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HomeMy WebLinkAboutSWG2023-00167 - SWG As-Built - 6/28/2023 Mason County OSS Installation Report pg. 1 � _ MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00167 Parcel # 12229-43-00010 Applicant Name LOFTIS CIO 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 6980 E GRAPEVIEW RD Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type PRESSURE Pretreatment Type N/A >5 ft. from foundation? - - --- - El N/A ® YES ❑ No >50 ft. from wells? - - ❑ ® ❑ Z >50 ft. from surface water? -f--E-Il-7- - El ❑ < Cleanout between building and tank? -- R t - ❑ ® ❑ U Tank baffles present? - T 1 UlV_L 4-2 2�_ _ ❑ 0 ❑ d24"access risers over each compartment?- - - - - ❑ NI ❑ CO W Effluent filter installed?- 6- ElFM ❑ Septic tank capacity(working) 1200 gal Manufacturer EXISTING 9 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ Ill QQCheck valves installed? - - ❑ ® ❑ 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 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ CO ❑ W >100 ft. from surface water? - - ❑ NI LL >10 ft. from potable water lines?- - ❑ ® ❑ Z >5 ft. from property lines and easements?- - ❑ It d > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ Drainfield level and observation ports present - - ❑ IX ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ • ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A re YES ❑ NO • Pump tank capacity(flood) 1275 gal Manufacturer SOUND PLACEMENT Q 24" access riser(s) and accessible from surface?- - ❑ • ❑ H a Alarm or Control Panel Installed? - - ❑ 0 ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ II ❑ D a- Pump installed in ❑ Bucket or ❑ On Block or 0 Other PUMP VAULT a• Pump Make/Model LIBERTY FL61M I ® Floats or ❑ Transducer a. Tank draw down 1.33 in/min Pump capacity 33.3 gpm Squirt Height 2.5 ft a Pump on time 40.5 sec Pump off time 3 hr Daily flow set at 180 gpd Updated 8/21/2018 Mason County OSS Installation Report pg- 2 Parcel# 1ZZZ � " y3-OODIU ABANDONMENT RECORD �_ Were existing septic components abandoned as part of this project? - - ❑ YES II NO If yes, please describe: El No Were all components pumped out and properly abandoned per WAC246-272A-0300? - - El YES 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 Drv:,ngs 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 ■ 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 attached Record Drawing is accurate. form and attached Record Drawing is accurate. 6-I -Z3 Si auure of inst Date ___ _ . __ _ ._ —1 `or I one� t �c.F Printed Name of Signee z a 1^ a .s MASON COUNTY PUBLIC HEALTH ;� sio s s, The undersigned approves this Installation Report and O TOBY j.TAHJA_SYIiFt-f � LICENSED DESIGNER Record Drawing on behalf of Mason County Public EXPIRES: 06/07/21 ESIGNER 0-1\QXY\Ae(6/4/1 (0 /z(b1 -S 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 8/2112018 0 o tiI ,- o 0--I 0 Y p z H•Z u_ to I)0 Li/.- 0 I I ' XF-I- W�0 M N YZto(n - O _O W o 110 a.°�Q p a 0 cUn ao=� W Q a �u��m QZ �i , , - - - - -- ;i %�.�• Q co Z ON C9Q tJ ou co oI- r ��- ' I— W O. to N� r --- W CO Q W b C7Z~LL �a I r • 'o P0co ice~ z ii wMV o O �oa IQm� O Q , 9 Z , , - O COUNTY ENVIRONIME JTAL HEALTH z F TCt W I I 04 Z C�S. ,/ ,'' Zk Q'rI• l `.% 4 OI I 1=�0 / / A i, ;Ti. 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