The URL can be used to link to this page

Home My WebLink AboutSWG2024-00101 - SWG As-Built - 5/3/2027 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00101 Parcel# 22023-75-00040 Applicant Name Temple Family Trust Subdivision (Name/Div/Black/Lot) Applicant Address PO Box 784 City, State, Zip Mercer Island,We 98040 Installer Name Arrow Excavation Site Address 671 Woodland Beach Lane Designer Name Bob Paysse INSTALLATION CHECKLIST ® Full System Installation ❑Tank(.)Only ❑ Drainfield Only ❑Repair ❑Other System Type ATU-Drip Pretreatment Type NuWater BNR 600 >5 ft.from foundation? --------------- ------------ ❑ NIA ®YES ❑ NO >SO ft.from wells? ------------------------------ ❑ ® ❑ Z >50ft.from surface water! ------------------------ ❑ ® ❑ FQ, Cleanout between building and tank? ------------------. ❑ 0 ❑ V Tank baffles present? - --- -- - -- ------------------ ❑ ® ❑ a24"access risers over each compartment?.--------------- ❑ ❑ rW Effluent filter Installed?----- - --------------------.- ❑ ❑ Septic tank capacity(working) NUWater pal Manufacturer Haggennan �13 D-box water level and speed levelers used? --- -- --------- - NIA El YES ❑ No 9 O Manifold/D-box accessible from surface?---------------- - ❑ 0 ❑ Qa= Check valveslnstalled? ------- ------------------- ❑ ® ❑ �S Transport Line Size 1' SchedulelliUm 40 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 05 ❑6 ❑Commercial/Other >10ft.from foundation?-------------------------- ❑ NIA ® YES NO >100 ft.from wells?----------------------------- ® ❑ ❑ W >100 ft.from surface water? - ----------------------- ❑ ® ❑ 2 >10 ft.from potable water lines?--------------------- - ❑ ® ❑ >5ft.from property lines and easements?--- ------------- ❑ ® ❑ >30ft.from downgredient curtaintfoundation drains?---------- ® ❑ ❑ C Dnslnfeld level and observation ports present -- - --- ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?-- - ---------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------ - ❑ WA W YES ❑ NO iPump tank capacity(flood) 1800 pal Manufacturer Haggerman R 24"access riser(s)and accessible from surface?------------- ❑ ® ❑ aAlarm or Control Panel Installed? - -- --- -------- - ----- - ❑ 0 ❑ Control Panel equipped with Timer/ETM/Counter-- --- - ---- - ❑ ❑ C Pump installed In ❑ Bucket or ❑ On Block or ❑ Other Flow Inducer IL Pump Make/Model Pentair 112 hp turbine ® Floats or ❑Transducer IL a Tank draw down N/A In/min Pump capacity 5.3 gpm Squirt Height N/A ft Pump on time 12 min Pump off time 3 hm. Daily flow set at 500 ppit rpa.we an+m+e Mason County OSS Installation Report pg. 2 Parcel n 22023-75-00040 ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? -- - - - - - - - _ . .. . Q YES NO If yes, please describe:Pump out and removed Were all components pumped ou!and property abandnned per WAC246-272A-0300? - - - -- - - IM yes No RECORD DRAWING Tnb b a pvmmanl,eaoN artl mu1 M auvaY Mtl CaaulPaua Muup�ro mlocab N Ma nsp el mablM1nNCa MIa111N arlC NNIa bWlopmaM ryp.M HYyN prawcrx{wnNln p-r6rkb 6 nncNaW emorpppr 61ayvA `w r pomp NtJ ro'arnm N.c'e n r n msnry J'anfxk <i fUnJ A-J rrrcVna W1Af.a 4vn'eu i.l F"4ry WNms 'aetla aESYYeWn pans cbamr.0 iN oWr manbwu wwas wn4. InmryW Rxautl Dnwrpa mar oaab e0erumci eaWra n 4W eWYo"n ppruval arq raWCpanM. Record Drawing Allached 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 septir. 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 Meson 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 fhrs form and attached Record Dower' accurate. form and attached Record Drawing is accurate. atoreoflnstaller Data d . C John Gilliand Printed Name or Signee 4 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and (.�Eh5,p.06s�y„cr.. Record Drawing on behalf of Mason County Pu66r, .,. Healt Signature of Envitm ntal Health Specialist Date, (stamp, signalum and do1c) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON?HE MASON COUNTY WEB SITE exvex;a otpA ) RESERVE: —1-- AP—�ROVED 1500 SOFT —* � : I n?AY 0 2024 cSCNCCUtirYENVIROhNNTALHEALT RET EXISTING WELL ? WN EXISTING WELL EXIST. WELL �`\�e �\ / i O p 26k� ac i i TRANSPORT RETURN LINES DRAINFIELD 1125+ SOFT � Pi ♦ EXISTING FAILED �\ �\ EXISTING HOME DRAINFIELD 7 u GARAGE (IN CONST.) \ '� NEWATU& PUMP TANK � G PASSAGE RWORD DRAVMG PICKERIN CUSTOMER: AN[]]REW TEMPLE TEST HOLE I: TEST I ILE 2 TEST W E Y PIONEER. DIGGING, INC PARCEL K.220737smm0 3661`Ih 2i.1`12A H` SEPTIC DESIGNS ADDRES 671WDDDLAMIBCHLN Tut@, llLd3 DEGGNER: RMEIVT H PAYSSE 3063EMA4lN BFI��ON RD. LRAI'EVIEW,WA 9115.16 OM Mt" JW3 FAX-3U}427B53 cHEET. ASBULT SCALE P-Sd