HomeMy WebLinkAboutSWG2022-00085 - SWG As-Built - 5/3/2023 immosimismor
Mason County OSS Installation Report pg. 1 0 ct MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2022-00085 Parcel # 12108-34-00050
Applicant Name Jeffrey and Sally Ann Honeycutt Subdivision (Name/Div/Block/Lot)
Applicant Address 9227 Mary Ave. NW
City, State, Zip Seattle, Wa 98117 Installer Name Jack Johnson
Site Address 211 E. Grape Drive Designer Name Bob Paysse
INSTALLATION CHECKLIST
0 Full System Installation ®Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type ATU Pretreatment Type NuWater BNR 500
>5 ft.from foundation? - - ❑ N/A III YES ❑ NO
>50 ft. from wells? - El MI ❑
Y >50 ft. from surface water? • ❑
Z 111 ❑
Cleanout between building and tank? - - ❑ al ❑
V Tank baffles present? - - ❑ ® ❑
R. 24"access risers over each compartment?- - El NI El
W Effluent filter installed?- i ❑ ❑
to -
Septic tank capacity(working) 1050 gal Manufacturer Haggerman
9 D-box water level and speed levelers used? - ® N/A ❑ YES 0 NO
oO Manifold/D-box accessible from surface?- - Pi El El
oQ Check valves installed? - - I 0 El
2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (check one) ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO
tn >100 ft.from wells? 0 ❑ 0
W >100 ft. from surface water? - ❑ 1::/ ❑
t% >10 ft. from potable water lines?- ❑ 0 ❑
> 5 ft. from property lines and easements?- El Elii >30 ft. from downgradient curtain/foundation drains? - El
Drainfield level and observation ports present - ❑ ❑ ❑
❑ Graveless chambers or ❑ 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) gal Manufacturer
Q 24"access riser(s)and accessible from surface?- - ❑ 0 ❑
1--
Alarm or Control Panel Installed? ❑ ❑ ❑
d
• Control Panel equipped with Timer/ETM/Counter- - ❑ ❑ ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
n' PumpMake/Model
� ❑ Floats or El Transducer
d Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 81211201a
Nom
Mason County OSS Installation Report pg. 2 Parcel# 12108-34-00050
ABANDONMENT RECORD
Were existing septic comments abandoned as part of this protect" - - - . YES No
If yes. please descnbe:
Were all components pumped out and property abandoned per WAC246-272A-0300" - I YES Ei NO
RECORD DRAWING
This 1s a permanent ripcord end muM b•accords and d..Cstpehn enough to ro-brat.In the n..d of rrdnsenane.ac .4e..and future d.vslopwt.nl. �c.at.n Aov-^.
Ora+mrys ontan Oranfteia I nwoltaa Qno'iseon 8 tayoyt.Sa kipump:err bobon Nab,snow r..cwc drarrf.ld,cooling and propu..d t,ukangs Dc.non d rota,roatenTss
*e/h,aaiervo/1m pats.raaanouts,and:OAr nlflnld+m"-1 scow,pants incompisa R.00rct Gawwrqs may mate a0, ei O.tay7.,tine nataMtcn aPt vial:aV r.ia1.d pe rrxts
111 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
i certify that I installed the system in accordance with 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 cleartid/appmved 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 1 further certify that all information contained on this
forprind a ed Record Drawing is accurate. form and attached Record Drawing iS accurate.
n .xp of t faller Date
JAL k
Printed Name of Signee
MASON COUNTY PUBUC HEALTH
The undersigned appmves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
C-13 ��
Signature of Environmental ealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uD*,.+d'"'
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APPROX. SHORELINE / /
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APPROVE
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// _ / _ . ,\ ___MASON COUNTY ENV1RONMENTA
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EXISTING RESIDENCE r \\\ \\ \�\
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AP 'ROX. EXISTING \ \ 1
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10X30 RESERVE AREA ' \t -1
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EXISTING 10X30 DRAINFIELD II ��ti':- �\
TABLE-9 RESERVE AREA WOULD / 114, ► i , ,
REQUIRE PRE-TREATMENT DUE TO ti�';.7c : . """'� •
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PROXIMITY TO SHORELINE. $-' s.c..A,°31,0( �-:
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' PIONEER DIGGING, INC. CUSTOMER: J!1 f REY I IONLYCU El SCALE.:I:30
PARCEL# I2108-34.00050 REFERENCES:PROVIDED SURVEY.COUNTY GIS,
SEPTIC DESIGNS ADDRESS 20 CRAPE DRIVE COUNTY 055 RECORDS. FIELD MEASUREMENTS
3083 L M1.k�N BENSON R.D. GRAP[VIF.W.WA 98546 DESIGNER: ROBERT H.PAYSSE
OFFICE 36O42&I8U3 FAX-36O•a27.2353 DESIGN PACE OF