HomeMy WebLinkAboutSWG2022-00627 - SWG As-Built - 10/31/2024 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
[Applicant
rmit Number swG 2022-00627 Parcel# 31904-51tL
plicant Name Ken Goguen _ Subdivision (Name
Address 2442 Gravelly Beach Lp NW Apt 3 Fawn Lake#2/TR 1ty, State, Zip Olympia WA 98502 Installer Namete Address 1510 BE Crescent Dr, Shelton Designer Name nc
INSTALLATION CHECKLIST
Repair ®Other sro-aeiv T�T.ea
❑ Full System Installation ❑� Tank(s)
uW Only ❑Drainfeltl Only ❑ p NuWater BNR-500
System Type NuWater-OSCAR Pretreatment Type
>S ft.from foundation? — _ _ _____________________ __ ❑xue ®yes ❑ No
>50ft.from wells? -__ _ _ __ _____ __ ______________. ❑ ® ❑
Y. >50ft,from surface water? ----- - - ---- -- ----- - - -- - ❑ Cl
_ ❑
r Cleanout between building and tank? -------___-__ ❑ ® ❑
O Tank baffles present? -- - --- -- - - M ElR 24°access risers over each compartment?-------- -- - - -- -- ElElN Effluent filter installed?----- R-S� ❑
SA
Septic tank capacity(working) NUWatef gal Manufacturer infiltrator
� D-box water level and speed levelers used? --------- ---- '- ❑ WA ❑
YES NO
00 Manifold/D-box accessible from surface?- -- ------------ -- ❑
mZ Check valves installed? -- -- - - - ---------- - -- - - - - --
Transport Line Size 1' Schedule/Class 40
Bedrooms installed(check one) 02 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?--------------------- ----- ❑ NIA ® YES NO
G >100 ft.from wells?- --------------- -------------
❑ ❑
W >100 ft.from surface wate(7- --- - -- -------- ❑ ❑
LL >10ft.from potable water lines?- -- - ---------- --- - ---- ❑ ® ❑
QZ > 5ft.from property lines and easements?----- -- - - ----- -- ❑ ® ❑
C > 30 ft.from downgradient curtain/foundation drains?--- - - --- -- ❑ ® ❑
Drainfield level and observation ports present - - --- - -- ------ ❑ ® ❑
Proper cover installed over drainfield?- -- - - - - --- - - --- --'- ❑ ® ❑
Pump tank setbacks consistent with septic tank?------ - ---- -- ❑ NIA ® YES ❑ No
Y. Pump tank capacity (flood) 1.287 aal Manufacturer Infiltrator
i24.access riser(..)end accessible from surface?-- - -- -- - - -- - - ❑ iW ❑
6 Alaon or Control Panel Installed? - - ------ -- -- - - - - - - - -- Cl
2E Control Panel equipped with Timer/ETM/Counter-- --- - - -- - - ❑
a_
Pump installed in ❑ Bucket or ❑ On Block or [I Other
�- Pump Make/Model AY McDonald E-30 ® Floats or ❑Transducer
:3 Tank draw down - in/min Pump capacity 30
a gpm Squirt Height - ft
Pump on time 22 sec(factory) Pump off lime 3 min-44 sec Daily now set at 240 gpd
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Mason County OSS Installation Report pg. 2
Parcel If 31q0�'S1-
ABANDONMENT RECORD
� ._ _ _ ___ __ __ __ _ . YES 1. NO
Were ,dsb,g septic oomponems abandoned as part of this prolect
If yes,please describe. YES NO
Were all db,ponenla pumped out and properly abandoned per WAC246272A-03007 .__ _ _ __.
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certAy 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 deviations shown Mason County Public Health and that any deviations
hem have been deamoVappmved by both the designer shown here have been cleare&approved by both
and Mason County Public Heal and meet all State myself and Mason County Public Health and meet all
and Mason County Cod State and Mason County Codes
I further certify that of —Wion contained on this I further oerdfy that air information contained on this
forth arld� Record Drawing is accurate. form and attached Record Drawing is accmals.
// % 10-3-zit
Sgnatf fl stellar Date '
Printed Name o/Signee
MASON COUNTY PUBLIC HEALTH `'
The undersigned approves Ibis Installation Report and ew w r r
g PP PO PAULA JOT 10N"5
Record Drawing on behalf of Mason County Public ' X1'i1
Health: alw2
lOm o,4 to -
Signature olEnvirwrmenfM tth Speaelist Dare (stamp, signature and date)
THIS FORM MAY BE SCANNEDANDAVAILABLE FOR PUBLIC VIEWONTHE MASON COUNTYW SSITE Lae.werzl'xte
tau, v, La 1« )
APPROVED
OCT 31 1014
� - N0V*SON COUNTY
E"ONMENTALHEALTH
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