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HomeMy WebLinkAboutSWG2021-00219 - SWG As-Built - 2/23/2023 CC Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG .< c72 ( -'oc)-21 ' Parcel # 1 21 08-77-90020 Applicant Name Katona, Blanca Subdivision (Name/Div/Block/Lot) Applicant Address 12930 475th Ave SE City, State, Zip North Bend,Wa 98045 Installer Name Franklin Clark Site Address 180 E Keen Rd,Grapeview,WA 98546 Designer Name Franklin Clark INSTALLATION CHECKLIST il Full System Installation ❑ Tank(s)Only ❑ Drainfield Only LI Repair ❑Other System Type Pretreatment Type >5 ft. from foundation? - - ❑ N/A II YES ❑ NO >50 ft. from wells? - - ❑ 11 ❑ Z >50 ft. from surface water? - -- - ❑ IN ❑ 1-- • Cleanout between building and tank? - - ❑ ❑ U Tank baffles present? - - ❑ MI ❑ d24" access risers over each compartment?- - ❑ U El W Effluent filter installed?- - II ❑ ❑ cn Septic tank size 1500 gal Manufacturer Infiltrator il 9 D-box water level and speed levelers used? - - 11 N/A ❑ YES ❑ NO 00 Manifold/D-box accessible from surface?- - ❑ II ❑ 002 Check valves installed? - - • ❑ ❑ 0< 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 • 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A in YES LI NO CI >100 ft. from wells?- - ❑ I ❑ w >100 ft. from surface water? - - Ill 0 ❑ u. >10 ft. from potable water lines?- - ❑ • ❑ Z > 5 ft. from property lines and easements?- - ❑ IP ❑ Q C > 30 ft. from downgradient curtain/foundation drains? - - ❑ II ❑ o Drainfield level and observation ports present - - ❑ I ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) II Low Ridge Technologies-OSCAR II Proper cover installed over drainfield?- - ❑ MI ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A YES ❑ NO • Pump tank size 1200 gal Manufacturer Infiltrator Q 24" access riser(s) and accessible from surface?- - ❑ MI ❑ H a Alarm or Control Panel Installed? - - ❑ I ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ M ❑ n n- Pump installed in ❑ Bucket or I On Block or ❑ Other a Pump Make/Model AY McDonald/2205E2AJ MI Floats or ❑ Transducer 2 • Tank draw down 2.8 in/min Pump capacity 30 gpm Squirt Height N/A ft Pump on time 00/00/22 Pump off time 00/03/38 Daily flow set at 360 gpd Updated©12"/2C1 B Mason County OSS Installation Report pg. 2 Parcel # 1 21 08-77-90020 ABANDONMENT RECORD Were any existing septic components abadoned as part of this project? - - 1. YES ❑ NO If yes, please describe: Existing Septic and Pump Tanks were abandoned,tanks were empty at time of our arrival. Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES 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&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines. wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. See Attached ROVE FEB 2 3 20Z3 MASON col,,,vivry ,. • EA VIRONMENTA JBW L HEALTH ® 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 Record Drawing is accurate. form and attached Record Drawing is accurate. 09/15/2022 Signature of Ins alter Date Franklin Clark Printed Name of Signee t� t MASON COUNTY PUBLIC HEALTH a, ..`a1,1 "; 510e173 The undersigned approves this Installation Report and Fiy4KUNJclAPot :4, Record Drawing on behalf of Mason County Public ow s:,oizano2a Health: Sign tureib vironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 SYMBOLS LEGEND aEANaT &I RAA 1811 ® MO•GAL SEPTIC TRIM OEGONOPRWEATY CORNER 2 0 TREE ENERGPEEN t i•P IR 1.g: fCMIST Kr LOCATION s g Q.2 O WATERSuPPLY WELL V i M Xp e © WATER MEIER C i 0 ELECTRICAL ITW6EORIEA .d L@i 9 OJ ELECTMCAL AR2ICN BOX €P $5 IIIETIY POLE sI F F2 n WWS PORT LOCAT1ON g L ss E O EING IAEEEGENERC) F WATRREA INE cg. 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