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HomeMy WebLinkAboutSWG2023-00286 - SWG As-Built - 12/20/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00286 Parcel # 12107-32-50100 Applicant Name Carlos Estrada and Rick Buckner Subdivision (Name/Div/Block/Lot) Applicant Address 11659 SE Black Rd LOT 1 OF LLS#10-02 AF# 1998830 PTN OF NW SW City, State, Zip Olalla, WA 98359 Installer Name Shumaker Construction Site Address 400 E McLane Cove Dr Designer Name Arrow Septic Designs INSTALLATION CHECKLIST O Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair a Other 500 gallon pre-trash tank System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? \\' 3 L �-�'�I- ,: ❑ N/A Q YES ❑ NO >50 ft. from wells? - *�}a U ! ,❑ 0 ❑ Z >50 ft.from surface water? - DEC -2,-(} 3 - - ❑ 0 ❑ H• Cleanout between building and tank? - - ❑ ❑■ ❑ U Tank baffles present? - _ ❑ E ❑ a 24" B�- - _access risers over each compartment?- - ❑ El El co W Effluent filter installed?- NN E - El 0 ElSeptic tank capacity (working) BNR-500 gal Manufacturer Hagerman J D-box water level and speed levelers used? - - El NiA E] YES E NO XO Manifold/D-box accessible from surface?- _`n _ - ❑ 0 ElOOZ Check valves installed? - - - - > ^^'e ^"1_ - ❑ ❑■ ❑ 6Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO 0 >100 ft. from wells?- - ❑ I ❑ w >100 ft. from surface water? - - ❑ E El ti >10 ft. from potable water lines?- - ❑ ❑■ ❑ z > ft. from property lines and easements?- - El ■❑ ❑ CC 5> 30 ft. from downgradient curtain/foundation drains? - - I ❑ ❑ Drainfield level and observation ports present - - ❑ • ❑ ❑ Graveless chambers or J Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA i YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ El ❑ F- a Alarm or Control Panel Installed? - - El0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ © ❑ D n- Pump installed in ■❑ Bucket or ❑ On Block or ❑ Other d• Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer eL a Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 5 ft Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd Upaaced 8,2tl20i8 Mason County OSS Installation Report pg. 2 Parcel#12--\C1-32-' O1 DD ABANDONMENT RECORD ❑ YES III. NO Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Grainfield&manifold orientation&layout.Septic/pump tank location,North arrow.reserve drainfield,exsang an proposed buildings,location ot wedelawate lines. wells,observation ports.dcanouts,and other maintenance access points. Incomplete Record Drawings maycreate additional delaysir.final installation approval :A/LJ 74 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 1 further certify that all information contained on this 1 further certify that all information contained on this form and att e Drawing is accurate. form and attached Record Drawing is accurate. q Z Z3 ��t Signature of Installer Date _.,. ke. 4.,t)) Printed Name of Signee i wA •? Li. �,h MASON COUNTY PUBLIC HEALTH to.. • The undersigned approves this installation Report and • 519 349 `Ii 1"rt PAULA JOY JOH.NSON'r Record Drawing on behalf of Mason County Public O•: LiC � -c\-- .—- Health: �^�» r a��� c�-�� EXPIRES e i i Signature of Environment 1 Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE "0dated arz'rmte SCALD :V" = 1O4' O 30 uo a6 ,10 N N ( ... ift Asbu:‘C� k+ � C ort.0 5 E r -& a. 'F '�N-' PA c L*1Z-t01-32-50\OC) p 6aL•DF.SA 400 L� 1 `LN� CL-PCov5 DSZ �7Ag1 DEC jVr=ff1A. \ _j0, PROPOSED _ ` N PavNt 0 • .-t _': ,sP �_ c pa.VVC 02PA N ni‘ WELL ON ?ARLO-AV \ \ tZt01-32-50300 \ t • Ol Audio-Visual Alarm i 22 Cleanout . 3 500 Gallon Pre-Trash tank 3' X 50' p r tm 4 NuWater BNR-500 ATU Tank dram �� d �"r cn c 05 1.000 Gallon Pump Chamber r ! NC Valve Control Box " l pp ,'; 1`• ; .� 1 Rp ;t Z \ 0iy„0uhry4NYl 0 ?p?3 17 RFT°"�E,TAL y� NTH I .,,, • ,.. ., _ .4,7 r, "fp i...4? -,........„ ...D , ,.... 05 ftr r . -,:i1 510.309 y O1: PAULA JOY JOH L NSON id exgr,.., A, LO—z —Zi3