HomeMy WebLinkAboutSWG2022-00427 - SWG As-Built - 9/27/2023Fla Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00427 Parcel # 22032-50-90921cl
Applicant Name B-LINE CONST Subdivision (Name/Div/Block/LoApplicant Address 2971 E PHILLIPS LK LP RD
City, State, Zip SHELTON, WA, 98584 Installer Name B-LINE CONST
ISite Address 50 SE JOHNS RD Designer Name TOBY TAHJA-SYRETT
INSTALLATION CHECKLIST
o 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? - [E- r` •-tt Z'- { I. ❑
• >50 ft.from surface water? - ® ❑
Cleanout between building and tank? - ,�I _ �UJ� u 8 z023 - ❑ ❑
U Tank baffles present? - ?- - - - ❑■ ❑
d24" access risers over each compartment?- - - By-- - - 0 CI
W Effluent filter installed?- - ❑ IN ❑
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Septic tank capacity (working) 1500 gal Manufacturer SOUND PLACEMENT
D-box water level and speed levelers used? - - ® N/A El YES ❑ NO
oO Manifold/D-box accessible from surface?- - CIII ❑
032 Check valves installed? - - ❑ ® ❑
6Q
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
>100 ft. from wells?- - ❑ ® ❑
o
W >100 ft. from surface water? - - ❑ In El
ti >10 ft. from potable water lines?- - ❑ 0 ❑
> 5 ft.from property lines and easements?- - CI 0 CId > 30 ft.from downgradient curtain/foundation drains? - - ❑ 0 ❑
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Drainfield level and observation ports present - - ❑ 0 Cl
❑ Graveless chambers or jr Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ MI ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
• Pump tank capacity(flood) 1585 gal Manufacturer SOUND PLACEMENT
< 24"access riser(s)and accessible from surface?- - ❑ IS ❑
H
a Alarm or Control Panel Installed? - - ® CI CI
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 El
n
EL Pump installed in ❑ Bucket or El On Block or NE Other PUMP VAULT
C'• Pump Make/Model LIBERTY 280 ® Floats or ❑ Transducer
0.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Uodaled 8/21/2018
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Mason County OSS Installation Report pg. 2 Parcel 1 2.O 3 2 - So - 1 6 I 2l
ABANDONMENT RECORD1
Were existing septic components abandoned as part of this project? - - ❑ YES ® NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO 1
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
1
INSTALLER DESIGNER/ ENGINEER
/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 l 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 ecord Drawing is accurate. form and attached Record Drawing is accurate.
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Printe&Name of Signee IC) ,f
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MASON COUNTY PUBLIC HEALTH �` / so)...
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The undersigned approves this Installation Report and O TOBY).TAHJA_SYREi i y
Record Drawing on behalf of Mason County Public LICENSED DESIGNER
EXPIRES: 06/07/2/..(
Health: I
07
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D g Signature of Environmental Health Specialist Date (stamp, signature and date)
'si THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
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