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HomeMy WebLinkAboutSWG2023-00533 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00533 Parcel # 12229-50-01002 Applicant Name BORSETH 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 7801 E GRAPEVIEW LOOP RD Designer Name TOBY TAHJA SYRETT INSTALLATION CHECKLIST Il Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other System Type PRESSURE Pretreatment Type N/A >5 ft. from foundation? - - - ❑ N/A I.YES ❑ NO >50 ft. from wells? - �� 1 - - ❑ II ❑ • >50 ft. from surface water? - 1 ❑ 0 ❑ Z l • Cleanout between building and tank? BEE_4 2 2� - 1- - ❑ 0 ❑ U Tank baffles present? - SII - - - ID 0 ❑ a24" access risers over each compartm' tsy- - - - - -_-- - ❑ II 0 LU Effluent filter installed?- - ❑ ® ❑ tn Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT Ca D-box water level and speed levelers used? - - It N/A ❑ YES ❑ NO oOJ Manifold/D-box accessible from surface?- - ❑ 0 ❑ u. OOZ Check valves installed? - - ❑ © ❑ oa 2 Transport Line Size 2" Schedule/Class SCH 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? - - ❑ N/A ® YES ❑ NO O >100 ft. from wells? - - ❑ El ❑ W >100 ft. from surface water? - - 0 0 ❑i >10 ft. from potable water lines?- - ❑ II ❑ � a > 5 ft. from property lines and easements?- - ❑ 0 ❑ cc > 30 ft. from downgradient curtain/foundation drains? - - ❑ II ❑ a Drainfield level and observation ports present ❑ ❑ Graveless chambers or pi Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A NO YES ❑ NO z Pump tank capacity (flood) 1200 gal Manufacturer SOUND PLACEMENT < 24" access riser(s)and accessible from surface?- - 0 0 ❑ H a Alarm or Control Panel Installed? - - ❑ Ill ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ 0- Pump installed in ❑ Bucket or ❑ On Block or II Other PUMP VAULT a' Pump Make/Model LIBERTY 280 ® Floats or ❑ Transducer a Tank draw down 4 in/min Pump capacity 33 gpm Squirt Height 4 ft Pump on time 61 sec Pump off time 3 HR Daily flow set at 270 gpd Updated Al2t/201A Mason County OSS Installation Report pg. 2 Parcel# 12229-50-01002 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES 113 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 • • 1.A), ACC— 5eaC'e r. HOuyL SQ` l00 O� `C_ 0,.n� e� 75t, r' rn es i • •-te`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. Z-(f-2S Sigf tore of Installer Date .�t�, 1 C'' l 0 r I a ray 'i , ',� J PrintAd Name of SigneE' ,:_ R: � I I) C/1- f MASON COUNTY PUBLIC HEALTH • 'A J' ,I The undersigned approves this Installation Report and . L •51'RETf ,• 41 Record Drawing on behalf of Mason County Public -- ' DESIGNER AMIj, Health: — "• EXPIRES. 06/07/ /�_ RCS/'PTO 41 1-? q(Z--- 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 e121/201e . , . •A 0-56^+GLS PRIMARY&RESERVE ROOTS TO 56" DRAINFIELD —•.._— ORAPEVIEw --- -TN. ---,LOOP RD. 1 A 0-50"+GLS % , \ ROOTS TO 50" / ' \ / 1 !. EXISTING WELL --''1/..--``----____ i / , 100'R ,��+ e 11 /// SOUL LOGS / s4oQ - -- l/ ,� Boa �I `, '' - PROPOSED DRIVE/PARKING t BUILDING - ,' (APROX) . 1 f • - - % / 1 � • / FIM ' . , 50'R / `‘ 4 / / PROPOSED i______� WELL U 1 ,i i • r t / / , MPpRp,00 R `� ` y - - _ , VE APROX _. .. FUTURE GARAGE 'fi% DEC 1 EXT • '�HSONO DRAINAGE UIV"E6 y1RUh, SURFACE MENTAL HEALTH / WATER ' - - - - - R_T. 30' , ..,.../../ APPROVE I JAN AN r G 2O2� 0 pa. �TASOI coo f55' 60' 4 ' ' JBW '.. �1 ' ,, :4. y '+; 23 DRAINFIELD SITE PLAN: / . ' ��/i FOR: BORSETH JOB #: -� '� PARCEL#: 12229-50-01002 DATE: 22 DECEMBER 2023 • S. s .•' BY: TJS DESIGN PAGE, S OF le _ NORTH ARROW: SCALE 1" = 6' ► l" 0 DMS 0 0' 6' 12' ri nt r�PM 6I �►ty Printed from Mason County DMS