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Home My WebLink AboutSWG2023-00462 - SWG As-Built - 9/27/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY P LIC HEALTH APPLICANT/PERMIT INFORMATIOMGonstrucWn Permit Number SWG 2023-00462 Parcel# 22003-50 Applicant Name Randy and Lori Pinkerton Subdivision(Name Applicant Address 5679 Gazania CL Orcutt City, State,Zip Cals.93455 Installer Name Site Address 341 E.Fox Lane Designer Name INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other System Type ATU-Pressure Pretreatment Type NuWater BNR 500 >5ft.from foundation? -------------------------- - ❑WA ❑Wit ❑ No >50ft.from wells? .---------------------------- ❑ ® ❑ _ >50ft.from surface water? ------------------------ ❑ ❑ H Cleanout between building and tank? ------------------ - ❑ ❑ [7 Tank battles present? .-------------------------- ❑ 0 ❑ Q. 24'access risers over each compartment?---------------- ❑ El W Effluent fitter installed?-------------------------- - . ❑ ❑ m Septic tank capacity(working) 1050 gel Manufacturer Sound Placement 0 D-box water level and speed levelers used? --------------- NiA ❑yes NO 00 Manifold/D-box accessible from surface?---------------- - ❑ ❑ t?Z Check valves installed? - ------------------------ - ❑ ❑ 04 f Transport Line Size 2- Schedule/Clan 40 Bedrooms installed(check one) ❑2 E 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther soft.from foundation?-------------------------.- 0 WA ❑yes ❑ NO 0 >700 ft.from wells?----------------------------- W ❑ ❑ >100 ft.from surface water? .----------------------. ❑ ■ ❑ M >10ft.from potable water lines?---------------------- ❑ ❑ QZ >5ft.from property lines and easements?--------------- - ❑ ❑ K >30ft.from downgradient curtain/foundation drains?---------- ❑ ❑ 0 Dminfield level and observation ports present -------------- ❑ ❑ ❑ ❑ Greveless chambers or M Clean gravel used? (check one) Proper cover installed over drainfield?------------------ - ❑ ❑ Pump tank setbacks consistent with septic tank?------------- ❑ WA dyes ❑ No Z Pump tank capacity(flood) 1200 at Manufacturer Sound Placement Q 24'access nser(s)and accessible from surface?------------ - ❑ ❑ aAlarm or Control Panel Installed? -- ------------------- ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter----------- ❑ e ❑ ll Pump installed in ® Bucket or ❑ On Block or ❑ Other Il Pump Make/Model Liberty 290 Floats or ❑Transducer f Tank draw down TBD a INmin Pump capacity alum Squirt Height 24'+ ft Pump on time Pump oR fims Daily flow set at gpd uwe. W101e Mason County OSS Installation Report pg, 2 Parcel# 22003-50-00024 ME NTRECORD Were ASANDON axiseng eapt'C components abandoned It yes, please descdbe: Pen of this pmjepl7 -............. . Were all components pumped Out And xo rEa ® Wopedy abandoned per WAC24fi.g71A.p3007 .______ . � � � NO RECORD DRAWING N�a 1itl cowl b ppq.y N �.M'IOe CnY1M1: gpMflW M1 maegy R1N 41'CNw bNM1 b nixAb N W nM M PIWR. ra,aaslwolwm,arnaa, M1mms s^�101n blwavue,,sae rraw.Iwr.. """••uxr..a Aaub GwbPiw2.��Rmy vaemrmWlnwromwwBb. ammpalM1 gamN pra�mN'ambmaEonl C6nln�timnam wpmW as nlwtl pr,db. ® Record Drawing Attached INSTALLER CERTIFICATION OF INSTALLATION I certify that l installed the system in accordance with DESIGNER/ENGINEER the sepao design stamped APPROVEO"by Meson 'certify that the system has been Installed in a=r- County Public Health and that any tlev/el/ona shown dance with the sapt/c design stamped AppROVED"by here have been cberad/a rov Mason County Public Health and that any deviations esiIh and Masan County Public Health and meet all Stater shown here nave been Weem end Masan County Codas. myself and M un saun Coty PublicpPMMdby Health and�meet all I further ce'dry that 8/1 u"ormetion o0nhImed on this State and Masan County Codes >oa end attached Re Omwlrg/s accurate, 1 further oemfy that all lnfom+al/on contained on this cord icmr and attached R ecoN Omw/ng/s accurate. 9�lA�i c( a aru rlgn e Locan Spear Pdraed Name of S/gnas MASON COUNTY PUBLIC HEALTH The undeyigned approves this Installation Report and Record Drawing on behalf of Mason Health. County Public EXPIRES S/gnatun dEnNmnmw,y/Apaah SPem'aab Dare (stamp,signature and data) THIS FORM NAY BE SCANNED qNp AVAaABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE ePab]m+rme FOk LANE FUTURE WATERLINE i MAINTAIN 10FTSETBACK TOOSSCOMPONENTS I Q / I � I' o I 4ft :.r gym„ / For•K s f•��k t«yrs.�ih I NUWATER BNR500 / PROPOSED PPROVED & PVMP TANK / 3 BEDROOM I SEP 27 2024 HOME MAS04 C3t1NTY ENVIRONMENTAL HEALTH / I RET 1 I I I ` i I i � I 1 1 PROPOSED � DRAINFIELD i I Amr9 ANABBULTIBMTALLNBNOW REWU BE CNANBEB Ar me oT ixBTALunoN PIONETf1OTLTCCp Dff"/"1Af�+ INCCLLTOME0.: RAMYPPOmLTCN TER WU I: TESTth l ER 1 EER 1triI NQ INC PARCIl.s 770034000024 aMQN, SEPTIC DESIGNS ADDRES& 34EFCXLAM R\TL°si u' aem.i,v 3W43E41A\W BF�It�RD UWBIR%%%'.A%5* DESIGNER: ROBMTRPAISM ��F}hE-3d1JJnitkq IA\-IW4N Ml DIiEI:T: SITE PLAN SCALE ?-XF