HomeMy WebLinkAboutSWG2022-00593 - SWG As-Built - 7/26/2024 Mai on County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00593 Parcel# 12108-21-00070
A; plicant Name GEOFFREY SAUNDERS Subdivision (Name/Div/Slock/Lot)
Applicant Address 12221 2ND AVE NW
City, State, Zip SEATTLE, WA. 98177 Installer Name ,rTlQ eNeff-E-
Site Address 4364 E GRAPEVIEW LOOP RD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type OSCAR Pretreatment Type BNR 500
>5ft. from foundation? --------------------------- ❑RYA AYES El No
>50ft.from wells? --- - ------------------------- ❑ ® ❑
Z >50ft.from surface water9 - - --- ------------------- ❑ ® ❑
FCleanout between building and tank? ------------------_ ❑ ® ❑
V Tank baffles present? - - - - -- -- ----------- -- -- --- - ❑ A ❑
a24'access risers over each compartment?-___________ ___. ❑ 0 ❑
LU Effluent filter installed?- - - -- -_-rpey/�'____ __ _ ________ ❑ ❑ ❑
Septic tank capacity(working) Nr+/'16' Manufacurer
o D-box water level and speed levelers used? -----
-- -------- 0wA ❑Yle; ❑ NO
1
0 Manifold/D-box accessible from surface?------------ ----- ❑ ❑
GaCheck valves installed? - _ _ _ _____________ _______ __ ® ❑ ❑
2 Transport Line Size SUPPLY/RETURN 1' ScheduWClass SCHEDULE 40
Bedrooms installed (check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑CommeroiatiOther
>10 ft.from foundation?-- - - -------- - -- -- --------- 0WA INYES ❑ NO
c3 >100ftfrom wells?-__ _ _ __________ ______________ ❑ ❑
tj >100 ft.from surface water? -- ------- - - ------------- ® ❑
W >10 ft. from potable water lines?----------- - ---------- 0 ❑
QZ >5 ft. from property lines and easements?---- - ----------- ❑ 0 ❑
C > 30 ft from downgradient curtain/foundation drains?---------- ® ❑ ❑
Dminfield level and observation ❑ ® ❑ports present -___ _____ __ __.
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?-------- - --------_-
❑ ® ❑
Pump tank setbacks consistent with septic tank?------------- ❑ II/A YES ❑ NO
= Pump tank capacity(flood) ,gal Manufacturer it
F 24"access riser(s)and accessible from surface?---- -- ----- - - ❑ ❑
ll Alarm or Control Panel Installed? ----- - ---- - ---- - ----. ❑ ® ❑
? Control Panel equipped with Timer I ETM/Counter--- - - -- -- -t- ❑ ® ❑
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other TeS C)s
1 Pump Make/Model -Perm- Ol n bfFlOdLs Or Cu..—/�- M: ❑ Transducer
y ank draw down in/min Pump capacity opm Squirt Height ft
Pump on time Pump oftfime Daily flow set at apd
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Ma n County OSS Installation Report pg. 2 Parcel u 12108-21-00070
ABANDONMENTRECORD
W e existing septic components abandoned as part of this project? YES NO
if y s, please describe:
Wale all components pumped out and propeny abandoned per WAC246-272A-03007 - - -- - - - - YES NO
RECORD DRAWING
mb a pm.amm ncoN aM mimt M+ccuntr and aoMptive maupN to nRa[kh In M,nwE al ma...xtivaln end lulu.devNop..a T,D Rix.
ga ox in: dewkH&maniroM annnalba&tr ,Sept"1xw tank la w,NmIM1 arrow.reserve tl.infleW evigep and geW.d auitlsgs b tm Nwlb onnwInm,
wgly, parla.dtln. eM�O ,nin nnan¢aacss poinK. Incwnpkte RttoM IXawNigs maY c2ate aatlnimal tl¢Ieys inlwl ngaWgion apgnvaleM nlaletl pem�as
I J r(r�lrh i d1J�cp/!✓ a 1' ,nc c�rr.�.
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P4aanY
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0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
IN TALLER DESIGNER/ENGINEER
1 cE r*that I installed the system in accordance with 1 certify that the system has been installed in occor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped'APPROVED"by
Co my Public Health and that any deviations shown Mason County Public Health and that any deviations
net R have been cleared(approved by both the designer shown here have been cleared/apphi by both
an Mason County Public Health and meet all State myself and Meson County Public Health and meet all
and Mason County Codes State and Mason County Codes
1 fu Thar certify that alfinform this /further certify that all information contained on this
to" aa& card Drawin rate. form and attached Record Drawing is accurate.
Z "
Sig a of/nstaller `` Da
Pd d Name of Sigmas
MA SON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and Dr wad"
Rec Did Drawing on behalf of Mason County Public LICENSED DESIGNER
Hot Ith: ax°mex ovlw
S' lure of Environmental He Uh Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR m1BLlC VIEW ON THE MASON COUNTY WED SITE tlpuawaerz'rzae
I
t
APPROVED '
JAN Oq 2023
MASON COUNTYENORONMENTAL HEALTH
' Proposed new residence RET t
2. 1000 Concrete trash tank
3. BNR 500 in concrete tank
tank. I E k
4. 1500 gallon concrete pump tan p
5. Existing garage kp,PPROViE `
s. Reserve Oscar drainfield JUL 26 20 \
7. Primary Oscar drainfleld
8 PrOPOsed Private well MASON COUNTY ENNRONMENTAL NEAL '
9. Existing ADU R
10. Existing 1150 concrete tank Y �V e iv
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