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HomeMy WebLinkAboutSWG2021-00419 - SWG As-Built - 7/24/2023 Mason County OSS Installation Report pg. 1 C\, , MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00419 Parcel # 22133-23-90131 Applicant Name Great Market LLC Subdivision (Name/Div/Block/Lot) Applicant Address 10024 138th AVE NE City, State, Zip Kirkland, WA 98033 Installer Name Bo Russell - Russ Construction Site Address 60 E Duck Cove Shelton, WA Designer Name Justin Russell INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Oscar 2 Pretreatment Type_ ___ >5 ft. from foundation? - - - - - -- - - ❑ N/A Q YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ 0 Z >50 ft. from surface water? - - ❑ ❑� ❑ H• Cleanout between building and tank? - - CI © ❑ U Tank baffles present? - - ❑ ■❑ ❑ I a 24" access risers over each compartment?-W - El © ❑ Effluent filter installed?-cn ❑ I ❑ Septic tank capacity(working) 1,500 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - El N/A ❑ YES ❑ NO OOJ Manifold/D-box accessible from surface?- - 0 El 00 2 Check valves installed? - - - - ❑■ ❑ ❑ 0< 2 Transport Line Size_1" Schedule/Class Schd. 40 Bedrooms installed (check one) ❑ 3 0 4 ❑■ 5 ❑6 ❑Commercial/Other 4 >10 ft. from foundation?- - pR_o_ N/A 0 YES ❑ No C) >100 ft. from wells?- ❑■ ❑ W >100 ft. from surface water? ---- - -.J Q- I ❑ Li >10 ft. from potable water lines?- -IW4 aoDNTY ❑� ❑ Z > 5 ft. from property lines and easements?- ENV1i�pN,�E ,4. EAtTH� 0 ❑ 12 > 30 ft. from downgradient curtain/foundation drairl$8W - ❑ 0 El ci 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 Y Pump tank capacity(flood)_1,500 gal Manufacturer_Sound Placement < 24" access riser(s) and accessible from surface?- - ❑ El El1— Alarm or Control Panel Installed? - - ❑ © ❑ a 2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ D - Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model AY Mcdonald 1/2 hp turbine ❑I Floats or ❑ Transducer aTank draw downAper Oscar in/min Pump capacity 30 gpm Squirt Height oscar ft Pump on time_oscar Pump off time_oscar Daily flow set at 360_gpd Updated 8121201e Mason County OSS Installation Report pg. 2 Parcel# 22133-23-90131 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - El YES No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - 111 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 drainfiield,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. 4.1 A sod fel Ofr 4/0,, 4b tiF9�Ty Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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. Qe'.`°""" ' 5/1/23 Signature of Installer Date Bo Russell :Oh /Z3 7 f�, Printed Name of Signee h 41 MASON COUNTY PUBLIC HEALTH 1j J,I/ The undersigned approves this Installation Report and bah s�oao834 � !� �; 14sTlNSpVF3tll � Record Drawing on behalf of Mason County Public . tic N V SI N E R I 4171, Healt . )(PI'ES 071191 1. /V1, 7 Y-2-� Si a f Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2 112 01 8 a W e_was �vEBQ h << V N j K 0 a > m 0 r 1 M O A J Y ^� o Z- u U a < �g�j B� as < v ., z o 6 X2.SX2� J n< Q p tu,, V I ..III ' OO I < 0 $ ° o a R 74, ell — W- ly s J N N ¢ ars.-7—. a 1 K IO 4 3 8 IA ° d i n a y / V . wU 2gOuC Z W \ Y�C Ih Ps rc +s ." i u W<, 0.1 goe< 'v i3f.L5 `Oo1 wLL-,. I •W ttl Znni I, oW? 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