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HomeMy WebLinkAboutSWG2021-00192 - SWG As-Built - 6/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00192 Parcel# 22222-12-00100 Applicant Name BRENT MILLER Subdivision (Name/Div/Block/Lot) Applicant Address 1900 W NICKERSON ST City, State, Zip SEATTLE,WA 98119 Installer Name KATTRAX-JOSH PETERSON Site Address 15171 E STATE ROUTE 106 Designer Name WESTSIDE SEPTIC DESIGN INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type BID BARRIER W/DRIP Pretreatment Type BID BARRIER >5ft.from foundation? --------------------------- ❑WA Yes NO >50ft.from wells? ----------------------------- ❑ e ❑ Z >50ft.from surface water? ------------------------ ❑ ® 0` FCleanout between building and tank? ------------------- ❑ ❑ 0 L) Tank baffles present? --------------------------- ❑ ® ❑ IL24"access risers over each compartment?---------------- ❑ ❑ w Effluent filter installed?---- --- -------------------- ❑ ❑ N Septic tank capacity(working) 1250 gal Manufacturer HAGERMANQj IIcI� 0 D-box water level and speed levelers used? --------------- ® NIA ❑m © NO DO Manifold/D-box accessible from surface?----------------- ® El OQ Check valves installed? ------ --- ------------- - - - - ❑ 1 11N Schedule/Class SCH 40 1 b f Transport Line Size r Bedrooms installed(check one) ❑ 2 ❑3 ❑M 4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?-------------------------- ❑ WA YES NO >100 ft.from wells?----------------------------- ❑ ❑ w >100 ft.from surface water?------------------------ ❑ ❑ 0 LL >10 ft.from potable water lines?---- ----------- ❑ ❑M ❑ a > 5ft.from property lines and easements?---------------- ❑ R ❑ IY > 30ft.from downgradient curtain/foundation drains?---------- ❑ ® ❑ Drainfield level and observation ports present ----- ❑ B ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?------------------- ® ❑ ❑ Pump tank setbacks consistent with septic tank?------------ - El WA 0 YES ❑ NO Y Pump tank capacity(flood) 1455 at Manufacturer HAGERMAN Q24"access riser(s) and accessible from surface?----------- -- ❑ 0 ❑ dAlarm or Control Panel Installed? ------ ------------- - - ❑ 0 ❑ 7 Control Panel equipped with Timer/ETM/Counter--------- - - ❑ 0 ❑ IL Pump installed in ❑ Bucket or ❑ On Block or E Other FLOW INDUCER a Pump Make/Model ORENCO PF200511 ! Floats or ❑ Transducer f ILTank draw down 4.6 GPM in/min Pump capacity 9.1 gpm Squirt Height N/A ft Pump on time 00:10 Pump off time 1:50 Daily flow set at 480 gPd lrypMeE erz1YA18 Mason County OSS Installation Report pg. 2 Parcel4 22222-12-00100 ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? -- - - - - - - - - - - - - - ❑ YES No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - - ❑ YES N NO RECORD DRAWING This N a ustram enl mom and must the accurate and descriptive enough to re-locate in the need or munterunca actinitlaa and false tlevelopTan- Typiml Rexr4 Draoings cmlan: Galn0eld&mamtold mentatim&lmout Santorini tank ldoatem honk ai reseave drein4Nd meting and proposed falunpa Nosliou dwells,wetmllnes. wells,odainvagon dons,desnwb,and Wier malnRnence sass points. Incompkk Recpd Drsi refs theme additional told,In fuel natural approval rid rutted pe-i 0 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 clearadiapproved 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 cer icy that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accull to=and attached Record Drawing is accurate. Signature of Installer Date JOSH PETERSON Printed Name of Signals MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 4() Record Drawing on behalf of Mason County Public 5 m PEl2ELHea 1: I SEDDE lGi �6V�1 � 6 (� `1() - Signature of Envfronnal I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE µmred&mrzgtg DESIGN CAPACITY-4604FD 51TE ADDRE55 15171 E 5R 106 OPERATIONAL CAPACITY- 3GO4PD 5EPTIC 5Y5TEM RECORD DRAWING PARCEL NUMBER 222221200100 LOT NUMBER CLIENT BUILD SEATTLE- 206-556-21 26 WESTSIDE '--�� SEPTIC DESIGN LLC . / OWNER BRENf MILLER !' KEITH PELZEL 1900 W. NICKER50N 5T, 253.200.9W8 5U1TE 116 FMB 128 KBmOWF5T Imfmc COM SEATTLE WA 981 19 PO SON 731069 FUYA OF WA SM79 DATE 05-14-24 PAGE I OF I ixieroewTAeuxr.enerrm� nwaeww:ra wmax mwmunw ors°evice`,u wL.r aiaoeeerrc oeeim":iacowEPP"vmeiw.i L8I aurvemx.�nnuwrnee useoro a+cawans mruL veeeoera........... Lie F TANK KEY APPROVED A- ICMF- TMONSINGIE JUN 06 2024 NORTH COMPARTMEN SINSUE TANK MASON COUNTY ENVIRONMENTAL HEALTH 8- 12504AR W/DI NGLE BEKO.5 DA[NT Q 2Q' 4O' ATU TPNK W/BID-0ARPJER 0.5 RET O- 12504ALLON 51NGLE LOMPA WT PUMP TANK ,00D CANgC BUI�fAO NEIGHBOR5 HOU5E CONE L PANELS 0 B \ 33'OF 1'SCR 40 PVC A FMMARY DRAINFIEID \ \ SUPPLY*RETURNUNE5 O 2600F 5U55URACE DIUF ON I'CENTERS \ AIR BR[AK[R9 - W/G'ORIFICE SPACING 5UPPLY-GREEN _ / `` . 26050. IT. RETURN \ PATIO`�`� l .'.'.'.'.'.'.'.'. . . . . . . . . . . . .I RESERVE ORAINFIgD Y \ YCO L . . . . . . . . . . . . . . . . . . 250 OF 9005URAG . . . . . . . . . . DRIP ON I'CENTERS - --Lr_-1—a\ ���••••••••�•rr.0 W/6'ORIFICE SPACING r I 250`A.IT. 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