HomeMy WebLinkAboutSWG2020-00351 - SWG As-Built - 9/10/2024 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00351 Parcel # 32031-14-90010
Applicant Name Ryan Finn&Roderic Dohleman Subdivision (Name/Div/Slock/Lot)
Applicant Address 103 W StOrY Rd PCL1 BLA#21-18 AF#2158622&REV1 AF#2175528
City, State, Zip Shelton WA 98584 Installer Name Daryl Hemley- Ron Hartley Septic
Site Address 105& 107(ADU)W Story Rd Designer Name Arrow Septic Designs Inc
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Oniy ❑ Drain P.eltl Ocly ❑ Repair
Other so""' Pra-Tnan rank
System Typo NuWater-OSCAR Pretreatment Type NuWater BNR500
>5 ft. from foundation? - - - - - -- - . - - - - - - ❑ NIA ® yam NO
>50ft. from wells? - - - --- - - - -- -- - ----- - - - - - - - - - - ❑ ® ❑
Y >50 ft.from surface water? -- - - - - - - - -- - - - - - - - ❑ ❑
z ❑
Cleanout between building and tank? - --- - - - - -- --- ❑ 'X
U Tank baffles Present? - - --- - -- - -- - -- - --- - -- - - - ❑ ❑
1- 24' access risers over each compartment?- - - - - -- - - - - - - - — ❑ ® ❑
NEffluent filter installed?- - - - - - - �� _�y��- - -- -- - - - - - - - ❑ '_
Septic tank capacity(working) BNR-500 gal Manufacturer Hagerman. I
O D-box water level and speed revelers used? - - - - - - - - - -- - - - - ❑ Nuk ❑ YES No
x0 Manifold/0-box accessible from surface?- - - - 4A tClE+s- - - ❑ ® Ell
Check valves installed? - - - - - - - - - - - - - - - - - - - - - -- - - - ❑ ❑
Q2 Transport Line Size 1" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑e ❑Commercial/Other
>10ft.from foundation?- - - - - - - -- - - - - - - -- -- -- -- - -- ❑ WA ® YES ❑ NO
9 >100 ft. from wells?- - - - - - - - - -- -- --- - - - - ---- ---- - ❑ ® ❑
W >100 ft.from surface water? - - - - - - -- - - - - - - - --- - - - ❑ ® ❑
u- >10ft.from potable water lines?- - - - -- - - - -- -- - - - - - - - - - ❑ ® ❑
Qz >5ft. from property lines and easements?- - - - - - - - - - - - - - - - ❑ ❑
K > 30 ft.from downgradient curtain/foundation drains?- - - - - - -- - - ❑ a ❑
G Drainfield level and observation ports present - - - - - ❑ ® ❑
Proper cover installed over drainfieid?- - - - - - - - - - - - - - - -- - - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -- ❑ NIA YES ❑ NO
Y Pump tank capacity (flood) 1 000 oai Manufacturer Hagerman
24"access riser(,) and accessible from surface,-- - - - - - - - - - ❑ ® ❑
~ Alain or Control Panei Installed? - - --'`RD='Y= fit `- P'P!?--- - ❑ ❑ ❑
Control Panel equipped with Tlmer/ETM/Counter- - - - - - - - - - - ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or a Other on bottom of tank
o. Pump Make/Model AY McDonald E-30 ' Floats or ❑ Transducer
a
Tank draw down - in/min Pump capacity 30 corn Squirt Height - ft
Pump on time 22 sec Pump off time 3 min-44 sec Daily flow set at 360 god
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Mason County OSS installation Report pg. 2 ParceiA ''11�'z,�" ��- -S�J�L'
ABANDONMENTRECORD
Were esing septic components abandoned as part of this project, ------- ❑ YES NO
pbaBe aesaeba.
Weft atl components pumped out and properly abandonea per WAC246-272A-0300? " '--- -- ❑ YES ❑ NO
RECORD DRAYWNO
S E E AT'rAGN'E'fl
Record Drawing A;achea
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that i ins/BCed tire systent in accordance ,In r certify that the system has been Installed in accor.
the septic design stamped'APPROVED-by Mason dance with lire septic design stamped-Ao?ROVED by
County Public Health and first any deviations shown Meson Counry Public'40i and that any deviations
here have been clea,,Vapprdved by both the designer shown here have been cleated/approved by twt9
and Mason County Public Health and meet all Stele myself are Mason County Public lisel,, cons mee;ail
and Mason Courtly Codes State and Mason Counry Codes
( er certify 1ha1 all mfommtinn conta:nod col lhrs' I further certify flat aN mtunraocr:comamed on this
norm nd ad Ch RBcor brewing is er.::mate_ form aro:atacheu Recor:: y is acrmare
G
Signor ctmstarrcr
211111 IhCMIG{ f
Printed ' o of Sgnee d
MASON COUNTY PUBLIC HEALTH
The mid--vireo approves this lnslairation Ropon Bind
ANE.Av 0,,;.np o,,Gah.Ud Mumn coup/y .+ublc j(r PAULA JIf
OY JOMN$pN -
.wurn _ It
Signature o/EnWronmenMl Heal(h spbcrenm Jala Islamp. SguaL:re And aw"
THIS FORM MAY SE SCANNED ANO AVAILA8'E FOR PUBLIC VIEW ON THE MASON OOUry r wES SITE ^""- �'
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� AS BuI�T
Y�ODL�\CDONL=M.
o i mnzi-t4" 016010
OAudlo-Visual Alan,
Cleanout
® 500 Gallon pre-T•ash Tank
NuP7ater BNR-500 Pmt*eatment T.
� 5\1,OD0 Gallon Single Compartcment
/ \ pump Chamber/Clarifier Tank
�\ \I
Cp Mound Drainfield
2-rAary � eg(t lA+`�
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7 -7
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APPROVED
SEP 10 20A
MASON COUNTY ENVIRONMENTAL HEALTH '
RET o
VAUI.A JOY JONMSON
IXANfS J 1 I