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Home My WebLink AboutSWG2024-00462 - SWG As-Built - 12/19/2024 • r OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH Mason County APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00462 Parcel# 31904-55-00123 Applicant Name B_LINE CONST. Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILI.IPS LK LP RD Installer Name &LINE CONST City, State, Zip SHELTON WA 98584 Site Address 50 BE CANNA PL Designer Name INSTALLATION CHECKLIST Grainfield Only ❑Repair ❑Othef— ❑ Full System Installation ®Tank($)Only ❑ pretreatment Type N/A System Type GRAVITY RR ❑ NIA ®YES ❑ NO >5 ft,from foundation? - - -- - -- - '� � II ❑ e Cl >50 ft from wells? - - -- - - - - - - - )IUtj ❑ ❑ Y. >50 ft. from surface water? - - - -- - - _ flEE"1 C ❑ ® ❑ F Cleanout between building and tank? -- - ❑ ® Cl rJ Tank baffles present? - - - - — - - - - By ❑ ® ❑ R 24" access risers over each compartmen . ® ❑ N Effluent filter installed?- - - - - - - - - - " -- ❑ SOUND PLACEMENT Septic tank capacity (working) 1200 oat Manufactu rer ❑ NO C D-box water level and speed levelers used? -- - - - - - - - - -- - " - ❑ NIA ves ❑ ? - - ❑ ❑ Cl 00 Manifold/D-box accessible from surface ❑ mZ Check valves installed? - - - - - - - -- - - pQ Schedule/Class f Transport Line Size_�� 3 ❑4 ❑ 5 ❑5 ❑CommerciallOther Bedrooms installed (check one) 02 ❑ _ ❑ YES ❑ No _ _ _ _ _ ❑ NIA >10 ft. from foundation? - - - - - - -- - - - ❑ Cl ❑ >t00 ft. from wells?- -- - -- - - - -- - - - � - " r ❑ ❑ ❑ J >t 00 ft. from surface water? - - -- - �" ' �r� ❑ ❑ W �- - - - - - _n__ ❑ a, >1oft. from potable water lines?- - - ❑ Z > 5 ft, from property lines and easements?- - - - - - - -- - - - - - ❑ ❑ > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - _ � ❑ ❑ Drainfield level and observation ports present - - - - - - - -- - - -" ❑ Graveless chambers or ❑ Clean gravel used? (check one) ❑ ❑ ❑ Proper cover installed over drainfield?-- - - -' - ❑ NIA ❑ YES ❑ NO Pump tank setbacks consistent with septic tank?-- - - - - - -- ---- ❑ ❑ Y. gal Manufacturer Pump tank capacity (Flood) ❑ Q24" access riser(s)and accessible from surface?- -_ ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - - - - - - - ❑ ❑ Control Panel equipped ❑ n' ed with Timer I ETM I Counter - - - - - - - - - - Z k or ❑ Other d Pump installed in ❑ Bucket or ❑ On Bloc ❑ Floats or CO] Transducer 0 Pump Make/Model m Squirt Height ft � Tank draw down in/min Pump capacity 9P a Daily Flow set at 9Pd Pump Off time u�uaemimre Pump on time Mason County OSS Installation Report pg. 2 Parcel# 31904-55-00123 ABANDONMENT RECORD _ _ _ _ ■ yam NO Were existing septic components abandoned as partt of this pro'ecl? - -- - - - -- - - - If yes, please describe: 0 h NO Were all components pumped out a roperly abandoned per WAC246-272A-0300? - - YES &WYe RECORD DRAWING pment auibin bcetim of walls,waterlines. Tplc Is a permanent recortl antl muse W accurete end tlaectlptive anouph to ra-loceb in ipe neeO of maintenance activities antl I-.W Eaeelo Typmal ecor Drawm9s wnlain: 02N(ield 8 m kw aienlHlutl ut S Ptdpump tank b icn,NOM arrow,reaxaY tlreiMlMd,enistln9 antl popmaE 9 d mimed pannila. wells,obaervarwn%rls,Geerwuts,antlo xr mrwnan[ ssc ss oinb. Inc ,W.Re MDr—rgs ma create addnronel deleyt In(met insnllatbn approve en Cla�ea�' ua L Ne FI��,, �J 141oo .1 ° r[ �e^ ° �TEs ;s�'� � � Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER/ENGINEER INSTALLER that the system has been installed In Scour- 1 certify that 1 installed the system in accordance with I certi f)' 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 County public Health 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 Drawing's accurate. form and attached Recor wing is accurate. Vs, . Italler Date Ir Ip�♦ Pdnt d Name of Sign e MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: I21 �L)�r -N/—n �6y✓1 17�f (stamp, signature and date) Signature ofEnvironmental Health Speaahst Date uw,mtl anac,e THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE