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HomeMy WebLinkAboutSWG2022-00336 - SWG As-Built - 9/11/2023 OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Mason County p APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00336 Parcel # 22330-50-00091 Applicant Name Robert Scheffler Subdivision (Name/Div/Block/Lot) Applicant Address 601 NE Haven Lake Dr Haven Lake/ Lots 90-91 combined City. State, Zip Tahuya, WA 98588 Installer Name Shumaker Construction Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type OSCAR Mound Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - - - h `' -`- � ❑ N/A ❑ YES ❑ NO >50 ft. from wells? 1!�ti L5-Lt-�-L .t-� '-I.}- ❑ ❑ >50 ft. from surface water? - , - ❑ 0 ❑ HCleanout between building and tank? - -- - J El0 ❑ U Tank baffles present? - - ❑ 0 ❑ d24" access risers over each compartment?- -By- —. -- ❑ 0 ❑ W Effluent filter installed?- - 0 ❑ ❑ cn N Septic tank capacity (working) BNR-500 gal Manufacturer Hagerman D-box water level and speed levelers used? - - UI N/A ❑ YES ❑ NO XO Manifold/D-box accessible from surface?- - ❑ 0 ❑ mZ Check valves installed? - 0. eu.---1:, ' ^^ - ❑ 0 ❑ ❑d n Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - -O- -V`�" e--- -`d k - 0 N/A ❑ YES ❑ NO >100 ft. from wells?- - - --C� 'i' S c2-- W - ❑ ❑ 0 W >100 ft. from surface water? - - ❑ 0 ❑ IL >10 ft.from potable water lines?- 0 ❑ Z > 5 ft. from property lines and easements?- - - - -A- Tp-pRoNE- D0 ❑ a _ _ _ ❑ ❑� > 30 ft. from downgradient curtain/foundation drain 1 �0 f irDrainfield level and observation ports present - - - - ■ © ❑ -0 C;ravalacG r u6�u! Ott �VIRONMENTAL HEALT, Proper cover installed over drainfield?- -JB.W❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ II ❑ F- a Alarm or Control Panel Installed? - - ❑ II E Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ 0 n- Pump installed in ❑ Bucket or ❑ On Block or E Other on bottom of tank d Pump Make/Model AYMcDonald 30gpm 1/2hp 115v ❑ Floats or ❑ Transducer E a Tank draw down -- in/min Pump capacity 1.75 gpm Squirt Height -- ft Pump on time 22 sec Pump off time 3 min-44sec Daily flow set at 240 gpd Updated a/212018 Mason County OSS Installation Report pg. 2 Parcel# 22- 330— TOo OOc U ABANDONMENT RECORD El YES NI NO Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? 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 contam: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve crainfield.ensiing and proposed buildings,location of and wets, waieeenn s, wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in.final installation approval S.€—e— Q PPR ° V E SEP 1 1 21)23 0 MASON COUNTY ENVIRONMENTAL HEAL JBW II Record Drawing Attached ICERTIFICATION 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 1 further certify that all information contained on this I further certify that all information contained on this form and att e Drawing is accurate. form and attached Record Drawwing is accurate. 1—tics -23 Signature of installer Date ,,, Punted Name of Signee . �A. • ��> MASON COUNTY PUBLIC HEALTH ECT'it ,: .,} The undersigned approves this Installation Report and if1LPA....UL . Record Drawing on behalf of Mason County Public Q-1- A JOY3JOHYSON••4�49 Health: Es_,. SI om IoNv EXPIRES� -bg)1 1 , rd �,�,�,�� (1—I1,2) % —( 4S— 7-3 Sig/Cat zillie nvironmental Health Specialist Date (stamp, signature and date) If THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 812trz3ta l N N }� v..n L rake Se, s - ciz-- rA it, �v N .� ^r `- ober4 SCheff 1{r PaYCe141-123o -50-6°o 9I r ioDI N E 1-i av-t v\ Lake Dr ! t t 1 1 o r5 30 #5 60 © y Z' '�-i- Hole 6o - ho irS 0-12 ��. . . v 1 d;s-wrbd 95L, . of-�� ! 12--30 y 5L / 4 \ \ 54 ,.(' •. ti�� k Sty .(.}`� \ U rf;m a r i •s'A 30' \ 1" • xe4: -- \art o,M�° ppsCa r..� _L— Ol Audio-Visual Alarm (o,rr fos}) t �, — " ros.cr 2 Cleanout 1 Re r r ve 75 - 33 NuWater BNR-500 Pretreatment Tank I - 15' 1\\* 01,000 Gallon Single Compartment \ �Q{ Pump Chamber/Clarifier Tank t 1u` h / v'i 11 O OSCAR Mound Drainfield a Aro6\ 11 .;;;I'N\* v. _ � °PRO � ,1�)' ''.• , , i'i....r,��)- MASON CO.. 4 EP 1 12023 °J t UNr►'E i . �%luJlp: • 5100349Nl f jaw EALrr