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HomeMy WebLinkAboutSWG2019-00186 - SWG As-Built - 9/27/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2019-00186 Parcel# 42212-50-14001 Applicant Name Blase Cylwik Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1806 HOODSPORT BLK: 14 LOTS: 1-11 AF#2123479 City, State, Zip Hoodsport,WA 98548 Installer Name Scott Johnson Site Address 134 N Harrison Ave, Hoodsport Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair Other 500 gallon pre-trash tank System Type OSCAR Pretreatment Type NuWater BNR-500 >5 ft.from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - © ❑ 0 Z >50 ft. from surface water? - - 0 El H Cleanout between building and tank? - - ❑ X ❑ O Tank baffles present? - - 0 © ❑ a24" access risers over each compartment?- - 0 ® ❑ W Effluent filter installed?- - ® 0 ❑ co Septic tank capacity(working) NuWater BNR gal Manufacturer Hagerman CI D-box water level and speed levelers used? - - ❑■ NIA ❑ YES ❑ NO p0 Manifold/D-box accessible from surface?- - © ❑ 0 D3 Check valves installed? - - I 0 0 th Q E Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO CI >100 ft. from wells?- - 0 ❑ ❑ W >100 ft. from surface water?- - D ❑ ❑ LL >10 ft. from potable water lines?- - ❑ U 0 Z > 5 ft. from property lines and easements?- - ❑ ® ❑ ec > 30 ft. from downgradient curtain/foundation drains?- - 0 ❑ ❑ Drainfield level and observation ports present - - ❑ 0 ❑ ❑ CrQVCIC93 chambcra or ❑ Clean grovel u3cd? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24"access riser(s) and accessible from surface?- - ❑ El ❑ r a Alarm or Control Panel Installed? - - ❑ ® ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ I 0 a Pump installed in ❑ Bucket or ❑ On Block or li Other Tube n'• Pump Make/Model AY McDonald 22050EAJ ❑U Floats or 0 Transducer 0. a Tank draw down — in/min Pump capacity 30 gpm Squirt Height — ft Pump on time 22 seconds Pump off time 3 min,44 sec Daily flow set at 240 gpd Upda•.ed S'21,20'.S � Mason County OSS Installation ReportParcel# G 2 I 2'50- t Got ABANDONMENT 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 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 nk .North arrow.reserve d.existing and weds,o s contain: ans,cle &manifold other maintenaentation&ayout.Septic/PumP nce access points. Incomplete nRecord Drawings may createt additional delays inf nalliinstal installation approvn of val anderlelatedtpelrmits. wells,observation ports.Ueanouts.and• r KRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 certify that all information contained on this I further certify that all information contained on this for and attached Record D wing is curate. form and attached Record Drawing is accurate. Signature of Install / 1/14t(23Date , •. , SCO ahvlso h .i •�� qr Printed Name of Signee ° iti,11),, . � •r � MASON COUNTY PUBLIC HEALTH (+ ,.;4j , The undersigned approves this Installation Report and ,fir?` •, 9 yr ' PAULA JOHNSON Record Drawing on behalf of Mason County Public a. PAULA JOY .NSON Health. EXPIRES I 111,—)(13 -- ZdO---nt:1 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/212018 -'4 1-k 0 / Jae • 25'. Vii\ tAArg 30' �� COX_� �s o. V{1 ©�- v. stops 20-'X 30' _ • 0 05Ca'r© ! v, sty-vet a 0' y wa rlin{ !, . I,Viz pin hei2. — L 4-ts too 51 4 / • ?rota/ 4-7 1 s been, (Zi./0-t, . coN.Lqnexi/ex fomz\ed _____ta 442-2-1/- 1) \ NI 5-tv\ (--e- -- 21vYle g4e1(iv-, 34t- Audio-Visual Alarm ' Q Oi Audio- a�f. o� lb O2 Cieanout ahi1.. . 1 O 3 NuWater BNR-500 Pretreatment Tank .,---,(�.• 51G0349 : r_srj !IS-. PAULA JOY JOHNSON \ LiC�tS�tlp�SiGNE'it;V O4 1,000 Gallon Single Compartment ij^ct� `. i Pum Ober/Clarifier �� �-a1�s 'fix 9 -ZQ-2'3 OOSCAR Mound Drainfield APPROVED . SEP 2 7 2023 MASON COUNT``ENVIRONMENTAL HEALTF', RET