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HomeMy WebLinkAboutSWG2021-00415 - SWG As-Built - 3/20/2023 C. c., Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00415 Parcel # 41909-41-00000 Applicant Name Ken Stickley Subdivision (Name/Div/Block/Lot) Applicant Address 13229 184TH AVE SE City, State, Zip Renton, WA 98059 Installer Name Arrow Excavating Site Address 700 W Wivell Rd Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Gravity Trench Pretreatment Type >5 ft. from foundation? - No >rtcUSElEC - 0 N/A ❑YES ❑ NO >50 ft.from wells? - CIRI ❑ >50 ft.from surface water? - MW-y'Y ' - - 0 ❑ ❑ z ❑ HCleanout between building and tank? - - ❑ Tank baffles present? PiaM 1-)- 223 - L` ❑ I ❑ d 24" access risers over each compartment�Y — ❑ 0 ❑ W Effluent filter installed?- z ❑ I ❑ N Hagerman Septic tank capacity (working) 1,250 gal Manufacturer 9 C1 D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO (1E Manifold/D-box accessible from surface?- - ❑ 0 CI mZ Check valves installed? - - © ❑ ❑ 0Q 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑ 3 4 ❑ 5 ❑6 ❑CommerciallOther >10 ft.from foundation?- 1\101-10U5E `JET 0 N/A ❑ YES ❑ NO CI >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - El ❑ ❑ II >10 ft.from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ It > 30 ft.from downgradient curtain/foundation drains? - - MI ❑ ❑. Drainfield level and observation ports present - - ❑ II ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ .a.• tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES i NO Y Pump tank ca•--'. (flood) gal Manufacturer Z CI a 24"access riser(s) and a = ible from surface?- ■ El I- a. Alarm or Control Panel Installed? - - - ❑ ❑ ❑2 Control Panel equipped with Timer! ETM/Coun El ❑ El- D CI- installed in ❑ Bucket or ■ a = ock or ❑ • r " Pump Make/Model ❑ Floa or ❑ Transducer = Tank dra n in/min Pump capacity gpm Squirt Height ft -ump on time Pump off time Daily flow set at -•• Updated 8/2 t/2C'8 parcel# CAOC\^A\' 00000 Mason County OSS Installation Re ABANDONMENT RECORD - - - - - - - - - - E YES II NO Were existing septic components abandoned as part of this project? - - _ _ _ - YES � NO If yes, please describe: '- - Were all components pumped out and properly abandoned per WAC246-272A-0300. RECORD DRAWING Recorc e Noah arrow,reserve of maintenancen n a and proposed andd twin de, of wTUpiwaterlines, D s is a perm anent record and must be accurate and descriptive enough to re-locatein the need activities and future development-lnG�elatceele Pet�t� s create additional Bela in final installation P we0s, gs contain: Drainrield&manifold orientation main a layout.Sept cipum.tan location. r� • we9s,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may S EE b .' )' AP MAR 2 0 2023 MASON COUNTY ENVIRONMENTAL HEALTH JBW I 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 andnd Mason aso Countyy Public Health and meet all and Mason County Codes. St that all information contained on this odes I further certify that all infor" ation contained on this I further certify form ar)crittached R ord Drawl s.accurate. form and attached Record lying is accurate. 31 �� Date 1.. •���J. nature of Installer t dt o� w.tay,���,�, ol�n C�%llilari� f.�%0\1 i :; o phi Phn ed Name of Signee .`n4., . .tsy S100349 }� MASON COUNTY PUBLIC HEALTH r st ? PAULA JOY JOH�SON ?r�/l The undersigned approves this Installation Report and J-�'`-� JOY it jNSON�7 '� Record Drawing on behalf of Mason County Public TICS - T i c—Ni Health: ) -<- Z 3 l ; j 3j-20-2 Signet e o vi nmentai Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Update,:dal c0 8 • 1 SCALE: V.: 50 A 40 S—?u` .. 7 � 100 \NI \vLi c-.9 • P sus wP�e - c ...,. ae\ -°-"--------—"--—--------' - N.. (4.1-\ 6";1\ . l ' C. ' R-�Q s4 d / ,M.r• fl LOOT �` �a MO' x�p' 5� 3X�0 �rtrMa� 7u-tu2E Cz x\\-\\ uot�E = 1 �racnf t�,ta �r{,>t�c,�nTE ap a 0•�. uJ+'C�•si C � � 1 1C- ,Serv{ r h� . tWZ/Cn 4 i \ \ i 1 1 l \ PpR 011E0 ,ABM c�MAR,2 O 2023 . _� � Z � A YEAVIRpNME A Jew NTALHEALTH CCleanout 'Gallon Tank _%4;._ O1,2 SO Effluent Filter r ..- 2-COentticith �L, �. Q D-Box with speed-levelers •• and cover 7 •�,T A. •A7 to surface �% 51C` 1 C? r1 a AAULA JOY JOHNSON •;t FxP,aes oer g7'L14 _. 3- (-2.3 - .