HomeMy WebLinkAboutSWG2024-00245 - SWG As-Built - 9/19/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-00245 Parcel# 22112-77-90031
Applicant Name B-LINE CONST. Subdivision (Name/Div/Block/Lot)
Applicant Address 2971 E PHILLLIPS LAKE LOOP
City, State, Zip SHELTON WA 98584 Installer Name B-LINE CONST, aA
Site Address 940 DAWN DR Designer Name CINDV WAITE N�bll
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑Repair ❑Other
System Type PRESSURE Pretreatment Type
>5 ft.from foundation? ---------- ------- ---------- ❑ N/A ®YES E] NO
>50ft.from wells? - ----- ---------------------- .. ❑ ❑
14 >50ft.from surface water? - --- -- ---------- --- --- -. ❑ ❑
FCleanout between building andtank? ------------------- ❑ ® ❑
V Tank baffles present? -- ---- ----- ------- ❑ � ❑
Fa 24"accessrisersovereachcompartment?---- - - --------- - ❑ M ❑
yEffluent filter installed?.------ -- - - ------- - - ------ - ❑ ❑
Septic tank capacity(working) 1200 gal Manufacturer SOUND PLACEMENT
OJ D-0ox water level and speed levelers used? - ----- - - - -- --- - M NIA ❑YES El No
0O Manifold/D-box accessible from surface?- - - - --- --- ❑ M ❑
CQCheck valves installed? --- ❑ ■ ❑
2 Transport Line Size 2' Schedule/Class SCH 40
Bedrooms installed (check one) ❑ 2 M 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?---- -- --- -------- -- ------- ❑ N/A MYES NO
>10011.fromwells?- - - - ------------------------- ❑ ® ❑
W >10011.from surfacewater?-- -------- ------------- - ❑ M ❑
MQ >1Dft.from potable water lines? ------- - ❑ M ❑
K >5ft.from property lines and easements?- --- -- -- --- ----- ❑ M ❑
>30 ft.from downgradient curtainRoundation drains?-- -- ---- -- ❑ M ❑
Drainfield level and observation ports present -- - -- ❑ M ❑
❑ Graveless chambers or E Clean gravel used? (check one)
Proper cover installed over drainfield?- ---- --- -- - ---- ---- ❑ M ❑
Pump tank setbacks consistent with septic tank?------------ - ❑ r9A M YES ❑ NO
Z Pump tank capacity(flood) 1475 at Manufacturer SOUND PLACEMENT
Q 24"accessriser(s)and accessible from surface?--------- ---- ❑ M ❑
aAlarm or Control Panel installed? ----- ------------ - -- - ❑ E ❑
jControl Panel equipped with timerIETM/Counter----- -- --- - ❑ M ❑
a Pump installed in ❑ Bucket or ❑ On Block or E Other PUMP VAULT
IL Pump Make/Model LIBERTY 280
2 M Floats or ❑Transducer
a Tank draw down 1.66 in/min Pump capacity 41.5 pm Squirt Height 4.2 ft
Pump on time 48 SEC Pump off time 3 HRS Daily flow set at 270 apd
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Mason County OSS Installation Report pg. 2 Parcel 0 22112-77-90031
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? --- - - - -- 0 YES NO
If yes, please describe:*0 2. -64K
Were all components pumped out and properly abandoned per WAC245-272A-0300? --- - - - -- 10 YES ❑ NO
RECORD DRAWING
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❑ Record Drawing Attached
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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 cleamolapproved 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 alliFfAid Rec g is accurate. form and attached Record Ofiving is accurate.
9'-lo-Zy
Sig�ure of Installer Date
Printed Name of Signae
y
MASON COUNTY PUBLIC HEALTH -� y E WAITE ;
The undersigned approves this Installation Report and LICENSED DFsicNER
Record Drawing on behalf of Mason County Public Ex„l„Ls ls„N
Health:
Signature of Environmental Health Specialist Date (stamp,signature and data)
THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITEa�Avveote
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