑ W >100 ft. from surface water? - - ❑ Ii ❑ u. >10 ft.from po:able water lines2- - ❑ 0 ❑ z > 5 ft. from property lines and easements?- - ❑ X ❑ a ❑ LII 0 W > 30 ft. from downgradient curtain/foundation drains? • - - Drainfield level and observation ports present - - ❑ II' ❑ (] -Gravrle.ss chamber of 0 Cleerre, eael aced? (eheek erc) Proper cover installed over drainfield?- - 0 E ❑ Pump tank setbacks consistant with septic tank? - - -. ❑ NIA ili YES ❑ NO Pump tank size 1,200 gal Manufacturer House Brothers < 24" access riser(s) and accessible from surface?- - ❑ El ❑ ~ Alarm or Control Panel Installed? - ' ❑ © ❑ a 2 Control Panel equipped with Timer!ETM /Counter- - ❑ D a Pump installed in ❑ Bucket or ❑ On Block or 0 Other In Tube a Pump Make/Model AYMcDonald 22050E2AJ-1/2hp, 115v ® Floats or ❑ Transducer a Tank draw down -- in/min Pump capacity Squirt Height ft Pump on time 22 sec Pump off time_3 min30 44 secgpm Daily flow set at 360 gpd update('A2'.'20+8 Printed From Mason County DMS Printed from Mason County DMS CPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 32-0 3114OOOC)) RECORD DRAWING CIo m.r,lrota i atrrbnsiorts dot V- A , ' 1 're-location. J / Q-sue__-- ---- -- dimensiorts and / critical distances f�/A' a/ ( . .Jc Ti \ / _ ent \L I j/��) 1 L Wv��•�M 1 • �I V exist'n}1FropaEe[f 7 { c ,' l ' l Q Observation aorta.; t I \,,,`- g.%_1:_,-.oean•out ice, "1-46 VI' ,� 3 &man6-4osrc•boxes --�---- ' i ,t r.L.I t3 ELomtian of wens, 't �! _ - surface water,made, - i U4eseri areas) rV'W�' ; r 2 • LOC ArTE I fF Arrow t l.$ V RA • — 1 If the designer or installer feel the need for additional information/comments,it may ce attached. Record drawing may also be on a separate page attached. No.Pages Attached 2 .: CERTIFICATIONOF INSTALLATION .____—.4 INSTA1 I FR DESIGNER 1 l certify that I installed the system in accordance with I certify that the system has Dean installed in acto,'- the septic design stamped"APPROVED'by Mason dance with the septic design stamped"APPROVED"b.) County Public Health sac that any deviations shown Mason County Puolic Health and that any cievielio!ts i here have been deared/approved by both the designer shown here have been cfeerearapproved by botn i and Mason County Public Health and meet all State myself and Maser, County Public Hearth and meet all i 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 attache ' ecord Drawing is accurate. form and attached Record Drawing is accurate. Signature of i er Date A 1 * c qm i� - � i j Printed Name of Signbe - .. 4@ •T 1fj� MASON COUNTY PUBLIC HEALTH - � `} i The undersigned approves this installation Report and ` s It.h ' Record Drawing on behalf of Mason County Public f-' •• PAUL A.10Y JOhNSON . ,,J'� Health: 11/6 7�3 <-� Ex, �IRES a ri$, �� i WI - Za -2Z S nature of Environmental ,Health Specialist Date (designer,stamp, signature and data) THIS FORM MAY SE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updcs ILT4iE Pri lied From iviason LAiut Iy L :: Printed from Mason County DMS i . . As \ou\- 1 i' Roa ectC johlemah i\'/ \ Ku Pats{1#3203f-)4-90n0 Ol Audio-Visual Alarm - a"` Pusi-, 103 w Story R ct / w �. zf- Scalt: 1 yo I OCleanout 0500 Gallon Pre-Trash Tank t 0 20s 410 bo 8o 0 NuWater BNR-500 Pretreatment Tank \ O 1,000 Gallon Single Compartment q Y/\ \ Pump Chamber/Clarifier Tank 4 / O6 OSCAR Mound Drainfield f/ • \ , 0!) i -tt\ / \ — \ \ i/ c R\h /It',7P-IR ti •r. \ \iJ £tofosed; 1 v•\ ..,...., r- ‘"-.-E- BR -: \ 1 _.,' OT 1- •. -.: 1 1 -' s 1 \\ M ®cr ° _�° -� 1 APPROVED " t APR 06 2023 \ ° ' •SON COUNTY ENVIRONMENTAL HEALTH 1 � f �. � � RET N 1 -‘1% N.. Cv:, Z.r. \ \ \ N oe \ . .. f + C .. O L 8 b�. 20.04. 38.39 eil—.. ::b. ,o,17.1% LO -T. ---- .r.:0 °1'n) , • �� r'Iw. • •• 51C0349 QPAULA JOY JOHNSON exw�s r, 'rinted3Fror `Mason County DMS Printed from Mason County DMS • I I I.;S. Ap'b I 27.y7 za t7 _T , • 1 CZ i 7... 1 zb ♦♦ 6 • • ♦ X I I74 III A ♦• Di _ ♦ •` 1 2 \. k ; c : :n:r ♦ a ` • • w1, S E-. n $ 5.Sect ... o'a'c",v''I*1 �t". • 1 --- aas:It 5 1 — -- u 1 %;. � : sc1 4 V rgi:R 2 ElII: I litt ;.Si 4 , i. 7,111.,.4 I 1 N It It rom anon County Printed from Mason County DMS