HomeMy WebLinkAboutSWG2025-00058 - SWG As-Built - 4/30/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number swG! 2025-00058 Parcel# 22129-31-90001
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 323E PICKERING RD Designer Name CINDY WAITE
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type 1 PRESSURE Pr tment Type N/A
>5 ft. from foundatio9? - - --- -- -- --- -- - - - ❑ N/A AYES ❑ NO
>50 ft.from wells? -- -- - - - - - - - - �� - - -- ❑ ® ❑
>50 ft. from surface*ater? - -- - - - - - - - - - - ® j- - ® ❑
Cleanout between b9ilding and tank? - - - A - -NQ-1b.1.%
--- ❑ ❑
Tank baffles present! -- - - -- - - -- -- - - - -- - - - ❑
24"access risers ov9r each compartment?- ..\- j. - - - - - ❑ ® ❑
W Effluent filter installed?- - - -- - - - -- - -- - _ _ '-- -- - - - - - - ❑ ® ❑
Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT
0 D-box water level and speed levelers used? - - - - - -- -- - - -- - - Q N/A ❑ YES ❑ NO
Q.0 Manifold/D-box accessible from surface?- - - ---- - -- - - - - - - - - ❑ ® ❑
0d2 Check valves installed? - - - -- - - -- -- - - - - - -- - - - -- -- - ❑ 0 ❑
OQ
S Transport Line Size 1 2" Schedule/Class SCH 40
Bedrooms installed (check one) 4 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - - - - - - -- - - -- - - - -- - - - - - -- - ❑ N/A ® YES 0 N
>100 ft. from wells?- -- - -- - - - -- -• ---- ---- -- - - -- - - - ❑ ❑
J >100 ft. from surface water? - - - - ❑ ® ❑
IZ >10 ft. from potable ater Iines? ^' - � F�' ' }s ❑ ® ❑
;,;
> 5 ft. from property lines and easerraenfs - - -;, -J:�, 0 ® ❑
lY > 30 ft. from downgradient curtain/foundation drams?'-� '"t- - [] ® ❑
i MASON rnUN F�,pNin .: r+
Drainfield level and 'bservation ports present - - - P.J„C ;J;A�hr-L` ❑ ® ❑
❑ Graveless chamfers or 0 Clean gravel us&L''�'j(check one)
Proper cover installed over drainfield?- -- - - - - -- --- - - - - - - - ❑ ® ❑
Pump tank setbacks
I onsistent with septic tank? --------- - --- ❑ N/A ® YES ❑ NO
Z Pump tank capacity (flood) 14.75 gal Manufacturer SOUND PLACEMENT
24"access riser(s)a n d accessible from surface?----- - - - -- - - - ❑ ® ❑
fL Alarm or Control Panel Installed? - - - - - --- - - - - - -- - - - -- - - Q ❑ ❑
Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - - - ❑ UI ❑
0 Pump installed in Bucket or ❑ On Block or 0 Other PUMP VAULT
Pump Make/Model LIBERTY 280 ® Floats or ❑ Transducer
d Tank draw down 6'.sp _ in/min Pump capacity gpm Squirt Height ft
Pump on time *_ I1 ����o Pump off time 3 N,e . Daily flow set at /�7• -gpd
PLIO S trtc Q-f' r e • p j.4 oohUct .I2iI2oi8
9- I3- 2(p J
Mason County OSS installation Report pg. 2 Parcel# 221293190001
ABANDONMENT RECORD
Were existing septic compo gents abandoned as part of this project? -- ---- - --- - - -- - - ❑ YES ❑■ 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 relocate in the need of maintenance activities and future development. Typical Record
Drawings contain: Grainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation pons.cleanouts,and gther maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
C\CtX,otn�s SS
SQ
4' G iaa uaL'
ahk P eZ I q 0.G r Oki
S ac. � t
. . . ....................l Y RON ';; ..,
��- _f� 1r HEA1LTH 0 Record Drawing Attached
I _ _
CERTIFICATION O F INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that!installed thT 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/ pproved 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 infprmation 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.
-25"
Sig ature of Installer Date
Prinfed Name of Signbe �S� c Nis
MASON COUNTY PUBLIC HEALTH Py�
The undersigned approv IQs this installation Report and
Record - wing on beha f of Mason County Public
p CINDY E WAITE �..
Health. LICENSED DESIGNER
J.e,1tr'4 LIJJLNL\ Lt
/ �
c ExPii LS 051101
Signature f Er vi n ental(-lealfh Specialist l/Date (stamp, signature and date)
THIS FORM AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
SITE PLAN revised 4/29/25 *NOT AN APPROVED SEPTIC DESIGN*
Use approved scplic design forscptic syslcm instatbtion
Hoff/.Hegi,and
323 E. Pickering Road, Shelton, WA 98584 SCALE: 1"=30' NORTH
Parcel No: 22129-31-90001 RR5
184'
r ..._..�..�.r-. ._.� --- ---- •. -- ..�...._e— Slope:Site
-5 Q I rJ Cz is flat except
for NW corner
~ ti which slopes
' in oDO52 i,l `zyr s N I' StoSE.NW
house maybe
I " k flPvpoc''4
I f a I
56 i /\ • ),
in f \
• f r'ti r?' Onaig, L.
\ ) ( (j�l �C.n p' CIND E WAITE
u If - e,F LICENSED DESIGNER
vi a w;..::;:., oo• �c
15'easement:ingress/egress,utilitie5$e iitàfwater system. I
____ . _. --I-----'--- EH APPROVED
n,timr. ocnzroxs
I _ - �.. —' 5
{ Disclaimer:Mason County does not require a
survey to obtain a building permit.As a result,site - tA- g s•
plans may not reflect accurate data. It is the rU)
►' applicant's responsibility to comply with setback 1n
requirements.
Access 30' See AF#594666 i84'
RR5 Zoning ''''',��E ;,�E�•e
Front Yard Setback.25'. a a�
Setbacks:Frontyard 25'. Side&Rearyards 201. Drainfteld 5'. Side&Rear Yard Setbacks. Residential dwelling m a o
51 212025
and accessory structures is 2O'. a CIAA
DM iR 10%width of lot if not more than 100'wide a o �
AP"QD oNz.z,
MASON_CQtlh7f BCpP3R ,&INGJ QQ A QR approved ADV a m c P oz
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