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Home My WebLink AboutSWG2023-00502 - SWG As-Built - 3/26/2024 Masnn County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00502 Parcel# 52004-50-00026 Applicant Name ROBERT L,P;ro .sec. Subdivision (Name/Div/Block/Lot) Applicant Address 2221 235TH CT NE City, State, Zip SAMMAMISH, WA 98074 Installer Name &LINE CONST. Site Address 301 W NAHWATZEL BEACH DR Designer Name CINDY WAITE INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type PRESSURE Pretreatment Type N/A >5 ft. from foundation? ------- -------------------- ❑ N/A YES NO >50 ft.from wells? - ----- ---------------------4 - ❑ e ❑ Z >50ft. from surface wateR ---- - -- ------- ---------- ❑ ® ❑ HCleanout between building and tank? ----- -- -- -------- -- ❑ ® ❑ U Tank baffles present? - -- - -- - ------- - - - - --- ----- - ❑ N ❑ a24"access risers over each compartment?-- -- ----___ - ❑ e ❑ NEffluent filter installed?- ---- ---- ------ - - ------ -- - - ❑ ® ❑ Septic tank capacity (working)__L 1200 gal Manufacturer SOUND PLACEMENT �0 D-box water level and speed levelers used? --------------- ® run YES El No 00 Manifold/D-box accessible from surface?---------------- - ❑ ❑ a?Z Check valves installed? ------- ------------ ----- - - ❑ ® ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 02 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >1Oft. from foundation?--------- -- - - - - ---------- - ❑ NIA YES NO G >100ft.fromwells?-- ------------ --------------- ❑ ■ ❑ W >100ft. from surfacewatef? --- - -- - ----------------- ❑ ® ❑ ELL >10 ft. from potable water lines?- --- - ------ ----------- ❑ W ❑ QZ >5ft. from property lines and easements?-- -- ------------ ❑ ® ❑ K > 30 ft. from downgradient curtain/foundation drains?- -------- - ❑ IN ❑ Drainfield level and observation ports present - - --- -- ------ - ❑ 0 ❑ ❑ Gmveless chambers or ® Clean gravel used? (check one) Proper cover installed over dramfield?------------------ - ❑ N ❑ Pump tank setbacks consistent with septic tank?----------- -- ❑ NIA ® YES ❑ NO Z Pump tank capacity (flood) 1200 gal Manufacturer SOUND PLACEMENT Q 24'access riser(s)and accessible from surface? ---- - El ® ❑ I.- Alarm or Control Panel Installed? ------------- ------- - ❑ 0 ❑ Control Panel equipped with Timer/ETM/Counter------ --- - - ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ® Other PUMP VAULT EL Pump Make/Model LIBERTY 280 e Floats or ❑ Transducer a Tank draw down 1.33 in/min Pump rapacity 33.3 gpm Squirt Height 1.08 ft Pump on fime 45 we Pump oft time 3 hr Daily flow set at 270 gptl �Wiwie Mason County OSS Installation Report pg. 2 Parcel# 52004-50-00026 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? --- - --- - l'e'1-- NO If yes, please describe: Were all components pumped out and property abandoned per WAC24&272A-0300? ------- - ❑ YES ❑ NO RECORD DRAWING This to a permaam rtaaed and meet Ee arcuate and deeWdded anauge b mloole In the need of maintenance aegvltln and ratan develapmenc Typical Record! Dmvi,ga cavain' rnaar a s,nngdtl mmYlion s brem.Sep4rJpunpfsk Im4im,NMM1 anew,rwrve Ommaea,engine and pmf eEWMings,b tw dr ll.,w ire wage,meavamn pMe,tlenauU,ana aMermaMerence ercen ponb. Inminplete Racal Drae+npe mry vests edtldianel tlelaye in fi�l W Wlalbn a pprwal ana nlaled pa,mib. Lle. esy 10 [i�cw Sle}i 50 uc\\ 2 - SX 30' racy I cgs pgel Leto- AR 2 6 20A . ,f.,W COUNTY ENVIRONMENTAL hEAi T,- �a( �t5 JBWs d ❑ 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 clearad/approved by both the designer shown here have been clearedyapproved 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 Rec cawing is accurate. form and attached Record Drawing isaccurate. �—� 3-1 -zy Sig tumof/nsta11 Date 4• Pn—n�r Name o(Signee 3p°r . y w� MASON COUNTY PUBLIC HEALTH st .� The undersigned approves this Installation Report and LICENSED DESIGNER Record Drawing on behalf of Mason County Public eapwLs ua,a H Ith: ran nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upa.aaarztngte APPROVE MAR 16 2024 D 3— 5L / 7 C --" D `"SO COUNTVENVIROh'4- TAL UEFLTu JB W 2A) U le l o yt <,`ce pate derh .` ' c �j• i ro�i I�u t( ,r / Ac/nl 3r` i ✓ I 711i . � - �`i3 V 1. RESIDENCE i 2. EXISTING 1000 GALLON SEPTIC TANK HAS BEEN PUMPED AND j DECOMMISSIONED 3. 1200 GALLON SEPTIC TANK �1 1 <. 1200 GALLON PUMP TANK P- 5- AUDIONIS,ALALARM 6. CLEAN OUT "J,J F 91 D1'� v 7. TRANSPORT LINE e pE r e 6. EXISTING BLOCK RETAING WALL LICERSfD E IGRER 9. VALVE BOX S „o- ?7 10. TWO 5'X20 BEDS(PRIMARY) ..,.�.� l:, 11. RESERVE AREA(OSCAR 10 X30') 12. WELL WITH A 36' SURFACE SEAL ' I 13. WATERLINE sa oov-so-ao 0 ./N-JI P +.4.4 Peach 1 p _ l$iAi Printed From Mason County CAMS PnnbW fmm MwSart County DMS