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HomeMy WebLinkAboutSWG2022-00532 - SWG As-Built - 4/12/2023 Mason County OSS Installation Report pg. 1 C. C MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2022-00532 Parcel# 32106-75-90132 Applicant Name Eric Goffrier Subdivision (Name/Div/Block/Lot) Applicant Address 4337 15th Ave NE Apt 814 LOT: 2 OF SP#1069 PTN TR M SURVEY 6/45 City, State, Zip Seattle, WA 98105 Installer Name Arrow Excavating Site Address 121 E Skyview Dr, Union Designer Name Arrow Septic Desgins INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair 0 Other System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? - - 0 NA 0 YES ❑ NO >50 ft. from wells? - __ _ - 0 ❑ ❑ Z >50 ft. from surface water? -If -fJ- /- D ❑ 0Cleanout between building and tank? --- ��'; ❑ ❑ C? Tank baffles present? - L;t-MAR iri ZQJ 0 0 ❑ r- 24" access risers over each compartment?'- ` ❑ ® ❑ CO Effluent filter installed?- :y - 0 ® 0 Septic tank capacity (working) 1,201 (la - •":771"7-1 Hagerman 0 D-box water level and speed levelers used? - - © N/A ❑ YES ❑ NO J X0 Manifold/D-box accessible from surface?- - 0 I mZ Check valves installed? - - ❑ 0 ❑ 0Q 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed(check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 0 6 0 Commercial/Other >10 ft from foundation?- - ❑ N/A 0 YES ❑ NO 0 >100 ft. from wells?- - 0 ❑ ❑ WEl>100 ft.from surface water? - - 0 ❑ u. >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 0 a 0 El ElIX > 30 ft.from downgradient curtain/foundation drains?- - 0 Drainfield level and observation ports present - - ❑ 1. 0 0 Graveless chambers or o Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ I 0 Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO ZPump tank capacity(flood) 1,000 gal Manufacturer Hagerman 4 24" access riser(s) and accessible from surface?- - 0 El Cl 1 a. Alarm or Control Panel Installed? ❑ 0 Li 2 Control Panel equipped with Timer/ETM I Counter- - 0 0 ❑ m d Pump installed in 0 Bucket or ® On Block or 0 Other a. Pump Make/Model Liberty 253 0 Floats or I Transducer M a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 4 ft Pump on time 2.33 minutes Pump off time 6 hours Daily flow set at 360 gpd Updated&21,2O18 Parcel# j21b - "IS-901S2 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD 0 YES 0 NO Were existing septic components abandoned as part of this project? - If yes, please describe: 0 YES 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING This is a permanent record and must be accurate layout Septiu'pump tank location.North arrow.and descriptive enough to re•locate in e reserve drainfield,existing and p need of maintenance roposed bus and ildings,location of wens,re development Typical Record Drawings contain: ts.Drainfield&manifold one wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may ovate additional delays in final installation approval and related permits. uq Record Drawing Attached — CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER I certify that 1 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 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 1 further certify that all infor, ation contained on this I further certify that all information contained on this form at ttached R o!d Drawi s.accurate. form and attached Record Drawing is accurate. �j/�r O b ate ''�_ •. �) nature of Installer �• �� L 0 n A G\ 41 i \Q.1/l�j 3to :���J..r Printed Name of Signee .`,, 9}' try MASON COUNTY PUBLIC HEALTH '2-2 • . •�J. :� Sf.^.L,a9 •.p+f lien PAULA JOY JOHNSON ' � The undersigned approves this Installation Report and Record Drawingon behalf of Mason County Public e,_ �� �� ; �� EXPIRES Ti Hea Li ,(2 - '� -30-2.3 Sign ure-/Af (A\ 1\/.10:1 �i n ironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/2t20t8 - Skjview Dr. D „eji, ,si. N _ _r_ __.. ._ „,,„.,,,, __+.—.-„, --, , x 1 \ 3 0 /7 L Aso l P -G:re. l 0J O e w,,N 4- '(%,Ce,<Vo = Ye'\ ,'t 0 N ��v( ylor 0,I,to i / / CD Audio-Visual Alarm r r ' 6T \- ev�1e,d / � 3Cleanout ji "'"°` � 3 1200 Gallon Septic Tank / / 2-Compartment with / -----i. / Effluent Filter O1000 Gallon Pump Chamber / O Valve Control Box I ZS' 6" 454 .Sri.,,, ,clylyO ' APR ROVE - R w� , , 60 8o MASON Cp(JNTy 2 2�23 �„. . . :, i! °ems , AS bui It Je ,. w N�ENTALHEALTH ?. 5,"oo349 .1,k !--r. PAULA JOY JOHNSON oCPIRES r15! far�l 3 Z/06 ` / � " %3G ' - 3o-Z3 • • Ill E 5 vie tA) Dr-) '. .Yti