HomeMy WebLinkAboutSWG2023-00134 - SWG As-Built - 2/27/2024 RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION Permit Number SVVG 2 �� -59- Assessor Parcel # 22 -7 3 / ;.5 90b 31
Applicant Name J0"Q Q.0 15c kt Subdivision (Name Div'Block!Lot)
Applicant Address 213 1 i i 3 LA tiCu)
City. State. Zip O i m imp i elf w Cj isc2.• Installer Name „1.0 S,'la Ike Ic.►\5\- 1 on
Site Address l i ( pYi.) - ) • Designer Name 1 M 1-'UArl-'17-
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Dra^field Only ❑ Repair 0 Other
System Type Ci�4\9._ xi) 2 Pretreatment Type g 0 2- O SC-10���
>5 ft from foundation? - - ❑ N/A glYES ❑ NO
>50 ft. from wells? • •- ❑ Ef, 0
Z >50 ft. from surface water? • - ❑ a 0
H
Cleanout between building and tank? • - El Q� ❑
✓ Tank baffles present? - - El [,� El
t- 24- access risers over each compartment?- - ❑ E 0
4 ❑ ❑
w Effluent filter installed?• -
u' 1 rr
Septic tank size I�G 0 gal Manufacturer
0 D-box water level and speed levelers used? - - ❑ NSA ❑ YES ❑ NO
XOO Manifold/D-box accessible from surface?- - 0 El
mz Check valves installed? -- El ❑
o a 1•� c � e
2 Transport Line Size ( Schedule/Class ,J
Bedrooms installed (check one) 0 2 ❑ 3 ❑4 0 5 6 ❑Commercial/Ot er
>10 ft. from foundation?- -- ❑ N/A YES 0 NO
>100 ft. from wells?- - - 0 [� ❑
W >100 ft. from surface water? - - 0 [� ❑
I >10 ft. from potable water lines?- - 0 EV 0
Z > 5 ft. from property lines and easements?- - ❑ Eli/ ❑
Q re > 30 ft. from downgradient curtain/foundation drains?- - El riff 0
10
Drainfield level and observation ports present - - El 11.11V ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one) /
Proper cover installed over drainfield?- - ❑ L,l/ 0
Pump tank setbacks consistant with septic tank? - - N/A YES ❑ NO
Y Pump tank size 16 Jo gal Manufacturer f 141\ `Vsx"1 VY
< 24-access riser(s)and accessible from surface?- - 0 0
l—
d Alarm or Control Panel Installed? - - 0 7/ ❑
• Control Panel equipped with Timer/ET /Counter- - ❑ ❑
M LJ
O. Pump installed in Bucket or On lock or (❑ Other_
a Pump Make/Model � 0-1-9U 1 Floats or 0 Transducer
a ,
R. I�
Tank draw down N' in/min Pump capacity •if'/ gpm Squirt Height 1J I Pc" ft
Pump on time "36 5C.C• Pump off time 1j MIA• Daily flow set at ��V gpd
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel# 1 3�7 5900 31
RECORD DRAWING
❑ Dra•nficld&manifold
orientation&layout
w:dimensions for
re-location
❑ Trench,bed
dimensions and
critical distances
within layout
❑ Septicapump tank
placement
❑ Location of buildings
exist,ngiproposed
❑ Observation ports
clean-out locations.
manifolds'd-boxes
❑ Location of wells.
surface water,roads,
&waterlines
❑ Reserve area(s)
❑ North Arrow
If the designer or installer feel the need for additional informationicomments, it may be attached
Record drawing may also be on a seperate page attached No Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
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 certif that all information contained on this I further certify that all information contained on this
form d tt c cl cord Drawing is accurate form and attached Record Drawing is accurate
.1I1513
Signature of Installer Dare �f
SOYI •, r.
Printed Name of Signeevi
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and J L�
Record Drawingon behalf of Mason CountyPublic '- • 51.HUNTER
_r-
p• ADAPAJ.HUNTER
Health: •
7/in("n-i
0-Noi,(Apc 6Yy `
Signature of Environment*Health Specialist Date (designer's stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE `'�''`"'
OSCAR-XO2 Check List
Date: `1\1 ZC 21J
Re: OSCAR-X02 installation at:
Address: 1 i r !Drib Ea r i2-t) � •)Pt olbS8<-}
Tax #: 9-,)-1 2 31 00,31
This letter is to confirm that the system installed at the above listed address
was installed as per Lowridge Onsite Technologies, Inc.s specifications.
