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HomeMy WebLinkAboutSWG2022-00209 - SWG As-Built - 8/20/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00209 Parcel# 12108-50-01003 Applicant Name Tessa Griffin Subdivision (Name/Div/Block/Lot) Applicant Address 8525 1Oth Ave NW PIRATE'S COVE BILK 1 LOT:3&N1/2 LOT:4 City, State, Zip Seattle,WA 98117 Installer Name Cedar Septic Services Inc Site Address 530 E Lombard Rd S Grapeview Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST ❑ Full System Installation E Tanks)Only ❑ Drainfield Only ❑ Repair ®Other 500 canon Pre trash tank System Type Pump to Grav'dy Pretreatment Type NuWater BNR-500 >5ft.from foundation? ------- ----- - -- - --- ------- El NIA OYES [I NO >50ft.from wells? -- -- - --- - - - ---- - - ------------ ❑ Z >50ft.from surface water? --- --- - - --- - --- --- - ----- ❑ ® ❑ Cleanoul between building and tank? - -- --- - --- --------- ❑ ❑ U Tank baffles present? -- --- -- - ---- - -- - --- ------ -- ❑ ❑ 1- 24"access risers over each compartment?------- - - ------- ❑ ❑ WEffluent filter installed?----- ---5--------- ------ - - - ❑ El Septic tank capacity(working) NUWater BNR gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - - ----- ❑ WA © YES ❑ NO 0J 0 Manifold/D-box accessible from surface?- - - - - - ---- ❑ ® ❑ a?Z Check valves installed? --oi - P1Ar"�Q_T -- --- --- -- ❑ ❑� ❑ oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑CommemiaVOther >101t.from foundation?- - --- - - ------ - ----- ❑ NIA ® YES NO 0 >100 ft.from wells?----- - --------------I--------- ❑ ❑ w >100 ft.from surface water?- ->:7`Ski[��-�_7S- -- ------- ❑ ❑ LL >10ft.from potable water lines?- -------------- ------- ❑ ® ❑ >5ft.from property lines and easements?- -- -- - - - ----- - - - ❑ ® ❑ K 130 ft.from downgradient curtain/foundation drains?--- - - -- - -- Cl Drainfield level and observation ports present -- -- - - - - - ----- ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) fSExisfin9 Proper cover installed over drainfield?----- ------------- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ----------- ❑ NIA YES ❑ NO Y Pump tank capacity (flood) 1000 gal Manufacturer Hagerman a24"access risers)end accessible from surface?------ -- - -- -- ❑ © El F-a Alarm or Control Panel Installed? ---- - - - - -------- --- -- ❑ ® ❑ M Control Panel equipped with Tmer/ETM/Counter-- - -- --- - -- ❑ ® ❑ o_ Pump installed in ® Bucket or ❑ On Black or ❑ Other a Pump Make/Model Liberty 290 ■ Floats or ❑ Transducer a Tank draw down 2.25" in/min Pump capacity 43 gpm Squirt Height n/a ft Pump on time 2 min Pump off time 6hr. Daily Flow set at 360 gpd ul a vnasts Mason County OSS Installation Report pg. 2 parcel# Iyo D - 50 -3k0c�'3 ABANDONMENT RECORD a p YES NO Were existing septic components abandoned as part of this project? ------ _ Ifyes,pleasedescrax, old +Li Y1 L' de GOw,e'ntS510ltPrl Were all Components pumped out and properly abandoned per WAC246-272A-0300? ------ -- m YES ❑ NO RECORD DRAWING mn a pmNnex remm.w imar a xcurm eoa eescgee nouyn w masrn in as e..4 m Nou.anc..•ww.s.ne ruw..a..ewpnem. ryaw a+mv oa.,,y:arum o..rlea m.mce a..uuasw�.swmwmn mro Lrcriort xmn enw..reeerv.armmew,ueuro ad waNwmnc.iwarb�e..aw..�axrnes .aix,oa....mm wm,u.vwa.ere au•.:�Nm�a*euww. Incwww.aaw.+om+re:,Nr oele.eee�w aa.ye n ryaI imWlNvm NNM'e ane ..lea�u. See a } a [� Record Drawing Attached .ram TIFICATION OF'INSTALLATtON - 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 clearedrapAroved by both the designer shown here have been cleared/approved by both end 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 car*that all information contained on this 1 further certify that all information Contained on this forth and attached Record Drawing is scorn form and attached Record Drawing is accum1b. Date �./m of Installer /rJ r�`7 Rn6 1112 S'*- r/ Punted Name of Signs t MASON COUNTY PUBLIC HEALTH ( f The ur#eraiglsd epprevea this illatWieNon Repoli and so o.a Record Drawing on behalfof Mason Counly Public r pAULA JOY Jo NSHas h. N y " $- is-z Signature of Envlro uha tal Health SPOVAIIat Date (stamp, Sghature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VISE SITE °ea+•+am0imie Law�b4r.q __II —' s � �i a•n,in �ar .eQ # SOS I ron rr rr ovi PfC bL,lkkcad PropoSP Comm,, o 3$Q ` li nY IV li' }�CoLm; r,h LJ Orr Z CIO 6 I I U N � f zis+; In C Audio-Visual-Aax 1 SX `�I�t, I O2 C!eancu. 500 Oallior ?re-Trash tars j 0 NuWa=5VZ.500 ATU Tv k U1,000 Cell=P-sp Chamber S?eeOl- :eucle.s . - Fk:^�L\_W4;�-yt_ `J -•`d '6nC (,�.-5 b.�z„\ d e G 55 ion ed APPROVE AUG 20 2024 g MASON COUNTY EN11WNMENTALH G HEALTH -G . . �+o =.. REi PAUIq JOY 4ONN8 1