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HomeMy WebLinkAboutSWG2017-00124 - SWG As-Built - 2/6/2024 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 fhtez,.j '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 YY0 I FIREWEED Designer Name TOBY TAHJA SYRETT ___ INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only [' Repair ❑ Other System Type PUMP TO GRAVITY Pretreatment Type >5 ft. from foundation? - - ❑ N/A • YES ❑ NO >50 ft. from wells? - - ❑ NI ❑ Z >50 ft. from surface water? - - ❑ 0 El HCleanout between building and tank? - - ❑ • ❑ V Tank baffles present? - - ❑ ❑■ ❑ d24"access risers over each compartment?- - El El El W Effluent filter installed?- - ❑ 0 ❑ Septic tank capacity (working) 1200 gal Manufacturer HAGERMAN D-box water level and speed levelers used? - - ❑ N/A ❑■ YES ❑ NO J ><O Manifold/D-box accessible from surface?- - ❑ 0 El LL o0Z Check valves installed? - - ❑ ® ❑ OQ E Transport Line Size 2" Schedule/Class SCHEDULE 40 Bedrooms installed (check one) D2 ❑3 114 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO o >100 ft. from wells?- - ❑ © ❑ W >100 ft. from surface water? - - El ® ❑ u. >10 ft. from potable water lines?- - ❑ ❑� ❑ Z >5 ft. from property lines and easements?- - ❑ NI 0 c > 30 ft. from downgradient curtain/foundation drains? - - II ❑ ❑ Drainfield level and observation ports present - - ❑ IN ❑ ❑ Graveless chambers or II Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1200 gal Manufacturer HAGERMAN < 24" access riser(s)and accessible from surface?- - ❑ In ❑ a. Alarm or Control Panel Installed? - - ❑ 0 ❑ E Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ M a_ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other \\,"1. J a- Pump Make/Model 69 e("'C.0 P ID Us _ ® Floats or ❑ Transducer • Tank draw down in/min Pump capacity_ _gpm Squirt Height ft d Pump on time _ Pump off time Daily flow set at 360 gpd Updated 8/21/2018 Gir..1 ->°rVi a Mason County OSS Installation Report pg. 2 Parcel # ABANDONMENT RECORD . Were existing septic components abandoned as part of this project? - - YES s 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 draintield,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. ® Record Drawing Attached 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 I further certify that all information contained on this I further certify that all information contained on this form and attached Drawing is accurate. form and attached Record Drawing is accurate. Sign re of Installer Date t s le r11 "7 '�►�=" �y te Print Name of Signee I � 'o • ' i�l � • z r'1 MASON COUNTY PUBLIC HEALTH �. 5100299 The undersigned approves this Installation Report and 104 TOBY J.TAHJA-SYRETT '17, 1+ LICENSED DESIGNER Record Drawing on behalf of Mason County Public Health: EXPIRES: 06/07/2 9 ‘1?1 cq6 ( r Signature of Environmenta 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' fF1A 1 1 X 1r.' "•"• :.1. -.4 '749'4 v:'1• X X ' FAI: -,t A.;..-1., Ire .r... \\\ jel:11.. A.V. , r' .,,•t.r 7 t-_.•“,...- ,. X 1 1 1 .4z, ,. AA.. X \ kfC.w x ,,%•= * ''''''. ,t %.% 1:1 4... :r r.• h. • •- X \\\ \\\ VC \ 1 \ \ • . \-:: , w..., \ s V 4 , l - , . . -ii,liff \ X 1.f...:, X ‘si:%•;.** • L X - \ X \ 1 PRIMARY •-, :, ...k..- \ -,sv, % A p ,.A, 50' % • n_% GRAVEL TRENCHES ; '-,A -1_ , , : A.., , , 1‘.- -,. ,.....kr,, \ \ \ -1,I's .1h). \\ ‘ • \ -It% \ 3,. ‘ \ •?..-ir, ._ -• ei•i' \ -.A ' X 1..; :' X 't•, -., \ \ \ \ ' v., \ ,.•... , %,,, , -:.4 1 \ 'L.: 1\::,, 4"PERF PIPE \ ,.t.'. ,•- s.., ,,P,;., ‘ ., 1._ . \\ \\\. k 'ff:-:. -.' \ .• \ 1111 . -Inov-r---0 D-BOX "4"FEEDER LINES sr-41 ri--. ta , ••- . • -, r ,,..s.kTH MAY 2 4 2017 2"TRANSPORT LINE CHANGE TO 4" 10'OUT FROM D-BOX 1\A,- . DRAINFIELD LAYOUT DETAIL: ..._ !.., , FOR: BATEMAN JOB#: ,.. . .... _ _ - - 3>-- - PARCEL#: 32026-75-00100 DATE: 05 MAY 2017 BY: TJS DESIGN PAGE KO OF (Z_ _ _ NORTH ARROW: SCALE: 1"= 10' C) B-LINE CONSTRUCTION, INC. 0 ot 10' 20' Z (33 'D TI c • N 'i (7 .. m a► _ r D N 08 Qs3M5 m `� O N D o r• N Z 00 .�> O x o 73 ca O o Z m w R 9. O rr- n a G) f?t • . - o m o Z r 2 < m D 0 c mD DmC/) ?m — —'�r- mc) 0 rC M /I p O 111 LON". lic,\Isli/tirli . i ` • D� � -I, i0 II 0 � Z i • 2.c. O O z t- I ; 1 o I O / o o _� omr / - � ,, ��} ' i / FDA ` { i p rri0 + n n Dco C O cn mZ � , ..�� � ', "\ ,-- 0z i -...-- - - m T m c 0 0 0 '` m Sp . ..___._..-:' OW .D r X -o95 z u_ \--,---...... c mrm m n >ZN ° rT Z7o O v` lzCA " :;: c O :ry- a vO Z `o "i�, 1.\ " O / • x 1111/ Operation & Maintenance Reporter This service is for a El Residential ❑ Motel ❑ Mobile Home Park Space# residential property ❑ Community Drainfield ❑Youth Camp ❑ Food Service Restaurant sale? yes no ❑ RV Park ❑ Campground ❑Vacant Lot ❑ Other, Please Describe: Property Owner HENRY BATEMAN Phone#425-418-5921 Mailing Address 980 SE FIREWEED RD City/State/Zip Shelton, WA 98584 Site Address SAME City: Shelton. Tax Parcel# 32026-75-00100 Components Inspected ❑ Yes ❑ No ❑ N/A Grease Trap ❑ Yes ❑ No ❑ N/A Septic Tank ❑ Yes ❑ No ❑ N/A Pump Tank ® Yes ❑No ❑ N/A Pump ❑ Yes ❑ No ® N/A Control Panel ❑ Yes ❑ No ® N/A Pretreatment Unit ❑ Sandfilter ❑ Gravel Filter ❑ Textile Filter ❑ ATU: Choose ❑ Yes ❑ No ❑ N/A Disinfection Unit: Choose ❑ Yes ❑ No ❑ N/A Drainfield: : Gravity Comments and Recommendations: PUMP TO GRAVITY Inspection Results: d{ Satisfactory [ Unsatisfactory Date of Service: October/10/Choose year Operation & Maintenance Specialist Signature: Findings and determinations of this inspection reflect conditions as they existed on the day the septic system was serviced. No claim is made by this cYompany, either expressed or implied, concerning success or failure of the septic system. —B-LINE— (360)426-4221 2971 E Phillips Lk Loop Rd , Shelton. WA 98584