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HomeMy WebLinkAboutSWG2021-00534 - SWG As-Built - 11/21/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2021-00534 Parcel# 32104-58-00047 Applicant Name Troy&Annette Klein Subdivision (Name/Div/Block/Lot) Applicant Address 26702 227th Ave SE Alderbrook G&Y/Div 9/Lot City, State, Zip Maple Valley, WA 98038 Installer Name Menke Excavating, LLC Site Address 231 E Susan Ln, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST O Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair "[Other son Gem Pre-Trash TanK System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft from foundation? • ❑ N/A A YES ❑ NO >50 ft. from wells? - ® ❑ ❑ Z >50 ft.from surface water? - li ❑ ❑ < Cleanout between building and tank? ❑ ❑� ❑ U Tank baffles present? - ❑ ❑i ❑ F 24'access risers over each compartment?- ❑ ❑� ❑ W Effluent filter installed?- - ❑� ❑ ❑ N Septic tank capacity(working) BNR-500 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? ® NIA ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ I ❑ mZ Check valves installed? - COr Ey'1b'? -170.'.-` ❑ © ❑ oa 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑� 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- ❑ NIA ® YES ❑ NO O >100 ft. from wells?- 0 ❑ ❑ W >100 ft. from surface water? - al ❑ ❑ M >10 ft. from potable water lines?. ❑ ® ❑ Z Q > 5 ft. from property lines and easements?- - ❑ MI ❑ 0: >30 ft. from downgradient curtain/foundation drains? ® ❑ ❑ Drainfield level and observation ports present - ❑ ® ❑ ❑ Crea.k.,.,ek.,14k.,.3 e. ❑ Ck.e,, g,e.el ,,.cd^ (,.it..,.k,.,,..) Proper cover installed over drainfield? ❑ I7 ❑ Pump tank setbacks consistent with septic tank? ❑ NrA I. YES ❑ NO- ^-- Y Pump tank capacity(flood) 1,250 gal Manufacturer Sound Placement Q 24'access riser(s) and accessible from surface? - El0 ❑ c aAlarm or Control Panel Installed? - ❑ I7 ❑ 2 Control Panel equipped with Timer/ETM/Counter- ❑ 0 ❑ ' C D O. Pump installed in ❑ Bucket or ❑ On Block or • Other Tube c O. Pump Make/Model Orenco PF200511-20gmp,115v, 1/2hp ❑� Floats or ❑ Transducer d f • a. a Tank draw down 1.5" in 10 min in/min Pump capacity 3.3 qpm Squirt Height — ft `„---- Pump on time 9 min Pump off time 1.84 hr Daily flow set at 360 gpd Mason County OSS Installation Report pg. 2 Parcel# sZ 0 LF-S 3 -00041 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - ❑ YES ® NO If yes please descrioe' Were all components pumped out and properly abandoned per WAC246-272A-0300B ❑ YES ❑ NO RECORD DRAWING m6 is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance anlwle5 and future development Typical Record oravnngs contain Dra:,fields mandold onentation a layout Sep'gtpump tank location,Nonti arrow,reserve drainfield,easing and proposed bulhinga,location Cr wells,waterlines, wells,observation ports,deancuts,and other maintenance access points. mmmplete Record Drawings may create addleoral delays in final mstalellron approval and related permits. S 6(\42 . ® 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. p /./ %-4;11 10 -3o-z,3 Signature staller Date LAtruzy Printed Name of Signee MASON COUNTY PUBLIC HEALTH `et =� 4'•7 A tpt , The undersigned approves this Installation Report and - -171.fr: 51n0]J9 ":;'^ Record Drawing on behalf of Mason County Public ��v PAULAJCY JnHNSDN t, Health: K`• al.L ES b p _ web Signature of Environmental H Ith Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upoa:ed8at.ote 3olf „Doors° gq .QS' 1FS— V,wTl-4a-- Om e Trcil iLlClh © re upm s r ,i) � ' .+0 a tw..�> r 1 facre 70_321 oy-Se-000Lo Z31, F Sin wvt LI1 © 2 � i I l Scare. 20' J 1 00 © l \ 0 to 20 30 q s�rrvc� g - Pr��osed i = TeSj; Nape Ava+ft , 3P�� � j i #1, Z4 " (25L - roo±r w;rr, N fo No it- "c' '4 simir +I4 &RaAGE Nause • #2ti 22 " (ESL { tools wmpamtiS 1 vCO fie matf G EPvc r. ' o =a d #3� 21" &SC f roots F ;c" 04 1, -e ryi01'{- ntin O t V c5ll , 2% stOP'- ! ° +A 1 �I 36 xi 069 9F x,z l Dr ,r ^/ 4444 Al 51op< 10 I ,.4-u 5 r.�:n Ai Pic O k w"-`` — E. S U SA N LN — 9 y . C�ROV fr o.- 1:,). O1 Audio-Visual Alarm NOV 2 1�i7 1. SO4C: c o , . 2® Cleanout '�Ej.,�u �ALFH u A i J'11-oH Nsory\\ L v Ea L`_SGvEN �3 O3 500 Gallon Pre-Trash Tank - "5 "="� l'/ NuWater BNR-500 Pretreatment Tank 1 1—('1- 23 O1,000 Gallon Pump Chamber 0 Subsurface Drip System Headworks