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HomeMy WebLinkAboutSWG2022-00572 - SWG As-Built - 7/17/2023 2 2o ( 6 — � ( -- 0003G Mason County OSS Installation Report pg. 1 C . ,. MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION i_.1ri I (- Permit Number SWG 2022-00572 Parcel # 3210G-51-00036 Applicant Name Thomas Burgess Subdivision (Name/Div/Block/Lot) Applicant Address 240 Hames Rd Oakland Beach/TR 36 City, State, Zip Watsonville, CA 95076 Installer Name Bay Shore Construction, Inc Site Address 2230 E State Rt 3, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST 1,o o 5a,%,4-+1:..•d e- -.- -L'f II Full System Installation ❑Tank(s)Only El Drainfield Only 0 Repair I] Other Barnes SEV412 solids pump System Type Pressure Bed Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ ❑ El Z >50 ft.from surface water? - - ❑ ❑ • a Cleanout between building and tank? - - El El ❑ U Tank baffles present? - - ❑ 0 ❑ H 24' access risers over each compartment?- - ❑ 0 El a W Effluent filter installed?- - ❑� El El v) Septic tank capacity (working) BNR-500 gal Manufacturer Infiltrator o D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO Q0J Manifold/D-box accessible from surface?- - El ❑■ El OO Z Check valves installed? - -if) ' ' "St"--Is - El II ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 El 3 ❑4 Cl 5 ❑6 ❑Commercial/Other >10 ft. from foundation? ❑ N/A 0 YES ❑ NO o >100 ft. from wells?- - P P-R-a V-E- . El ❑ ❑l W >100 ft. from surface water? - - - - - - ❑ ❑ El Li >10 ft. from potable water lines?- - - -JUL-2-s .823- -- ❑ El ❑■ Z > 5 ft. from property lines and easerq, muINTYENVIRGMIDTTA1T-lEAtT-❑ ❑■ ❑ IY > 30 ft. from downgradient curtain/foundation drainsimp - ❑ LI Al Drainfield level and observation ports present - - ❑ U ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - El N/A 0 YES El NO Pump tank capacity (flood) 1,530 gal Manufacturer Infiltrator Z CIQ 24" access riser(s) and accessible from surface?- ~ Alarm or Control Panel Installed? - - El © El Q 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ I El D a Pump installed in 0 Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Liberty 250 0 Floats or ❑ Transducer a • Tank draw down 1.25 in/min Pump capacity 44 gpm Squirt Height 4 ft Pump on time 1.33 min Pump off time 6 hr Daily flow set at 240 gpd undated en 1 rro,e Farce:. # S201 (...-Si-aoo3L, Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as part of this project"% - - ® YES NO If yes, please descrbe. � ° � ° —% NO Were all components pumped out and properly abandonec per WAC24o-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 Typica Record Drawings roman: Dm:Wield&manicld orientation&layout,Septic/pump tank location North arrow,resekve o„afield existing and proposed buildings,location of weds.waterlines. wells observation ports.deanouts.and other maintenance access points. incomplete Record Drawings may create additional delays v'Gtal instal anon approval and related permits APPROVE JUL 2 6 2023 MASON COUNTY ENVIRONMENTAL HEALTH JBW ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l certify that 1 installed the system in accordance with 1 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 Cod ' State and Mason County Codes 1 further certify that information contained on this 1 further certify that all information contained on this form e2 a?a le Record Drawing is accurate. form and attached Record Drawing is accurate. Signatu �of1 staller Date i t517:(ll(i,..e il Mit: itt,(2-Se/1 0, v Printed Name of Signee '4 yf1 MASON COUNTY PUBLIC HEALTH ; 'e ' 7r J cr'�� The undersigned approves this Installation Report and yt stora4g ,t, Recor awing on behalf of Mason County Public +-Z PAULA JOY JOHNSON . ,,bs H ith: � E (S� :N-R csdi tT �br;' tGr (z( 014.---...) 1 —i.Ci — 7.-3 Sign ur vironmento!Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAI ABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE r'+Dant"°21212''18 C %5 30 45c�'��O r A�CIuI.N/ TA7-. w� f U �C \ T a�-�Q - ' 7JZ�7 tdO o e s,. 3 i Q- - i gt r , ?i.---ig--n, .115‘'ir . 9x i c) xlci FY t may,/ t7. 8 e3 5 _ . \ik. f H i��` 1 D`d �.o.-"''� .. d ec.or,A.w.15s i e 64 --' o o ci ^('Le- 2 b K abc.......c.c v -c' QCL - 7cfec I; r c ,- ,,,,_,, ,,,.9.„. P P h necc q JV OVEr " t A/VPif M SONCOONr ?6 2023- .is• I- 01 Audio-visual Alarm , VE Je/RON41FNTt(y ' ) Cleanout �H(7f � 0. 0 Z- Gcw.{Pa.)✓4- k +ru.,k 3 L3, t 0t 3k 1 t1:r ,u.,^p �h 5eceLid c t n NuWater BNR-SO0 ATE Tank 1,500 Gallon Pump Chamber C -5;ers- (a oo w v;.wa,w� U.7 i 0,._4-; - S i P ke ri. ' / ' .•1; .4 ftd 1-1..../,' 5100343 N.a: PAULA JOY JOHNSON ..1y �G LiCE 4.8_W •iGNM•' - --1, - 23