The URL can be used to link to this page

Home My WebLink AboutSWG2022-00503 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 �C MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00503 Parcel # 42329-50-00025 Applicant Name DAN MORGANSTERN Subdivision (Name/Div/Block/Lot) Applicant Address 2220 NE 30TH AVE City, State, Zip PORTLAND, OR Installer Name BAMFORD SEPTIC Site Address 291 N WYNOOCHEE Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑U Repair ❑ Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - M - - ❑ N/A El YES ❑ NO >50 ft. from wells? - "stCMUV - - ® ❑ ❑ Z >50 ft. from surface water? - MI MAY 2-2- 2 ❑ ❑� ❑ HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - V ______ - ❑ ❑■ CI a24" access risers over each compartment?- ,•- - ❑ CI CI W Effluent filter installed?- - ❑ ■❑ ❑ u) Septic tank size 1250 gal Manufacturer SOUND PLACEMENT 0 D-box water level and speed levelers used? - - ❑ N/A ❑] YES ❑ NO 0O Manifold/D-box accessible from surface?- - CI El Ili CO, 2 Check valves installed? - - ❑ ❑ ❑■ 0< 2 Transport Line Size 4 Schedule/Class 3034 Bedrooms installed (check one) ❑� 2 ❑ 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A • YES ❑ NO o >100 ft. from wells?- - ❑ ❑■ ❑ W >100 ft. from surface water? - - ❑ ❑� CI LI >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q cc > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ cl Drainfield level and observation ports present - - El 0 ❑ kr Graveless chambers or C:I;lean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑■ NO • Pump tank size gal Manufacturer Z Q 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? • Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other d• Pump Make/Model ❑ Floats or ❑ Transducer 1 a Tank draw down _in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 • Parcel r'1 A619 ®6�61fiioft9T R COf f _ .. Were existing septic components abandoned as part of this project? - �^ If yes, please describe: El YES ❑ Were all components pumped out and properly abandoned per WAC246-272A- 300? - ® YES 0 - NO _ 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 orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. `' 0/l kf -Cti./J/c' A/ p/ dL!(/nl ,c/1 be 61.24,f Y. 1 CS-Ad 9 c .l..1r S GG or-- f I w t. s�*�. r,.)a r m70 .1) 0 --TC ! i G2/io4/ GAI 4-,•/-rf r Z • • r a I iio l ��++ g Record Drawing Attached li I a►E `E`IECLTI OFn (Slt - ON INSTAILLA- EC.,le • INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with l I certify that the system has been installed in accor- the septic design stamped"APPROVED"byMason dance with the septic design stamped APPROVED"by h County Public Health and that any deviations shown Mason County Public Health and that any deviations li 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. t State and Mason County Codes 4 further certify that all information contained on this I further certify that all information contained on this I; form and attach 1^ h ecord Drawing is accurate. form and attached Record Drawing Is accurate.did . ,� or 1 Signature of Installer Date (� s, L. s hi f Printed Name of Signee t ,. fk\trj ii 11 �� MASON COUNTY PUBLIC HEALTH p, �1 j The undersigned approves this Installation Report and "' c E. AITE . +!^t1 I Record Drawing on behalf of Mason CountyPublic • r LICE o DESIGNER �' i, Health: EXPIRES OSnOr R-i7N2 * 6 (q ("? ' .23 II Signature of Environmt3ntal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE undated 8.211201a • " - 2o' r 1 rie APPROVED JUN 09 2023 MASON COUNTY EN'MONMENTAL HEALTH RET ,i /251 all ar 4., 12, # -tp X'�AS 9i�'+ ^ G a '') :.:.,., o , ��". r „Is/ At CIN Y E WAI E \ ,1 r LICENS ES lI N6� 4 I EXPIRES 05110, i Z Cu tit .a ' O 0 &airs ( 3 Qf U0 Sv",J plQ[,e,Het/1-0 ? citd,ao - CG) ,' I / / - (oXbS =Soos7 f 3l?) 0 �w0,0,.....4,4J. / ,/ q 1 Iry G✓Y moo c4ec Sr. t N23.2 -• So _ 00026