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HomeMy WebLinkAboutSWG2021-00323 - SWG As-Built - 11/15/2023 or ' Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2021-00323 Parcel # 32109-50-00067 Applicant Name Olive Construction Subdivision (Name/Div/Block/Lot) Applicant Address 210 E Emerald Lake Dr W ALDERBROOK G &Y#5 TR 67 DIV 5 City. State, Zip Grapeview,WA 98546 Installer Name TJ's Excavating Site Address 21 E Blueberry Hill, Union Designer Name Arow Septic Designs, Inc INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair a Othe- boo gallon ore-crash tars System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? ❑ N/A MI YES ❑ NO >50 ft.from wells? - NI ❑ ❑ Z >50 ft.from surface water? - ❑� ❑ ❑ <4 Cleanout between building and tank? - ❑ ❑� ❑ 0 Tank baffles present? - ❑ ❑� ❑ d 24"access risers over each compartment?- es' ❑ El W Effluent filter installed?- I. ❑ ❑ w Bloc Septic tank capacity(working) NuWater 500 gal Manufacturer Hagerman 0 D-ocx water level and speed levelers used? - © NIA ❑ YES ❑ NO QO Manifold/D-box accessible from surface?- - El • ❑ mZ Check valves installed? - - ❑ 0 ❑ 04 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 02 03 04 ❑ 5 ❑6 0 Commercial/Other >10 ft. from foundation? - ❑ N/A ❑� YES ❑ NO CI >100 ft. from wells?- - ❑� ❑ ❑ W >100 ft. from surface water? - ❑� ❑ ❑ Li >10 ft. from potable water Ines?- ❑ Q ❑ Q > 5 ft from property lines and easements? ❑ 0 ❑ K > 30 ft. from downgradient curtain/foundation drains?- - Ill ❑ ❑ 0 Drainfield level and observation ports present - ❑ El ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? ❑ N/A Q YES ❑ NO `t Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z I— a. 24' access riser(s) and accessible from surface? . . . ❑ I. El Alarm or Control Panel Installed? ❑ Q ❑ j Control Panel equipped with Timer/ETM/Counter- ❑ IN - Pump installed in ❑ Bucket or ❑� On Block or ❑ Other S• Pump Make/Model Liberty 280 0 Floats or Transducer a Tank draw dowi 2.2 in/min Pump capacity 45 gpm Squirt Height 5.5 ft Pump on time 2 min Pump off time 6 hours Daily flow set at 360 gpd Mason County OSS Installation Report pg. 2 Parcel# 3Z1 D9-5O- coo 61 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ Yee ❑ NO RECORD DRAWING This a permanent record w mat be eccunte end deecdW.e enough to maocate in the need of maintenance activities and hwm e..+eom.ne Typical Rend travelogs°oaten' oNrt.0&manifold cne,mtlm&layout Septa/pump tank!Oaften.NOT arrow.reserve draEMdd.existing mE proposed bats buom of vests,xatera,ee. ..me owamton pans,dame,and other nunrsanm access poems. Inmflete Record Drinking May tetra*edmdonei deign in Oral Malabar,epnd+d and related Permits. r /vmVA ^vlJf 4 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 ascot- 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 hem 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 form and attached Re m, Drawing is accurate. form and attached Record Drawing is accurate. �'> - ,' IC/I2723 Signature fln Iler date i'r� 711 &icaj .4 Printed Name of Signee �`c 4....0 f}A MASON COUNTY PUBLIC HEALTHFirr;:ltS� The undersigned approves this Installation Report and .d Record Drawing on behalf of Mason County Public k • '^np'av rXil 4 PP Ur&p JOHNS DN1': '� Health: ( LICKN I Ub l.Gi R y), Lo Z.a -Z3 Signature of Environment l Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE FFIFF0 411212p15 • 153.‘.3' l ( 9 O 0 s9 {{- i I, I Dr 'a aesCYve, �o� L Atrect. ' Fly —I' HV r ` III II Olive C,orakrLnvl'ion. ?nrctl 32 006? I _ "� Q o ' 2( EBivtbirrti H 11 s- ` 1 — CD , I I o 10 20 3a va 1 17Y \VtWIjVA / n ; r 'rr PAULA YJCI tNSUN ':".vh. 1SS»T`.S C,SxC Fsnfc, n 3 esr�.�. Ol Audio-Visual Alarm \ OC1ean01L 3 500 Galion Pre-Trash rank Y �N O4 NuWater BNR-500 ATti Taak 1n p,'rw �\ii), }�511— Os 1,000 Gallon Pump Chamber . — F 3�+ I$$1ll•ebf(CU OValve Control Box APPROVER (K) 3x35 (2) 3'x30 1Aa r prirj �raLN-iZ1.6 NOV 15 2023 '-rt,NGAnts 0 y .SrWIn VASO'rC.,nii0'r�4:.SM;.�1-'- HeAL'i Ov w� ^ g00saTt, Yip rQSGYv�- PET