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HomeMy WebLinkAboutSWG2022-00565 - SWG As-Built - 1/17/2023 (2) 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-GRE(iTOM5 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? - - ■❑ N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ I ❑ Z >50 ft.from surface water? - - 0 ❑❑ Q Cleanout between building and tank? - - ❑ El ❑ I— C..) Tank baffles present? - -, - ❑ ❑ I— 24" access risers over each compartment?- - ❑ 0 ❑ a W Effluent filter installed?- - ❑ N Septic tank capacity (working) 1200 gal Manufacturer Miles ❑ D-box water level and speed levelers used? - - ❑ N/A i YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ ❑ El co-2 Check valves installed? - - ❑ El ❑ ❑Q 40 E Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑ 3 ■ • P. :I 6 ❑Commercial!Other - fJ >10 ft. from foundation?- �1-Will - El N/A ❑ YES ❑ NO CI >100 ft. from wells?- - ❑ CI w >100 ft. from surface water? - - JAN-0-7- 2it23- . - 00 ❑ tr. >10 ft. from potable water lines?- - - - - - - - - - ❑ ❑� ❑ z Q > 5 ft. from property lines and easement-?B . - ❑ 0 ❑cc > 30 ft. from downgradient curtain/found- . . -ins. - - ME ❑ El ❑ Drainfield 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? - - ❑ N/A 0 YES ❑ NO Pump tank capacity(flood) 1200 gal Manufacturer Miles Z - ❑ ® ❑ < 24" access riser(s) and accessible from surface? ~ a Alarm or Control Panel Installed? - - ❑ El 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ UI ❑ n a Pump installed in ❑ Bucket or ❑■ On Block or ❑ Other CI- Pump Make/Model Zoeller N152 II Floats or ❑ Transducer 2 CI. Tank draw down 2.5 in/min Pump capacity 55 gpm Squirt Height 2 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at 360 gpd Updated 812 112 0 1 8 Mason County OSS Installation Report pg. 2 Parcel# (0 2011-Z I-000 20 ., ABANDONMENT RECORD'• _ � YES (� NO Were existing septic components abandoned as pan. of this proiddt? If yes, please describe: 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? YES RED- ..Ji� d' 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: Drainfeld&manifold orientation&layout Sepdcfpump tank location.North arrow,reserve drainr+eto,eacstng and proposed buildings,location of wells.waterlines. wells,observation ports,aeanouts,and other maintenance access Points. Incomplete Reword Drawings may create additional delays in final installation approval and related permits. 5.e e, 4ç+ac &icc APpRovE JANi - 1U?.3 IA + NT, ENVIRO kJ/MENTAL HEALTH Jew ®-Record Drawing Attaches . . . CgRTfF to TioN 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 cieared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all 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 forma •/ r ( } •C - •ing is accurate. form and attached Record Drawing is accurate. I _ 8/ /z/ Signs re of ,slier Date %`cam' •A Wc_k liri,j re_figi f__________ nt. Printed Name of Signee ...A , MASON COUNTY PUBLIC HEALTH •` n, 51003-19 t`�:t� The undersigned approves this installation. Report and NQ PAULA JOY JCHNSON .y'•)\ Record Drawing on behalf of Mason County Public 'I c.yTie sGhr.Fi . He ExPtRestji 1. '-'•--- �� . i_ 17 23 / , S--z3 Si etc. Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ,1pda'ed&21'"'IS 330.8 Vi re,t5 //Th SS • \. \,...... ,Li080' )33 SlnoP ©8 n© ; cm I Pr Pnsrd 382 ffovst d oto lefe- r L 1 / f r -,. • PROVE i , I_:d`a , N �-� JAN 1 7 '10'3 -.,•b\r"Y ENVIRONMENTAL HEALTH ► JBW ij, ` Ke4: f .(-,.: -' - _- — Audio-Visual",lacy* C/ t a A 0 25 go 75 GOG 11 (7) Cleanout PcSbv;tt kl J n 1200 Gallon Septic Tank r o.• 71 v, C. r `J 2-Compartment with j i f / Effluent Filter Parck`AV.472.0 t2/2t -G 00 2-C "✓ 1000 Gallon Pump Chamber . A : Valve Control Box _J 44e...-11, .?..., . --. ....,, .. . s vv., . • • , •.7._ _ , )., Y/ 510v349 '(d1r ''1(5 PAULA JOY JOHNSON . 1 LICMSCtibrgrONta' 1- S- Z3