HomeMy WebLinkAboutSWG2020-00407 - SWG As-Built - 6/9/2023risis � 1
Mason County OSS Installation Report pg. 1 , __. MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2020-00407 Parcel # 31905-34-00000
Applicant Name JOHNS 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 50 SE EVERGREEN DR Designer Name TOBY TAHJA-SYRETT
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type PRESSURE Pretreatment Type N/A
>5 ft. from foundation? - - ❑ NIA ❑� YES ❑ NO
>50 ft. from wells? - rt2-1117 -71
❑ ❑Z >50 ft. from surface water? - ❑ ❑� ❑Cleanout between building and tank? - - -- my-i-9-2�23 - ❑ ® ❑U Tank baffles present? - ❑ ® ❑
- i
a24"access risers over each compartment?- gy- - k -I ❑ MI CI
Effluent filter installed?- _- - rill
® ❑
co
Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT
0 D-box water level and speed levelers used? - - INN/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ II Li
cot Check valves installed? - - ❑ ® ❑
6Q
E Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 111 YES ❑ NO
>100 ft. from wells?- - ❑ ® ❑
ca
W >100 ft. from surface water? - - CI 0 ❑
u. >10 ft. from potable water lines?- - ❑ I ❑
Z > 5 ft. from property lines and easements?- - ❑ ® ❑
CL > 30 ft. from downgradient curtain/foundation drains? - - ❑ II ❑
o
Drainfield level and observation ports present - - ❑ 0 ❑
❑ Graveless chambers or it 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) 1475 gal Manufacturer SOUND PLACEMENT
4 24" access riser(s)and accessible from surface?- - ❑ ® ❑
H
a. Alarm or Control Panel Installed? - - II CI CI
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑
m
a Pump installed in ❑ Bucket or ❑ On Block or • Other PUMP VAULT
a• Pump Make/Model LIBERTY 280 • Floats or ❑ Transducer
a Tank draw down 2.1 in/min Pump capacity 52.08 gpm Squirt Height 5.8 ft
Pump on time 38.9 sec IlPump off time 3 hr Daily flow set at 270 gpd
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Mason County OSS Installation Report pg. 2 Parcel# 3 I I G
OS-- 31 - pod()O
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES ® NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ 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.
Ill Record Drawing Attached
• CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
i certify that i installed the system in accordance with 1 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 ached Record Drawing is accurate. form and attached Record Drawing is accurate.
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Signature nstaller ��Date !11•
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Printed Na nee ( s °/ tio,t�
MASON COUNTY PUBLIC HEALTH I ~S,c14frq nz 9 ..s+1+
The undersigned approves this Installation Report and f o TOBY).TAH)A_SRE T 6
srLICENSED DESIGNER
Record Drawing on behalf of Mason County Public ..����.1.:`��� ..........,
Health:
EXPIRES: 06/07/21
. r6A/V\ ( ( Cri(Z3
Signature of Environmental Health Specialist Date 9
(stamp, signature and date)
4 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a/21/2018
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