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HomeMy WebLinkAboutSWG2023-00373 - SWG As-Built - 4/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00373 Parcel If 42223-50-00097 Applicant Name Cromett Family LLC Ltd.Co. Subdivision (Name/Div/Block/Lot) Applicant Address 3425 SE Insley St Potlatch Beach Tracts/Lot 97-98 City, State, Zip Portland OR 97202 Installer Name Bamford Septic Repair Site Address 22070 N US Hwy 101,Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST 2 Full System Installation ❑Tank(s)Only ❑ Drainfield Only 0 Repair ❑Other System Type Pressure Beds Pretreatment Type >5ft.from foundation? -- - --- -- - ----- - ----- --- -- -- El NIA xYES NO >50 ft.from wells? ----- - - ------- ----- - -- ❑ x ❑ Z >50ft.from surface water? -- - - -- -- - - - - - - -- - Ela ❑ F Cleanout between building and tank? ---- -- - - --- --- - ---- ❑ ❑ p Tank baffles present? - -- ---- - -- - - - -- - - - -- ❑ ❑ a24"access risers over each compartment?---- -- - - - ---- --- ❑ ❑ w Effluent fitter installed?----------- ---- --- - - - - - - - -- ❑ ❑ rn Septic tank capacity(working) 1 250 gal Manufacturer Sound Placement o D-box water level and speed levelers used? ------- - - --- --- ❑ NIA ❑ YES ® No DOManifold/D-box accessible from surface?-- -- - ❑ ® ❑ °?Z Check valves installed? - - - - —PkR`R - --- - - - - - - ❑ ❑ oQ Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 ®4 ❑ 5 ❑5 ❑Commercial/Other >10 ft. from foundation?-- - - - - - ❑ WA AYES NO >100ft.from wells?----- ---- ---- - - - - - - --- --_ ❑ w >100ft.from surface water?-- - -- - - - - - - - --- --�t i'... ff ❑ a >10ft.from potablewaler lines?-- - - --- - - - - ------ - -- ❑ ❑� ❑ > 5ft.from property lines and easerri- - - - - MAR_?i-g Z�Q_ PPP ❑ tY >30 ft.from downgradient curtain/foundation drains?- - - 0 ❑ 0 Dreinfield level and observation ports present - - - - - - - -- � ❑ ❑ Greveless chambers or 0 Clean gravel used? (check one) Proper cover installed over dreinfield?--- - - -- - -- - - -- -- --- ❑ ❑x ❑ Pump tank setbacks consistent with septic tank?-- - - -- - --- - -- ❑ NIA W YES ❑ NO hL Pump tank capacity(flood) 1,500 at Manufacturer Sound Placement 2 Q 24"access nser(s)and accessible from surtace?-- -- - ----- - -- ❑ p ❑ ~ Alarm or Control Panel Installed? - - - - - - - ❑ ❑ 0 Control Panel equipped with Timer/ETM/Counter-- - - - -- ---- ❑ ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other o_ Pump Make/Model Zoeller N153 ® Floats or ❑ Transducer g D Tank draw down 2" in/min Pump capacity 56 opm Squirt Height 3 ft IL Pump on time 2 min Pump off time 6 hr Daily flow set at 480 gpd UpYrctl&3lr s Mason County OSS Installation Report pg. 2 Parcels wzzn— 50- p�O`-' AB ANDONMENTRECORD __. ■ YES ❑ NO Were existing septic components abandoned as part of this. ,pAroje --LD x If yes, please describe: � F' Se15-""J ��" -__ YES ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING This is a peman e.nceN and mun he aecunte and tleewi-e enough to rNomW in Ne need of mnnu,nenea activities and Noun develognent Typigl Rewe Dmnvgs mnfain ormMnIE&maNfdd-ie-ov d hed" Sepdbyump 0nk lawtion,Nonn artaw,nserrc dreiN.eld---I end pmpomd duiWlnpe,lomtion of weAs,wale Ines. weLe,oomrvsdon pone dean,,, no oNa Mmnnanm access poinu. Inwnnehoo R-x nmrngs may cmce addidonel delsyx lnfinal InstlYTlwi eeprnel and rc1e1N peemM1e. ❑ 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 deviationsshown Mason County Public Health and that any deviations here have been clearedappmved by both the designer shown here have been clearetl/approved by both nd meet all and Mason County Public Health and meet all State myself and Mason County Public Health a 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. Signa�stalle Date Eag of Sigma f t a NTY PUBLIC HEALTH ' 5100Dap ned approves this Installation Report aL.R. ONTHEMASON.— 'PAULA JOY JOHNsON tr' ing on behalf of Mason County Public ' }• p ei ER" wara� c.f �3 � tam si nature and date) nvironments Health Specialist Date ( p g upemeaamrzp+a THIS FORM MAY BE SCANNED AND AVAIU COUNTY NfcB SITE SCALE: ` =4U 0 Y ���. �J 2107o Npc HWY 10 J t.9 . sLoPE Ae I I I D. Svc" Audio-VisuSl Alain+ wA1 R E 7 1 �Ss 0 © Cleanout ASEMEry �� o:{'Cr © Galion Septic Tank 2-Co 2-Compartment with O polder E8lumt Filter O4 1500 Gallon POMP Chamber QQ �0.fZr�iVle �1caded wL�u� , 24`43' i ��ti fL+�-�eri�+Rs i� e"G'R",•kG�A pid Y0.'nk5 AUAMM1SSl011Qd ea �rE4 A, 0l6 d F abandon4 J ' qoN 1AA � APPROVED APR 03 2024 MASON COUNTY ENVIRONMENTAL HEALTH RET j °10 341 3QR HODS c PAULA JOY JOHNSON '. PJffI 1 PRRc-✓tl#" PR2LELSTo SE LO�SINED Q 2219'S0-000gP' 4T1-25-50-�000.;� 1 ooD CANAL