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HomeMy WebLinkAboutSWG2021-00663 - SWG As-Built - 2/9/2023 Mason County OSS Installation Report pg. 1 / MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00663 Parcel # 42135-50-00055 Applicant Name Becker Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address 13407 117th Ave Ct E Clear Lake Lot 32 City, State, Zip Puyallup. WA 98374 Installer Name Able Industrial LLC Site Address 901 W Clear Lake Drive Designer Name Arrow Septic Designs INSTALLATION CHECKLIST • Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Sand Lined Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A El YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - 0 U CI H Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ 0 ❑ f— 24" access risers over each compartment? - - ❑ 0 ❑ a W Effluent filter installed?- - ❑ 0 ❑ cn Septic tank capacity (working) 1,250 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - 0 N/A E YES ❑ NO 00 Manifold/D-box accessible from surface?- - CI 0 ❑ OOZ Check valves installed? - - ❑ I ❑ o Q 40 E Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - - ❑ N/A ❑■ YES El NO >100 ft. from wells? - a r l - - ❑ ❑ ❑ W >100 ft. from surface water? - JAN 3 r 223 - r - - 0 ❑ CI '1'.ft. from potable water lines?- - - - - 1 ❑ ❑ ❑ z > 5 ft. from property lines and easements?- - - - -' - ❑ E ❑ £ > 30 ft. from downgradient curtain/foundaiic tY =`----- - - ❑■ ❑ ❑ cm Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ LU ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman Z - ❑ El CI 24" access riser(s) and accessible from surface? dAlarm or Control Panel Installed? -SIN - CI ❑ E Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ D n- Pump installed in ® Bucket or El On Block or ❑ Other a Pump Make/Model Liberty FL62M 0 Floats or ❑ Transducer eL d Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 5 ft Pump on time 2.7 Minutes Pump off time 6 Hours Daily flow set at 480 gpd Updated 8;2112318 Mason County OSS Installation Report pg. 2 Parcel# `�f?\ �5 - 50IGoo 5 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES III NO If yes. please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 0 YES 0 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: Drainfield&manifold orientation 8 layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports,cleancuts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 5 _..r_._ t \--1- -Ac-1-1. ® 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 certify that all information contained on this I further certify that all information contained on this form and attached cor Dr ng is accurate..- form and attached Record Drawing is accurate. 7,17,. or I —/0 _ z3 ZOl. Signature(of Installer Date ., Vr C L C� .1/l 'Gl A-V___ f Printed Name of Signee ,1% MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and NZ'• °tt.'.'Ae t4r • .d,: P.AUL�,IOY JOHNSON Record Drawing on behalf of Mason County Public Littt4Stb'iiegfGN5:; 1 Heal ExPiRFs ltitt 0r ?F(96 ?cz; I a�—Z 3 Signature of Environmental Health Specialist Date (stamp, signature and date) Updated 82v20t8 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 3, ! r !4 1,.i t ( s t i P ,rCoi `42. 3 5 -GGC a 0, \ti C!.E.AR: .A^r 7)R._ F , ;I! 2 0 2CIO qO i2c) • PPROVE " t FEB 0 Q 2023 MASON COUNTY ENVIRONMENTAL HEALTH F i . ,t1<,, � f , s i � i 7 Key; 0 Audio-Visual Alarm CCleanout irs 03 1250 Gallon Septic Tank L;1 2-Compartment with e,i I • Effluent Filter s1 { I 1250 Gallon Pump Chamber I OS Valve Control Box i t j+.„.; - -•,z.mow 'Y O - cX6Q. FctrtiAR'1 DRA1IVF\E_L • "7' ' - i w,...- i 1 • Mav E, DE- LI s A, , �OrJ t '+� 5,co.3ns _.(y PAULA JOY JOHNSON 7 ' EJCPIR.;W1 5/ i - 60-Z'