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HomeMy WebLinkAboutSWG2025-00025 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00025 Parcel # 22331-51-00057 Applicant Name John Brusco Subdivision (Name/Div/Block/Lot) Applicant Address P.O.ox 1012 COLLINS LAKE#2 TR 57 City, State, Zip Belfair, WA 98528 Installer Name Bamford Septic Repair Site Address 1220 NE Collins Lake Dr, Tahuya Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only 0 Drainfield Only ® Repair IN Other 500 gallon pre-trash tank System Type Shallow Pressure Trench Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - S� ❑ N/A Q YES ❑ NO >50 ft.from wells? t �� Z >50 ft. from surface water? - - - - - S 37.6- f,- - o 0 ❑ HCleanout between building and tank? t - U El ❑ U Tank baffles present? - u` ❑ El ❑ a 24" access risers over each compartm -- - - ❑ ■ El El Effluent filter installed?- $�Q_ ❑ U) Septic tank capacity (working) NuWater 500 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ■ NO �O Manifold/D-box accessible from surface? El ❑ °? Check valves installed? ❑ I ❑ oQ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO ID >100 ft. from wells? El I ❑ __I >100 ft. from surface water? - - El ❑ I it >10 ft.from potable water lines?- - ❑ I El z > 5 ft. from property lines and easements?- - El I ❑ a CC > 30 ft. from downgradient curtain/foundation drains? El LI ❑ Drainfield level and observation ports present El II El MI Graveless chambers or El Clean gravel used? (check one) Proper cover installed over drainfield?- - El x El Pump tank setbacks consistent with septic tank? - - ❑ N/A (■] YES ❑ NO Y Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator z - ❑ © ❑ < 24- access risers) and accessible from surface? El~ Alarm or Control Panel Installed? - - El •a 2 Control Panel equipped with Timer/ETM /Counter- ❑ U ❑ m a Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other 0- Pump Make/Model Orenco PF200411, 20gpm, 115v, 1/2hp ❑■ Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 50 gpm Squirt Height 3 ft Pump on time 1.8 min Pump off time 6 hours Daily flow set at 360 gpd Updated 8212018 Mason County OSS Installation Report pg. 2 Parcel# Z233I —SL- DOD51 ABANDONMENT RECORD - TJ� YES � NO Were existing septic componentsO ajb1aidonec as par,. :? - `F-�ti If yes, please describe: a l� iil'� Q •CT1 YES NQ Were all components pumped out and properly abandoned per WAC246-272A-0300? - 1�' RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold onentatior.&layout.SeptiGpump tank location.North arrow.reserve drainfield.existing and proposed buildings.location of wells.waterlines, wells.observation ports.clearouts.and other maintenance access points. Incomplete Record Drav ngs may create additional delays in final installation approval and related permits. i Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself andnd Mason o Countyuty Public ub i Health and meet all and Mason County Codes. s I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. _. ._� 0 I/0112 r f tt �- -' Dare Jr);••.. Signature of Install .�91 n . , w r.. f •Printed Name of Signed ' if , r N, MASON COUNTY PUBLIC HEALTH . PAULA s�JOY oo�JO4a The undersigned approves this Installation Report and • kiNSON 'j' 1 Record Drawing on behalf of Mason County Public -L'IC SE01:010.101- 'f• Health: �_� Y �� Mtn \ket/il‘ Signature of Environmental Healt Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e2iCote , Ex-c-s-\---NgS\-41) pav,ei..., r,o,,,i1.11.',1,ie......,_, = a= li :. _ . ! , hn RruSr I 3:14 CEL 223311'- 5 1-oco5? • I2g --- !22c, NE CouMJ944 E a -.-r- .T' 'rcfiLE. ., - -(•. l t r P/N a (7 RA'V { r-0/4AM� 1 -Y Rr9fi rs -j p Gv t`tiPR�clND ;r11 _ — s> p l —' ~ , Z. Ztf GL$ -r R C 00Z5 0 Mci-rf _`~ c B ttPF}c-ncti 1 3rc' - 5 : 'LC > GL5 + TsT -' D Mc-TJ } 40' GptAeAc-T1GN 40' qq' U � (5) 3lJC�}G1 ?RIMAR3 D.F. —CREtvc:�f€5 qp1 C 5 ` D•c. t,0,i1f+-1- R Eg_vE 5,0vE 0; ,- (m a i Audio-V=1g 011 \ le , I ico C.9; ')alarlaut a 1 , ZOO Gail=Pre-Trash Tank I d ® ).--\ Lt,..,........0p2.„.....,,, . l' 1', 0 Low Pram;Cbalnher ® r t ;: 1 ! ;' VA[.v� G�ri✓o) Box 4i 1 ( 0 Oid D .F. — as000., &c,BOs' ly i` ;It' 0(,,,,.. .0);•-A,N, kt.dt'6-1'4 'I,. ';\ . . ..4, ..,.,, ,.CO3 a �� f PAULA JAY JOHNSON 11�� APPROVEDF ri' SEP 1 2 2025 9--3-t,1--- MASON COUNTY ENVIRONMENTAL HEALTH RET