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HomeMy WebLinkAboutSWG2023-00398 - SWG As-Built - 10/24/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00398 Parcel # 32104-54-00049 Applicant Name Pam 8 William Adkins Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1180 ALDERBROOK G 8 Y#4 TR:49 City. State, Zip Sugarloaf, CA 92386 Installer Name Bamford Septic Repair Site Address 641 E Jack Pine Ln, Union Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation 0 Tank(s)Only ❑ Drainfield Only Q Repair 0 Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? ❑ N/A 1.YES ❑ NO >50 ft. from wells? 0 ❑ ❑ Z• >50 ft. from surface water? ❑■ ❑ ❑ f Cleanout between building and tank? 0 I5 0 U Tank baffles present? 0 ® 0 Q 24"access risers over each compartment?- 0 ® 0 W Effluent filter installed? ' 0 ® 0 co Septic tank capacity(working) 1,250 gal Manufacturer Snyder 0 D-box water level and speed levelers used? - ❑■ N/A 0 YES ❑ NO J 0 © 0 OO Manifold/D-box accessible from surfaces - - Dili Check valves installed? OJ-F- -i 9. 0 I ❑ Inc 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed(check one) 0 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation? ❑ N/A In YES ❑ NO Q >100 ft. from wells? IN 0 0 W >100 ft.from surface water? ' f__ ^� , - ® 0 ❑ ��, LL >10 ft. from potable water lines? "'_"`r ❑ 0 rRno �i--? Q > 5 ft. from property lines and easements? . 0 II L< s K > 30 ft. from downgradtent curtain/foundation drams? - - - I• El 1-1-- • Drainfield level and observation ports present ❑ ® ❑t - yL t 0 Graveless chambers or ❑ Clean gravel used? (check one) t -- ^� Proper cover installed over tlrainfield? 0 I ❑ j y 4 Pump tank setbacks consistent with septic tank?- ❑ N/A It YES ❑ 1 i, l� `L Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator 1 syskn Q 24' access riser(s) and accessible from surface? 0 II 0 1 Alarm or Control Panel Installed? ❑ . ❑ `d Control Panel equipped with Timer/ETM /Counter ❑ . ❑ 2 O. Pump installed in D Bucket or ® On Block or 0 Other O.E Pump Make/Model Zoeller NI52D 0 Floats or 0 Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 8 ft Pump on time 1.8 minutes Pump off time 6 hours Daily flow set at 360 gpd Jpcaied sn ao,8 Mason County OSS Installation Report pg. 2 Parcel# 32i 0A- 54- 0004c1 ABANDONMENT RECORD y Were existing septic componentsn abandonedn as part of this project? YES NO It yes, please describe. O \d *m- y4A'40 QC_d, Old D.F' asioantebue Were all components pumped out and properly abandoned per WAC246-272A-030Co L YES 0 NO RECORD DRAWING This pe anent re cord and must be d descriptive enough to re-locre in the e of maintenance actIvMesand future development- Try I ReCord w nes wails 95maton era.fi eaEmanand otn nw Slayout,s p o p ok - " - r f L S G pna r IC.o , d li, el wells,oGservavon pots,tleaneu s,anc onn maintenance points. lrw. Flele Recoro eravi..5 may e....anal delays �sr la o. approval :elated pmrns. L v Record Drawing Attached CERTIFICATION OF INSTALLATION 7' 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 furthercertify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Attk Signature of Installe Date Printed Name of Signee 'i" 4. 1 S(5, at 0 ; `m J MASON COUNTY PUBLIC HEALTH " t :024G .*, The undersigned approves this Installation Report and Q. PAUTA JOY JOHNSON Record Drawing on behalf of Mason County Public J -CICKNSELMESGNEN- ,� =cc�Era �§ilE/ Health: ire`of En l `vi'roon" Signature mental Health Specialist Date (stamp, signature and date) THIS sORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE .P"tet am¢ce - E PhkNT 1:2,ush LN - -- `QC o to 2e 30 4 Wq7 Asbu' 1 t PAM *\JJ\WW \ kv# ws APPROVED FApx.C-at 32.to44-59-0001q _`i OCT 24 2023 N ' ct 3AGk {�lN� k-N) L6 MAS0�4CO���M1TYEnV9,d0tiMENT4LHEALiH y RET S x7 Ly•I l' bE 1 i ck Q4. (5) 3x40 primar� �-yF �— din l�td br�u clues ® " � 5 D-C. 3 O O O I -2 <, 0 • xv: G O Audio-Visual Alan • :'IA i 0 Cleanout i- 31200 Gallon Septic Tank D�! �R111� •.l- 2-Compar'haent with .,, � 11` Effluent Filter ��.. a IILA eV JONH50N ' E C J hgk P N ti— c sD T yccc 0 3 1000 Gallon Pump Chamoe FJwnu ttsiG w-74u- e..,F:- s:15`,, CValve Control Box ® Sleeved toziedivw