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HomeMy WebLinkAboutSWG2021-00333 - SWG As-Built - 10/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00333 Parcel # 32109-50-00085 Applicant Name Daniil Dozhuk Subdivision (Name/Div/Block/Lot) Applicant Address 20213 71st Street E ALDERBROOK G &Y#5, TR 85 City, State. Zip Bonney Lake, WA, 98391 Installer Name TJ's Excavating Site Address 31 E Rhododendron Ct, Union, WA Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST • Full System Installation E Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Subsurface Drip etreatment Type NuWater BNR-500 >5 ft. from foundation? - C-\ - - ❑ NIA s YES ❑ NO >50 ft.from wells? - -" �,C j1 - - ❑ s ❑ >50 ft. from surface water? - - - - - \- � - - -0-3-la - ❑ ul ❑ H Cleanout between building and tank? -ti* +k ❑ 0 E]0 Tank baffles present? - '7 C —'- - ❑ 0 ❑ d 24" access risers over each compartmerM-�� - ❑ 0 ❑ W Effluent filter installed?- ` il._ - ❑ ❑ 0 Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO 00 Manifold/D-box accessible from surface?- '0 8•fk3 - ❑ El CI u. m 2 Check valves installed? - - ❑ 0 ❑ o< 40 Transport Line Size 1" Schedule/Class Bedrooms installed (check one) ❑7 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑■ YES ❑ NO 0 >100 ft. from wells?- - ❑ D ❑ W >100 ft. from surface water? - - ❑ II ❑ it >10 ft. from potable water lines?- - ❑ 0 ❑ � Q 5> ft. from property lines and easements?- - ❑ • ❑ re > 30 ft. from downgradient curtain/foundation drains? - - ❑ Al ❑ CD Drainfield level and observation ports present - - ❑ IA ❑ ❑ Gr3volocs chambors or ❑ Cloon gravcl uccd? (chock onc) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ © ❑ H Q. Alarm or Control Panel Installed? - - ❑ • ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ © ❑ D a Pump installed in ❑ Bucket or ❑ On Block or 0 Other Flow Inducer 0' Pump Make/Model Zoeller 5031-0005, 19gm, 1/2hp, 115v ❑Q Floats or ❑ Transducer 2 a Tank draw down 1.25" in 10 in/min Pump capacity 2.38 gpm Squirt Height -- ft Pump on time 8.4 min Pump off time 1.84 hr. Daily flow set at 240 gpd Updated 8121/2018 32 I a9-50- ono ?S Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES II NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES El NO 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: Drainfleld&manifold orientation&layout.Septicipump tank location,North arrow,reserve drainfield,existing and proposed bui.dings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additonai delays in final tnstalation approval and related permits. S e Q I Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER 1 certify 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 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 and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached Re 'rd Drawing is accurate. form and attached Record Drawing is accurate. Ir ��'� ir Signature of lnsta ler Date . `ACC c) Printed Name of Signee yj MASON COUNTY PUBLIC HEALTH 4 `-i �' 2 ,), The undersigned approves this Installation Report and .. u' (f , ,1 ' •LI' F Record Drawing on behalf of Mason County Public T`' st 00349 ' Heal' ts-11_=riCgi.ONg 6)11 \ 61 15)-LC v. PAUU1 JOY JOHNSON ' ' .\,....tvia OR 1�-2-2,j Signature ofEnvironmen I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SfTE updated 821/20/8 imaisumwmiiimminvimismomw oo' , 49, Primary cover it It Pa fio PI+to 9 Drip 13, 43' �� DF 2 B, 9=) Zr 38' H o uSe 1.13' icy 1I _ 4 r � T 4 1 100 0 oX �j-ara9 e \ 5 I k er)e_ Q fch ,_ `\ f 0 � � , _1 © a II T Vi.-,0e-W0,. 36 1 Propose d khockoci\ ndro Gy- ca 1'( = z0' 1 0�1 t S 0 c 0 20 30 '}o AS - ui {, APPROVED Ni Ts „N stru,Q.*ate O C T 13 202.5 Pc,rce1z:3Z.\0 CA- o ' 54fr" AS ON COUNTY ENVIRONMENTAL HEALTH 3 E. ,ododeh'\dro - G-t. RET 4k'tp, xey: ; 0 Audio-Visual Alarm '4C`. `per • erf O2 Cleanout 1,,�yv,`Z`ti� 0 NuWater BNR-500 Pretreatment Tank �. QZ�PAULA JOY3JOHNSON..'� O4 1,000 Gallon Pump Chamber i �.jj; '1. 0 Subsurface Drip System Headworks O-Z-Zs