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HomeMy WebLinkAboutSWG2021-00553 - SWG As-Built - 3/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00553 Parcel # 32104-52-00128 Applicant Name Charlie Williams Subdivision (Name/Div/Block/Lot) Applicant Address 16404 SE Newport Way ALDERBROOK G&Y#2/Div 2/TR 128, S 49/104 City, State. Zip Bellevue, WA 98006 Installer Name Mikkelsen Septic, LLC Site Address 1010 E Vine Maple Ln, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair 111 Other 500 gallon pre-trash tank System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - 0 ❑ ❑ Z >50 ft. from surface water? - ❑ ❑ H Cleanout between building and tank? - tl-R- -0-W- - i. 1 T' ❑ 0 ❑ U Tank baffles present? - wk� II^S�D�� -U ❑ X ❑ a24" access risers over each compartment?,- - - ❑ ❑ W Effluent filter installed?- rTvx,V,fo.. _ - ------- — — , ❑ 0 ❑ co Septic tank capacity (working) BNR-500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ❑ NO )<J O Manifold/D-box accessible from surface?- - ❑ mZ Check valves installed? - - ❑ 0 ❑ oQ 1" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 LI 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO O >100 ft. from wells?- - ❑� ❑ ❑ W >100 ft. from surface water? - 0 ❑ ❑ i,i, >10 ft.from potable water lines?- - ❑ 0 ❑ � 5 Q > ft. from property lines and easements?- - ❑ 0 ❑re > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑ • Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambcrs or -0 Clcon-gravcl uscd? (check onc) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman < 24"access riser(s) and accessible from surface?- - ❑ © ❑ a. Alarm or Control Panel Installed? - - ❑ El E Control Panel equipped with Timer/ETM /Counter- - ❑ It ❑ m flow inducer 0- Pump installed in ❑ Bucket or ❑ On Block or ® Other t1'• Pump Make/Model Orenco ORP200511-.5hp,115v,20gpm 0 Floats or ❑ Transducer d Tank draw down 1.5" in 10 min in/min Pump capacity 3.3 gpm Squirt Height -- ft Pump on time 9 min Pump off time 1.84 hr Daily flow set at 360 qpd Updated 8r212018 Mason County OSS Installation Report Parcel# 2-1 0� 28_ ABANDONMENT RECORD YES NO Were existing septic components abandoned as part of this project? - If yes, please describe: - ED YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING This is a permanent record and must be accurate layout,Septi pump tank and descriptive 9ogtfoh to n�Nortfearrow,in eese a dra fie'd need of nexrist existing and proposed ce activities and future uQ de9svlocatio.eof welnt �1�waterl et Record Drawings contain: Drainfield 8 manifold orientation Y and related permits. wells,observation ports,deanouts..and other maintenance access points. Incomplete Record Drawings may create additional delaysin final Installation approval l( 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. ,,,,,v.,„,„„ 0 z/0z`23 9 naturr Date - 1 P � a� Printed Name o Signee TO •I :.y MASON COUNTY PUBLIC HEALTH •�.' { .) • 'r The undersigned approves this Installation Report and � StDu3.9 c�`� Record Drawingon behalf of Mason County Public . PAULA JOY JOHNSON ' . Health: EXPIRES 16 L. ('Y"1 P5(qt 2— z.8-23 Signature of Environment Health Specialist Date (stamp, signature and date) Updated 8212ct8 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE A`jK)Ut �� — Ci (\ iC 1 «iOL S , 1010 V vLt, Q-ft- l✓n - /J� \ 7 * 'jL'- I SC a(e': t "=2Q /Q�'' Ss 9 7 0 ' to 20 30 40 {\ ^0\9° / 24'x 26.5" ..'`/ PY;wtavy Dv•,p D.F s\i a. / 13) \/ ` 0 O . 10 _,4,:, j/:- j17 ' -‘zi /ft 4A1*//./.,,,,_.-.•,._-''.. - '...0 , 0 ® is, ih;„ ff :%•• - •s-J-J --,-, I prop°Sri V 715 4� - 4 cif y ?�6 � v//QI.\.i.. ,... . g D m . 4 •• 2 s o 0 1 N m co Cfr.) / . .:5_,. r'" 0 ..,. Hey OAudio-Visual Alarm OCleanout .• ':� 0 500 Gallon Pre-Trash Tank • + `ni. x 0 NuWater BNR-500 Pretreatment Tank L 'v'1 sioo49 O1,000 Gallon Pump Chamber h PAULA JOY JO{NSON ' 1% 0 Subsurface Drip System Headworks au 2- ZS- -