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Home My WebLink AboutSWG2023-00104 - SWG As-Built - 4/27/2023 . ‘-)ed Mayon County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00104 Parcel # 12019-50-00025 Applicant Name MARIANNE PAINTER Subdivision (Name/Div/Block/Lot) Applicant Address 415 N BOROUGH RD City, State, Zip TACOMA, WA. 98403 Installer Name B-LINE CONSTRUCTION Site Address 70 E SMITH COVE Designer Name CINDY WAITE INSTALLATION CHECKLIST LI Full System Installation LI Tank(s)Only ❑■ Drainfield Only ❑ Repair ❑ Other System Type GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A ❑U YES ❑ NO >50 ft. from wells? - - ❑ ❑� ❑ Z >50 ft. from surface water? - - ❑ ❑■ ❑ HCleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ ❑■ ❑ a24" access risers over each compartment?- - ❑ 0■ ❑ W Effluent filter installed?- - ❑ 0 ❑ Septic tank size 1200 gal Manufacturer FRED HILL(EXISTING) 0 D-box water level and speed levelers used? - - ❑ N/A ElYES ❑ NO XO Manifold/D-box accessible from surface?- - 0 0 El u. OQ Check valves installed? - - 00 ❑ 2 Transport Line Size EXISTING Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO 0 >100 ft. from wells?- t t11 LL-ll- -� - ❑ 0 ❑ w >100 ft. from surface water? -��R ❑ El LI >10 ft. from potable water lines?- - - - - 1 1-20.. - ❑ UI ❑ Q > 5 ft. from property lines and easement •16Y_ - ❑ 0 ❑ Q > 30 ft. from downgradient curtain/founds _ - NI El El Drainfield level and observation ports present - r - ❑ I ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑■ NO `1 Pump tank size gal Manufacturer Z < 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ d Alarm or Control Panel Installed? - - ❑ ❑ ❑ • Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ ❑ Cl- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n' Pump Make/Model ❑ Floats or� ❑ 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 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12019-50-00025 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES E■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-03007 - - 0 YES ❑ 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. i,�J a 1(t'4 —4 7 ' Csa ec.01 r �Ul `. o = . 2. t - IllR 0V E `.". ��riMt f HE.. i !` APR 2 12023 it^ 'Ar eOtrNTY ENVIRONM ENTAL yEgl TN Iff Record Drawing Attached JEnnir 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 forrmand a hed Re rd Drawing is accurate. form and attached Record Dr wing is accurate. LI-17- � Sig ture of Installer Date �,� . •w �g of `s„ 1.), 4. Printe Name of Signee� " 0 a 0 MASON COUNTY PUBLIC HEALTH Q ��pr ND\441 I t•- The undersigned approves this Installation Report and L ENSED DE ER Record Drawing on behalf of Mason County Public Lxr•,Kt.S us lot He- ,ir.ide . iki-j-7._*s7) _ (4-2.7 -=0),.5 Sign. ur- . ironmental Health Specialist Date (stamp, signature and date) ��THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8l21/2018 • I , . ; --- .1-> ., 1 . • ,.-------'\ 1 • • ------- I , ------- I . i 1 e;, • t- \ • ... • 1 16 r 571W-riA (.4.9e. . .1 1 12 619,•. .5-40 -OboaS- . i . 1 I- i Q---I I 5011 . 9 " ,x)?Jr•• i .1 i 1 fir'\--'----- ' -‘ -\. • A\jPiPPROVED APR 2 7 2023 - 1 , v MASON-COUNTY ENVIRONMENTAL HEALTH 1 . .,„., 0 ke.c I el eivcc 1 il 1 -------.- L7----- - ,)1 i 111) f :cj I.,Lru i'll , I r . . . ir 1 . 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