HomeMy WebLinkAboutSWG2022-00196 - SWG As-Built - 7/29/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SvvG 2022-00196 Parcel # 22221-31-00010
Applicant Name HANNAH ROUSH Subdivision (Name/Div/Block/Lot)
Applicant Address 50 E FOREST LANE
City, State, Zip BELFAIR, WA. 98528 Installer Name MIKKELSEN SEPTIC
Site Address 50 E FORREST LANE Designer Name CINDY WAITE
INSTALLATION CHECKLIST
0 Full System Installation ❑Tani Only ❑ Drainfield Only ❑ Repair ❑ Otter
System Type OSCAR Pretreatment Type BNR 500
>5 ft from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - E] NIA AYES NO
,50 ft, from wells? - - - - - - - - - - - - - - - - - - - - - - - - - _ _ .. . ❑ ® ❑
2 >50 ft from surface water? - - - - -- - - - - - - - - - - - - - - —. — ❑ ❑
HCleanout between building and tank? - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
f..) Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - .- - - - ❑ ❑
d El
access risers over each compartment?- - - - - - - - - - - - - - - - 0 ❑
W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ K ❑
U)
Septic tank capacity (working) 998 gal Manufacturer HAGERMAN
0 D-box water level and speed levelers used? - - - - - - - - - - - - - - 0 NIA ❑ YES ❑ NO
DJ
O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ W ❑
°PZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - —
❑ ❑ ❑
QQ
M Transport Line Size 1" SUPPLY AND RETUF Schedule/Class SCHEDULE 40
Bedrooms installed (check one) W 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA AYES El NO
>100 ft. from wells? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - . ❑ ❑m El
LL >1Oft. from potable water lines?- - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
_ > 5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑ ❑
K > 30 ft from downgradient curtain/foundation drains? - - - - - - - - - - ® ❑ ❑
G
Drainfeld level and observation ports present - - - - - - - - - - - - - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - ❑ NIA YES ❑ No
`1 Pump tank capacity (flood) gal Manufacturer PER OSCAR 11 PARTS LIST
Q24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ❑ ❑
~ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑
a
rd Control Panel equipped with Timer/ ETM/ Counter - - - - - - - - - ❑ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other AA
a Pump Make/Model E] Floats or ❑ Transducer
a
a
Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time _ Daily flow set at gpd
GPGL 11. f 7l 22J?rt�d.,.d11vime
Mason County OSS Installation Rspoyd pB, a: Parcel r„�2 22 / . 3L OoaLi
ABANDONMENT R�6 ORD
Wen exhtlng apse COMPonente abandoned as part of thin pnJjecly
It yes,plasm doe sits,
Won all bomPlmaMe pumped out and properly abandoned per WAC246-272A4l300 t -..- B7 _. [� w®
RECORD DRAWING
Tina b I MUMMUM nPnM bad MUM be KePme NJ MUM MINM annah Id vn.YeceM In wa MG4 M malMenem,a aMINNI.entl VMma MMUMmaM. 7VMde a sm
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spa,OabaMeMMante MYlledle,ant dtlw mdlM....cans oft IN-Piave Re.,d❑rownpa maymUWdtltlW..I JNaye M fineNMIaVUUaelme,entl Meth,.M,.
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I(`�rktecprd tT'awing Attachod
CERTIFICATION OF INSTALLATION — -
INSTALLER ifJ E04uNP.Vk1 L'NOW ER
I Get*that I Installed the system In accordance with 1 codify Mat the system has boon installed in acoor-
the sepfe design stomped"APPROVED"by Mason dance with the soptic design stamped APPROVED"by
Coady Public Health and that any deviations shown Moson Urwaty Public.Health and Mat any deviation,
hero hsm boon coarod/approved by both the designer ,down here have been oaanCOODumved by both
aid Means County Public Health and meet all m to my"t,and IW'aeon r:-ImY Alb/ic Health and m"t ell
and Macon County Codes. Stale and Mason County Codes
I ANttwcGtW fret ab inhumation contained an this I further certify that all Information contained on this
fata and afachad Record DIawhig Is accurate, farm and attached Record wing is Separate.
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MASON COUNTY PUBLIC HEALTH y I c
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the ulnderolpnad approves this Installation Report and LICENSE DESIGNER
Road Drawing on behalf of Mason County
Health:
SlglretaAdEnWraxneMfal Specialist (late
(sMarnp,signature and date)
THIS FORM MAY BE SCANNED AWL)AVAILA141 aFOR PIJnI.IC VIE.VJ(IN FHE MASON COI JNI V WED SITU. °P°^" .1.1.
APPROVED
JUL 29 2024
DASDAC,:,�'�T�E��;IB7tiM�I,�C� r✓e.AL'�H
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p= CINDY E.WAKE ;
"-_"- -""'—'--"—"'—�----- LICENSED DESIGNER
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Headworks: HWN-.7-RF
'/."Arkal disc filter, mesh, 130 micron
'/4"Arad flow meter
Three oil filled pressure gauges
5 Netafim normally closed throttling solenoid valves
OSCAR-II Parts list. APPS ` Q `/f- f��
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Each OSCAR-II unit will include: 29 2o7y
LF1P-RF-BLWRR control panel +r•`�'�'�7C+d,��;�; ,
1/2 hp, 30 gpm Lowridge Onsite Technologies R;i ' "t4iT!'
pump
OS-50 or OS-100 Coils
PVC fittings and drip tubing adapters
HWN-.7-RF automatic headworks
Solid %2" poly tubing for connections
' 2 float switches
OSCAR-11 coil Connections e.
14i P
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Manifolds and supply lines are 1" Sch 40 PVC �1 1
15