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HomeMy WebLinkAboutSWG2022-00556 - SWG As-Built - 6/28/2023 Mason County OSS Installation Report pg. 1 t \ MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT/INFORMATION Permit Number SWG 2022-00556 Parcel # 32214-50-01027 Applicant Name Karl & Louise McBumett Subdivision (Name/Div/Block/Lot) Applicant Address 4422 237th PI SE MAGGIE LAKE ADD#1 BLK: 1 LOT: 27 S 49/207 City, State, Zip Bothell,WA 98021 Installer Name Shumaker Constuction Site Address 351 NE Lakeshore Dr S, Tahuya Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 111 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ®Other 500 gallon pre-trash tank System Type subsurface drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? ❑ N/A 0 YES ❑ NO >50 ft. from wells? ' `, ® ❑ ❑ z >50 ft. from surface water? - 4�a - - - - ` ❑ • ❑ Cleanout between building and tank? - -- S`-•1:� L��- - - ❑ 0 ❑ U Tank baffles present? - - - - �� - 7 0 ❑ a24" access risers over each compartment?- , - - r ❑ ❑ W Effluent filter installed?- - - - tr.4, 1::, ❑ ❑ N ......_ Septic tank capacity (working) NuWater BNR\ ,anufacturer Hagerman 0 D-box water level and speed levelers used? - 0 N/A ❑ YES ❑ NO DJ O Manifold/D-box accessible from surface?- e--9-a-14-/er41c-3 - ❑ 00 mZ Check valves installed? - - . -- ' M€' C - ❑ 0 ❑ ciQ 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- - ❑■ ❑ ❑ W >100 ft. from surface water? - - ❑ ❑■ ❑ LL >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ El ❑ Q Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ II Drainfield level and observation ports present - - ❑ ❑ ❑ GI dvCICSS d rcmLers or ❑ Ckpn grevcl uacd? (check ono) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - • - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ El ❑ H a Alarm or Control Panel Installed? - - ❑ El ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ I. ❑ a Pump installed in ❑ Bucket or ❑ On Block or 0 Other flow inducer tube a'• Pump Make/Model Orenco PF200511-1/2hp, 115v, 20gpm ❑ Floats or ❑ Transducer a Tank draw down 1.25" in 10 in/min Pump capacity 2.38 gpm Squirt Height -- ft Pump on time 8.4 min Pump off time 1.87 hours Daily flow set at 240 gpd Uoyatetl 8,21/2C13 f Mason County OSS Installation Report pg. 2 Parcel# 322- t k-SO O t p2'1 ABANDONMENT RECORD YES � NO Were existing septic components abandoned as part of this project? - O� � - n 0. If yes, please describe: l� `�a�� o"` 0 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 8 manifold orientation 8layout.Septic/pump tank location,North arrow.reserve grainfield.existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 1 further certify that all information contained on this form and att ed Re Drawing is accurate. form and attached Record Drawing is accurate. 2t/i� z3 Signature of Installer Dat0,114* Printed Name of Signee L �r , 'o� 1. MASON COUNTY PUBLIC HEALTH �k r , The undersigned approves this Installation Report and �� �F ;.., ) Record Drawing on behalf of Mason County Public Y 51 0V'i4y 'rl 9 � PAULA JOY!OHNSCN �� Health: l�SSE fGNt't1•c 11 -2' .—z.3 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Jpdated aR1/2018 CAAt \`` , -30 . 0 4 30 4t5' 14 Ma \,t, `akt, `1 GYM -t n, ,,se I�c,Burhe _ �5t 0� „lrrcl,n�t Imor 1 Sl�o�reE;�n e r- . ,\,- p-;..'-i," Sk k YQOC'S N t, pA:Y1�o�a 1 .5�—�5-4L- vJo`S - kl\,\ '� ' I GZ'�a 1 - 8,��c� �'' o c*i-o rA o� Vo\t 3 c (J r 8 Q ,9N-L-ese ® 0� i Key Oncove+ P IT)� �� l • .i j l t3 -1- 0 Audio-Visual Alarm — ©iS dta1- (" ' I OZ Cleanout r,OMMOn, 'S",.O' , a�' � i J�Z �� ` 500 Gallon Pre-Trash Tank ci3,•rJ� `1-1' } /L ntv U uWater B1VR-S00 pretreatment Tank � �on'� 1ju� lGlt1�1�! I( co.( tT re. 1 33 r tc' 2 _ "• 1,000 Gallon Pump Chamber cx `��`.. y 1 '' • ,? ® Subsurface Drip System Headworks z' • {\ -1 L-----c c“2_:—A: vA--le • tom... 4st5--)- APPROVED .t •:•%,. T — — --� 3.5 -i.So JUN 2 8 2023 '', ° h Fr f • Ne a _ S MASON COUNTY EN\ RONMENT.AL'n• '•- '► '- L— -- �cscrvt. i wA-?„,(-), A I RET ,-7( r k ����tPA� �YDJ.OHICOc '•� 60, 14/ � y__._ NE. LRSYt6 (Le' DR.S� Lf--t-8-Z3