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HomeMy WebLinkAboutSWG2024-00121 - SWG As-Built - 9/10/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00121 Parcel# 12330-52-00082 Applicant Name EASTMAN C/O B-LINE CONST. _ Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILLIPS LAKE LOOP RD City, State, Zip SHELTON,WA 98584 Installer Name B-LINE CONST. Site Address 31 NE LARSON LAKE LANE Designer Name TOBY TAHJASYRETT INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑Dminfiele Only ❑Repair ❑Other System Type SAND LINED PRESSURE Pretreatment Type WA >5 ft.from foundation? ----------------------- ---- ❑ NIA ®YES NO >50ft.from wells? ----------------------------.. ❑ ❑ 2 >50 ft.from surface water? - ❑ El FCleanout between building and tank? ------------------- ❑ 0 ❑ U Tank baffles present? - --- --- - -------------------- ❑ ❑ 1 24"access risers over each compartment?---------------- ❑ ❑ LU y Effluent filter installed?--------- -----------------.- ❑ ® ❑ Septic tank capacity(working) 1200 gal Manufacturer SOUND PLACEMNT �O D-box water level and speed levelers used? -------------- - ® N/A ❑YES ❑ NO O0 Manifold/D-box accessible from surface?---------------- . ❑ . ❑ GQCheck valves installed? ---------- ------------ ----- E] ® ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?--------------------------. E] NIA EYES NO >100R from wells?----------------------------. ❑ ❑ W >100 ft.from surface water?----------------------- - ❑ . ❑ M >10ft.from potable water lines?--------------------- - ❑ ■ ❑W o aZ >5ft.from property lines and easements?--------------- - ❑ E ❑j R' >30 It.from downgradient curtain/foundation drains?---------- ❑ ❑ Drainfield level and observation ports present - --- --------- i I�1 tl`� ❑ Graveless chambers or 0 Clean gravel used? (check one) i b Proper cover installed over dreinfield?-- -- - - -- ------ --- -- ❑ Q Pump tank setbacks consistent with septic tank?------------- ❑ Nip'! -10yES � NO Z Pump tank capacity(flood) 1475 at Manufacturer "SOUND PLACEMENT FQ 24"access risers)and accessible from surface?------------- ❑ , N El d Alarm or Control Panel installed? - --- --- ------------- - ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter-- -- - -- -- -- ❑ Q ❑ a Pump installed in ❑ Bucket or [I On Block or S Other PUMP VAULT a Pump Make/Model LIBERTY 280 Floats or OL ❑ Transducer a Tank draw down intmin Pump capacity Opm Squirt Height ft pPump on time Pump off lime 1- Daily`flow set at gpd 1 u vr•e Seg w4S bd r,1` ]me Le eC + ^C. O LOar1 P lfw -YG Nwea n+awa Mason County OSS Installation Report pg. 2 Parcel If 12330-52-00082 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ------------- 0 YES ❑ NO If yes, please describe: En51.via 1-4- Were all components pumped out and property abandoned per WAC246-272A-0300? -------- E YES ❑ NO RECORD DRAWING This Is a ya,m amen maximal and must be wasmale and desc,lptna anaugn an rabr Y In Ma rand at melMenarlre aNNuea and N4,re aewlopmenL rydrel newN D,ammcs c adlmn'. paiMiea 8 menlbN mddaMn 8larouc SaNiapanV lank bea5m.NaN ammr.reserve erelnfiela uniaEn9 an]gnPoaeo Wdfi Aga,bratim of welk,rakeinas, wBN.MBa1Ve11M ports,tleam�,aW oMer meinlenanm a-ma Ink. YlWmpbb Rand Gewings may vaaleaMltlonelede}2 N MN WIeYAon argmvela,M relemtl permits, YwSe Abe ✓ 5•}C 16sn Cor+wrn.iy wA� �� oo Clwka.4 ry � s O (aIYY lacni:.rk APPROVED 11111" 1V L h me PASONCOUNEPR10ti0241ALh'EALiH 4 O.�• bl car, ❑ 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 cleamdrapproved 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 Record Drawing is accurate. form and attached Record Drawing is accurate. `6-S-ZY Sig Lure oll-nstalle�r Date `�MC 1 ewu Printed Name of Sgneal MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health:SI ,� � LLe`nnrl, /-kv Signature of Envimnmenl Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmme srzvmtd