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HomeMy WebLinkAboutSWG2023-00328 - SWG As-Built - 2/2/2013 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00328 Parcel # 32234-34-00030 Applicant Name HAGGERTY 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 CONST Site Address 8090 E ST ROUTE 106 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? - - ❑ N/A ❑YES ❑ NO >50 ft. from wells? - - ❑ ❑ ❑ Z >50 ft. from surface water? - - ❑ ❑ ❑ • Cleanout between building and tank? - - - - - - V`_S -\n - - ❑ ❑ ❑ o Tank baffles present? - - ❑ ❑ ❑ a24"access risers over each compartment?- - - - �(- - ❑ ❑ ❑ W Effluent filter installed?- - ❑ ❑ ❑ U) Septic tank capacity (working) 1 060 gal Manufacturer EXISTING INFILTRATOR TANK 0 D-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO J DO Manifold/D-box accessible from surface?- - ❑ MI ❑ cot Check valves installed? - - ❑ ® ❑ Oa E Transport Line Size 1 1/4" Schedule/Class 40 Bedrooms installed (check one) ❑■ 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - ffil4MM (�- N/A YES ❑ NO O >100 ft. from wells? - -1J-IS El ❑ -u >100 ft. from surface water? © ❑ W 1 ?024 - Ii >10 ft. from potable water lines?- 0- -- 0 ❑ z > 5 ft. from property lines and easements?- - - - - - ME ❑ ce > 30 ft. from downgradient curtain/foundation dr ing _- ___- - - - 0 ❑ O Drainfield level and observation ports present - - ❑ PI ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ N ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 120 I u6ct er B-LINE CONST. < . -24" access riser(s) and accessible fro ce ❑ ® ❑ , I- Alarm or Control Panel Installed? - --��� ❑ U ❑ E Control Panel equipped with Timer/ M/� ouUnter- - - - -L - - it ❑ ❑ IR O. Pump installed in ❑ Bucket or ❑ On Block JAr■-� 4eifALT,-; PUMP BASIN w n'• Pump Make/Model ORENCO P1005 ® Floats or ❑ Transducer a. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd 77 p‘.Kw\t \ 04\ A.ew L.,,n L t 3�A‘i,\-le b. Updated 6/21/2018 t Mason County OSS Installation Report pg. 2 Parcel# 3 Z Z 3 9 - 3 L -00 c o 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&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. .. 4bsdda a 4 TA A ik\1 O< es<-s �p 0 0 0 o 0 O �� r 11 F I 1V60 S', �� �'1(l.�.SL �" 7 �. l-a (.,eSCcv�/ Co.,,,Q.k. ‘..r/ Li il\SC- bA'...\ I 7V \ID� S �t ,tom _ 6 64. tee.Ire t o 0 L f—J j J loot �t well pk /a14./n sil ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER! ENGINEER 1 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 1 further certify that all information contained on this form and attached Record Dr ing is accurate. form and attached Record Drawing is accurate. Sign ure of Installer / Date f, 4,i Printed Name of Signee" I ivo• ..,P "Oo'c°A 'I MASON COUNTY PUBLIC, HEALTH �. J Ns100 99 •�'�i The undersigned approves this Installation Report and ro TOBYJ.TAH)A:SYRETr _4 i LICENSED DESIGNER Record Drawing on behalf of Mason County Public .............. ..� 111101110116,, Health: EXPIRES: 06/07/2 ..e" P p Si nvi g �Fatii�p, g and date) THIS FORM MAY BE SCANNED AND AVAILABLE F LIC VIEWOi4 it16 ON 4UNTy WEB SITE Updated 8/21/2018 Aso; couNTr Ery v,R L I _ OMb1ENT/IL HEALTh natu f onmental Health Specialist Date JEAN • . ' 1 .......\,.. .._.... .__ �L HOOD CANAL CO 1 \ /'1Qc7k 1� W OHM - - - - - - - - s— O u_ CO 60' ROAD 0 II EASEMENT r-- = CO '�f I J 0 O N _ 1 < HWY 106 O0 J 0 o PARKING/ ' co 0 / O ItW 0 m I— us O 0 b o Z 0 _ EXISTING INFILTRATOR - IM1060 SEPTIC TANK < o RETROFIT WITH -�* U a o EFFLUENT FILTER OUT H 9 O COMMUNITY CT) co NEW 24 x 60"LIQUID PUMP BASIN WATER SYSTEM WELL IS GREATER W N THAN 200'AWAY < J < U = W THERE ARE NO WELLS _,� EXISTING 1BDRM CABIN d L. (V I- ON ADJACENT LOTS WITHIN 100' W O LL d CO O i2"TRANSPORT LINE aft- PROPOSED PRIMARY SOIL LOGS: 2 BEDROOM DRAINFIELD PUMP-TO-GRAVITY A 0-72"+VGLS _ _ 1 SOIL LOGS k A 0-72"+GLS Q 1 W Q = = = °I 0 au,'� J O (Y.')D BOX - �_�_ Z W , Q I I Q j I ' CU) U 17'x40'I Z RESERVE AREA.,:ra 4.:•.':"; i If I/ T 7e1.-0..(C.is.ti-"e:.r. . ..„v.-eN..c"6.."1.,.-.,.-.11 4.4.:-:I t-,",v '_7__ _-4_, „iPp'i't:o4„.nR,."1%4i A i i, '4.-::'‘,—::1i::t i..t.'9,i,,...tt. . ff y y sio R, ,o,I. •v,y CULNTYEtirVlRO Z r 1 JA sYrrr ,'I I1 ;�1E;NTgL FlFALr, OU i CENSED DESIGNER I — w �____•._____.�.________•w. Z EXPIRES: 06/07/Z c/ ovE _I 11 (n 27' "ASON coUFEB 2 0 2UZy v o NTY rorH� Jew HEALTH