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HomeMy WebLinkAboutSWG2023-00432 - SWG As-Built - 11/21/2023 Mason County OSS Installation Report pg. 1 4 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00432 Parcel# 31904-57-00025 Applicant Name GAGE C/O 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 CONSTRUCTION Site Address 60 SE MT ELLINORE CT Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Drainfield Only ■ Repair ❑Other System Type GRAVITY Pretreatment Type N/A >5 ft. from foundation? - - ❑ NIA .YES ❑ NO >50 ft. from wells? - .- ❑ I. ❑ Z >50 ft.from surface water? - ❑ ® ❑ FCleanout between building and tank? -. ❑ Il ❑ U Tank baffles present? - 0 a ❑ H 24"access risers over each compartment?- - ❑ ® ❑ W Effluent filter installed?- - ❑ IN 0 CO Septic tank capacity (working) 1200 gal Manufacturer EXISTING O D-box water level and speed levelers used? - - ❑ N/A • YES ❑ NO DO Manifold/D-box accessible from surface?- - ❑ II ❑ u. m Z Check valves installed? - - ® ❑ ❑ CIQ 4" Schedule/Class 3034 f Transport Line Size Bedrooms installed (check one) 0 2 © 3 04 ❑ 5 06 ❑Commercial/Other >10 ft.from foundation? - - ❑ N/A . YES 0 NO O >100 ft.from wells? - ' ❑ II W >100 ft.from surface water? - -- ❑ In a >10 ft. from potable water lines?- -- ❑ e 0 Z > 5 ft. from property lines and easements?- t ❑ e CIa El PI ❑ K > 30 ft.from downgradient curtain/foundation drains? - - Drainfield level and observation ports present - - 0 CI ❑ ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- -- ❑ IN 0 Pump tank setbacks consistent with septic tank? - ❑ N/A ❑ YES 0 NO • Pump tank capacity (flood) gal Manufacturer Q24" access riser(s)and accessible from surface?- - ❑ 0 0 ~1 Alarm or Control Panel Installed? - - ❑ El 2 Control Panel equipped with Timer/ETM /Counter- - 0 CI ❑ R Pump installed in ❑ Bucket or ❑ On Block or ❑ Other f Pump Make/Model ❑ Floats or ❑ Transducer 0. a Tank draw down in/min Pump capacity qpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd ..pawed 821 V019 Mason County OSS Installation Report pg. 2 Parcel# 3I 10 ci — 5-7- boo Z S ABANDONMENT RECORD . 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 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 8 manifold onentaton&layout,Sephtlpump lank location,North arrow.reserve drainfield,existing and proposed buildings,location of wells.waterlines, v.ells,observation ports,cieenctts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation appmvl.l and related permits. I• 0 Im<k \ Sat Et:515l2po,5.1 S.T u So a O F A\rivyJ6i p / a / — ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 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 1 further certify that all information contained on this I further certify that all information contained on this -formform and �attached�Recor Drawing is accurate. form and attached Record Drawing is accurate. Signature of Install? Date 1 e at \ 'e ' Y Printedd Name of Signgnete t W\ MASON COUNTY PUBLIC HEALTH $� slco>sp The undersigned approves this Installation Report and q TOBYj.TAa A-5YfEfl _ LICENSED DESIGNER �rti Record Drawing on behalf of Mason County Public b( Health: EXPIRES! 06/07/2 R-1-1131- 1 n R u 12-3 Signature of Environmental Health Specialist Date (stamp, signature and date) Updated Nnao+a -HIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE © )\V I i / lk r- II2 v �aA� / it lit m g9 .11er au •r \\, .. } het 9 `\\%%% / p N . -- p / c x o z 3 v O i z m JDi x z D F J D o m m n W fli�X x V m II z- zII =CarP o o J m m 0 v- no Do xn i • O m D 0 m O 2 ti ' 0 0 O 1 • � O • X I m O D D CO2m A co m C 73 co OC I V0a,b N oaa o I 0 0 � • © oho m N m m z -j D m, m v D m m m II m 1P {P fO FI[ ' II O � � 1 1 RIi V� F. n� �w . IV NOV 21 2023 IVIII �I^ I p . ntT J