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HomeMy WebLinkAboutSWG2019-00398 - SWG As-Built - 11/20/2023 • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION ; Permit Number SING 2019-00398 Parcel# 32207-50-00923 Applicant Name BLOEDEL C/O B-LINE CONST. Subdivision (Name/Div/Block/Lot) t Applicant Address 2971 E PHILLIPS LK LP RD City, State, Zip SHELTON, WA, 98584 Installer Name B-LINE CONST. . Site Address 20613 NE NORTHSHORE RD Designer Name ENVIROTECH ENGINEERING • INSTALLATION CHECKLIST IN Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type PRESSURE 'Type NuWATER/BNR 500 >5 ft.from foundation? - ❑ N/A •YES ❑ NO >50 ft.from wells? ❑ © ❑ ZIN>50 ft. from surface water? _ - - ❑ ❑ 1.— Cleanout between building and tank? - ❑ ❑ U Tank baffles present? - ❑ ❑ C24"access risers over each compartment? ❑ a ❑ LU Effluent filter installed? ❑ ® ❑ CO Septic tank capacity(working) 1094 gal Manufacturer INFILTRATOR o D-box water level and speed levelers used? - XJ - N/A ® VES ❑ NO I au. Manifold/D-box accessible from surface? ❑ MI OQ Check valves installed? ❑ ® O 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 0 3 ❑q ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO O >100 ft. from wells?- ❑ ® ❑ Set Gfo,rOeG —I >100 ft. from surface water? ❑ ❑ II W il Z >10 ft. from patabie water lines? ❑ ® O Q > 5 ft. from property lines and easements?- - ❑ ® ❑ oe > 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? - - ❑ WA © YES ❑ NO Y Pump tank capacity(flood) 1287 gal Manufacturer INFILTRATOR Z F24"access riser(s)and accessible from surface?- - 0 a y Alarm or Control Panel Installed? - ® ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter- 0 0 ❑ FFtl 11 Pump installed in ❑ Bucket or ❑ On Block or MI Other PUMP VAULT Pump Make/Model LIBERTY 253 ® Floats or ❑ Transducer 0_ Tank draw down in/min Pumpcapacity o- ca P Y gpm Squirt Height ft i Pump on time Pump off time Daily flow set at qpd Or Pyr.,Q Se kS,-=ny.i a..L beveS GAP*-kE t dJh4 w:1\ ceT0ti4,4 € it..., et vpaaiea erzvmie .A`A ,..0.‘it4,, ccr,sE<vtikoil Mason County OSS Installation Report pg. 2 Parcel# 3Z107- SO - 00g23 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 WAG246-272A-0300? DYES 0 NO RECORD DRAWING This is a permanent record and musk be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record ' Drawings contain Drainfield 8 manifold onenraton&layout.5apficfpump tank location.North arrow.reserve drainfieltl,exisfing and proposed braidings.location of wells,waterlines wells,observation ports,cleanwte.and other maintenance access points, Incomplete Record Drawings may create additional delays In final Installation approval and related permits. 1 S' ea.,wark _ ii111111d II .(� D. F of l (JfDx 1u',,'i^y C7� (, 1060 Sref.;L. oo u<e- 37.S\ to or. ,a I.1,A.1oki pwZ I Letr)Af( c)w.pTAk �✓f o r q(`eSecJ O OL� ena d C / / ,/ / / 0- 0 0 e...h tql— r 75 Ofiw W\ ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with I certify that the system has been installed in accor i. the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by ICounty 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 ached d Drawing is accurate. form and attached Record Drawing is accurate. I I l U Z� Z3 Sigtrure of Installe Date f J"a` to faytor Tomex O i Printed Name of Signee 0 MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 10/21/23 Health: \g OCalt 11<2-C /1 Signature of Envimlmental Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updaled9121/2o1e 0 0 o 0 `I Na W If A N Vi o 3 NORTN SHORE ROP➢Cr pN3 m > o o to I alEe /, a Ltzn oYnW Q Ll cn m3a, W �� W on_Wr ZrcA4w nab -, r 3 DO CC�� £wamm I I I cl w - 09 - Y la V. N ` Y p „�d3 p 5t Q\�o §1a W ox £ ,n r W N I\ K I Z W C I Qce A £ IA oI rcQ� Lid/1,, j`. 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