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HomeMy WebLinkAboutSWG2022-00439 - SWG As-Built - 1/19/2024 "\ Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00439 Parcel # 22114-76-90174 Applicant Name Jan Oosterveld Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 1709 LOT: 4 OF SP#2160(R) PTN NW NE 23-21-2 S 51/203 City, State, Zip Port Orchard, WA 98366 Installer Name B& C Building Solutions Site Address 670 E Wilson Way Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 4 Full System Installation ❑Tank(s)Only El Drainfield Only ❑ Repair ®Other 500 gallon pre-trash tank System Type Pressure Trench Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A El YES ❑ NO >50 ft. from wells? - - ❑ X ❑ Z >50 ft. from surface water? - rr-f }- - ❑ a ❑ Q Cleanout between building and tank? - W' ' - ❑ • ❑ F o Tank baffles present? - JA i`•; - ❑ U ❑ d 24" access risers over each compartment?- --- -` - CI 0 ElW Effluent filter installed?- -IV - ❑ ❑ 10 N Septic tank capacity (working) NuWater BNR gal Manufacturer Evergreen Pre-Cast O D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO oO Manifold/D-box accessible from surface?- - El ® ❑ co Check valves installed? cLicti'' P - ❑ ® ❑ a Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 El 4 El 5 ❑6 ❑CommercialiOther >10 ft. from foundation?- - ❑ N/A El YES ❑ NO 0 >100 ft. from wells?- - El ■❑ ❑ W >100 ft. from surface water? - - ❑ A LL. >10 ft.from potable water lines?- - ❑ . ❑ > 5 ft. from property lines and easements?- - - - - 4At 4.102l14.- - ❑ U] El Q Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ NJ ❑ Drainfield level and observation ports present - _�_ - El PI El ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A I YES ❑ NO • Pump tank capacity (flood) 1,000+ gal Manufacturer Evergreen Pre-Cast z El El ❑ < 24"access riser(s) and accessible from surface?- - F- a Alarm or Control Panel Installed? - - ❑ IN ❑ * Control Panel equipped with Timer/ ETM /Counter- - ❑ I. ❑ m a_ Pump installed in ❑ Bucket or 4 On Block or El Other a• Pump Make/Model Zoeller N-161 ❑ Floats or El Transducer a Tank draw down 3 in/min Pump capacity 57 gpm Squirt Height 5 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 360 gpd Upaa:ed 8:2 l20'3 Mason County OSS Installation Report pg. 2 Parcel#2 2 1 \'6 - (0-Ci O,l 13 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YEs 71§,NO if yes, please describe: ❑ YES 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-locate in the need of maintenance activities and future development Typical Record Oravm'gs contain- Dra+nfielC&manifold orientation S iayrout.SePdcrpu'nR tank location.N01'J:anew.reserve dranfeel.existing and proposed tfialdings.Iocabon cI wells.viatrfines, wefts.ooservation Dons.ctean0.11s.and other maintenance access points. Incomplete Rem drawings may create additional delays in fatal insiatlatron approval anc 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 and Mason County Codes I further certify that all information contained on this I further certify that ail information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. .2-A--,----)--7----"-, 09/08/Z.3 Jo Signs re of Installer Date 0 , 45), Printed Na the e of Signee , of *lay ,.' f\ MASON COUNTY PUBLIC HEALTH , .` __ ;%- • °n'f The undersigned approves this Installation Report and ,�.p. s,CC34 ,�t;, Record Drawing on behalf of Mason County Public .. PA ULA J G Y JtOH NSCN \(\ Health. LICtitSCtilo to 7 su5 �� -4^S.S5 cszls r1i 1 (- f(6( (z 1 -(1)- z}4 Signature of Environmental Piealth Specialist Date (stamp, signature and date) ` THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UpdatUpdated512t2018 . A.... / °:76 tiro N., - l 40 i 0 La 4o inv e6 CiaZwireid 1 Ja.R, .0 2il4-1(0-61O7 <-' I -10 = \tiCI . , �� -vt `, Y I `NA.,4z;if. t•,t0;T VA g$ LSI 5c . . l '` -SEC' APPROVED I ` ' ' 1 Z JAN 19 2024 M 50N COUNTY ENVIRONMENTAL HEALTh RET I a Os J � o ��y���v,e. is s�exAc� �� 2 �� t � IA1w"'N tc� �o" `( 5�• .�-.c 0 0e0 / i � , y OJ Ld-w..k001,1 i3 r,K ; , __, Ti ' ... // /2-q ; i p,t.o t_i , r 1 i G w L C.1 ///j, # ( f .', /j pe_ / --:.1 1 1 Audio-Visual Alarm 3 Cleanout f t j O3 500 Gallon Pre-Trash tn1c ' �f 3 NuWater BNR-500 ATU Tank _ 1OP i n•-..4% ,000 Gallon Pump Chamber f .._`o e i `4).. `.:J Valve Control Box CC A P �' ` • y�i1, 5100349 � \Q. •\�D� \?4' a i .'"4' PAULA JOY JOHNSON I yes /1 l`'"- t $- 2