Pressure & Flow:
Pressures on the OSCAR headworks:
Dosing: G1 = ( psi, G2= 6L-1 psi, G3= 1S psi
Dose flow rate= i Z gpm
Treatment tank:
Partition tee baffle bottom/by-pass hole at 40-60% of liquid depth
Yes: $ , No:
Discharge tank:
Partition by-pass hole at 18" to 27" above floor Yes: '< , No:
Aeration:
Diffusers close to partition wall Yes: , No:
Aerator in dry location Yes: x , No:
Aerator operable Yes: 'C , No:
Current sensor operable Yes: '( , No:
Installation:
OSCAR:
Correct number of coils: Yes: X , No:
Correct coil arrangement: Yes: X , No:
Inspection ports: Yes: x , No:
Proper sand depth: Yes: x , No:
Floats set correctly: Yes: x , No:
Timer settings correct: Yes: , No:
Basal preparation according OSCAR
Installation manual: Yes: X , No:
Certified Installers Signature:
dill'
� iurc
` CONSTRUCTION
EARTHWORK EXCAVATION SITE PREP SEPTIC
2103 Harrison Ave. NW, Suite 2774, Olympia, WA 98502 • Bus. (360) 866-9200
INSTALLER CONSTRUCTION COMPLETION FORM
DATE: 1/23/2024
FOLDER SEQUENCE: Permit#23109798
TAX PARCEL NUMBER:72 110006000
DATE INSTALLED i2L2zj2923
TANK MANUFACTURER: Infiltrator
TANK SIZE-SEPTIC TANK: i06o Gal
i PUMP TANK: 1060 Gal INFILTRATOR
EFFLUENT FILTER MANUFACTURER ORENCO
MODEL NUMBER: FTW-0444
EFFLUENT PUMP MANUFACTURER: Orenco
MODEL NUMBER:_PF-2005
CONTROL PANEL/ALARM MANUFACTURER: SIMPLEX
MODEL NUMBER:_mm0426
FLOATS MANUFACTURER: SIMPLEX
MODEL NUMBER: :010426
TIMER SETTINGS:ACTUAL RUN TIME ON: a Min 40►Sec
TIME OFF: `Flour~
PUMP CHAMBER#2 DRAW DOWN IN INCHES PER MINUTE:3/4 inch
SQUIRT TEST DRIP SYSTEM: N
CORRECTED DEFICIENCY ITEMS IDENTIFIED BY TCEH DURING THE FINAL INSPECTION.
INSTALLER SIGNITURE
PRINTED NAME BRANDON THOMPSON
TANK PUMPING REPORT
Sits N,n,.•
144'"*".405 SHADOW LN NE NA Service Company:
OLYMPIA
Tax ID:72110006900 A+Services
u..: 7225 Pacific Ave SE
Olympia,WA 98503
360-491-2900
Serviced:11/28/2023 by:Jeff Leonard Submitted 12/03/2023 by:Noah Santos
DempLocation:BioRecycling-Centralia Jurisdiction ID:336566
COMMENTS
TANK PUMPED FOR ANOTHER COMPANY TO PERFORM ABANDONMENT.
TANK:Septic Tank-2 Compartment
NOTE:THIS TANK WAS ONLY PARTIALLY SERVICED
Tank Pumped: YES
Tank Size(Galions)(Number only,no text): 1000
Effluent level within operational limits(if NO explain In comments):
Total Gallons pumped from tank(Number only,no text): 1000
Effluent returning back Into tank after pumping:
Tank depth below grade(Inches):
Access Risers installed to grade(N/A if not present):
Tank Construction Material:
Tank Condition Good:
Baffles in good condition(WA if not present):
Effluent screen cleaned(N/A if not present):
Effluent surfacing around site components(N/A if not checked):
Tank abandoned after pumping: YES
Were repairs made to the Tank or Tank Components?(if YES explain in comments):
Compartment 1 Scum accumulation(Inches,if other specify):
Compartment 1 Sludge accumulation(Inches,if other specify):
Compartment 2 Scum accumulation(Inches,if other specify):
Compartment 2 Sludge accumulation(Inches,if other specify):
Ttus report Indlcaf.s Wien UanKe.Ilst03 or tM onsl.sewage system.f the bmy of nut In no way is Nu sport a pv.rant.o of oper.non or Alf,'pertormance
ReportiD:693307 View pump reports online at www.onfinerme.com Page 1 of 1
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