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HomeMy WebLinkAboutSWG2017-00124 - SWG As-Built - 11/3/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2017-00124 Parcel # 32026-75-00100 Applicant Name knlap '0 B-LINE CONST Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILLIPS LKE LOOP City, State, Zip SHELTON, WA. 98584 Installer Name B-LINE CONSTRUCTION Site Address 1(PU I -FIREWEED Designer Name TOBY TAHJA SYRETT INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only El Drainfield Only ❑ Repair ❑ Other System Type PUMP TO GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - .- ❑ NI ❑ Z >50 ft. from surface water? - - CI Cl ❑ rCleanout between building and tank? - - ❑ II ❑ U Tank baffles present? - - ❑ © ❑ d24"access risers over each compartment?- - CI IN ❑ Cl)W Effluent filter installed?- .- CIIS ❑ Septic tank capacity (working) 1200 gal Manufacturer HAGERMAN �O D-box water level and speed levelers used? - - Li N/A Li YES El NO �O Manifold/D-box accessible from surface?- - Cl 0 ❑ mZ Check valves installed? - Cl III ❑ OQ 2 Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) D. 2 ❑ 3 24 ❑ 5 El 6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO C >100 ft.from wells?- - ❑ a ❑ W >100 ft. from surface water? - - ❑ CI ❑ Et: >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- ❑ • ❑ a - Q > 30 ft.from downgradient curtain/foundation drains? - - ® ❑ ❑ Drainfield level and observation ports present - - ❑ • ❑ El Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A I YES ❑ NO Z Pump tank capacity (flood) 1200 gal Manufacturer HAGERMAN Q 24" access riser(s) and accessible from surface?- - ❑ In ❑ aAlarm or Control Panel Installed? - - ❑ U CI .Control Panel equipped with Timer/ETM/Counter- ❑ NI CI- Pump installed in ❑ Bucket or ❑ On Block or Li Other a. a. Pump Make/Model 0 2 r'w 'P I-a U Us- 0 Floats or ❑ Transducer Tank draw down in/min Pumpcapacity _gpm Squirt Height ft d P ry--- ui q 9 Pump on time — Pump off time Daily flow set at 360 gpd p Updated 8 212018 Oh - / er77 C11446 3 Mason County OSS Installation Report pg. 2 Parcel# 3 2 cD Z‘ - 75-o b )6 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - YES III 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. III 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 I further certify that all information contained on this i further certify that all information contained on this form and attac ed Record is accurate. form and attached Record Drawing is accurate. 0941 Sign ture of installer Date Printed Name of Signee / i •.014475 MASON COUNTY PUBLIC HEALTH 100299 +i14 The undersigned approves this Installation Report and r�o TOBY).TAHJA_SYRE T � Record Drawing on behalf of Mason County Public AY LICENSED DESIGNER Health: II EXPIRES: 06/07/Z�.f Signature of 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 8/21/2018 CLEANOUT/OBS PORTS 12' 3'\\‘'ik"---- 5-','N,-). \ciN\ , \ :r \\ "' \1Y \\ � \\ RESERVE TRENCHES •'T'. \ \ dy \ 1 \ v3` f`'i \ k'1' T.. \ Y 9 rt \ i. \':\z's -7\ ''..k''' 1 \ '`y' \ ` \ ^`:i1�'; \\\ A. \ ,1-,i. PRIMARY \\ `''1 \\ , i` 50' \\ � \\ GRAVEL TRENCHES : \ \ `� \ \ \ v\ \ i'L \ a \ • _- \ s 1 ty \ 3 \ r' \ 4"PERF PIPE ' •,� \ "`° \ \ \-•:y ` `:11'£ ) D-BOX 4"FEEDER LINES -- s ;f, y~.It ` MAY 2 4 2017 L \h u -'i'' 2"TRANSPORT LINE CHANGE TO 4"10'OUT FROM D-BOX • ' .5t4Aj (1--- i)A.A '-.':-{ DRAINFIELD LAYOUT DETAIL: .-••T` _' �, FOR: BATEMAN JOB#: = �: PARCEL#: 32026-75-00100 DATE: 05 MAY 2017 y`I 6 BY: TJS DESIGN PAGE I CV OF 1 . NORTH ARROW: SCALE: 1" = 10' l © B LINE CON STRUCTION,NSTRUCTION, INC. 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