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HomeMy WebLinkAboutSWG2024-00154 - SWG As-Built - 6/5/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUB , ALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00154 Parcel# 212122-50-00418 ^� J Applicant Name Joel Roswall Subdivision (Name/DivBlock/Lot) -fi Applicant Address 2038 Beverly Beach Dr W Lake Limerick/Div 3/Lot 418419 City, State, Zip Olympia WA 98502 Installer Name Bamford Septic Re air �\ Site Address 41 E Glen Morgan Ct Shelton Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only M Repair ❑Other +.zoo cal 2-comp Pre Tmsn System Type Sand Filter Upgrade to NuWater Pretreatment Type NuWater BNR-500 >5ft.from foundation? -- --- --- -- --- - - - -- --- -- - - - ❑ NIA MYES NO ' ,50 ft.from wells? ---- -- - - - - - -- -gp ❑ ® ❑ Y >50 ft.from surface wateO --LNuWater u ❑ ® ❑ 2 � Cleanout between building andSAY�Y� ❑ © ❑ V Tank baffles present? -- - - - - ----- - --- ❑ ❑ F- 24"access risers over each co -- -- ---- ❑ 0 ❑ 0- W Effluent filter installed?----- ---- ❑ M ❑ V) " Septic tank capacity(working) pal Manufacturer Infiltrator o D-box water level and speed levelers used? -------------- - ❑ NIA El YES NO QOManifold/0-box accessible from surface?----- --- - --- - - ❑ ❑ mZ Check valves installed? -- - - - - - --- - - ❑ ® ❑ oa E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther ,loft.from foundation?- -- - ---- --- -------- ❑ WA MYES ❑ NO o >100 ft.from wells?- --------------- - ---- ---- -- -- ❑ W ❑ w >100 ft.from surface water?---------- - - - ---- - --- - -- ❑ 0 El EL >10 ft.from potable water lines?---- ---- - - ------------ ❑ M ❑ a , 5ft.from property lines and easements?---- - - - - ----- - -- ❑ M El X ,30ft. from downgradient curtain/foundation drains?- ---- --- - - ❑ M ❑ Drainfield level and observation ports present - - -- - - - - - ----- ❑ © ❑ M Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - ----- ❑ K ❑ Pump tank setbacks consistent with septic tank?-- ---- - --- --- ❑ NIA M YES ❑ NO Y Pump tank capacity(flood) 1,200 oat Manufacturer Existing NW Cascade Q24"access risers)and accessible from surface?-- -- --- ---- -- ❑ M ❑ GAlarm or Control Panel Installed? - - - - ----- - --------- - - ❑ ❑ 2 Control Panel equipped with Timer/ETM/Counter- - -- ❑ M ❑ a Pump installed in E] Bucket or ® On Black or ❑ Other a- Pump Make/Model Zoeller N-152 ® Floats or ❑ Transducer a Tank draw down 1 in/min Pump capacity 22 gpm Squirt Height 10 ft Pump on time 4 min Pump off time 6 hr Daily flow set at 360 gpd uPuaaemrm�s Mason County OSS Installation Report pg. 2 Parcel r 3�ZZ-So - o��ft8 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ---- --- _-__-__- YES ❑ NO If yes, please describe: .S0.`"rk-• rFI-I �"C' :'^a— WereallcomponentspumpedoutandpropertyabandonedPerWAC246-272A-03007 ------" ❑ Y� ❑ NO RECORD DRAWING mia a a wrmanam rtwN and moat 1».--and daacnpuva enoush la moots In u.neaJ of mamtenanco acrMrlas and Nmre eavM ArL TAMAN R -d Dominate.mMain: Draidiidd b maniltld wienlatim If lac SWtidpump tank lAnna.,Ho..,rcsarve dminfiaN.Inaing aM pdplad buNiys.I..NweAa.walulnu, aglA opaervad>n pmµ.NaanmM,And corer maimanance xzss pomu. Incmrp,na Revd Daaving.—V Raab additional sail in final mabllNan approval aM nAll prtm16, 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 eccor 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 chearedapproved by both the designer shown here have been clearedlapproved 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 car*that all information contained on this /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accum e. H-29-2� Signature of lnstalle Date Footed Name of Signee c J MASON COUNTY PUBLIC HEALTH Rd The undersigned approves this Installation Report and - + Record Drawing on behalf of Mason County Public - gag f Health: PAULA JOY JOHNSON'- alU-yE�51 Signature of Environmental ealth Specialist Data (stamp slghature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upanw arsrrzpm 9� i (1 PAVLA J6'I�}J�O.1, r ;. �b iy VVVV rj•(—L-F It,��� O Audio-Visual�Alarm� /j. O2 Cieanout 1 ."on on Pre-Trash tank e O H_yWate,BNNRa� ATU Tank p \ 1 DO 1 t n Chamber ppy.�c O Valve Control Box--ET:iSf, 00 �m S._A. S:c'"" N Yj f� Sc�lc= (•• - 30 � S E1o*�G 7't,—9kXk*- /39 Joy\ (2oswa>k APPROVEG �o . PC �A�3 Z(L7.--570 -0C'f(b if I E Ci\w. M<L�C t. 1UN V D24 MABON COUNP ENRE7 NMENTAL NFAUTN