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HomeMy WebLinkAboutSWG2017-00147 - SWG As-Built - 10/16/2024 Ida JAN 17024 Mason County OSS Installation Report pg. 1 RR EE D COU VTY PUBLIC HEALTH APPLICANT! PERMIT INFQ11Alf flt Permit Number SWG 2017-00147 Parcel # 32104-54-00033 Applicant Name Tim Ingraham Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 738 ALDERBROOK G &Y#4 City, State, Zip Union, WA 98592 Installer Name Joe Fassio Excavating Site Address 350 E Jack Pine Ln, Union Designer Name Peninsula (original)Arrow(asbuilt) INSTALLATION CHECKLIST • Full System Installation ❑Tank(s)Only El Drainfield Only ❑ Repair El Other System Type Pressure Trench Pretreatment Type NuWater BNR-500 >5 ft.from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ © CI Z >50 ft. from surface water? - e� ❑ ❑I ❑ < Cleanout between building and tank? - JA�-6Z - ❑ ❑■ ❑ O Tank baffles present? - - ❑ CI ❑ d24" access risers over each compartment?- - CI II CI W Effluent filter installed?- i 5\t _ __ - CI CIto --S00 IN Septic tank capacity (working) NuWater BNR gal Manufacturer Hagerman CI D-box water level and speed levelers used? - - ❑ N/A ❑ YES NI NO J p0 Manifold/D-box accessible from surface?- - CINI CI mZ Check valves installed? - - ❑ 0 ❑ ❑Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- PROD 0 ❑ W >100 ft. from surface water? - ❑� ❑ u. >10 ft. from potable water lines?- C - - - r ❑■ ❑ fi-�U1g Q > 5 ft. from property lines and easements?- - 1�,qg YENVIRO ❑ ❑ G'N-MASON cc > 30 ft. from downgradient curtain/foundation drains? NMF C HEALTH 0 ❑ O Drainfield level and observation ports present - `1BW ❑ 0 ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ UI ❑ H a Alarm or Control Panel Installed? - - CI II CI E Control Panel equipped with Timer/ ETM /Counter- - ❑ II ❑ D a Pump installed in © Bucket or ❑ On Block or ❑ Other Q.• Pump Make/Model Zoeller 152 ❑■ Floats or ❑ Transducer a. a Tank draw down 2.5 in/min Pump capacity 45 gpm Squirt Height 7 ft Pump on time 2 minutes Pump off time 6 hours Daily flow set at 360 gpd Updated 8'21.2Ct., Mason County OSS Installation Report pg. 2 Parcel# � 2'l C2�^ �� ^ d0�— ABANDONMENT RECORD No - El Yes Were existing septic components abandoned as part of this project'? - If yes, please describe: ElYES 0 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-Iouta in the need of maintenance activities and future development Typical Record tank location.North arrow.reserve draintleid.existing and proposed buildings,location of wells,waterlines, Draw ngs contact: Dra rtfield&man told mentation&layout.Sept upump in fine!mS�UaUon approval and related permits. wells, observation ports,deanouts,ane other maintenance access points. Incomplete Record Drawings may create additional delays APPROVED JAN 1 6 2024 MASON COUNTY ENVIRONMENTAL HEALTH Record Drawing Attached 1gW �` 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. R �F' Le '123 Si re of Installer 4 o e-s , lD e Printed Name of Signee `��, va•y�1� , MASON COUNTY PUBLIC HEALTH J �• .'i,trr The undersigned approves this Installation Report and p PAULq s1:-349 �f. JOHNSON Record Drawing on behalf of Mason County Public L'iC !$ [ib $.�NEFt. n. Hea 'jI- tli.- d-(( t -(-{-2..,-F I.: I LI i\Ar'(S^ �,� nvircnmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ,'Peale°ea'rz°'s Ail 111-2: __ i .,.., 11 ''.'... /:;". n.1.5`° / l W t 46, 00 ' — :, ..._ :„.. ia-_. ©� — i'vG 1 S GA LEI \u= 4%0' A 1,.*), y.o ko coo 8o .... e ?) ,,,,,,„..,:..„ w:,4,1,..v,... ,,,,s -,5 U1/411.:. •Ne2...:AA-'46 . .....,14,%ts a N�1'� 510f34 .._`(l 9 I 170.YCe1#32104t--54 00033 i JOY JONNSON ?`� 35° L "TA-�x,C'I.nrr✓t-N apiR g 1- '4"L`t Key: 0 Audio-Visual Alarm APPROVED OCleanout JAN 1 6 2024 0 NuWater BNR-500 ATU Tank MASON COUNTY ENVIRONMENTAL HEALTH JBW O1,000 Gallon Pump Chamber 0 Valve Control Box