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HomeMy WebLinkAboutswg2022-00489 - SWG As-Built - 11/13/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 022-00489 Parcel # 423185000040 Applicant Name Roger Bly Subdivision (Name/Div/Block/Lot) Applicant Address 150 N DISCOVERY DR City, State, Zip HOODSPORT, WA 98548 Installer Name BayShore Septic, Sewer, Water Site Address 150 N DISCOVERY DR Designer Name Jim Hunter INSTALLATION CHECKLIST U] Full System Installation ❑Tank(s)Only El Drainfield Only El Repair ❑Other System Type cu ern Pretreatment Type NuWater BNR 500 >5 ft.from foundation? - - ❑ N/A ®YES a NO I >50 ft. from wells? - - ❑ I n Y >50ft. from surface water? - - ❑ U] 0 o g Z 0 Cleanout between building and tank? - - ❑ 0c U Tank baffles present? - - ❑ NI .4-- a 24" access risers over each compartment?- - ❑ U 0 o^, <' 4 W Effluent filter installed?- - ,,n�° ❑ U �71`�'"''' Infiltrator � ..., . �� 0. Zaj Septic tank capacity (working) - � gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ll YES ❑ NO J �O Manifold/D-box accessible from surface?- - El IN 0 mZ Check valves installed? - - ❑ II ❑ OQ 2 Transport Line Size 2" Schedule/Class SCH 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 El 4 El 5 ❑6 El Commercial/Other >10 ft. from foundation? - - El N/A ® YES El NO O >100 ft.from wells?- - ❑ ® ❑ W lit El>100 ft. from surface water? - - ❑ i >10 ft. from potable water lines?- - 0 ® ❑ Q > 5 ft.from property lines and easements?- - ❑ NE cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ © ❑ ca El Il Dr infield level and observation ports present ❑ Graveless chambers or ❑ Clean gravel used? (check one) ro er cover installed over drainfield?- - ❑ © El Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES El NO • Pump tank capacity (flood) 1000 gal Manufacturer Infiltrator < 24"access riser(s)and accessible from surface?- - 0 ® 0 aAlarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - 0 0 0 D D- Pump installed in ❑ Bucket or 0 On Block or El Other 4.• Pump Make/Model MYERS ME7 0 Floats or ❑ Transducer a. Tank draw down 3/1 in/min Pump capacity 110 gpm Squirt Height ft a Pump on time 48 Sec Pump off time 4 Hours Daily flow set at 240 gpd, Updated 821/2018 Mason County OSS Installation Report pg. 2 Parcel# 423185000040 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES iiii NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES Ej 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: Dralnfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells.waterlines, wells,observation ports,cieanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I 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 c 'fy th II information contained on this i further certify that all information contained on this form tt d Record Drawing is accurate. form and attached Record Drawing is a curate. IWO/10;5 "Of Signature of Installer Date I fi ' Printed Name of SigneeA MASON COUNTY PUBLIC HEALTH / i ti-,II The undersigned approves this Installation Report and %4., sl own ��s'•,a Record Drawino on behalf of Mason County Public cT LAMES R.MJKiFR /i Health: ��e...�►1CF, c':iU Fwitoi mb ' 7) II 113'^S EX°PRFS: 03/22/ti(a Signature of Envirrbrnmental H Ith Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21r1018 • • • • .. , • i. 1 s . . . 1 . . !• . • ; . i -----j.. ----:—'91—cr i . - . 1 • ..____.. _ , , : ' . I i a 9 P —0111 i ? • ' i o A t N < : i I 1 tit • _1. • 0 . - --—---- -'—- --—--—110 7,1i., .. )1_; 11 ..„, . 1 J 1 • • 1 1 t . \ 1 01 tri• 1 : 1 th ca cj .. .. .. c •,,t.3 \ 1 S ...,--)- 4:41° 3 • 01 )... • e'd itp." 3 1 . a '8 "9 J I 1 0 l' of' i. 1 ....- ..-- _4 D 6 rs C3 Et CS '' . 4 . . . ; • 41 • , ....\. _-, \ i *. -2. 4 .. 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