HomeMy WebLinkAboutSWG2022-00525 - SWG As-Built - 9/11/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG P Q 20.22-00 25 Parcel # 22010-30-91003
Applicant Name WISSMILLER 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 530 E SOUTH ISLAND DR Designer Name TOBY THAJA-SYRETT
INSTALLATION CHECKLIST
❑ Full System Installation •Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type PRESSURE Pretreatment Type N/A
>5 ft. from foundation? - - ❑ N/A ❑ YES ❑ No
>50 ft. from wells? - - -❑ I ❑
• >50 ft. from surface water? 1-1 { - CIU CIZ< Cleanout between building and tank? - I ❑ ❑0 ❑
V Tank baffles present? - .G-1_a 2023 -v ❑ I ❑
n~. 24"access risers over each compartment?- - _ - ❑ IC ❑
tW Effluent filter installed?- By �`� - CIC7 ❑
Septic tank capacity (working) 1500 gal Manufacturer SOUND PLACEMENT
9 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface?- - ❑ ❑ ❑
m— Check valves installed? - - ❑ ❑ ❑
enQ
E Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO
0 >100 ft. from wells?- - El CI
J >100 ft. from surface water? - - ❑ ❑ ❑
ii. >1 a ft. from potable water lines?- e: -1 sj f - - - - ❑ ❑ ❑
a 5 Z > ft. from property lines and easements?- - ❑ ❑ El
Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑
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 Q YES ❑ NO
• Pump tank capacity (flood) 1585 gal Manufacturer SOUND PLACEMENT
Q 24"access riser(s)and accessible from surface?- - ❑ IX ❑
H
a Alarm or Control Panel Installed? - - CI U CI
E Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑
n- Pump installed in ❑ Bucket or ❑ On Block or 0 Other PUMP VAULT
Pump Make/Model ORENCO P3005 111 Floats or ❑ Transducer
a
• Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
�. j 'i]N L S J' "'".�-5 �� c G ' Updated 82?2018
Mason County OSS Installation Report pg. 2 Parcel# 22010 - 3 0 - 91 d O 3
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - 0 YES 111 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.
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////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
1 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.
II
Sign ure of Instal Date
-1 �y to C ► o-^e7 I
Printed Name of Signee ( t-
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MASON COUNTY PUBLIC HEALTH ;�f 5.0
ioo s9 s&
The undersigned approves this Installation Report and O TOBY J.TAHJA-SYRET ,�
LICEN JSED DESIGNER -Record Drawing on behalf of Mason County Public
EXPIRES: 06/07/2
Healtf r.`itI
Sig ture E 4nvironmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018