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HomeMy WebLinkAboutSWG2024-00291 - SWG As-Built - 10/8/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SwG 2024-00291 Parcel # 22127-50-02003 Applicant Name Kyle Emtman Subdivision (Name/Div/Block/Lot) Applicant Address 5970 NE Arrowhead Or MADINGS ORCHARD BEACH BILK: B LOT: 3 City, State, Zip Kenmore WA 98028 Installer Name Bamford Septic Repair Site Address 311 E Orchard Beach or Designer Name Arrow Septic Desgins Inc. INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfleld Only ❑ Repair ❑Other. System Type OSCAR X02 Pretreatment Type XO2I >5ft.from foundation? --- --- --- ----------- -- - ---- ❑era ® vas>50ft.from wells? - - - - - - - - - - ------- ---- ------- ❑2 >50ft.from surface wate? -- -- --- - -- ` - - - --- - - - - ❑ ❑�FCleanout between building and tank? --- - -- ------ -- - -- -- O Tank baffles present? - - - - - ---- - - - - -- - - - -"- -- ❑ ® El F 24'access risers over each compartment?- - --- -- - - ------- ❑ ❑ WEffluent filter installed?--------- -- - - - - -- - - - -- -"-- ❑ ❑ N Septic tank capacity(working) 1 050 gal Manufacturer 2-compartment Sound Placement o D-box water level and speed levelers used? --------------- ❑ NIA ❑ YES ® No 00 Manifold/D-box accessible from surface? ❑ ❑ ll Check valves installed? - - - --- - - --- - - - - - - --- - - - - "- ❑ ■ ❑ Da 1" Schedule/Class 40 2 Transport Line Size Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑CommerciaVOther >10ft.from foundation?- - - ---------- - - ---- - - - - - ❑ NIA ® YES NO 0 >100 ft.from wells?------ -- - ---------- - - -- ----- - ❑ ® ❑ -1 >1o0 ft.from surface water?------- - ----- -------- El-- ❑ ® u >loft.from potable water lines?- - - - -- - ----- - ----- ---- ❑ ® ❑ a > 5ft.from property lines and easements?- --- --- - ------- - ElGo B® ❑ C W > 30 ft.from downgradient curtain/foundation drains?--- - - - - - - - ❑ ❑ t o G O Drainfield level and observation ports present - - --- ----- - - -- ❑ ® ❑ I o G Proper rover installed over drainfeld?- -- - - -- --- ---- --- - - ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- - --- - --- - -- ❑ NiA YES ❑ =' p Y Pump tank capacity(flood) 1,050 at Manufacturer 2-compartment Sound Placement i Z 24°access nser(s)and accessible from surface?-- - - - - -- - -- -- ❑ ® ❑ aAlarm or Control Panel Installed? - - - ------- - -- ----- - - - ❑ ® ❑ E Control Panel equipped with Timer I ETM/Counter-- - - - - - - - -- ❑ ❑ 7) d Pump installed in ❑ Bucket or E On Block or ❑ Other o_ Pump Make/Model AY McDonald E-30 ® Floats or ❑Transducer 2 ft D Tank draw down — in/min Pump capacity 30 gpm Squirt Height — a Pump on time 30 sec Pump off time 3 min Daily flow set at 240 gpd uW.ae erz+ao+e Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD YES . NO Were existing septic components abandoned as part of this project? -"- If yes, please describe: NO Were all components pumped out and property abandoned per WAC24E272A-0300? -'--"'"' YES RECORD DRAWING Thjs 1s,pennanmt r...I end muff ee accuMe end d.urlpev.mauah W n4.1.in me new a maintenance aNv.ena tuWn dwel.pmenl TYPai n-- ,71A/dnQ6wn+nin: DminAeld&IsMod.nennowaeyom.ae a,nimp+rnk iNeam.N.nh en.w,.e .d,.fNd.eweens and purposed WA1,e1.icier-e` Me,wYsduxf weLa.Wf.rvad.n pant.de.noue,ena mnar mwnwmn.e acne prvmf. inrompne aernm omwncf mar ceam e admow delry mMel ineWlad.n wixnvw and mixed pe'nulf. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State Styseff and Mason county ate and Mason County Codes Health and meet all and Mason County Codes. 1 further certify that all information contained on this I further certify that all intormation contained on this fourr,and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Instalk((�` Date Printed Name of Signee MASON COUNTY PUBLIG HICALTN t The undersigned approves this Installation Report and �.Isic Record Drawing on behalf of Mason County Public `ry-pAULA JOY JOHNSON`. Health: `e Lit'f E IDUKRIES !o -(- L`F Signature or Envimnme al Health SPPCOIISt Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WEB SITE uwaw m+rsd+e Drag a 'g, w}# [ n r 1� �I I 1 G Scar i� f E lot I APPROVED OCT 0 g 2024 MASON COUNTY EAR HMENTAL HEALTH RET Leo 0A-+,�R> 3%Jf- Dw- 6�` RO zk� Co¢mol Panel wiN A¢d Vls Ala[m © 1,000 Gallo¢SaPJ?o1A�d°S1 Tam 1-Comp[1mm[mW au diR¢eer c 'r a 1,000 Gelb¢C�/P¢TMP Tam` l ''.N� O Haedaaots* © OSC R X02 MO=d DnlnUald Y42�PAUL JOYaJOHNSON`. _L_ fSppUl:5iGNEY1"