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HomeMy WebLinkAboutswg2023-00091 - SWG As-Built - 2/18/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00091 Parcel# 22114-76-90171 Applicant Name Jan Oosterveld Subdivision (Name/Div/Block/Lot) Applicant Address P O Box 1709 LOT 1 OF SP#2180(R)PTN NW NE 23-21-2 City, State, Zip Port Orchard WA 98366 Installer Name B&C Bu lding Solutions Site Address 650 E Wilson Way Grepeveiw WA Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST ® Full System Installation ❑Tank(S)Only ❑ Drainfield Only ❑Repair Other flag Ennar i"m iwr System Type OSCAR mound Pretreatment Type NuWater BNR-500 >5R.from foundation? ------ - - - ---- - -- - -- --- ---- ❑WA ® YES ❑ NO >50 ft.from wells? - - - - - -- ------ - -------- -- -- - -- ❑ ® ❑ Y >50ft.from surface wateR --- - -- -- --- - -- --- ----- - - ❑ ® ❑ Z ❑ f Cleanout between building and tank? - ---- --------- -- - -- ❑ ❑ ® ❑ U Tank baffles present? - - --- - - - - - - ----- -- ------- - - ❑ ® ❑ C24"access risers over each compadment?---- ------- --- - - rW Effluent filter installed?---- --$-R,�- --- - - - - - -- - - - ❑ ❑ Septic tank capacity(working) NuWater gal Manufacturer Hagerman O D-box water level and speed levelers used? --- - -------- - - - ❑ NIA ❑ YES NO -' ❑ ElQO Manifold/D-box accessible from surface?-- -- - -- mZ Check valves installed? - - - - - - - - ---- - - -- - ---- - - - - - ❑ ® ❑ oa 1' Schedule/Class 40 f Transport Line Size Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 [IS ❑Commercial/Other >t0ft,from foundation?----- - - -- -- - - - -- - ---- -- - - - ❑ WA ® Yes ❑ NO 0 >100 ft.from wells?- - --- - ---- ------- - ------- -- - - ❑ ® ❑ -t >100 ft.from surface water? - -- --------------- --- - - ❑ El u >10ft.from potablewater lines?--- - --- -- -------.--- - - - ❑ © ❑ Z > 5ft. from property lines and easements?- - --- - -------- - - ❑ X ❑ K > 30 ft.from downgradient curtain/foundation drains?--- -- - -- -- ❑ © ❑ Drainfeld 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) 1060 at Manufacturer Infiltrator Z 24"access risers)and accessible from surrece?------ -- - -- -- ❑ a ❑ ~ Alarm or Control Panel Installed? - - - -- - - - - - - - - - - - - -- -- ❑ ❑ M Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - ❑ ® ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model AY McDonald Lot 30 ® Floats or ❑ Transducer M Tank draw down — in/min Pump capacity 30 gpm Squirt Height — R IL Pump on time 22_Sec Pump off time 3 min-44 sec Daily flaw set at 360 cpd uruua yr.0 Mason County OSS Installation Report pg. 2 Parcel III 2211 � - [�'9aIZ1 ABANDONMENT RECORD No Were existing saptic components abandoned as part of this pto' If yes. please describe: WAC216271A-03Dg? . ____ __. ❑ V s NO Ware aii components pumped out and propedy abandoned Pat RECORD DRAIMNG xlll.s,F�aalaa nxuN aro rare!a xmlaM w exwlFe+Mws, .lm wait.a...esm•K T>ya wmc Ixr,syp main. o-sa5.ies+rade e..ana�sawl.sm5uwm wA su+a�.xama�e'..,«.wm,;maeemuNaro aron+e axureA�°"aww.+Ral^.x. ,ab.aYvaYT mW,tlun¢Ja 0.ro dMma.Neanm dY,Y6 R,a. Imm�CalY W W!CMh^�mtY auh edAMe atrft'n MW NNiial ax,wa,m niae5 pemR+. ® Retard Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that I instalted the system in accordance with I certify that the system has been installed in accor- the saptic 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 de nations here have been clearedlapproved by both the designer shown hem have been cleared/approved by bath and Mason County Public Health and meet all State myself and Mason Courtly Public Health and meet elf and Mason County Codes. State and Mason County Codes I further certiy that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. to=and attached Record Drawing is accurate. I2- 3-z 5A]na m of Instpelkr Date A $�Yfl1Al Yl�nYl o Panted Na of Slgnea 3`°' MASON COUNTY PUBLIC HEALTH The untlendpnad approves MIS Installation Report and srb in Record Drawing on behalf of Mason County Public PAULA JOT JOeNSON . N.Health: aYw41 Signalum of EnNronmental Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNEO AND AVMV.BLE FOR PUBLIC VIEW ON THE MASON COUNTYWES SITE IAv�ue vnmre i ' � I 6 I JaN---N _ p 4411 b L' r,1 I I E wtL-sal Ab ( A.-o+t) L o N Man ,Dip 3o Road Casctncf$ 36R l0 1 x SCovE� SHARED — � Mu/ T;ZIVEWA Z-�TY 314.9 t• y 105, APPROVED U Audio-visual Alarm MAR 0 4 2025 MASON COUNTYENV'"M Cleanout EN'iAl HEAL REi soo Cialloa Pfx-Trash Tank 04 NuWater BNR-500 Pieteatmmt Task 1,000 � efnave eomp.aem t Pump Chamber/ClarT=Tank . H C OSCAR Mound Thamteld 510 3�p PAULA JOY JOHNWN f 2 -6-ZS