HomeMy WebLinkAboutSWG2022-00296 DRAINFIELD ONLY - SWG As-Built - 2/21/2023 •
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00296 Parcel # 22004-75-00160
Applicant Name BOUSHLEY C/O B-LINE CONST. Subdivision (Name/Div/Block/Lot)
Applicant Address 2971 E PHILLIPS LAKE LOOP RD
City, State, Zip SHELTON, WA, 985284 Installer Name B-LINE CONST.
Site Address 301 E WILCHAR BLVD Designer Name TOBY TAHJA-SYRETT
INSTALLATION CHECKLIST
❑ Full System Installation ❑ Tank(s)Only ® Drainfield Only ❑ Repair ❑Other
System Type Pressure Pretreatment Type N/A
>5 ft. from foundation? - -- ❑ N/A ❑ YES ❑ NO
>50 ft. from wells? - -- I— ❑ ❑
Z >50 ft. from surface water? - -�-�- 1- ❑ ❑
HCleanout between building and tank? - •- ❑ ❑
✓ Tank baffles present? -EE$ 1 -0-292�- t ❑ ❑
a24" access risers over each compartment?- ❑ ❑
W Effluent filter installed?- By- - - `�-- - -- ❑ ❑
Septic tank size gal Manufacturer
4 `9 D-box water level and speed levelers used? - - El N/A ❑ YES El NO
�O Manifold/D-box accessible from surface?- - ❑ 0 ❑
o0 2 Check valves installed? - - ❑ ® ❑
ClQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A 11 YES ❑ NO
>100 ft. from wells?- - ❑ IN ❑
W >100 ft. from surface water? - -- ❑ 1. 0
al
1 >10 ft. from potable water lines?- -- ❑ ® ❑
Z > 5 ft. from property lines and easements?- - ❑ II ❑
w > 30 ft. from downgradient curtain/foundation drains? - - ❑ In ❑
Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or N Clean gravel used? (check one)
Proper cover installed over drainfield?- •- ❑ MI ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO
• Pump tank size gal Manufacturer
< 24" access riser(s)and accessible from surface?- - ❑ ❑ ❑
~ ❑ ❑ ❑
O..
Alarm or Control Panel Installed?
0 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑
o
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Q.• Pump Make/Model ❑ Floats or ❑ Transducer
EL
a _Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Jvdated 8.21/2018
Mason County OSS Installation Report pg. 2 Parcel# 2Z 1
0O - 7S-OO 16 0
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - YES 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: 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.
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Ci Malty 301
Il 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.
7i-Ti2.-7- 23 '�
Sig ture of lnstalle, Date �
�� t __ _
.,c (,,,,PY I , 7 Nq A
Printed Nameof Signee ( . ." 1..S f
.''s- » '^_ z Z>1e
MASON COUNTY PUBLIC HEALTH J 5100299 r�`f.6
The undersigned approves this Installation Report and �''o TOBY J.TAHJA-SYttETT _f' f
or LICENSED DESIGNER
Record Drawing on behalf of Mason County Public .��.....�•�.���`� ��,
Heal EXPIRES: 06/07/2Lf
i �V✓ - Z— ( Z 3
Sign ur nvironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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