HomeMy WebLinkAboutSWG2021-00173 - SWG As-Built - 4/29/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00173 Parcel# 41926-42-00000
Applicant Name 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 3080 W STATE ROUTE 108 Designer Name 3' llU�
n
INSTALLATION CHECKLIST as C. co g
El Full System Installation III Tank(s)Only El Drainfield Only El Repair 0 Other m
System Type TANK REPLACEMENT Pretreatment Type C
>5 ft. from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft. from wells? - - ❑ U ❑
Z >50 ft.from surface water? - . 0 ® CI
N Cleanout between building and tank? - - CI In ❑
U Tank baffles present? - - ❑ ® ❑
F--7 24"access risers over each compartment?- - ❑ 0 0
W Effluent filter installed?- - ❑ 0 ❑
Septic tank capacity(working) 1200 gal Manufacturer SOUND PLACEMENT
0 0-box water level and speed levelers used? - - 0 N/A ❑YES ❑ NO
0 Manifold/D-box accessible from surface?- ❑ ❑ ❑
QQCheck valves installed? - ❑ ❑
E Transport Line Size Schedule Cla
c.
Bedrooms installed(check one) ❑ 2 in 4 ❑6 ❑Commercial/Other
>10 ft.from foundation?- ❑ N/A ❑ YES ❑ NO
0 >100 ft.from wells?- \� ❑ CI
W >100 ft.from surface w er? ❑ ❑ ❑
ti >10 ft. from potable ter Ines?- - ❑ ❑ ❑
Z- >5 ft.from property line an Basemen . - ❑ ❑ 0
Q
cc >30 ft. from downgradien urtain/ ndation drains? - ❑ ❑ ❑
0
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank?- - ❑ N/A ❑ YES ❑ NO
ZPump tank capa (flood) gal Manufacturer
Q 24"access riser(s)and sible from surface?- ❑
d Alarm or Control Panel Installed? -- -- ❑ ❑ ❑
• Control Panel equipped with Timer/ET ❑ ❑ ❑
d Pump installed in or 0 On Block or ❑
O.• Pump odel 0 F o or 0 Transducer
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 2/21l2018
Mason County OSS Installation Report pg. 2 Parcel# 41926-42-00000
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - Q YES EI NO
If yes, please describe:EXISTING SEPTIC TANK
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 relocate in the need of maintenance activities and future development. Typical Record
Drawings contain Drainreid 8 manifold orientation&layout.Septiapump 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
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I. 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 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 I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
9 -17-ZS
Slure of Installer Date
Printed Name of Sign&
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
Signature of Environm ntal Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Ucdaled e/21/2918
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5(r' EH APPROVED
Rhonda Thompson 04.:.`9.7024
This site map was created by MCPH by 4 A5 Ora r
coordinating mmenu and information •.775�re41 — \S T—¢-Ar••— 6104—�6,,
from several sources, including the Mason w
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County GIS and a field review. All locations A. outfl-cxxD
are approximate.
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IEH Setbacks Record Drawing
A) Urarntield./Reserve requires 10'setback horn tooungnoundatrons
R)Septic tank(strequires soft:*from all foodroloundattons b^-O)No roundalroorPenmeter Drams within 301f.Wwngradent of 'C A Parcel: 1 Z� - O
Draintteld'Reserve area r
D I No Cut Bank(s)(greater than 5tt and over 45 degrees)wlII .
50)? down gradient of DramffieldWReserve area ,,,,11 per'
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Date: T(7 1 P-1
Always working for a safer healthier Mason County
Page: y of 9'--
,.. ; .: turn Mason .:° unfv DM; APPROVED
Printed from Mason County DMS
APR 292025
MASON COUNTY ENVIRONMENTAL HEALTH
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4/25/24,11:12 AM Septic Tank Drawings-Sound Placement Services LLC
: n �{� ` 1200NCSR & 1200NCSR-HW
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EH APPROVED
Rhonda Thompson 04/29/2024
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24' OrtENCO TAN( ADAPTERS
4' CAST-A-SEAL GASKET ' I
� �--4' PVC BAFFLE4
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FLOOD FLOOD CAP. 965 GALS. - — 65"
4&3 GALS.
54" 51"
30"
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2-1/2 -"d
3"
APPROX. WEIGHT 114j�B�vEO
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