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Home My WebLink AboutSWG2021-00301 - SWG As-Built - 4/18/2023 Mason County OSS Installation Report pg. 1 C , Q MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021, 00301 Parcel # 223205000021- Applicant Name ROBERTO RODRIGUEZ Subdivision (Name/Div/Block/Lot) Applicant Address 10022 8th AVE NW City, State, Zip SEATTLE, WA 98177 Installer Name KATTRAX Site Address 51 NE PARK LN Designer Name BRANDON JONES i INSTALLATION CHECKLIST il 0 Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type PRESSURE Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ It ❑ Z• >50 ft. from surface water? - - CI ❑■ ❑ a Cleanout between building and tank? - - ❑ EU ❑ U Tank baffles present? - - ❑ ❑■ ❑ a24" access risers over each compartment?- - CI II CI W Effluent filter installed?. - ❑ El ❑ u) Septic tank capacity (working) 1250 gal Manufacturer HAGERMAN CI D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ElI CI 002 Check valves installed? - - ❑� ❑ ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO >100 ft. from wells?- - ❑ © ❑ o w >100 ft. from surface water? - - CIMI CI LT. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ In ❑ Q cc > 30 ft. from downgradient curtain/foundation drains? - - © ❑ ❑ • Drainfield level and observation ports present - - ❑ ® ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - x❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1250 gal Manufacturer HAGERMAN < 24" access riser(s)and accessible from surface?- - ❑ El ❑ ~ a Alarm or Control Panel Installed? - - CIRI Cl E Control Panel equipped with Timer/ ETM /Counter- - ❑ PI ❑ M d Pump installed in 0 Bucket or ❑ On Block or ❑ Other a• Pump Make/Model LIBERTY 290 li Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 36 gpm Squirt Height 6 ft Pump on time 75s Pump off time 3h Daily flow set at 360 gpd Updated 8/21/2018 .111e Mason County OSS Installation Report pg. 2 Parcel # 22320500002 ABANDONMENT RECORD 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? - - ❑ 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 builCings,location of wells,waterlines, wells,observation ports,deanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. I I 0 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. Josh ?ete1Jon 4/17/2023 Josh Peterson(Apr 17.2023 07:06 PDT) Signature of Installer Date o'II JOSH PETERSON ? k , . '�X^$1 Printed Name of Signee i •' Y,\ dir r7• F WAS MASON COUNTY PUBLIC HEALTH 1' 1 _Rawl z ;sa l The undersigned approves this Installation Report and ;,• _� •: I, Record Drawing on behalf of Mason County Public i o•.• 5t00388 3 II Brandon R. Jones •. Health: i it I I NER EXPIRIES f h .aaaaaa�a aaaaaa�/, kINXINPV1 2/26/24 i n ture of Environmedtal Health Specialist Date (stamp, signature and date) Signature P q Updated arztf20 e THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Illik ' J ° • T V. . a • • -• m 3' . • ^ ° ^ N * N o n . •• � , o 0 • • . 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