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HomeMy WebLinkAboutSWG2023-00355 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00355 Parcel# 42216-52-00166 Applicant Name James&Valerie Vines Magee Subdivision (Name/Div/Block/Lot) Applicant Address P.O.Box 223 LAKE CUSHMAN#12 LOT 166 City, State, Zip Manzanita,OR 9730 Installer Name Maples Excavating Site Address 60 N Cod PI, Hoodsport Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pressure Bed Pretreatment Type >5 ft.from foundation? ❑ N/A [DYES ❑ No >50 ft.from wells? - ® ❑ ❑ _ >50 ft. from surface water? r 3-7,".r- ® 0 0 Q Cleanout between building and tank? - D III ❑ i- 0 o Tank baffles present? - ❑ f- 24"access risers over each compartment? ❑ ® ❑ O. • Effluent filter installed?- 0 I ❑ N Infiltrator Septic tank capacity(working) 1,060 qal Manufacturer o D-box water level and speed levelers used? ® NIA ❑YES ❑ NO oJ O Manifold/D-box accessible from surface? El e El o72 Check valves installed? 0 MI 0 0Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed(check one) . 2 ❑ 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- ❑ NM ® YES ❑ NO G >100 ft. from wells?- In 0 IDW >100 ft. from surface water?- 0 El LL >10 ft. from potable water lines? 0 III 0 zQ > 5 ft. from property lines and easements?- ❑ III 0 R' > 30 ft from downgradient curtain/foundation drains? II 0 0 ci Drainfield level and observation ports present 0 II ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed overdrainfield? ❑ I 0 Pump tank setbacks consistent with septic tank? ❑ NIA ® YES 0 NO • Pump tank capacity (flood) 1,287 gal Manufacturer Infiltrator Z Q 24" access riser(s) and accessible from surface? ❑ II ~ Alarm or Control Panel Installed? 0 0 El a f Control Panel equipped with Timerf ETM/Counter- 0 ID 0 o 4 Pump installed in El Bucket or ® On Block or 0 Other d f Pump Make/Model Zoeller N152 ® Floats or ElTransducer a a Tank draw down 1.5 in/min Pump capacity 38 qpm Squirt Height 12 ft Pump on time 1.5 Pump off time 6 hours Daily flow set at 228 qpd vwsea 5r.»1e 422. I10- 52 - Do1Colc Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD YEa NO Were existing septic components abantloneo as part of this prcieC? If yes, please describe. NO Were all components pumped cut and properly abandoned per WAC246-272A-0300? - ❑ YES RECORD DRAWING T al Record Drp'n a cnloln: Drnt record and must ne accurate and descriptive enough to to Mood+in the need of maintenance acng tivdities and future development vW wens,ob mnla:n: os eaamanand e main lance*.Saccess pourtmcomp ter,Nort.anmw.reserve Record Drawings may dcreate eddloonal delays in final lntslledcnn approval and related permits.e wrens,odurwaden pine.ae+nan.and other maintenance wxd points. 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 certify 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. ./7 4 1n/21�3 A /nature of Installer ate - .a, c S�1C'VN'� IL•u I'E . tea+ AQr`�f�I. Printed Name of Signee !ice i%- Ts,,, MASON COUNTY PUBLIC HEALTH H . �. mY JOHNSON The undersigned approves this Installation Report and it. PAULA JOY JO .. R Record Drawing on behalf of Mason CountyPublic �'[ ENE TJE5i NEp' / E%3 ,i Health: �� n I I"`�1 11116 it-3 1 1 -1-Z3 Signature of Envwnm tel Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uednedemrzwa , 1.2.5' Sca1-€: 1 10' 2. 3 6,6,, o as so ,o Asbul 1—c 1 t iP ES.Vq-ERE ViI,IESMK,E QnRCEc4*42211fl-51 ON b(o �'J�KE ` IZ. (o0 N GOD PLAGE SHED RQ — O2r r ZS' X 2S Cr O-o \ — ••=:;— o �. > • O ate © 0 e 4 [ ' 0 1 , o I \ � 1 ',� 2 E ERv, it 1 i O x 30 P RL.i M Pc'Ry , f ' = s E H � in3p , �tRk 'N7' ELO w P DINAR iI itcSERvrr APOVE y rM,, I 22' clq ti Rev: S Cop 62 , , A 1 Er O Audio-Visual Alarm pL 7 0 Cleanout '4C i 1D00 Gallon Septic Tank 2-Compartment with Effluent Filter 1, �, 3 1000 Gallon Pump Chamber Sc /i 130.34D �h iV' PAUUASJOY JOHNSON ;`K AP� LsY �srnn� rcHe-s R O yED 11—( —t 3 �asovC- 'NDV 16 2023 RFr " airL