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HomeMy WebLinkAboutSWG2020-00441 - SWG As-Built - 2/7/2023 �! 360 (a-7- 9C0 Y- 3 sz . Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00441 Parcel # 22230-24-00000 Applicant Name B-LINE CONST. _ Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILLIPS LK LP RD City, State, Zip SHELTON, WA, 98584 Installer Name B-LINE CONST. Site Address 11510 E STATE ROUTE 106 Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ■❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type 1 end-ry Pretreatment Type N/A >5 ft. from foundation? - - ❑■ N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ ❑ Z• >50 ft. from surface water? - - ❑ ❑ ❑ HCleanout between building and tank? - - CI ❑ U Tank baffles present? - - ❑ 0 ❑ d24" access risers over each compartment?- - ❑ ❑� ❑ W Effluent filter installed?- - ❑ 0 ❑ co Septic tank size 1530 gal Manufacturer INFILTRATOR 0 D-box water level and speed levelers used? - - ❑ NIA 0 YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ 00 u. mZ Check valves installed? - - ❑■ ❑ ❑ CaQ E Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ■❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑] YES ❑ NO a >100 ft. from wells?- - ❑ ❑■ ❑ /r,, W >100 ft. from surface water? - - ❑ 00 u. >10 ft. from potable water lines?- - ❑ ■❑ ❑ - Q Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q• > 30 ft. from downgradient curtain/foundation drains?- - ❑ 00 Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or • Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank? - - ® N/A ❑ YES ❑ NO • Pump tank size gal Manufacturer Q24"access riser(s) and accessible from surface?- - ❑ ❑ ❑ t— a Alarm or Control Panel Installed? - - ❑ ❑ ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ D a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a• Pump Make/Model ❑ Floats or ❑ Transducer a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # Z2- Z J o -ZI - ©ooOO ABANDONMENT RECORD _ Were existing septic components abandoned as part of this project? - - [] YES 1. NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES D NO RECORD DRAWING 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 Record Drawings contain: Grainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells.observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final Installation approval and related permits. 11 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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 certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. V I 7 1 - zi-Z3stall`— Date �� +,- I �, Ay Q.� 1 hG\/ . 100- i ; . 1 t Printed Name of Signee J I '^ is •,. "-•ctis.t - z MASON COUNTY PUBLIC HEALTH � �! ...> i S100299 �`raF�t The undersigned approves this Installation Report and ro TOBYJ.TAHJA_SYRETr , Record Drawing on behalf of Mason County Public = LICENSED DESIGNER �4, Health: EXPIRES: 06/07/21 .6(7) ---- .7 Feb zo z? Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated aa112o1e t APPROVE . , • DRIVE FEB 0 6 2023 •I' MASON ENTY ENVIRONMENTAL H77 AkNAL • 22230-21-00021 R WleV STREAM FOUND SURV PIN SHED PROPERTY LINES ti 22230-24-00000 s pp 2223p,23� l oo' )\ PRIMARY& SOp • RESERVE ' • DRAINFIELD . , ' 70 onr � q, �, - VE F . i, SOrVOI wry. �i , L r;. TRANSPORT LIN SOIL LOGS: A 060"-60+" GSL REST. COMP. COx, `sO-0 - - MOTT SAND (� .�o P�4CZ 1100,,,p A0-36" GSL - ` 36-60'. GMS POCKETS / • OF MED SAND �/ 100'R ‘ 60"+ REST.COMP. MOTT. SAND r I POSSIBLE i lir WELL LOCATION i 50 SEPTIC TANK -----_ ' / // ,fit POSSIBLE HOME FOOTPRINT ' �•'�, t s SITE PLAN DETAIL: //0 'O2� ���es 11� FOR: STEFANKO . JOB#: i o2 ,ByI.TAIi)A-SYRETT -. 1, PARCEL#: 2230-24-00000 DATE: 20 AUGUST 2020 / LICENSED DESIGNER _"'� DESIGN PAGE b OF i EXPIRES: o I07/t Z BY: TJS NORTH ARROW: SCALE: 1" = 80' © B-LINE CONSTRUCTION, INC. 0 0' 80' 160'