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HomeMy WebLinkAboutSWG2021-00283 - SWG As-Built - 7/28/2023 oimb Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00283 Parcel # 32104-58-00038 Applicant Name FTM Construction- Fadi Karam Subdivision (Name/Div/Block/Lot) Applicant Address 21020 SE Yamhill St ALDERBROOK G &Y#9 TR 38 SURVEY 30/83-100 • City, State, Zip Gresham, OR 97030 Installer Name Mason County Excavating Site Address 40 E Susan Ct, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - ( Trtt--\ ❑ NSA ■❑ YES ❑ No >50 ft. from wells? - - 1 -i4,- - i} ® ❑ ❑ Z4>50 ft. from surface water? - 2MI. 0 ❑ ❑ Q Cleanout between building and tank? - - - -kut—2 -ki- - - ❑ U El U Tank baffles present? - - ❑ ❑ El d24" access risers over each compartment?-\-133- - - - - - 0 II ID W Effluent filter installed?- - © ❑ El cn Septic tank capacity (working) NuWater BNR gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - 0 N.A El YES ❑ NO DO Manifold/D-box accessible from surface?- - 0 El El in.2 Check valves installed? - 0•-. `'(o - El 0 El o< 40 E Transport Line Size 1 inch Schedule/Class Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑0 YES ❑ NO CI >100 ft. from wells?- - 0 El El W >100 ft. from surface water? - - ❑■ El❑ LL >10 ft.from potable water lines?- - ❑ 0 ❑ Q Z > 5 ft. from property lines and easements?- - ❑ 0 El re > 30 ft. from downgradient curtain/foundation drains? - - El 0 ❑ ci Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Crevelees Jrarnbers e. [} C6a,,,grav i-ti cd? (,,hest,on ) Proper cover installed over drainfield?- - El 0 El Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Infiltrator < 24" access riser(s) and accessible from surface?- - ❑ © ❑ F- Alarm or Control Panel Installed? - - El © ❑ a ontrol Panel equipped with Timer/ETM !Counter- - ❑ • ur�i �!_:a� cket or ❑ On Block or ® Other On Bottom of Tank ❑ d • Pump Make/Modelite Step 20, 20gpm, 1/2hp, 115v 0 Floats or ❑ Transducer R. Ta>1i�/ratdc�'3 1.25 in/min Pump capacity 3.1 gpm Squirt Height n/a ft M`SON CO time 6.5 min Pump off time 1.84 hr Daily flow set at 240 gpd "�'�IAICNTAL HEALTH updated 821.2018 ��A Parcel# -3 2 10 - 5 S C O0y$ Mason County OSS Installation ReABrt pg. 2 ANDONMENT RECORD YES YYY"��"� NO [were existing septic components abandoned as part of this proje ? -yes, please describe: 0NO ere all components pumped out and properly abandoned per WAC246-272A-0300? O YES RECORD DRAWING buildings,a vecation of wells.waterlines, 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 g and Drawings contain: Drain`eld&manifold onentation&layout.Sept Jp )tan location, o North Drawings create addmo art delays final proposed installation approval and related peines, wells,observation ports,deana.s,and other maintenance access points. IncompleteS may rmits. (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 atta .ed Record Drawing is accurate. Drawing is accurate. —4 --- . 0-1/0 APPPbVE5d Signature of Installer ate J U L 2 8 2023 P. `'.\co, 4�kY� .4;5 MASON ;OUNTYENVIRONMENTA ��h_s' ""i Printed Name of Signee DJA '_'�`-f •j it,..; ',), MASON COUNTY PUBLIC HEALTH ,, i� ►• -1 • The undersigned approves this Installation Report and yf S100349 '• A.I- NQ. PAULA JOY JOHNSON Record Drawing on behalf of Mason County Public 4 L�;�(gE{i�ESIGNF Hea j^c��'�T' _ 7(2F77og 1_4;3 .4.,,cf, Signature o Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8272018 �! bra `� ! ' o,1,:,.!* her g`!. 8s• na<-G e`,*4.):2404-St-00038 hJ � \ L-[ C E. 5 J s a n G--r. S Ca i.e." ! c 1 20' i , 1 o cc; 20 30 Ai il • i ,,easN . a`a i, : . iii ....., J , ,..., . ,i, OF (,pp 5 ...• .k. •,,,„, , / Reset'ge./ 4 N. C / _ v N :: © PPROVED * \ (5111 . • 4:1 + . , I JUL 2 8 2023 2 B O MASON COUNTY ENVIRONMENT co:�b�xi DJA AL HEALTH P�w�c; ,, , -,,,, , 5 1 A ' dew K T. "-a;. !LemO H OA1I{IiC4.7lSi:2?bsla-W •41r 51OC_349 •� I, Cieanout 1Q'LIC `JO YUSGNO8Nit'. �e- 0 NuWater BNR-3OO ?e'er=er_Z 7.' O 1,000 &anon? raP C az be_ n Subst:rface D. p System =ea.ti o.ss