The URL can be used to link to this page

Home My WebLink AboutSWG2022-00610 - SWG As-Built - 7/24/2023 Mason County OSS Installation Report pg. 1 C �` MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT IN ORMATION Permit Number SWG 2022-00610 Parcel # 22132-14-00080 Applicant Name TATOM 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 240 E LAKEWAY DR 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? - t,- :-,Tr t?-`. �-:ty 1 - - - ❑ N/A ® YES ❑ NO >50 ft. from wells? - .r' 1- \4- - - ❑ 0 ❑ Z >50 ft.from surface water? �1, - ��.i } -? Z- -. - ❑ MI ❑ Q Cleanout between building and tank? - -- - - ❑ U ❑ ~ ��-�' U Tank baffles present? - -- ❑ ® ❑ a▪ 24"access risers over each compartmen Y - ❑ MI W Effluent filter installed?- - ❑ ® ❑ co Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT 0 D-box water level and speed levelers used? - - ® N/A ElYES ❑ NO go' Manifold/D-box accessible from surface?- - ❑ 0 ❑ mZ Check valves installed? - - ❑ ® ❑ 0Q Transport Line Size 2" Schedule/Class 403 Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Q YES ❑ NO C) >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ It LL >10 ft. from potable water lines?- - ❑ ® ❑ z > 5 ft. from property lines and easements?- - ❑ II a ❑ PM ❑ CI > 30 ft. from downgradient curtain/foundation drains? - - • Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or IN Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 1475 gal Manufacturer SOUND PLACEMENT Q 24" access riser(s)and accessible from surface?- - ❑ I ❑ 1-- Alarm or Control Panel Installed? - - © ❑ ❑ a E Control Panel equipped with Timer/ETM /Counter- - ❑ • ❑ D a- Pump installed in ❑ Bucket or ❑ On Block or • Other PUMP VAULT a• Pump Make/Model LIBERTY FL 151M IN Floats or ❑ Transducer a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at �a gpd Coevi-CC l Pa t e l con �(my,e j'e \1 l r; Se.' �ri ': MG 0 C_ 60 0.f Ie,a I�G Gted 8'21/2018 Mason County OSS Installation Report pg. 2 Parcel# u 132 6 W — OP' O ABANDONMENT RECORD Were existing septic components abandoned as part of this project? • - ❑ YES II 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: Grainfield&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. PPROVE JUL 242023 MASON COUNTY ENVIRONMENTAL HEALTH i JBW Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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 I 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 a ached Record Drawing is accurate. form and attached Record Drawing is accurate. 1"----- 7 l3- 23 IS Wei Si ture of lnsf Date �_ 1 P 1 �, ay Lr °:cy m e .. ,�c :,4 Printed Name of Signee t� y� ��/ �` .sue MASON COUNTY PUBLIC HEALTH �.4 5100299 s.�, The undersigned approves this Installation Report and 'o TOBYJ.TAHJA-SYRET T _-7 t ar LICENSED DESIGNER + Record Drawing on behalf of Mason County Public 41.,. •�.��o�� r. EXPIRES: 06/07/2 1ill\ 2 2 YJ.23 Sig,at tTEnvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated a/21/2018 gisaginsimialMIMIIINIMIMINIMIlir , . 4. • _ i ,-, • , ..t.irtoe'l uosevs- t I iti....cip. p;.4-1.•i,ii,ic 1 . _____ ! • , " c . rn, — i __I ...• i -1....•e! 0 C.3 I 1 2 2 o r 0 1, 1‘ 2 ¢ ! Li: ; • Q !.• 171 ... 1V \ I r;v, ,•••-74, i_ ,.., 8 6; 1 i ° • . 1 \ 1, oi.l• .)- 1-• r 1 -4* 1 2 d 7 a ei / V) .., , ,.. , ; •-, g ffi t • ,,,, I,. ,--- -r) 1 "- -,, \N . / 1 7 1-/ -- - ' 1 '27 0 E gg 2 za' .2 i ‘. 3- /10 /i A 'ci M 1 w s It• ! I' . a V3 I 370. —, 3.• ',. ‘) ,. . o 0t/ I) a a -r-: z-a•-• __I , I - ---- - x ) '•-• i ' -2 .- lit rd .--:- . i !!..4 r.; 1 L I ••••. -•.:, II gr :r4 it ‘Ii Tr-...,....,.. • 4, \ , ,. N "...- •._ s ... i vl 1, 3 -) 1,3 , ce . 8 g 4 1 ca :.:. . fi \ ..,, 4111110 44,) 1 j . .,. i 41'7 .: I,/ ,t',.'.i ; xi ,u, ...,•4-.• ..,,,I. 5: . ii tiki4ii .31/ tA i., -4 ; 7 • ... , eild ; ut . ,,,. ; .‘ e) • • t . • 10 {, , , lit i _ ..1 , ' : < ' .,," ,•`;I j I + 0•Wl- ` c.' ,,, ' -;-' • k 1 : 1 i P. ) ‘1. ' d to ; 1 • ' te r / I % 0 ?J i 0 J .011--''';''' z•:,-".,"-..-. ' ' I- -I /( i;: •._-- 7 \ . ' `.; 1.'7.4- 74 i..g I: . ; • ' ‘,4111•1 7. is,... • s.-• is 4.. .... iAllilitill '•••i - / /* . f' • .r.m;. 0 i fit i _ I 1 V. • , ; :f. .— ,--- / • %II 11 hit - ' • ..-^' I i ' I i. U4I -- fq-7•.' , 1 e i u 1 " ' r irfiril& -*"ill ',, .„--- . z, ... 44211-- . A 2 4 2023 .PPROVED r . .... „ JUL- , . . ;_.. -- 3 1 I ' I 19e:• ,,,,_„.,..'... :„,..:....") I 1 ' . 1 ii lb ,.. 1 , ----- MASON COUNTY ENVIRONMENTAL HEALTI- fliaal su. JBW i• , -- 1 iii 1' ,-• A — I . ' tii - , 1 p _ \I 1 4.44 -, , .0: 1 1 r_ i PI I id '0: <1.; -fa 4:Y:.i 's • ' --. . 0, 4e .^? ri• %.! <i .10-3-4 •e, , vs) 40* 6 eir,1 9,0..,..___ -4.—A N ---- -r %) ,....-- i - e _J % ---0 7 --f/--. ._ -......4..%**- !