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Home My WebLink AboutSWG2023-00077 - SWG As-Built - 4/13/2023 • F.' Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00077 Parcel # 22206-50-00050 Applicant Name DILLON C/O 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 81 NE SNOWCAP DR Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ® Repair ❑ Other System Type GRAVITY Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - 1- - .- ❑ - I ❑ • >50 ft. from surface water? - S i - - ❑ © ❑ Z HCleanout between building and tank? -r - -APR'-6-6-ma -;lJ - -- ❑ I ❑ U Tank baffles present? - lig - ❑ 0 ❑ a24" access risers over each cornpartmeliri- ___ - ❑ 0 ❑ W Effluent filter installed?- - ❑ © ❑ U) Septic tank capacity (working) 1150 gal Manufacturer EXISTING C) D-box water level and speed levelers used? - - ❑ N/A MI YES ❑ NO �O Manifold/D-box accessible from surface?- - ❑ II El o0Z Check valves installed? - - ❑■ ❑ ❑ OQ 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 ❑ YES ® NO O >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water? - - ❑ MI L.T. >10 ft. from potable water lines?- - ❑ ® ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑ 0 Q ee > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ Drainfield level and observation ports present - - ❑ ® ❑ ❑ Graveless chambers or PE Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 120 gal Manufacturer B-LINE < 24" access riser(s)and accessible from surface?- - ❑ 0 ❑ ~ Alarm or Control Panel Installed? - - ❑ 0 ❑ a 2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ • M n- Pump installed in ❑ Bucket or ❑ On Block or • Other BLOCK a• Pump Make/Model BARNES 1/3 HP ® Floats or ❑ Transducer CL a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd ` Updated 8/212018 vt.rnP �o �( aJ:}y %JAL - P`^ P C urq\,•n_S Or A j wk64v1J_ • Mason County OSS Installation Report pg. 2 Parcel # 2 L2 0 6 - sU-00 D C-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? - - YES El 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,SeptiGpump 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. �4on, 4p o y Je�NMENTqk yFACr H I. 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 att hed Record Drawing is accurate. form and attached Record Drawing is accurate. u I " -Z3 Signature of Installer Date — 1 Aylbr I ear - t,-I.?c 7a e.�� y Printed Name of Signee t ' A. � MASON COUNTY PUBLIC HEALTH � F5100299 �`r-F,,4 The undersigned approves this Installation Report and ro TOBY J.TAHJA-SYRETT i LICEtJSED DESIGNER Record Drawing on behalf of Mason County Public Health: EXPIRES: 06/07/21.( Sign.to 1 �� 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 8121/2018 NE SNOWCAP DR. r COMMUNITY WATER F Q APROX a. PROPERTY —s_ w LINES Ei 0 i / RESAREA ERVE 1 v EXT.HOUSE cv I 1 -11 I EXISTING LOGS 0.,�.�-- 1200 GAL 2 — 9' SEPTIC TANK 1 jI1 i °fl .1 III.i I11 I 1 1 I f' ,I •I __ r- 1 I 1 i. L 1 - i I ;1 SHED 4 0°P c\-/ J• .I' 1 ____ i "mil 1;9, ..... (/N/.y 07 , ,;,,.,„ :fir h= FAILED DRAINFIELD BED ��/RQN4��3 _ 3�.i"OS ED NEW • ••,: s D LATERALS SOIL LOGS: %y,6:4, 0-48"MED SAND SMALL POCKETS OF COARSE SAND 2 AND GRAVEL -,,`.i .. m3M Z3 ' DRAINFIELD SITE PLAN `y 5IM229 '.-' FOR: DILLON JOB #: a, TOBYI.TAFJA-SYRETT LICENSED DESIGNER PARCEL#: 22206-50-00050 DATE: 03 MARCH 2023 -x�ss NE BY: TJS DESIGN PAGE 5 OF Mt EXPIRES: 06/07/Zy NORTH ARROW: SCALE: 1" = 30' 0 o' so' so' © B-LINE CONSTRUCTION, INC.