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HomeMy WebLinkAboutSWG2023-00187 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION • Permit Number SWG 2023-00187 Parcel # 51908-51-00160 Applicant Name HAKKOLA 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 1894 W STAR LAKE DR Designer Name CINDY WAITE INSTALLATION CHECKLIST ❑ Full System Installation El Tank(s)Only ❑ Drainfield Only I Repair El Other System Type GRAVITY Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A ® YES ❑ No >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? - - ❑ I El FQ- Cleanout between building and tank? - - ❑ II ❑ V Tank baffles present? - r4,-,_ _ - ❑ ® ❑d24"access risers over each compartmentY g ��� - ❑ ® ❑W Effluent filter installed?- - ❑ ® ❑fnSeptic tank capacity (working) 109 ; gal nuf�.ctur- INFILTRATOR — CID-box water level and speed levelers used? By - ElN/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - CI CI m Z Check valves installed? - - ❑ ❑ ❑ CI et 2 Transport Line Size Schedule/Class Bedrooms installed (check oneI El 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES El NO 0 >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - - - - •10 •- V`- P S - ❑ CI CIu. >10 ft. from potable water lines?- ✓ - ❑ ❑ ❑ k). z > 5 ft. from property lines and easements?- - - ❑ ❑ Eld > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑ a 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 ❑ NO Pump tank capacity(flood) gal Manufacturer Q24" access riser(s)and accessible from surface?- - ❑ ❑ ❑ F- a Alarm or Control Panel Installed? - - CI CI E Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ M d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other EPump Make/Model ❑ Floats or ❑ Transducer p=., 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 r , Mason County OSS Installation Report pg. 2 Parcel # lO g- 51 - k6 0 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES NO If yes, please describe:-_ 75-0 c,w n l 5 �-:G -r n k 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 deveiopmenL 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. • Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 R d Drawing is accurate. form and attached Record Drawing is accurate. 43 Sig ature of Install,sr Date .4.1.4 Pnnte Name of Signeet MASON COUNTY PUBLIC HEALTH ,ram o 5100249 ��F 4 The undersigned approves this Installation Report and • O, TOBY).TA>')A_SYREIT _� i LICENSED DESIGNER Record Drawing on behalf of Mason County Public Health: EXPIRES: 06/07/241 (ct (2 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 a212018 o ! f 3 I ' I V A a�s a l Cam , ,� LiIIIIIE , f 0 1060 rw , 11 C/f 4ru ic low w X f1v .1) °'�t II �, tm- Il tO 01 7Sp w If kit k' ---- E. i t j • -, 1 ilect • - 7 © APPROVED I ~----- - JUN 0 9 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET ------'-- \< cAotelr'''' s, go7-Sl- 06 /GO