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HomeMy WebLinkAboutSWG2023-00208 - SWG As-Built - 8/15/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00208 Parcel # 32106-12-00020 Applicant Name Tami Hendrickson Subdivision (Name/Div/Block/Lot) Applicant Address 120 Dorsey Street TR 2 OF GOVT LOT 1 &TAX 703G-1 City, State, Zip Cincinnati, OH 45202 Installer Name Bamford Septic Repair Site Address 3971 E State Route 106, Union Designer Name Arrow Septic Designs INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other OSCAR X02 System Type OSCAR Mound- below grade Pretreatment Type >5 ft. from foundation? YES 0 NO - 1 ❑ N/A ❑ ❑ >50 ft. from wells? • >50 ft.from surface water? - - ❑ 0 ❑ Z ■ El • Cleanout between building and tank? - 7,, ,rcr 71T/n- - ❑ U Tank baffles present? - 0 0 ❑ d24" access risers over each compartment?- - ❑ 0 Cl W Effluent filter installed?- L�y�— — - 1 El El ❑ ❑ N Sound Placement XO2 Septic tank capacity (working) 1,000 gal Manufacturer O D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?- - ❑ 0 0 COZ Check valves installed? - �,-\-- 'p_`~'w` ❑ 0 0 64 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - ❑ N/A YES ❑ NO _ bri ❑ ❑ ci >100 ft. from wells? A �54,o--c- - Trees.;<.r_ V ❑■ W >100 ft. from surface water? � z E u. >10 ft.from potable water lines?- - ❑ z ?- - - - - -1144 c'oUN_ - -- 23 ,,0 ❑ Q - > 5 ft. from property lines and easements. �4�! rt > 30 ft. from downgradient curtain/foundation drains? �RcfNttic N5ti`. ❑ ❑ 0 Drainfield level and observation ports present - jam 0 ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,428 gal Manufacturer Sound Placement-2-compartment Z < 24" access riser(s) and accessible from surface? ❑ El ❑ N Alarm or Control Panel Installed? - - ❑ 0 a ❑ 2 Control Panel equipped with Timer/ETM /Counter- - - - ❑ d Pump installed in ❑ Bucket or ❑ On Block or 0 Other on bottom of tank a• Pump Make/Model AYMcDonald E-30, 30gmp,115v,1/2hp 0 Floats or ❑ Transducer p capacity -- in/min Pum ca acit 1.75 gpm Squirt Height -- ft a. Tank draw down Pump on time 30 sec Pump off time 3 min Daily flow set at 240 gpd upcated 8.2'!2C 3 Parcel## -32-10f:)" IZ—DCO20 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD - YES 0 NO Were existing septic components abandoned as part of this project? F�Mo� "�AI If yes; please describe: O k a D•c-. a- -d e� ) a` Y - 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 K en ac ties and future development Typical Record ."��.� � sad buildings,location of wells,waterlines, Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow.res- ,k -Id,ewstin p 9 wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawingprtay cr, additional delaO tallation approval and related permits. 4CoN0EGOUTy IS F 1 : /�F' NT Fq�Tti tRecord 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 1 further certify that all information contained on this i further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of instafle 2DD8te Z 5A &c., , , ....„;.* _ 4..c. ,,,,,,, Printed Name of Signee IRV. •oT*"• •'>*1}, MASON COUNTY PUBLIC HEALTH • O g 'Ri. lP�, The undersigned approves this Installation Report and ;11 y-7'', 510.349 •;h Y• Re rd Drawing on behalf of Mason County Public �P{AULA JOY JOHNSON \r Heal tJS� USi� EXPIRES W sI C Sig at #� nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated arzt/2ctc „- _ 4 Tam. }�esldr1C_5o, �, f, „1 32f o 6-12- 00020 3 71 S+a- RO Ot>r (o 6 Sca ,e: I "- 20` 0 to 20 30 y° 42.47, Boa.1' rc►rn p g” 1 i Co 0 o-cr ;, Qd lai ' Th I peck r Ir Usr- � voO1 EX' S�'in anise ,.r ,k + 2 6 Ek i 0 o f dt �.se .. p ©i Doc R ..f. -,.. e 1--- i !only a s. o 0 1 , ,::, 1 1 LI 00-41:13:1 .r co T rr nomin p : E- c5 C _o j -xt5$; hq J a c L=—r Uacage L G Said >i! A ' " E AUG 15 2023 allillI . ��'''� MASON COUNTY ENVIRONMENTAL C Control Panel with Audio-Visual Alarm HEALTH 0 Clear,out \ /` 2_ 4q /'� 3 By 1 Q 1.000 GaRoa Septic/He=-acrnTank 1/`JT (�.J�� (�pJ� 2-Compartment with air diffuser ( 1,2S0 Gallon Clarifier/Pump Tank �\ / 4?'.) 2-Compartment �� O Headwork& ` 1S K 9f fr _o1 ?yam\ > G OSCAR X02 Mound Drainfield �i� j Z�j 7,�s-4slu.��S.euo C�w4L ? •'349 • eSt:tr'''SaiijOYDjaH•t4s9 N -c:czi -.s---s 3-1-1 MI-„,_c,c,)si4b b-3'23