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HomeMy WebLinkAboutSWG2023-00076 - SWG As-Built - 4/4/2023 , ,..., Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00076 Parcel # 22206-50-00072 Applicant Name SALTY GULCH C/O B-LINE CONS 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 291 NE SNOWCAP DR Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ❑ Full System Installation El Tank(s)Only El Drainfield Only ❑i1 Repair ❑ Other System Type GRAVITY Pretreatment Type N/A >5 ft. from foundation? - - El N/A ® YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ 8 ❑ • Cleanout between building and tank? - - ❑ 0 ❑ o Tank baffles present? - - ❑ ® ❑ CI_ 24"access risers over each compartment?- - CI MI W Effluent filter installed?- - ❑ • ❑ Cl) Septic tank capacity (working) 1200 gal Manufacturer EXISTING `C1 D-box water level and speed levelers used? - - ❑ N/A ® YES ❑ NO DO Manifold/D-box accessible from surface?- - CIMI ❑ coE Check valves installed? - - ® ❑ ❑ OQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑Commercial/Other >10 ft. from foundation?- ,cT �• tC, �' N/A ❑ YES El NO >100 ft. from wells? yak `_ ❑ ❑ W >100 ft. from surface water? - -� ;� 260 - CI CI Li >10 ft. from potable water lines?- Ot..\ - ❑ ❑ - Q > 5 ft. from property lines and easements?- F7 ❑ CI � > 30 ft. from downgradient curtain/foundation dra n - ❑ CI CI ca Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A © YES El NO • Pump tank capacity (flood) 120 gal Manufacturer B-LINE CONST. < 24" access riser(s) and accessible from surface?- - ❑ 0 ❑ ~ Alarm or Control Panel Installed? - - El MI ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ PI n CI- Pump installed in ❑ Bucket or ❑ On Block or MI Other BLOCK a• Pump Make/Model BARNES 1/3HP 0 Floats or El Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 821/2018 evhM e k-a tcrJ 11 Di, Vtrnwn k Mason County OSS Installation Report pg. 2 Parcel # 2220 6 -Sd —0007 7 ABANDONMENT RECORD Were existing septic components abando ed as part of this project? - - YES NO If yes, please describe: T u�.,� ci k Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YEs EI 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: Drainrieid&manifold orientation&layout,Septiclpump 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. P API? %I r i.i • MASON CuUN r ENVIkONMEVTAL HEALTH -> JBw 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 1 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. 3 ,zq-Z3 SigKature of Installer Date - Printdd Name of Signee t i "�o z _, MASON COUNTY PUBLIC HEALTH •Msio 99 "1.1 The undersigned approves this Installation Report and O TOBY J.TAHJA-SYRETT F.7 Record Drawing on behalf of Mason County Public LICENSED DESIGNER EXPIRES: 06/07/241 Hea Sign ture o E vironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated enlr2ot9 .. ! • Z Z - O J o \ �09ix F- I°z�DJ o O 011 - Z �w I!1II0 71 z $o l'iIH� ; co °° w b 1 O z� Ili o �Q o APPROVE IIi'iL4 .4 ��� � 2023 m lii'! 1 \ �Ot}NrYENvI:o,I \ �1B "AL ,: 1 (L a.- W L. 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