Loading...
HomeMy WebLinkAboutSWG2019-00319 - SWG As-Built - 9/25/2023 err 9 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2019-00319 Parcel # 12229-44-00020 Applicant Name WILLIAMS 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 151 E NELSON RD Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair El Other System Type PRESSURE Pretreatment Type N/A >5 ft. from foundation? - - ❑ N/A •© YES ❑ NO >50 ft. from wells? - - - -T i El It ❑ Z ❑■>50 ft. from surface water? - - " { ❑ ❑ cil 1� Cleanout between building and tank? - - - -s ���e�- MICI ❑ U Tank baffles present? - ' � -1 ❑ ❑■ ❑ a24"access risers over each compartment?- ❑ II ill Effluent filter installed?- By - ❑ ❑■ ❑ N ISeptic tank capacity (working) 1 500 gal Manufacturer SOUND PLACEMENT �0 D-box water level and speed levelers used? - - • N/A ❑ YES ❑ NO �O Manifold/D-box accessible from surface?- - ❑ IN 00 Z Check valves installed? - - El II ❑ 6Q 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 ❑■ 4 ❑ 5 ❑6 El Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO >100 ft. from wells?- - El © El W >100 ft. from surface water? - - ElMI ❑ u. >10 ft. from potable water lines?- - El El ❑ Z > 5 ft.from property lines and easements?- - El ® El Q ix > 30 ft. from downgradient curtain/foundation drains? - - El 0 ❑ Drainfield level and observation ports present - - El Al El ❑ Graveless chambers or NI Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El El Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES El No • Pump tank capacity (flood) 1585 gal Manufacturer SOUND PLACEMENT Q24" access riser(s)and accessible from surface?- - ❑ II El ~ Alarm or Control Panel Installed? - - MI ❑ El a 2 Control Panel equipped with Timer/ ETM /Counter- - El II El m a. Pump installed in ❑ Bucket or ❑ On Block or In Other PUMP VAULT a'• Pump Make/Model LIBERTY FL61 II Floats or ❑ Transducer a. a Tank draw down 1.58 in/min Pump capacity 46 gpm Squirt Height 4 ft Pump on time Iw 1 min Pump off time 1 �` D3 hr Daily flow set at 360 gpd %' Pd.�G\ a, ( , 0V,Sr ....:t\ �L l� T SG`le`4 @ �F'. ,....e1Ca 4,L Upca:ec 3'21:2C'3 C o '(UL1-:OV` 1 Mason County OSS Installation Report pg. 2 Parcel #112 2-1 --4 4•` bOv ZO 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 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. Q c 1..e.i' > C,...1.4 Sri) c: �� ISCX.) -�o �T..,epert-t.:..0 CI enAdj-S Iw,k- tvoNa &softJ f fr I \ / t A__ \ t t I 1 1\:_( III Qs:Je..�,.r , ElRecord 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 form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. _J 9-1S Z. ��' Si ature of Installer Date — • Printed Name of Signee ( i• 4',° l ,F 4 MASON COUNTY PUBLIC HEALTH dir'Mr sf 9 tr I The undersigned approves this Installation Report and Go TOBYI.TM-IA-SWOT _�" or LICENSED DESIGNER Record Drawing on behalf of Mason County Public ., ..9. ������.....� ���,, Health: EXPIRES: 06/07/Z/ CCM 1q, (ILI 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 4 A 1 00 �14.l -� r I -0'1t� z f ,' T,£L1. m ' �-- H mN r- m ,0�ra '� •• m A G 0 , aa,, . m l vW XGi 02 r AJ ____4...' E. 1 �I (n Z C rS _' `_ m O Z S m o , N cn m ae \� - ifir . o o G) m Z O C 2 K z T ♦ m p ♦ m x m m ••♦ z x 0-0 0 m `♦ m - zEl O -Z{ ♦♦ G� Z 0� Sm % v N mXIX \ m m -I 73 2n� p mZ • D 2 2 co > O � DOm o / xi pp° 70 77 m x 7 o I m 0 xi -a y �' rm- * n 2 �� ♦ 1 m 0 0n 7rb �G ✓ o I GARAGE o cn �` O 1 ' . • m2 • y i, l , _ - . \Om o o F�yO ,b / . �_1_, , Li] )61..: i In 1 5r� ` i + z m ` ` �� i Dm o 1,[, :' . /i N rri c cnmD 0o r N c W_ mX-0 o vcn -ov>73 u Ocom I `\ o u)co 0 • c Zn • m mS m m0 �K Ch 0 -im 0 • •