HomeMy WebLinkAboutSWG2022-00120 - SWG As-Built - 3/30/2023 Mason County OSS Installation Report pg. 1 0 .C MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00120 Parcel # 42329-50-00201
Applicant Name Jamie Ryan Subdivision (Name/Div/Block/Lot)
Applicant Address 5218-42nd Ave. SW
City, State, Zip Seattle, Wa. 98136 Installer Name Spear Construction
Site Address 50 N. Mt. Rose Place Designer Name Bob Paysse
INSTALLATION CHECKLIST
1E Full System Installation 0 Tank(s)Only 0 Drainfield Only ❑ Repair ❑Other
System Type ATU - Pressure Pretreatment Type Nu Water BNR 600
>5 ft. from foundation? - •- ❑ N/A ®YES ❑ NO
>50 ft. from wells? - ❑ ❑
Z >50 ft. from surface water? - - ® 0 El
Q Cleanout between building and tank? - - ❑ Il ❑
U Tank baffles present? - - 0 ® ❑
a24" access risers over each compartment?- - 0 III
U) Effluent filter installed?- - ❑ IN ❑
Septic tank capacity (working) 1060 gal Manufacturer Infiltrator
0 D-box water level and speed levelers used? - - • N/A ❑ YES ❑ NO
pJ
0 Manifold/D-box accessible from surface?- - ❑ IN
m— Check valves installed? - ❑ ill
0 Q
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑■ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A IN YES ❑ NO
0 >100 ft. from wells?- - 0 NI
W >100 ft. from surface water? - - ❑ ill ❑
u. >10 ft. from potable water lines?- - ❑ ® ❑
Q > 5 ft. from property lines and easements?- - ❑ 0 ❑
ce > 30 ft. from downgradient curtain/foundation drains? - - I. ❑ ❑
GI
Drainfield level and observation ports present - - ❑ 0 0
0 Graveless chambers or o Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
Pump tank capacity(flood) 1200 gal Manufacturer Infiltrator
Z
Q 24"access riser(s)and accessible from surface?- - ❑ ® 0
aAlarm or Control Panel Installed? - - ❑ II ❑
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ II ❑
D
a Pump installed in • Bucket or ❑ On Block or ❑ Other
Q. Pump Make/Model Liberty 280 ® Floats or� �, ❑ Transducer
Tank draw down m S uirt Hei ht 24"+
a ,. in/min Pump capacity 3e gp q g ft
Pump on time / /Zeel .r-_ Pump off time (4, -f Daily flow set at 4:: 410 gpd
Updated 8I21/2018
Mason County OSS Installation Report pg. 2 Parcel# 42329-50-00201
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -
If yes, please describe: YES ® NO
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 ectividea and future development. Typical Record
Drawings centarn Dra f.ea d r-anifolo o:ienabon 6:aycu,Seppdpump tan.,Iccabon.North arrcw,reserve dam'reld.exis'ing and proposed huilo:rgs location of weds.wale:Iines.
wells,ocservatIon ports,cleero.ls.una other maintenance access poems. :nrh•rplete Record Drawngs•ney aaa:e additional delays in ri.,al installabol`approval and related permits.
III Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that 1 installed the system in accordance with l 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 clearedlapproved by both the designer shown hate 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
1 further certify that all information contained on this /further certify that all information contained on this
form and attached Record Drawing is accurate, form and attached Record Drawing is accurate.
4/3I 22
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S/gnatflnstell r Date
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Printed Name of Signee y
MASON COUNTY PUBLIC HEALTH t� •1
The undersigned approves this installation Report and / � r � •
`! •
Record Drawing on behalf of Mason County Public �;,
• Stde,l7
Health. � ��e. R�9E'• lives SE
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�1 . /t C� J EXPIRES
Signature of Environmental Health Specialist Date
(stamp, signature and date)
THIS FORM MAY RE SCANNED AND AVAILABLE FOR PUBLIC ViEW ON THE MASON COUNTY WEB SITE a;dated ate. to
A pPRO
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MASON COUN�R 3 o 2023
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DESIGN
PIONEER DIGGING INC. CUSTOMER: JAMIERYA�I s�.\LeI:2o
} PARCEL=:42329-50-00201 TEST HOLE I: TEST HOLE 2:
SEPTIC DESIGNS ADDRE.: 50 N MT ROSE PLACE 0-228 GIS 0-3I CIS
28-36 GMS 31+H2O
3083 E.MASON BENS'N RD. CRAPF\'IF\\',\\-:\08;I0 DESIGNER: ROBERT H.PAYSSE Ii-32 12-31
OFFICE 360-1261803 FAX-36-427.2353 DESIGN PAGE ASBUIL:f