Loading...
HomeMy WebLinkAboutSWG2020-00263 - SWG As-Built - 8/11/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00263 Parcel # 32104-58-00073 Applicant Name Pavel Bulubenchi Subdivision (Name/Div/Block/Lot) Applicant Address 1808 Circle Mountain Rd ALDERBROOK G &Y#9 TR 73 City, State, Zip New River,AZ 95097 Installer Name Mason County Excavating Site Address 240 E Susan Ln, Union, WA 98592 Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ C:'er System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - N/A ❑■ YES ❑ NO >50 ft, from wells? .� �!--- El - Z >50 ft. from surface water? - V �9 - - �[:1 ❑ ❑HCleanout between building and tank? - - - - 1U-L �' - �' ❑■ ❑ U Tank baffles present? - \ kr- - - I� ❑a 24"access risers over each compartment?-- - - - ❑ ❑I ❑ W Effluent filter installed?- •— `�__ - ❑ ❑ ❑■ fn Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - - ❑■ N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - III ❑ ❑ ME Check valves installed? - - -C--� �w" �' `43 - ❑ I ❑ E 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?- - I ❑ ❑ -1 >100 ft. from surface water? - - ❑■ ❑ ❑ w ti >10 ft. from potable water lines?- - ❑ D ❑ Z > 5 ft. from property lines and easements?- - El 0 E]Q Q > 30 ft. from downgradient curtain/foundation drains'? - - I] El Drainfield level and observation ports present - - ❑ UI ❑ ❑ Gravetess-chambers or ❑ Clean grovel uaed? (check en -) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - ❑ El ❑ aAlarm or Control Panel Installed? - - ❑ UI ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ © ❑ D a Pump installed in ❑ Bucket or ❑ On Block or 0] Other On bottom of tank a' Pump Make/Model Zoeller5031-0005, 19gpm, 1/2hp, 115v ❑ Floats or ❑ Transducer E a Tank draw down 1.25/ 10 min in/min Pump capacity 2.4 gpm Squirt Height n/a ft Pump on time 8.4 min Pump off time 1.84 hr Daily flow set at 240 gpd .. atec 8212018 if �2tc� _S�a— �00�3 Mason County OSS Installation ReAB Parcel#ANDONMENT RECORD YES 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 cal Record D s in a permanent record ma must be accurate layout. S p UPu^tP tank Vocation,Nor arrowescriptive enough to re4ocate in eeser�e dra field e>dsting and p need of maintenance roposed bus and ild ngs,lre ocation development weyswaterli es, Draw.o s contain:ports. eld&manifold ter on&ay wells,observation ports.dranous,and other maintenance access points. Incomplete Record Drawings may eeate additional delays in final installation approval and related permits. , I ICI w r, pI. p,UG 1 1 2023 MASON COUNTY ENVIRONMENTALHEALTH Record Drawing Attached a16� 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 4 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 atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. , . 01 11 ‘ --,Z Signature of installer ate A Pc\,la‘n kit k Printed Name of Signer !/��; 4.a� tea• il MASON COUNTY PUBLIC HEALTH -C'li li.. � 4 The undersigned approves this Installation Report and ..1 • �. tit. ��,PAULA JOY3JOHNSON Record Drawing on behalf of Mason County Public i r Health "L'tC�J$1' b�SiGN>:a" EXPIRES W%V�r 1 _Z�— 23 Sign ur vironmental Health Specialist DateS (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE °Panted 821/20/8 • ti •- • rao ' CTs' ____, / / AO iI jL ;'# I7 Dr.% i Q 1. illihm- . rte.__ a I 1 Resevo J . .. _ ph ..7-7- * -7,. ... ... -4 •OLD o •?: �C'"i • o I _-.. - . s . - 1 I-! I _��d •-1�1 I Ar--- ,.... ,. ytl I Pill I . tor i , tit, 0 • 1 Je e • i t D.F. 5t°Pe: .41- 0 1 jbrc , ay Z$' Fr.?• wit*_4V . E . S %AZAAA. Ln. j ? s 3 !O TAPPROVE ?I�v.Q i 3210�- 5 s- 00013 AUG 1 1 2023 ?LI D • s.vt.aso.ss•' MASON COUNTY ENVIRONMENTAL HEALTH - . lI Yu.�., (A r 9 859 2 J BW • O Audio-vg}3a1 Alarm t.., T. ' •A,‘Q). J~ O CIeanout ~°� 's O Nu. WWater BNR-500 Pretreatment Tank y IZ ` 1•1'••••s�, I. 44 1,000 Gallon Pump Chamber rp, 5100349 411 1^Q'‹' PAULA JOY JOHNSON'T OSubsurface Drip System Headworks EXpiRES i13a "7-24--23