Loading...
HomeMy WebLinkAboutSWG2022-00565 - SWG As-Built - 1/17/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00565 Parcel # 62012-21-00020 Applicant Name KILLIAN CREEK LLC-GREGTOMS Subdivision (Name/Div/Block/Lot) Applicant Address 4366 HIGHLINE DR SE W1/2 SE NE NW City, State, Zip OLYMPIA WA, 98501 Installer Name Custom Cedar Construction Site Address 180 W KILLION CREEK RD Designer Name Arrow Septic Designs INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - M N/A ❑ YES ❑ NO >50 ft. from wells? - ❑ • ❑ >50 ft. from surface water? - - 0 ❑ ❑ Z - ❑ ❑ H Cleanout between building and tank? U Tank baffles present? - ❑ 0 ❑ H 24' access risers over each compartment?- - ❑ X ❑ a - ❑ I ❑ W Effluent filter installed? � Septic tank capacity (working) 1200 gal Manufacturer Miles 9 D-box water level and speed levelers used? - - ❑ N/A CI YES ❑ NO X0 Manifold/D-box accessible from surface?- - ❑ mZ Check valves installed? - - ❑ 0 ❑ OQ 2" Schedule/Class 40 E Transport Line Size Bedrooms installed (check one) ❑ 2 ❑ 3 ■ , PI !I 6 ❑Commercial/Other >10 ft. from foundation?- ri ,_ ,_,q_l _ . N/A ❑ YES ❑ NO >100 ft. from wells?- ❑ 0 ❑ W >100 ft. from surface water? - JAN-�� 2a2 - 0 ❑ ❑ L >10 ft. from potable water lines?- - - - - - ❑ ❑■ ❑ Q > 5 ft. from property lines and easement-?By - - - - ❑ CI ❑et > 30 ft. from downgradient curtain/found- • • ains. - - © ❑ ❑ o Drainfield level and observation ports present - - ❑ It ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES El NO • Pump tank capacity (flood) 1200 gal Manufacturer Miles Z ® ❑ < 24" access riser(s) and accessible from surface? ❑~ Alarm or Control Panel Installed? - - ❑ El ❑ a 2 Control Panel equipped with Timer/ETM /Counter- - El I ❑ n a Pump installed in ❑ Bucket or 0 On Block or ❑ Other fl- Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a E 2 ft Tank draw down 2.5 in/min Pump capacity 55 gpm Squirt Height Pump on time 1.5 min Pump off time 6 hr Daily flow set at 360 gpd Updated8;2'.f2C 8 Mason County OSS Installation Report pg. 2 Parcels l02011-ZI-00020 i,: AemociNMENT RECORD . Were existing septic components abandoned as part of this project? - YES ® NO If yes, please describe: ED No Were all components pumped out and properly abandoned per WAC246-272A-0300? - 0 YES RECORD K _ 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: grainfield&manifold orientation&layout.Septicipurrp tank location.North arrow,reserve da,nfieio.ewstng and proposed buildings,location of wells,waterlines, welts,osservaticn ports.deanous,and other maintenance access points. Incomplete Record Drawings may create additional delays r,final installation approval arc related permits. 5.ee. APpRovEi 4ac *íw BAN 1 - :.1q�N 2„, ONTY ENVIRON MENTAL, LBW EACTH Record Drawing Attached • .CERTIF#CATIQ.R 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 ail and Mason County C••es. State and Mason County Codes I further ce-% th-t-.' information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form a • - � � . . .T. � �ing is accurapte. A th z/z, Signs re of ,sta/ter Date p Wc-k iii4,cf/sey/ami) , .I:.,, Printed Name of Signee ' $..,-f , ' I. li',. �f -.. t. MASON COUNTY PUBLIC HEALTH y� 5100349 •t.0:, The undersigned approves this Installation Report and s*.Q-z PAULA JOY JOHNSON .t.\(\, Record Drawing on behalf of Mason County Public 10ENSc �£\1NEt2 `!�, LS ",51 — ��S�r�sr Hs- Ili. (41,A _ ,---7_2_,3 / 5--z 3 Si. atil P Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updered 6121 OC13 i • i -e.,t5 l\ ` -. - -- <'` ' Qr ,� 'l:''D tj • •v. XV © O s ! 38R iio u5r t O to lar' / ;�Y1vewIIV /r ,r, OVE 1 JAN 1 i 2023 ;�v-Y ENVIRONMENTAL HEALTH 1 JBW j t i \ U N>l_C, `" _50' 0 Audio-Visual Alarn 1 1 t Cs o 25 50 `i7 :oo r 3 Cleanout A5bU \t /1 O3 1200 Gallon Septic Tank `-gip D n /# v 2-Compartment with ` Effluent Filter Pare V2.0 Q/2\ GOO LC O 1000 Gallon Pump Chamber t 80 W lA 1 a,n r.‘(e e; c . IA} O Valve Control Box -... IN pA j N. it y• • • (h y. ,t rj1 �' cf�, ,�—fry,•. 51'05349 i10' PAULA JOY JOkNSON . , ucEws�bu�s�c�; a. � Q(PIReS U /��� I S-'' 2i