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HomeMy WebLinkAboutSWG2023-00453 - SWG As-Built - 7/5/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00453 Parcel# 22018-50-00278 Applicant Name Ruth Russell Subdivision (Name/Div/Block/Lot) Applicant Address 3116 Wilderness Dr BE Timberlake Division: 1 Lot:278 City, State, Zip Olympia WA 98501 Installer Name Bamford Septic Repair LLC Site Address 70 E Raccoon Ct Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Dreamed Only ❑ Repair ❑Other System Type NuWater-OSCAR Pretreatment Type NuWaler BNR-500 >5ft.from foundation? -- ------ - ----- - --- ------ --- ❑ NIA AYES ❑ NO >50ft.from wells? ------ -- --- -- - -------------- ❑ ® ❑ Z >50ft.from surface water? -- -- - --- - -- - - --- - - - - - --- El ❑� ❑ QCleanout between building and tank? ----- --------- - ---- ❑ 0 ❑ U Tank baffles present? -- - - -- - --- ---- - --- - -- - ---- - ❑ ❑� ❑ IF- Q. 24"access risers over each compartment?- - -- - ----- - ----- El W Effluent filter installed?----- -------- - -- --- --- --- - - W Septic tank capacity(working) BNR-500 gal Manufacturer Sound Placement o D-box water level and speed levelers used? -- -- -- -- - - - - - -- ❑ NIA ❑ Yes Q NO J 0OO Manifold/D-box accessible from surface?.-A— ❑ ® ❑ mZ Check valves installed? -- - - - -- - -- -- - -- ❑ ❑ oa M Transport Line Size 1" Schedule/Claw 40 Bedrooms installed(check one) ❑2 ®3 ❑4 ❑ 5 [:1 6 ❑Commercial/Other Go MS-] >10ft.fromfoundation?-- - - ------- - --- - - ---- -- - - - ❑ NIA ® YES PNi }'\ O >100 ft.from wells?--- ----- -------- - - -- ❑ ❑� Q �LI J >100 ft.from surface wateR-- - - - - ------ - ------ - ---- ❑ W c p M >10ft,from potable water lines?- - - - -- - - - - ---------- - - ❑ ❑� [] c a > 5ft. from property lines and easements?- - --- - - - --- -- - - - ❑ M b i X > 30ft.from tlowngretlient curtain/foundation dreins?- -- -- --- - - ❑ IN Drainfield level and observation ports present - - --- - - ❑ 0 Propercover installed overdrainfield?- -- - - -- --- - - -- - - - -- ❑ ® ❑ Pump tank setbacks consistentwith septictank?-- -- -- - ---- - ❑ NIA W Yes ❑ NO Y Pump tank capacity (flood) 500/1000 gal Manufacturer Sound Placemnt-Combo pretrash pump Q24"access risers)and accessible from surface?--- - -- --- - --- ❑ ❑ ~ Alarm or Control ---�`-- -- ❑ ❑ ELl l Panel Installed? Control Panel equipped with Timer/ETM/Counter-- - - - - -- - - - ❑ ❑ 7 a Pump installed in ❑ Bucket or e On Block or ❑ Other 0' Pump Make/Model AY McDonald E-30 ® Floats or ❑ Transducer Tank draw down in/min Pump capacity 30 gOn Squirt Height — ft a -- Pump on time 22 sec Pump off time 3 min-44sec Daily flow set at 360 gpo uw.i.a erziawe Parcel# 2 2 0 IS — 51D- C)C) Mason County OSS Installation Report pg. 2 AIANDONMENTRECORD 1 YES NO Were existing septic co Proect? _mponents abandoned as part of this If yes, please describe: YES NO Were all components pumped out and property abandoned per WAC246-272A-03009 -- ---- - - RECORD DRAWING This..nem••nem,.gore and mom he aao.zu.nd d-drion-mooch to m4goere in the need or m.imenann.amirma sod wmne a..monmmc Tvnioei RKe n Inoen,donuln: oainfi.m4mmdMa odmuliansi.voN.sepnWumo�.nkwuuon NoM anpr,,re.erve Nemdmd,eAsdnh and Propose♦eumings.lootian ofweAs.weleames. q.,nryceau.aaroonm xl mnnai inmuadon approvN and rei..P.-rd. w S;oburndon I.,oeaneW,ma Phe enlIne1P, In�InU. hPinhAon R—d on++n m Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 cleamd/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 aand attached Record Drawing is accurate. form and attached Record Drawing is accurate. / I Signatu2 of Installs ((LL Dafe Printed Name o1 Signee of MASON COUNTY PUBLIC HEALTH `. , The undersigned approves this Installation Report and > r croon♦. '+ Record Drawing on behalf of Mason County Public PAOLA JOY JOHNSON .; "IC144 K[S SIGN ' Health. EWB6 far Signature of Environmental Heath Speclabst Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE unax.a"rams I OX 4�` IJUVJ4CTE12 OSGAk� P R c Ia5.U2' N �u 20 � 6-t 5 sgff `i.sbr� 10 P y S 10' t o Z0 q 3o o AS�$U1lS U (tr ussELL PACCOON GT— �IO 7�Yh.uxN 1/� i Kev: OAudio-Visual Al.— �—Z" O2 Cleanout e NuWater BNR-500 Pretreatment Tank COMBO SO 0 92E TRASH 1,000 on APPROVE; O Pump Chamber/Clarifier Tank 0 =as JUL 05 2021 PAULA JOY JOHNSON'� 5 OSCAR Mound Drainfield tpnssrcNEW' MpSONCOUNTYEWRONMENTALHEAL) RET to- z6 -`vf