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HomeMy WebLinkAboutSWG2023-00227 - SWG As-Built - 8/14/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00227 Parcel # 22230-23-00120 Applicant Name Brucee Stokes Subdivision (Name/Div/Block/Lot) 1 Applicant Address 25008 Green Mill Ave TR 12 OF GOVT LOT 3' &TAX 1038* City, State, Zip Santa Clara, CA 91321 Installer Name Maples Excavating Site Address 11181 E State Route 106, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST $c.. w:�tA. Drainfield Only0 Repair III Other Zoeller Solids Pump M264 ® Full System Installation ❑Tank(s)Only ❑ System Type Pressure Bed Pretreatment Type NuWater Bnr-500 >5 ft. from foundation? - - ❑ N/A ❑ YES 0 NO❑ >50 ft. from wells? - - 0 ❑ >50 ft. from surface water? - - ❑ ❑ Ill z ❑■ CIH Cleanout between building and tank? - ❑ V Tank baffles present? - ❑ 0 ❑ 1 224" access risers over each compartment?- - ❑ ❑ a. W Effluent filter installed?- ❑ co Infiltrator Septic tank capacity (working) NuWater BNR gal Manufacturer O D-box water level and speed levelers used? - - © N/A ❑ YES ❑ NO❑ �O Manifold/D-box accessible from surface?- - 0 ❑ co-2 Check valves installed? - - - - " ❑ 0 ❑ 0Q 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES 0 NO 0 >100 ft. from wells?- APP-R-av -Eo ❑ 0W >100 ft. from surface water? - ❑ EJ Er. >10 ft. from potable water lines?- - - - - -AU& 1+2(123- - ❑ Z > 5 ft. from property lines and easemer�}� ❑ 0 Q 1PfHS��I ubUNTY ENVIRONMENTAL YEA* ❑ Ce > 30 ft. from downgradient curtain/foundation drains?-GBH( © El Drainfield level and observation ports present - - ❑ ❑ 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 ;'5❑ N y; Manufacturer Roth Pump tank capacity (flood) 1,060 gal ❑ o < 24" access riser(s) and accessible from surface?- ❑ © i ❑ f, V. H Alarm or Control Panel Installed? ❑ i1 ❑ j a • Control Panel equipped with Timer 1 ETM /Counter i , n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other c__--_ p Zoeller N152 ■❑ Floats or ❑ Transduce0 � Pump Make/Model 0_ Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 4 ft Pump on time 0.8 min Pump off time 4 hours Daily flow set at 240 gpd Updated 8212018 Parcel# Mason County OSS Installation Report pg. 2 2223D -23- Do ►zo ABANDONMENT RECORD NO YES Were existing septic components abandoned as part of this project? - 1^a I o�v.Y. Y*e ,n xo•1ed O t . F. a.YJ ..r.t1_ ec) If yes, please describe: ib(YEs [ No Were all components pumped out and properly abandoned per WAC246-272A-0300? " to RECORD DRAWING proposed buildings,evecation of Typical rc This is a permanent record and must be accurate do,n&layoutaSepd pump tank Iocatave enough to �Norh arrow,reserve drainfield exs ng and sefuture development wells,waterlines,Re Dravrings contain: Drainfield&manifoltl orients Y in 5na1 instaAat:on approval and related perm wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may aeate additional delays 0 i i IF 1 VE AUG 14 2023 MASON COUNTY ENVIRONMENTAL HEALTH JB 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 1 further certify that all information contained on this I further certify that ail information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. /? % -- D1 l2o 23 Signature of Installer ate t:;1 Printed Name of SigneeIpP0 IV,1,0‘. MASON COUNTY PUBLIC HEALTH ��. , The undersigned approves this Installation Report and r. T, Nf� 5100347 �,f Rec Drawing on behalf of Mason County Public PAULA JOY JOHNSON tiZ H alth. d ,�V� _ ems,x i� �� z3 2�Z1- date) Sign ure o ironmental Health Specialist Date (stamp, signature and THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Jpa;Ev Ba t 23'8 i. . --_ 0 4 SRN PO ✓t.- J 60` -6L,J,K (-50L.0 , c.0:A, k! Q,' Q o 0 ' P E-NIS-\---Cn cZ 35.X.;..--- e ,e),c . a,.--c , -c-i -,4 , , " d a 1)99i} , czPikcE c '. \ 6- .,'1' '11 -1.5')aq' - ...a , 13 :ell\ 111104 0 p bs . ,....-- O't• SLOPE O ____.... ��� �ETRINANC7 `nr�tLL i0�' p�Z,OP�Zy Ltiv� _„�$1 MSA -ram E -c'E c `�-- ter' Len j r a Audio-Visual Alarm < tc t3 2� �`Iv� 3 Cleanout 0 5 0NuWater BNR-500 ATU Ta: 9.\A 0`(-,ES O 1,000 Gallon Pump Chain12 12.C, --t.- 3a-2.75 -C'0-24CD PLIJA/T b a S _111.il_ __S_L_A—- -g°\---L-f4-----ki 1°& / c, h „...„.„....,,,, _________,_ , bv\, ,,, , PiKwNe -4 4 PA).--,.e 'i3.,._s ... , PH uVEA 0'4-'0, 14"6 I 4 2023 ;V:: \ , ..I.T•'t o, `% ON9ENTAL[: H 0...,,,,4_ vt....y....a_cu-cuktkvzs .0;4. 1 rPS�k �Jto r= 4;!`,. S1 Q 49 :S Nc PAULA JOY3JOHNSON. _ 'iCalSttl1%giaiVI:. . �EPRsL4gee:-