HomeMy WebLinkAboutSWG2023-00092 - SWG As-Built - 9/27/2023 pl , CC
Mason County OSS Installation Report pg. 1 LA MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2_07_3 boo 9 Z Parcel# 'tZZ Z 3 SooeOON D
Applicant Name '-Co* X/'4,4-t e;-- Subdivision (Name/Div/Block/Lot)
Applicant Address of t CI(P C-L4'r0C ,qr;L'F /
City, State, Zip 230i Z /V ,i /G•`1 y /o / Installer Name /rt cya/ 1 vr/`
Site Address )yG16,G'5/1e i bv/¢ `r ) Designer Name 4i).4N1 ,4--/vitirc,ez 4 455
INSTALLATION CHECKLIST
$Full System Installation ❑Tank(s)Only ❑ Drainfield Only falltepair ❑Other
System Type 0 5C a X 0 Z Pretreatment Type 4711 `- 4
>5 ft. from foundation? - } A YES El
>50 ft. from wells? - k-r''-- 11 ) El
Z >50 ft. from surface water? - 1.
- 1)-12�0- 1I, L, '4-fr 0 0
< Cleanout between building and tank? - `-j IL' ❑
V Tank baffles present? - - ❑ ❑
a24"access risers over each compartment?- : ❑
Itu Effluent filter installed?- - ii4 ❑ ❑
d Cl)
Septic tank size /.2 5-0 gal Manufacturer Soc>N./ / 4C.e/yc.c,..,. I-
Si D-box water level and speed levelers used? - - El NIA ❑ YES ❑ NO
O0 Manifold/D-box accessible from surface?-l�-¢ / - El ❑ 0
0°Z Check valves installed? - I/ V - El ❑ 0
[]Q
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) El 2 0.3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A gl YES ❑ NO
CI >100 ft.from wells?- - 0 iic4IR„-- ❑ X
w >100 ft. from surface water? - - 0 ❑ -CI-
LT >10 ft. from potable water lines?- - ❑ a ❑
Z > 5 ft. from property lines and easements?- - Elg- Eld > 30 ft. from downgradient curtain/foundation drains?- - ❑ El
Drainfield level and observation ports present - - 0 ON,....
❑
0 Graveless chambers or 0 Clean gravel used? (check one) 4S r n 3 3 SAN'd
Proper cover installed over drainfield?- - ❑ 0 El
Pump tank setbacks consistant with septic tank?- - . N/A YES ❑ NO
• Pump tank size 56' gal Manufacturer � ,v r,, . 1L- 1----
< 24"access riser(s)and accessible from surface?- - ❑ 24 ❑
aAlarm or Control Panel Installed? - - 0 J- El
• Control Panel equipped with Timer/ETM/Counter- - 0 kl. ❑
n- Pump installed in 0 Bucket or 0-On Block or ❑ Other
2 Pump Make/Model ervi9r/-6,ri? C 5 Co-,' X C' Z. 2f-floats or ❑ Transducer
pR„ Tank draw down in/min Pump capacity 3 qpm Squirt Height /t/ -I4- ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abadoned as part of thi proj� ❑? - - 1'ES NO
If yes, please describe: ��cpo h4A1 e4ij11 A i2 it r7 Id mc_ 4 A' V_
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES ❑ NO
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 contain: Drainfield&manifold orientation&layout.Septic/pump tank location.North arrow,reserve drainfieki,existing and proposed buildings,location of wells,waterlines.
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
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As '�ZI�
❑ 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
I further c ify that all information contained on this I further certify that all information contained on this
form a c Record Drawing is accurate. form and attached Record Drawing is accurate.
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Sign of 1 staler Date S �' /
-) /its /" ` C gyp, /,/�/ �� 1�/
►/ �lc/ y . :
Punted Name of Signee /4. .•?'+�'
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.;. .�.•
•
MASON COUNTY PUBLIC HEALTH i V., ••ks
•
The undersigned approves this Installation Report and 4�' '.1'++
Record Drawing on behalf of Mason County Public !' s,°°„s %`
ADAM J,HUNTER
Health: `� i 4`Ciiq. t512S'G lt=• .
WWI& %
(OVAI 7 .%' ' �«t •�
( rvj� u:,f1�
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Signature of Environmen!a!Health Specialist Date
(stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8212018
OSCAR-X02 Check List
Date: O t o V
Re: OSCAR-X02 installation at:
Address: 2-30ZZ A) /-/(41/' /o /
Tax #: GtZ2z3.5orocovro
This letter is to confirm that the system installed at the above listed address
was installed as per Lowridge Onsite Technologies, Inc.s specifications.
Pressure & Flow:
Pressures on the OSCAR headworks:
Dosing: G1 = "ID psi, G2= 50 psi, G3= '' psi
Dose flow rate= 12 gpm
Treatment tank:
Patrician tee baffle bottom/by-pass hole at 40-60% of liquid depth
Yes: � No:
Discharge tank:
Patrician by-pass hole at 18" to 27" above floor Yes: - , No:
Aeration:
Diffusers close to partition wall Yes: , No:
Aerator in dry location Yes: , No:
Aerator operable Yes:-& , No:
Current sensor operable Yes: X , No:
Installation:
OSCAR:
Correct number of coils: Yes: , No: 3
Correct coil arrangement: Yes: >Z , No:
Inspection ports: Yes: )C , No:
Proper sand depth: Yes: /- , No:
Floats set correctly: Yes: )( , No:
Timer settings correct: Yes: ) , No:
Basal preparation according OSCAR
Installation manual: Yes: )4— , No:
Certified Installers Signature: (J-i(A.
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