Loading...
HomeMy WebLinkAboutSWG2024-00232 - SWG As-Built Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00232 Parcel # 32319-24-00030 Applicant Name L'lliwaup Trust Subdivision (Name/Div/Block/Lot) Applicant Address 4221 E Lee St City. State.. Zip Seattle, WA 98112 Installer Name Samford Septic Repair Site Address 601 N Lilliwaup St Lilliwaup Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Full System Installation ❑Farris') Only ❑ Drainfield Only O Repair ❑Other. System Type Non-Conform Repair-Shallow Pressure Pretreatment Type >5 ft from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA AYES NO >50 ft from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ © ❑ Y >50 ft from surace water? - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ Z Q Cleanout between building and tank? - - - - - - - - - - - - - - - - - - - ❑ O ❑ H O Tank baffles Present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ El H 24 access risers over each compartment?- - - - - - - - - - - - - - - - ❑ ❑ a W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N Septic tank capacity (working) 1,060 at Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - - - - - - - - - - - - - ❑ rviq ❑ YES 0 No 0O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - I?�Z Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - — ❑ ❑ OG 2" Schedule/Class 40 Transport Line Size Bedrooms installed (check one) O 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commerccal,Other >1 Oft from foundation? - - - - - - - - - - - - - - " - - - - - - - - ❑ N/A OYES ❑ NO O >100ft. fromwells?- - - - - - - - - - - - - - - - - - - - - - - - - ❑ W >100 ft-from surface water?-- - ---- - --- (� 0 ❑ u_ >10ft. from potable water lines?-------- -- � - O El > 5 ft. from property lines and easements?--- - - - -�IUf-fib 7,�2� ❑ lY > 30ft. from downgradient curtail-Koundatlon drain - -- -- ❑ 0 ❑ 13 Drainfield level and observation ports present - - - - - - - - j� ❑ O Graveless chambers or ❑ Clean gravel use - Propercoverinstalledoverdrainfaid?- - - - - - - - - - - - - - - - - - - ❑ ❑� ❑ Pump tank setbacks consistent with septa tankY----- ----- - -- ❑ NIA OYES ❑ No Y Pump lank capacity (flood) 1,287 gal Manufacturer Infiltrator 4 24" access risers)and accessible from surface?---- ---- - - -- ❑ K ❑ f- Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - ' - ❑ ® ❑ D. ❑ O ❑ 5 Control Panel equipped with Timer; ETM I Counter- - - - - - - - - - - d Pump installed in ❑ Bucket or N On Block or ❑ Other Pump Make/Model Zoeller N152 O Floats or ❑ Transducer Z) Tank draw down 2" In/min Pump capacity 50 gpm Squirt Height 6.5 ft a Pump on time 1,2 min Pump off time 6 fir Daily flow set at 240 god 3Z31r1 - Z-� -'oIIfl30 Mason County OSS Installation ReABA Parcelfi NDONMENT RECORD vas ❑ No cnents abandoned as pa.'. c` :h's p,,act�i�y 'If a please septic camp ' ___ - BYES ❑ No If yes, please describe: ed abandgned per`N.AC246-92A-C6C0? - " " - Were all components pumped out and prop Y RECORD DRAWING R�w,a sadN C Pe ,a gF t et [h tl . des m a ae.a C tl Pa sb g a=Ioai m P s Pdc rel P eo�ecw av, weoa,oe.1.1 `Pone.'JeanoVs.sce o�per memteoaem ac:e°e Sa°`-`. m pate ® Record Drawing AHached CERTIFICATION OF INSTALLATION _ DESIGNER/ENGINEER INSTALLER l certify that the system has been Installed in accor- I certify that i installed the system in accoNance wan the septic design stamped"APPROVED'by Mason dance wan the septic design stamped APPROVED"by ' County Public Health and that any deviations shown Mason County Pi Health and that any donations here have been ciearedoeoproved by both the designer shown soli and Maio been clenty Public provedand by meet al! and Mason Counfy Public Health and meet ail State State antl Masan County Codes . I Curtner certlry that all information contained on this and Meson County Codes 1 further certify that ell in(ormaton contained on this form and attached Record Drevring is accu2te. farm ant attachenRecord Drawing is accurate. Slcoamre of Instal)el-� a.e Printed Name of Signee MASON COUNTY aueuc. HEALTH 2 eAuu aoY jOHNSDN `t The undersigned aWo'✓es this lnah"latior, Repoli and Ott EbyIE51CNER I/` Record Drawing on behalf of Mason County Public rxvr+Fs� nsr�7P Health: -� _ 'LI _ (stamp, signature and date) Signature of cci,00tnmental Health Specialist Late uPeFm amrso-,e THS FORM MAY 9E SGANNEO AM1O AVAILA6�`OR PG5LiC VIEW ON THE MASON COjMY VJE3 SITE Rev- Audio-visual .u�n`rn Cleanout �LtI�S'f uJ I 1 3 ;000 Gallon. Septic TxT-k 2-Ccmp rttnent with ^ Effluent Filter � L000 Gallon Pump Chasber c0b \ ,1,` •I OS Vzve control Sox �'sryrySL � l kv pa;.�t5t casv.�� i 11, 1 j,j , k Twe L 1 91 g'L ,C a za C L 3231a 2g •CGOG�- �` 5�I LLLLIW � JT. N� ] GAUD JOv JON14SON';1�1 '. tmai1xHAE!; b-(a -2