HomeMy WebLinkAboutSWG2022-00156 - SWG As-Built - 6/30/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG 2022-00156 Parcel# 22007-51-00070
Applicant Name ERIC KELLY Subdivision (Name/Div/Block/Lot)
Applicant Address 12404 137TH AVE E
City, State, Zip PUYALLUP, WA 98374 Installer Name CORY BROWNSON
Site Address 1560 E. TIMBERLAKE EAST DR Designer Name JIM HUNTER
INSTALLATION CHECKLIST
IC Full System Installation
s�❑Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
System Type �� ' " ,,S AY.Q, Pretreatment Type
>5 ft.from foundation? - - ❑ NIA 0 YES ❑ NO
>50 ft. from wells? - •- 0 0 ❑
Z >50 ft.from surface water? - - El El El
H Cleanout between building and tank? - - El El 0
U Tank baffles present? - - ❑ ❑ ❑
a24"access risers over each compartment?- - El El ❑
W Effluent filter installed?- •- ❑ ❑ ❑
to
Septic tank size 1250 gal Manufacturer EVERGREEN PRE-CAST, INC
o D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - El El
mZ Check valves installed? - - 0 ❑ ❑
CIQ
M Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 '3 ❑4 El 5 0 6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A 0 YES 0 NO
CI >100 ft. from wells?- - ❑ ❑ El
W >100 ft. from surface water? - - 0 0 0
t. >10 ft.from potable water lines?- - ❑ ❑ ❑
Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑
Q
re > 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?- - ❑ ® ❑
Pump tank setbacks consistant with septic tank?- - 0 N/A 0 YES ❑ NO
• Pump tank size 1250 gal Manufacturer EVERGREEN PRE-CAST, INC
Z
Q 24"access riser(s)and accessible from surface?- - ❑ ❑ 0
F-
a Alarm or Control Panel Installed? - - El ® El
2 Control Panel equipped with Timer/ETM/Counter- - El ® ❑
M
IL Pump installed in 0 Bucket or 0 On Block or ❑ Other
a'• Pump Make/Model ZOELLER N-161 NI Floats or 0 Transducer
a Tank draw down 2 in/min Pump capacity `k-O gpm Squirt Height $- ft
Pump on time I M, Pump off time 4- (Z S Daily flow set at al gpd
Updated 8.212018
Mason County OSS Installation Report pg. 2 Parcel# 22007-51-00070
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - Ei YES Q NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - [] YES El 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: Orainfield 8 manifold orientation&layout.Septic'pump tank location,North arrow,reserve drainteld,existing and proposed buildings,location of wells,waterlines.
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits
[Record Drawing Attached
CERTIFICATION OF INSTALLATION
4 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.
07:11/-7 6/21/2023
Signature ofaller Date
^ ` (1)_22 7 -3
CORY BROWNSON (B &C BUILDING SOLUTIONS) .
Printed Name of Signee �s' ,».; 1„{
MASON COUNTY PUBLIC HEALTH st7 [ '
The undersigned approves this Installation Report and s sr�3
Record Drawing on behalf of Mason County Public o JAMr_s A.HINTER
LatsiS£tb t?fClriyrR
6(501 Ci� �(nre[S: 63172/2
Signature of Environmental kealth Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8,'21nolt3
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