HomeMy WebLinkAboutSWG2023-00121 - SWG As-Built - 10/17/2023 1 'rL
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Mason County OSS Installation Report pg. 1 MASON COUNTY P BLIC_HL� Ff1u
APPLICANT/ PERMIT INFORMATION 44 t
Permit Number SWG 2023-00121 Parcel# 32231-44-00060
Applicant Name Jesse Carpenter Subdivision (Name/Div/Block/Lot)
Applicant Address 8836 N Edison St TR 6 OF SE SE
City, State., Zip Portland, OR 97203 Installer Name Arrow Excavating
Site Address 151 E Skyview Dr, Union Designer Name Arrow Septic Design
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Dra'intield Only D Repair MI Other 500 gallon pie-vam ask
System Type Subsurface Drip Pretreatment Type NuWater BNR-500
>5 ft.from foundation? - i ❑ NIA 0 YES 0 NO
>50 ft. from wells? ' • . IR ❑ 0
Z >50 ft. from surface water? IN ❑ 0
f Cleanout between building and tank? - El ® ❑
O Tank baffles present? - •'-`�' - ❑ ® ❑
d 24"access risers over each compartment? ElII ❑
W Effluent filter installed?- 0 ❑ ❑
co goo iP
Septic tank capacity(working) NuWater BNR-gal Manufacturer Hagerman
0 D-box water level and speed levelers used? ® NIA ❑YES ❑ NO
DOLL Manifold/D-box accessible from surface?--�gfitbkl lr.5 ❑ ® 0
GQCheck valves installed? ❑ 0 0
2 Transport Line Size 1 inch Schedule/Class 40
Bedrooms installed(check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- ❑ NIA Q YES ❑ NO
O >100 ft.from wells? ® 0 0
W >100 ft.from surface water?- ® ❑ 0
a >10 ft. from potable water lines? ❑ II 0
Z > 5 ft from property lines and easements?- 0 i 0
a
cc > 30 ft from downgradient curtain/foundation drains? Q ❑ 0
0 Drainfield level and observation ports present - ❑ IN ❑
0 Ga.,.kay.,Lamba., a. ❑ GI..a..ymAd-B .«
Proper cover installed over drainfield? 0 ® 0
Pump tank setbacks consistent with septic tank? 0 N/A ® YES ❑ NO
• Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
Z
Q 24"access riser(s)and accessible from surface? ❑ El E
F0. Alarm or Control Panel Installed? 0 NI El
-
E Control Panel equipped with Timer/ETM /Counter ❑ ® ❑
n
a_ Pump installed in ❑ Bucket or 0 On Block or • Other in tube
a Pump Make/Model Sta-Rite Step 20-20qpm, 1/2hp,115V 0 Floats or Transducer
a Tank draw down 1.88 in/min Pump capacity 3.58 gpm Squirt Height -- ft
Pump on time 8.3 minutes Pump off time 1.84 hours Daily flow set at 360 gpd
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Mason County OSS Installation Report pg. 2 Parcel# 32-�-3 ( ' 4`k DO`���
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project - ❑ YES El NO
If yes please describe'.
Were all components pumped out and properly abandoned per WAC246-272A-03004 ❑ YES ❑ NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough ea re-locate in the need of maintenance activities and future development. Typical Record
Drawings contain nralrfmd&manifold oden:soon a layout septdpump risk IdcaGon.North arrow.reserve grainfield.BnAins and proposed buildings lacaton or wens.taatedines,
v2na.ohservacon ports.deanouts,and other mantenan a access polrts Incommets Record Javings may=ea:e addlnonal delays in eon installation approval and related permits.
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 end Mason County Codes
I further certify that all infswnation contained on this I further certify that all information contained on this
form andlitt er ached Red Drawingtfaccurate form and attached Record Drawing is accurate.
J,,//�:V� %r cif-Les 23
*nature of Installer Date i )
Printed Name of Signet . .era
MASON COUNTY PUBLIC HEALTH 1 r
rat'1
The undersigned approves this Installation Report and r era%zaa •
Record Drawing on behalf of Mason County Public PeuLA JOY dMNroN ki:�•�
Health: Cl_�..� 'FYilSEf riC5;^NEYt" f.
o.'>'-"Fx'q.aiEss'o�/is% i<V•b
bl 1 d 11I7 3 tO-3 3
Sign'a`uree of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updatedsorapre
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