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HomeMy WebLinkAboutSWG2022-00412 - SWG As-Built - 8/15/2024 f r Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANTI PER INFORMATION Permit Number SWG 2022-00412 Parcel# 32116-75-00200 , Applicant Name Re v 8 Erin Gutierrez _ Subdivision (Name/Div/Block/Lot) �s CPC Applicant Address 2301485th AveW City. State, Zip Edmonds,WA 98026 Installer Name Workman Contractin Site Address 120 E Spirit Ct E Shelton Designer Name Arrow Se tic Desi ns Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other. System Type Shallow Pressure Pretreatment Type YES s NO >5 ft.from foundation? ---- ---- --- " - - - " - -- - -- - - - ❑NIA >50ft.from wells? . - - - - - --- -- - -- - -- - - - - -- - -- --- ❑ ® ❑ Z >50 ft from surface water? - - - - - -- - - - - - - -- " - - ❑ ® ❑ H Cleanout between building and tank? __ ___ _ ____ _ ___ __ O ® El Tank baffles present? - - - - - - - - - - - -- - _ _ a F 24"access risers over each opmpartment?-- ---- -- -- - --- -- ❑ ® El WEffluent filter installetl?-- -- - - - - - - - -- - - -- - - - - - -- ❑ ® El N Sound Placemennt Septic tank capacity (working) 1,250 pal Manufacturer ❑ D-box water level and speed levelers used? ----- - - - - -- - - - - ❑ NIA ❑ YES NO 0O Manifold/D-box accessible from surface?- --- ---- - - - - -- - -' El ® ❑ ❑Z Check valves installed? - - - - - - - - -- - -- - - - - - - - - - - - Transport . m ® ❑ ❑ rt Line Size 2- Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑CommercialiOther >10 ft.from foundation?- - - - - - - -- -- - -- - - - ❑ NIA ® YES ❑ NO ❑ >100 ft.from wells?. -- - - - - - ------ -- -- - - - - -- - -- - - ❑ ® ❑ W >i e0 ft.from surface water? - - - - -- - - - -- - - - - - - - - -- - - ❑ LL >10ft. from potablewater lines?- - - - - - - - - - -- - - - - - - - - - ❑ ❑ ? > 5ft. from property lines and essemems?- - -- - - - - - - - - - - - - ❑ ® ❑ K > 30 ft. from downgradient curtain/foundatlon drains?- - - - - - - - - - ❑ ® ❑ ❑ ❑ ® ❑ Drelnfield level and observation ports present � - - - - - - " - - -- - - ❑ Graveless chambers or K Clean gravel used? (check one) Proper cover installed over drainfield?-- - - - - - --- -- -- - - - -- ❑ . ❑ Pump tank setbacks consistent with septic tank?- - - - - - - - -- - -- ❑ NIA ® YES ❑ NO Y. Pump tank capacity (flood) 1,500 oal Manufacturer Sound Placement Q24- access nsil ana accessible from surface?-- - - - - -- - - - - Ala"or Control Panel Installed? - - - - - - - - - - - -- - - - - - - - - ❑ ❑ d ❑ ® M Control Panel equipped with Timer/ETM/Counter-- - - - - - -- - - ❑ 7 a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Liberty 280 ® Floats or ❑ Transducer f a Tank draw down 2' in/min Pump capacity 56 gpm Squirt Height 4 ft Pump on time 2.15 min Pump off time 6 hr Daily bow set at 480 gpd uonem s�rme O parcal Mason County OSS Installation Repot pg. 2 1ENT RECORD ___________ _ . YES NO Were existing Septic components abandoned as part of this project? -- YES ❑ NO It yea,please descdbe: Were all components pumped out and properly abandoned per VIAC246-272A-0300? RECORD DRAWING _ L r a Raa,ra muu96 b McCala m N.nBN er m.IMfnanK ecerE.a anadlda+daga.Idrdad'dvetle.+valenln6. Tula la a pnssrd rewad and ad a .aKuns and deacripare an,k Ixa�n.NOM anw'.e..'a dra0did.a0da9 e^a D+°NI imnl�e4W apPrd�and..d dd d- pr.Nrga wrNi¢ eraMfiep 6mea,da alenudan 6 izp'h a¢DddPa'nP Inmmpleb Rarara OnvanBa^W nevre atldNcnre dalayi in wlK.dada f.Dame.tlaanala.and dsr naanmanm acrosc Dd^ra Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNEW ENGINEER INSTALLER I certify that the system has been installed In acco- I certify that I installed the system In accordance with the septic design stamped"APPROVED"by Mason dance with the septic design stamped°APPROVED"by j County Public Health and that any deviations shown Mason County Public Health and that any deviations lil here have been cleared/approved by both the designer shown here have been clearedlapprOved by both and Mason County Public Health and meet all State mysStatefand Meson County Codes nd Mason County Public Health and meet all and Mason County Codes. that all information contained on this i fuller cordfy that all information contained on this I further certify form and afteched Record Drawing is accurate. form and attached Record Drawing is accurate. Signature oflnstaller Date u a, rt;. Printed Name of Signee MASON COUNTY PUBLIC NE.ALTN �.. The undersigned approves this Installation Report and pnuu for donrvsoN'. Record Drawing on behalf of Mason County Public 'L' E U'..5�1' Health: Signature of Environmamal Health SPeoae— Dale (stamp, signature and date) THIS FORM MAY BE SCANNED ANO AVAI W8LE FOR PUBLIC VIEW ON TnE M0.50N COUNtt WE6 SITE uoaae arzvm+e _ _ _ P.emMtErin �7UESLmtr. ?arct Z116-'75-oowG ISO ISO fsr:; G+ E S Ga(C: 1:(y0 Tve. Cilos O 01 4G • w� \ Qoyr�c 1� 8c+uxevl � � G \ PAULA Jpy/pNNSpN !�q `PJWXPS�$I p`i�fl � AppR0102" ESN 8 - 3 - Zak p�G ONMENSP�HEp ,is COON, Ej will MPSON RES �' 6� O b / 10o Audio-Visual Alarm ' Cleanout ® © 1200 Gallon Septic Tank 2-Com EtIluent�l ec` with ' \ O I500 Gallon Pump Chamber n Valve Control Hox 3 ® Q Ra 4. lr