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HomeMy WebLinkAboutSWG2019-00312 - SWG As-Built - 4/12/2022 . , . -DVED evona, -,DOO62 D Mason County OSS InstallW# ri ifiepioit pg. 1 MASON COUNTY PUBLIC HEALTH Wffi PERMIT INFORMATION Permit Number SWG 2019-00312 Parcel # 22212-56-00026 Applicant Name Bob& Christina Kirk Subdivision (Name/Div/E3ldckIL °N MENTAL Applicant Address 1125 142nd Ct SE HEALTH City, State, Zip Mill Creek,WA 98012 Installer Name Maples Excavaitng Site Address 18291 E State Route 106 Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Pam" It Full System Installation ❑Tank(s)Only 0 Drainfield Only ®Repair ❑Other System Type Sand-Lin:-•,7, \ -P1retreatment Type >5 ft.from foundation? - 11 z' - ❑ N/A 0 YES 0 NO >50 ft.from wells? 4 A% ZtL.- - - - - 0 ® ❑ Z >50 ft. from surface water? - i� V 1.__' - ❑ IN H Cleanout between building and tank?1/0 Nc W HO( 1 yt-- - - ❑ ❑ ❑ V Tank baffles present? - - ❑ ❑ F- 24" access risers over each compartment?- - ❑ ® ❑ a W Effluent filter installed?- - ❑ Septic tank size 1200 gal Manufacturer Hagerman-Traffic rated D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - NJ ❑ mZ Check valves installed? . a+ PI/Yr1? - ❑ 0 ❑ aQ 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- r - ❑ N/A © YES ❑ NO • >100 ft. from wells? 7 5 W t V{r 0 h P ❑ ❑ ii W >100 ft. from surface water? - ❑ 0 ❑ tLL. >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ © ❑ 12 > 30 ft. from downgradient curtain/foundation drains? - - -- - ® ❑ ❑ 0 Drainfield lave' and observation ports present ❑ 0 ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - ❑ N/A ❑ YES ❑ NO • Pump tank size 1000 gal Manufacturer Hagerman-Traffic rated < 24" access riser(s) and accessible from surface?- - ❑ ® ❑ I— EL or Control Panel Installed? - - ❑ Ii ❑ a 2 Control Panel equipped with Timer/ ETM/Counter- ❑ II ❑ - M a Pump installed in ❑ Bucket or 0 On Block or ❑ Other D.• Pump Make/Model Zoeller N163 ® Floats or ❑ Transducer a Tank draw down 3 in/min Pump capacity 57 qpm Squirt Height- 5 ft • Pump on time 1.5 min Pump off time 6 hr Daily flow set at 360 gpd 'JFdatee 8t21RJ18 'Tinted From Mason County Dr 4 is :. Printed horn Mason County DMS Mason County OSS Installation Report pg. 2 Parcel# 2 2 2 t z-' 5(0—0007 co ABANDONMENT RECORD Were existing septic components abandoned as part of this project?e '+ "�` D YEs a If yes, please describe: �� - ode- t.Cr"A NO Were ail components pumped out and properly abandoned per WAC246-272A-0300? - []YES RECORD DRAWING This is a permanent record and must ne accurate 1 yndou descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record be Drawings contain: Draafield&man roltl orentaticn&layout.SepdGpur tank location,North crow,reserve d sirleld,existing and proposed buildings.location of wells.waterlines, S it final installation approval and related penrats. wets,obseration ports.deanouts,and other malltenan access points. Incomplete Record Drawings may create additional delays /,,(...)d----_, l r yy, APR MASON COUNTY 1:N v.V,RONME,yT, HEALTb. 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. 3 ( IZ2 Signature of Installer Date • i /, Printed Name of Signee lig"-:•.ot ~Aaq%: �q-� MASON COUNTY PUBLIC HEALTH ill ; ' ` '! IN The undersigned approves this Installation Report and r'�' 3.t�' S1r,034y .C'r), Record Drawing on behalf of Mason County Public �'-p':~ PAULA JOY JOHNSON .:y 114)4, Heals : d s .. i art Mita e•'l,,QN5 cs `ti �h�S - zc -zZ S:a at Tr Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE •;pdnec 8rs1n018 printed From Mason County DMS Printed from Mason County DMS AS b u i. if ` BGb tC.lnrIiha ��Y� / 2- 5b-00 OZ 6 Pal-c?l #22z � ► 13.7 o 1$ 2 91 E Sta t•t RC L)ft f 06- SCaf{• / ''- 90 H00 d \aYla \ ../ 0 20 KC 6c o Q=T-es wr H i 14 [A' 7 ' LS-- roo Bin it1^t a oar - .2N (' LS 4- roots UAudio-Visual Alarm oh Wit I 3 Cleanout 33 1200 Gallon Septic Tank _ v 2-Compartment with !! Effluent Filter -tl-C c rA it d f rEYi S n• •r. s ^�B R prop• `(c o 3 1000•Gallon Pump Chamber I_ M �-/ - 'a c-c,.0 rct tt d Ya : � m s _ _ r~ ( Z 8 R . . �J M• 11 �. d•Q C v../,'S s��tie,d\ o� v-e,rtia ved 4 ,' 1 \ k,W..Q� ®� v. Dv�S e e'er"'L''--k-cs� tee 1 0 u&. ^^- - \194t- 0.-b 4-•'.4-x•-zki.., c t 70. 0 P P R 0 V E ,.. - ' i . . S1�ty� wq-krl�nc, APR 1 4 . JL y cc a< {hC4 c1Yl f W t�1rY+ Ohi COtiNTY ENVIROA'h1kNiNi HEh�T,. �°,4'kk- ;lj 10 I of* a tic JRW COYH paru,h rc . . OA 7511 ' R/'►s't wen 6� (1 1 ,SS A. ' \ wtta ' -0 '. 'a: -`\' ., j-f--• 51r3 4g '(%%4, , 105.l0` — 1 \010 Vs4* tiO- PAUTAJOYJUMNS�JN •y LfC�Fl� b�siONE �t �� 3 EXPiFti S�AI 1 ' irated From gila;"Nt �` it �l l -z F - Z.Z.Printed from Mason County DMS