HomeMy WebLinkAboutSWG2022-00518 - SWG As-Built - 11/14/2023 Mason County OSS Installation Report pg. v Qci i M• .ON COUNTY PUBLIC HEALTH
APPLICANT/ I l RIVi T INFO' TATIllaill
r• B Permit Number SWG 2022-00518 Iarr.e. • - I 50-00072
Applicant Name CURTIS SPROGE _- 3'ab(Ilvision (IVarne/Div/Block/Lot)
Applicant Address 7613 FOREST PARK DR NW
City, State, Zip OLYMPIA, WA_ 98502 itibt Mei Name SCHOENING EXCAVATION
Site Address 75 NE HAVE LANE 11%signer Name CINDY WAITE
INSTALLAhION CHECKL 'ST
® Full System Installation ❑Tark(s) Only ❑ iii lin,,I r my ❑ Repair ❑ Other
System Type OSCAR Pretreatment Type BNR NUWATER 600
>5 ft from foundation? - - - - -- - - - - - - - - - - ❑ NIA A YES ❑ NO
>50 ft from wells - - - - - - - - - - - - - - - - - _ _ _ _ ._ _ ;1 El Et ❑
Z >50 ft from surface water? - _ .: . _ _ _ _ _ _ . _ LI ❑� Li
r Cleanout between building and tank' --- - '— I ?p7' - ❑ 0 ❑
O Tank baffles present? - - - - - . . ❑ U ❑
a24" access risers over each compartment"- - - - - - .
rW Effluent filter installed? - _ __ - • ❑ ❑
Septic tank size 1060 gal ilai Mar iei INFILTRATOR
0 D-box water level and speed levelers used - - dal N/A ❑ YES ❑ NO
-_J
XO Manifold/D-box accessible from surface?- - - - - - - - - - - - - El [ ❑
ui
QQCheck valves installed? - - - [00 ❑
2 Transport Line Size 1"(SUPPLY AND RETURto) Idctieciule,iClass SCHEDULE 40
Bedrooms installed (check one) El 2 ❑ 3 14 ] b ❑6 ❑Commercial/Other
>10 ft from foundation? - - - - - 0 NIA L. YES ❑ NO
O >100ft. from wels?- - -. _ _ _ _ _ . - - _ . . 1_JI U ❑
W >100 ft from surface water? - - - - - - - - - - - [,I . ❑
r_ >10 ft from potable water lines?- - - - - ❑ 0 ❑
Z- > 5 ft from property Imes and easements?-- - - -
a ❑ o ❑
cc > 30 ft from downgradient CU tare tour.fatio I •na ? la ❑ [il
o
Drainfield level and observation ports present - - - - C1 I. Ci
❑ Graveless chambers or ❑ Clean tan,t,'. a..-t „ r noel
Proper cover installed over drainfield?- - - - - - LI El El
Pump tank setbacks consistent with septic tank' • YES ❑ No
2 Pump tank size 1060 _gal Nlkn ,fl i c _ lfdEILI RAI OR
_ .
Q 24 access riser(s) and accessible from surfaces - --- - ❑ El ❑
CAlarm or Control Panel Installed? - - - ❑ Q ❑
2 Control Panel equipped witn Timer/ ETM Cnur1n - - - - ❑ [I El
D
a Pump installed in 0 Bucket or
Hj
CL
2 Pump Make/Model PER O CAri _ - Ti i In its or ❑ transducui
dTank draw down it/mn- lid 6 r.li Sgdl • I I ',„iht f'
Pump on time ,i r I Id, -ot it __ TAU
Parcel o- 22330-50-00072
Mason County OSS Installation Report pg. 2
ABANDONMEN ; RECORD
Were existing septic components abandoned as pan of Di, [ mini '' - - -- - YES • NO
If yes, please describe:
Were all components pumped out and properly ahar iorod r. Wilt' 27:U A% ❑ YES ❑ NO
RECORD DRAWING
This permanent record and must be accurate a descriptive n t.. II the cc.ai tit mairmininve activities and future acvelopne ir Ion .tl ueroul
Dra ,q. a field x marxod orenit a . l .nt.,iII tu,c ,.¢Fills r1a'I.e darer'e
weu . oervaten Eons.cleanonrs.am o.per a.._ r ,si _i.ued ,,.;wls
n4 (:Ii ,/ I .r..� if"'' l,
, CI, r_,
❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
I certify that I installed the system in accordance with I featly that the system has been installed in accor-
the septic design stamped "APPROVED'by Mason dance Lath 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 deslyncl r en het ha✓e bcon cleared/approved by both
and Mason County Public Health and meet all Stab rnve;oi'f and Mason County Public Health and moot all
and Mason County Codes s and Mason County Codes
I further certify that all lnfonnatron contained DI) info I gnt,hel rcrtrfy Ihal vll nrtomrahon contained on this
form and attached Record Drawing is accurate form am]attached Record Drawing is accurate
Sly/labile of Installer Datrr
tit P L
Bra d� Sets e� ,. 9 1
Printed Name of Signee sa'�6 vc b \]yU�
m
MASON COUNTY PUBLIC HEALTH _.. 0�owle 1t
The undersigned approves this Installation Renoir and LCE�NSEp DESIGNER
Record Drawing on behalf of Masora County Pr biro tSsi.nccc<c—
Health:
Signature of Environmental Health Specialist Date (stamp. ,signature and date)
THIS FORM MAY BF SCANNEDANDA/A AHI I,I-(il Ill In HE ra II-IF MASON ¢OUNrY WEB SP II -� -
1. 1060 INFILTRATOR TANK WITH BNR600
2. 1060 INFILITRATOR PUMP TANK 1
3. OSCAR DRAINFIELD
4. EXISTING WELL TO DECOMMISSIONED I,-lb
5. EXISTING CABIN
6. PROPOSED WELL SI1tE
7. AUDIO VISUAL ALARM I ^,
8. CLEAN OUT
9. PROPOSED RESERVE AREA ,
1b. . .ClcWJ1 P.454 to v'.Ix I"f
/1 ? <� �L' ..,, , ' APPROVED
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