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HomeMy WebLinkAboutSWG2024-00102 - SWG As-Built - 1/30/2025 Docvsi9n Envelope ID:SGCFD28&A68A-4934-962G71D512723455 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG SWG2024-00102 Parcel# 22134-50-00005 Applicant Name sooft strozyv Subdivision (Name/Div/Block/Lot) Applicant Address 13410 S E. 52^d St City, Slate, Zip Bellevue WA 98006 Installer Name Jamie Workman Site Address 2533 east Pickering Road Designer Name Micah Halverson INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑Other System Type AT i to Fvistino 2mmity Pretreatment Type N Water BNR-500 >5 It, from foundation? -- - - - - -- - --- -- - ❑ NIA x❑YES NO >50 ft. from wells? - - - - -- - - - - - - n - ❑ El ❑ Z >50 ft. from surface watef? - - - - - - - Y - -'- - - - - - - ❑ ❑ ❑ H Cleanout between building and tank? - -- )P.a-�B � - - - ❑ x❑ ❑ U Tank baffles present? - -- - - - - - - - - - - - - - - - - - - ❑ El a24"access risers over each compartmen W - - - - -- -- ❑ ® ❑ W Effluent filter installed?- -- - - - - - - - - -- - - - - - - - - —- - - x❑ ❑ ❑ to Septic tank size 500+ NUwater gal Manufacturer Sound Placement C D-box water level and speed levelers used? - - - -- - - - - - - - -- - ❑ NIA ❑YES x❑ NO J �O ManifoldlD-box accessible from surface?-- - -- - -- - - - - - - - — ❑ ❑ x faZ Check valves installed? - - - - - - -- - - - - - - - - -- - - - - - - - - ❑ ❑ O2 Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - - -- - - - - - - - - - - - - - - -- - - - - ® NIA ❑ YES NO >100 ft. from wells?- -- - - - - - - - - - - -- - - - - - -- - - - -- - - El ❑ ❑ W >100 ft. from surface water? - - -- - - -- - - - - - - --- - - - - -- - ID El ❑ M >10ft. from potable water lines?- -- - - -- - - -- - - - - - - - -— - ® ❑ ❑ 2 > 5ft. from property lines and easemenis?- - - -- - - - - -- - - - -- ® ❑ ❑ R > 30 ft, from downgradient curtain/foundation drains?- - - - - - - - - - El ❑ ❑ Drainfeld 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?- - - ---- - ----- ❑ NIA x❑ YES ❑ NO Y Pump tank size 199'3 gal Manufacturer Sound Placement Q24" access riser(s) and accessible from surface?- - - - -- - -- - - -- ❑ In ❑ f d Alarm or Control Panel Installed? - - - -- - - - - -- - -- - - - - -- ' ❑ jControl Panel equipped with Timer I ETM/Counter- - - - - - - - - - - ❑ ® ❑ a Pump installed in ❑ Bucket or ❑ On Block or ® Other 6" Pump Va It C' Pump Make/Model Oren^n PVA 1005 x❑ Floats or ❑ Transducer a IL Tank draw down 2.25 in/min Pump capacity 5 gpm Squirt Height Gravity ft IL Pump on time ?1__ygc____ Pump off time 1 hr Daily flow set at 360 9pd Docusign Envelope ID:86CFD28BA48A4934-962C-71D51272M55 Mason County OSS Installation Report pg. 2 Parcel n 22134-50-00005 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - - - -- - - - - - - - -- ® YES ❑ NO If yes, please describe:Pi imparl and Abandoned cirl Single GnGnmPadmaot Septc tank Were all components pumped out and properly abandoned per WAC246-272A-0300? - - -- - - -- ® YES ❑ NO RECORD DRAWING This Is a permanent m:ord and must be accurate and dachptla sodden W n-Iocala In tM a0E a main name anlvltlx and Mum MvNognem Typoel Raoso Drawings contain'. DranreN a mannold orientd on 8laoul,SeplklWmp tank Icvallon.Nam amw,reserve dninfia d,aistng and proposed buildings,ka staxi alwelle,watMina, ,s,11h observmimpans,C abnou, a oNermd,....boadx In¢mplele RaCIXE Dmwnea cosy aeale aMI1IMal deNyeMfinal inalelktion apgtnal ridreWMpetmM1z. Pump timer set to Pump 15 Gallons per dose every 1 hour. Daily Flow set to 360GPD © Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 cleamolapproved 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 certify that all information contained on this 1 further certify that all information contained on this f4uN,agtA,aggChed Record Drawing is accurate. form and attached Record Drawing is accurate. II( __���t� 1atearo5 �. Signature oflnstaller Dare lamie workman ' Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and 6low as Record Drawing on behalf of Mason County Public Health: Signature of Envimrrmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmud earn"' 0 F Me�_zppgs� Gp a \ ��WII'[ gigis EASUng Ee Mnt I m' S�d6Mrg Ea66 nt 1 u MEWgg m I $ m 1 33 1 c I 1 � I m' O ` ` - - - - - D a ID @ 2 � � �E n N 3$ N z O Y N % N N QCD N � ONN DCO ao y OA� 3 �2 O N W 0 m m 3 �p z� 3n fDm 3 ,a O 3 x n r l m c m 3 3 �} oo, n"E v z n ®o3R G k > � 3 3 3 �6 5mm Y rtn nC m W� m 0 m m O OD Wi T � w � p BLPYYf1O6176 N 0 w A �fINO:Ez zN .No yc �d c �6 3 w 0 Z = H D v <omo= � g z ^ym � mOso c T ET16tlng 0u N? 1 x Z N r m _ rn PICKE�NG 0 PASSAGE TE M.Halverson Design LLC �WOPr/An�nlirant Scott Strozyk FRolnin' Parcel# 22134-50-00005 iml 9 Shelton Wa 98584 Mailing: 13410 s.e.52nd sl. 2533 East Pickerin Rdnllc outlook.com Bellevue.We98005g