Loading...
HomeMy WebLinkAboutSWG2023-00381 - SWG As-Built - 11/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT!PERMIT INFORMATION Permit Number SWG 2023-00381 Parcel # 22220-34-00030 Applicant Name Mona Cacciari Subdivision (Name/Div/Block/Lot) Applicant Address 6212 Avenida Cresta City, State, Zip La Jolla, CA 92037 Installer Name Bamford Septic Repair, LLC Site Address 12831 E State Rte 106, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST IN Full System Installation ❑Tank(s)Only ❑ Drainfield Only IN Repair ❑Other System Type OSCAR X02 Pretreatment Type OSCAR X02 >5 ft from foundation? D NIA ❑ YES Q NO >50 ft.from wells? - N ❑ 0 z >50 ft. from surface water? - ❑ ❑ MI 1.— Cleanout between building and tank? - ❑ © ❑ U Tank baffles present? - ❑ NI ❑ a 24"access risers over each compartment? ❑ II ❑ W Effluent filter installed?- 0 ❑ ❑ N Septic tank capacity(working) 1,500 gal Manufacturer Roth 0 D-box water level and speed levelers used? - 0 NM ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - 11‘20�w�kZ ❑ ❑ ❑ mZ Check valves installed? - - -a—Li- Qv^"W-AkO""k ❑ ❑ 0 04 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑� 5 ❑6 ❑CommerciallOther >10 ft.from foundation?- ❑ NIA ❑ YES ❑� NO CI >100 ft. from wells?- E ❑ ❑ W >100 ft. from surface water? - ❑ ❑ El I. >10 ft.from potable water lines? ❑� ❑ ❑ Q > 5 ft. from property lines and easements?- ❑ ❑ 0 d > 30 ft from downgradient curtain/foundation drains? - In ❑ ❑ Drainfield level and observation ports present - ❑ .1 ❑ ameba Cleargfc _I-i.,e.l?—r..ln,--k,,..j— Propercoverinstalledoverdrainfield? 0 0 ❑ Pump tank setbacks consistent with septic tank? - ❑ WA ® YES ❑ NO Y Pump tank capacity (flood) 1,500 gal Manufacturer Roth < 24' access riser(s) and accessible from surface?- ❑ Q ❑ F a Alarm or Control Panel Installed? ❑ • ❑ S Control Panel equipped with Timer/ETM/Counter ❑ • ❑ C Pump installed in ❑ Bucket or ❑ On Block or II Other on bottom of tank a Pump Make/Model AY McDonald E-30- 1/2hp, 115v ❑� Floats or ❑ Transducer 5 0. a Tank draw down -- in/min Pump capacity 30 gpm Squirt Height -- ft Pump on time 30 sec Pump off time 3 min Daily flow set at 600 gpd Jxa=d caiec,.a Parcel# Ztt zo- 3`+_ 0cO30 Mason County OSS Installation Report ABANDONMENT RECORD ® YES El NO If yes, please describe: 4` .ram Were existing septic components abandoned as part of this project,Il ZSY6C ® YES LI NO Were all components pumped out and properly abandoned per WA0246-272A-0300? RECORD DRAWING This is erecord and. bea and descriptive enough to relocate intheM activitiesnance and development TypicalR a b oaa+ns:contain oartemamar "m uo . a layout.5 vcupunv ia,xlocation. of _ s and proposed b le v .l ton of a does. e eate wells,observance,vane.deanouts and Omar mamanan�access points. i+�"vl•�ae=ooramns�mayaeases"al delays nnm n ' approval and relatedpermits. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER I certify that I tatl the system O EDordance" wh I certify dancwith t the system has the septic designbstamped installed by Co ntytP designHstampedthand "APPROVED"by Mason 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 andwn re have Masoneen cle Public Prov d by both all and Mason County Public Health and meet all State State myself and aso Countyouty Codes and her Mason Cy hty Codes. I further certify that all information contained on this I further certify that all informationraicontained toon this form and attached Record Drawing is accurate, form and attached Record Drawing is accurate. I_1 ' Z3 •. � Signature oflnstalle _ Date t b., mow.& 'dr— e' . f�Y'h_ Printetl Name of Sgnee y tt -. .+ A MASON COUNTY PUBLIC HEALTH j } ° ; The undersigned approves this Installation Report and s,uu,ae .. rj'� PAu r JOY rose:SoN 1,ih Record Drawing on behalf of Mason County Public F `j p4 . E'S114 i NER 1. Health: 11 (� 17— Ezm;ass Olin e ..) �vv l 1—t-1 '2,3 (stamp, signature and date) Signature of Environments Health Specialist Date uvm�.e wuo�a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE • 'k00v 0ANAL 0 oEM K, 5X10 'Tcc cc p?..." c FN ��$uLK HEM) vir -, , . 7. , .. _...z , 3 0 0 0 11 _ �� , ,,c_,,_ ,... „,.. • •1 :00? am _. m to, limey'' ..�. �,925 I 1 f So' r it i f GARA E eA,-. -o-� ¶h��-AN6 �� — E. 5-txVE Ro x-t koco— I ev; SC/A LE: V :-)-o: 0 Control Panel with Audio-Visual Alarm i.0 ,i0 w Si0 40 A57 II 2 Cleanout S- ,DUI\T' MONK GA�( l ARO 1,500 Gallon Septic/Aeration Tank 2-Compartment with air diffuser PA9LEt.rnfl 10 -3q'"0o 'C 3 1,500 Gallon Clarifier/Pump Tank 2...5nk E St. Q.t 1010 2-Compartment OHeadworks A -TEST Ho LE O OSCAR X02 Mound Grainfield .mot-#3 A 21- COLS, o� R� 2')-" -t 2, ay...,.,,e b��T^- -t.t-atL ukc N 'r APPROVED . . ' r t 2023 �r 'NOV 21 A1 .E�t iJr1soti "Jt 'V.l1Y: T!: 4��ih Cer['. 1. RE '°� PAO,AJoy 04q pl j_ ifrhSEOp�S NrR '''). ExTai.S a;;;;; 's'll H..-(1 Z >