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HomeMy WebLinkAboutSWG2010-00015 - SWG As-Built - 4/24/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2010-00015 Parcel# 423075000032 Applicant Name JEFFERY CAIN Subdivision (Name/Div/Block/Lot) Applicant Address 8418 TILLICUM RD SW LAKE CUSHMAN#2 TR 32 City, State, Zip SEATTLE WA 98136 Installer Name UNKNOWN Site Address 221 N POTLATCH DR NORTH Designer Name TAJA 12109 J.RUSSELL4/24 INSTALLATION CHECKLIST 0 Full System Installatlon ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other System Type PRESSURE BED Pretreatment Type NONE >5ft. from foundation? ------- - - --- ------------ -- ❑ NIA AYES ❑ NO >50ft.from wells? ----- - - - - - - - - - -- -- ----------- ❑ © ❑ Z >50ft.from surface water? - ------ - --- - --- --------- ❑ © El f Cleanout between building and tank? ---- ----------- - --- ❑ tl Tank baffles present? ---- ---- - ---- ---- - --------- ❑ 0 ❑ t- 24'access risers over each wmpartment?-------------- -- ❑ WEffluent filter installed?------ ----- --- --- -------- -- ❑ to Septic tank capacity(working) 1200 gal Manufacturer UNKNOWN _ O D-box water level and speed levelers used? - - - - - - --- --- - -- ® NIA ❑YES ❑ NO J �O . Manifold/D-box accessible from surface?-- - - - -------- -- -- © ❑ ❑ m Z Check valves installed? -- ---- - - ---- - - ------ - - ---- ❑ El Transport Line Size Schedule/Class Bedrooms installed(check one) ❑ 2 ©3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundalion?--- -------- - ---- - - --- --- -- El NIA ® YES NO >100 ft.from wells?--------------------- - ---- --- ❑ ® ❑ W >100 ft.from surface water? --- ----------- - -- --- - --- ❑ ® ❑ LL >10ft. from potable water lines?- ------------- ------ -- ❑ ® ❑ ZZ >5ft.from property lines and easements?----- -- - ----- - -- ❑ ® ❑ K > 30 ft.from downgradient curtain/foundation drains?--- - --- - -- ❑ ® ❑ 0 Dreinfield level and observation ports present ----- - ----- - -- ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?-- -- - --- -------- - -- ❑ IN ❑ Pump tank setbacks consistent with septic tank?-- ----------- ❑ WA N YEs ❑ No `t Pump tank capacity(flood) 1200 at Manufacturer UNKNOWN Z 24'access riser(s)and accessible from surface?---- - -------- ❑ ❑ r n. .Alarm or Control Panel Installed? -- - - --- - -- - - - - - - ----- ❑ � 2 Control Panel equipped with Timer/ETM/Counter- - - - ---- - -- IL Pump installed in ❑-Bucket or H On Block or ❑ Other IL Pump Make/Model HYDROMATIC SHEF 50 ® Floats or ❑ Transducer E a Tank draw down 1.75 in/min Pump capacity 36 gpm Squirt Height 26 ft Pump on time A MIN 15 SEC. Pump off time 3 HR.58 MIN, Daily flow set at 270 gpd uaaum erzvm+e 7 Mason County OSS Installation Report pg. 2 Parcel# 423075000032 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - YES NO If yes, please describe: SEPTIC TANK ABANDONED Were all components pumped out and property abandoned per WAC246-272A.0300? ------ - - YES NO RECORD DRAWING Tile is a permanent record and must be accurate and descriptive an.uah w nJnceb In N.need 0 maintenance activities and rmum development. Typical Ramd pmwlnascunleln: Dminn &m"oldoaenuamale t.SepWpump Wk Wdm,Nonh ..mamdralnwd..AMin,andpmaoee bh lL a..lwelimplwella.w.ledlnas, walla.didedu uon pMa Uaanml..and ulhermelmma,cv xces+pWnb. L,wnplN.eecvN aaMnae mry cram.addlumel delara m MennelaYhm app.and rWled pmmlN. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that I installed the system in accordance with 1 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 clearadtapproved by both and Meson 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 to=and attached Record Drawing is accurate. form and attached Record Drawing is accurate. eignettife of Installer Date JUSTIN RUSSELL fill Printed Name of Sign" MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and u ]Fdadada m� Record Drawing on behalfofMason County Pubic 51 RN....... . Health: IPW SGakyt rn� Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAIIABLE FOR PUBLIC VIEW ON THE MASON COUNTY VIES SITE Dpladd°male N POTLATCH DR N 52.57 '�'l 0'X25 RESERVE IL------r-�� 10'X 20' RESERVE n if 0 II If m � n I n I I ° II 00 a II = mm I 2 W4e Y _ 5 Pi u 1 zl II X N 0 3: � mm � m > m O < M - Or OOmmmp OmP600 O C m >mO . Z > AwZ mO o A 0 0 v - II 3 0 CD '-° p A 0 � 0 D mFm DZ m 0 p0_ m mx II y m m m It o O V Z Ilan^ III [� 0 0 V Z O 0� m w ; O i If 70.65' 1 0 m I If 10 II 'i y I II OR 1 m i II I I " I I I I 1 I I m r r2 -i 0 m > I � I y A 41 m �c w 0 f I r I Lwi s y v • � � I I f 9 r o D o x S I 1 F A 3 o y n m A D I I 25 H • ! m O o l 1 I O I LAKE CUSHMAN u ay LJ N A T y O $ m Z A z 0 c c m c y < j C Z A 4 Z Z � C O D_ TO F 0r n N Z !? 2 Zp x m I r N A 0 A y n N A 0 ti A N 9 u O A m A o D m F o Z 0