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HomeMy WebLinkAboutSWG2021-00003 - SWG As-Built - 8/15/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2021-00003 Parcel # 32023-23-90020 Applicant Name 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 415 E LEEDS RD Designer Name DALE J. TAHJA INSTALLATION CHECKLIST © Full System Installation El Tank(s)Only El Drainfield Only ❑ Repair El Other System Type PRESSURE Pretreatment Type N/A >5 ft.from foundation? - - ❑ N/A IN YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft. from surface water? - - ElEl0 HCleanout between building and tank? - - ❑ MI i U Tank baffles present? - - ❑ • ❑ R. 24" access risers over each compartment?- - El 0 ❑ IZ W Effluent filter installed?- - ❑ Septic tank capacity(working) 1200 gal Manufacturer SOUND PLACEMENT D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO .�XOO Manifold/D-box accessible from surface?- - ❑ II ❑ co-2 Check valves installed? - - ❑ IN El 6Q 2" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) El 2 03 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water? - - ❑ IP ❑ u. >10 ft. from potable water lines?- - ❑ II El Z > 5 ft. from property lines and easements?- - ❑ IN GI Q lE > 30 ft.from downgradient curtain/foundation drains? ❑ PI ❑ Drainfield level and observation ports present - - ❑ MI ❑ El Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - El N/A IS YES ❑ NO Pump tank capacity (flood) 1475 gal Manufacturer SOUND PLACEMENT < 24" access riser(s)and accessible from surface?- - El [U ❑ I— Alarm or Control Panel Installed? - - ❑ 0 ❑ a E Control Panel equipped with Timer/ ETM/Counter- - ❑ MI ❑ o PUMP VAULT a Pump installed in ❑ Bucket or ❑ On Block or In Other a- Pump Make/Model ORENCO PF7515 ® Floats or El Transducer a. a Tank draw down 1.5 in/min Pump capacity 37.5 gpm Squirt Height 8.5 ft Pump on time 54 sec Pump off time 3 hr Daily flow set at 270 gpd Updated 812 112 0 1 8 Mason County OSS Installation Report pg. 2 Parcel# 320 23- Z3 - g002o ABANDONMENT RECORD • Were existing septic components abandoned as part of this project? - - D YES 111 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - E YES 0 NO L RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the neod 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. APPR0VE . i. AUG 15 2023 3 MASON COUNTY ENVIRONMENTAL HEALTH Jaw Record Drawing Attached CERTIFICATION OF INSTALLATION , INSTALLER DESIGNER/ENGINEER I 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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Sig ture of Ins Iler Date _ i Jd l or om ey - rat , r. Printed Name of Signee t s?. „ , z 1..,,Mn „r MASON COUNTY PUBLIC HEALTH s,�oo�zsv sF The undersigned approves this Installation Report and Os TOBY).TAH')A_SYRETT _"7 LICENSED DESIGNER 1 Record Drawing on behalf of Mason County Public ��� EXPIRES: 06/0 /z H:-. . :P // 0 <_1 2 yS\ Sig aturt • 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 821f2018 4 L. 1:-Vor: V\C \ G , C,\-\r@:- F. b\'• 1 (3.,P l_. `Ckb,J0. 1 . 1 ey 3 O DALE L iAHJA y 1 • LiC fAED G SIGNER / 1 • , r FXF:-:tS: - - , i '4M79. 1 1/ G HOC/`/ ' ' p.P� 6," "U qwpw„A, 4, i�-.9,' . -____,_;-,r,./..-, t( L lyF S� l' "• t'` ; 0 �I� piji�F t �lT,S, 1 . 1 I 1 .4 „t \-r ‘0<.-(- 4:\ -,-„,_ b, • / . 1 / i 1` 1 .0 1 t20O 3., 5e,P"- (4"IL B Rest d 1 1,A rAt cvn. .... ---__ - ' ` ' Printed From Mason County D!V!8 „,c,,‘n \ Printed from Mason County DMS