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HomeMy WebLinkAboutSWG2021-00329 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Permit Number SWG o1-6 oZ 1 - Q c,3 D9 Parcel # 32224-50-00051 Applicant Name Todd Lucas Subdivision (Name/Div/Block/Lot) Applicant Address 1338 Alki Ave Apt 209 City, State, Zip Seattle, WA 98116 Installer Name Dano's Septic Site Address 11241 NE North Shore Rd Designer Name Rod Left r r��i •i.� ; s- > �3= .1 3_y`r - - - . .. . .c ztd. ` ^: ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Pump to Gravity Pretreatment Type >5 ft. from foundation? - - -- /• --8 [1]- - - N/A ®YES ❑ NO >50 ft. from wells? - c= �� - ❑ ® ❑ - >50 ft. from surface water? - - - - r - - - - ❑ ❑ lil Cleanout between building and tank^ -- SlaZil L 3Rn- - - -- ❑ ® ❑ Tank baffles present? - - - - fl - ❑ I ❑ 24" access risers over each compact. iJ/-�-- - ❑ ® ❑ Effluent filter installed?- - ❑ ❑ U] Septic tank size 1250 gal Manufacturer Roth D-box water level and speed levelers used? - - ❑ N/A ® YES ❑ NO Manifold/D-box accessible from surface?- - ❑ ® ❑ Check valves installed? - - ❑ ❑■ 0 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) 42 P 3 ❑4 CI5 El6 ElCommercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO >100 ft. from wells?- - 0 ❑■ 0 >100 ft. from surface water? - - ❑ © ❑ >10 ft. from potable water lines?- - ❑ El 0 -- > 5 ft. from property lines and easements?- - ❑ IN ❑ m- > 30 ft.from downgradient curtain/foundation drains?- - ❑ ® 0 _ Drainfield level and observation ports present - - ❑ ® ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 0 Pump tank setbacks consistant with septic tank? - - ❑ N/A ® YES ❑ NO ,.. Pump tank size 1250 gal Manufacturer Roth 24"access riser(s) and accessible from surface?- - ❑ I. 0 Alarm or Control Panel Installed? - - ❑ U] ❑ Control Panel equipped with Timer/ETM/Counter- - ❑ © ❑ Pump installed in © Bucket or ❑ On Block or ❑ Other Pump Make/Model PF201012 ® Floats or ❑ Transducer - Tank draw down 1 in/min Pump capacity 25 gpm Squirt Height n/a ft Pump on time 0:01:12 Pump off time 3:00:00 Daily flow set at 240 qpd .. Updated 8212018 \ Mason County OSS Installation Report pg. 2 Parcel# 1—YVZZA- )1D''OM P 1. ABANDONMENT RECORD. -. Were existing septic components abandoned as part of this project? - - aff YES ,;Q NO If yes, please describe:71 X- COCY\\SS\Qt Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO . ... . RECORE ORAVVING__ -- y . .... ... This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Ret-wd Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. • • Eif Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER /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 cleared/approved 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 , that all information air'in•ed on this • I further certify that all information contained on this _.` cr.-..ched..:''in.,. D ill.is•a rate_ form and attached Record Drawing is accurate. .._ )D- 6- ,,,.._:of Installer _ Date it --_ Qn �' 1111. Printed Name of Signee r'r+i' MASON COUNTY PUBLIC HEALTH ��. , �/Tr* F� The undersigned approves this Installation Report and ' i ` t,cEN•':4e NER c t. Record Drawing on behalf of Mason County Public i i i ' t EXPIRES 2/15 Health: RINAIV\T-' 01 t-- ILlt-ZA . .. ,. • Signature of Environmental Health Specialist Date (stamp, signature and date). . 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