The URL can be used to link to this page

Home My WebLink AboutSWG2024-00091 - SWG As-Built - 4/29/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2024-00091 Parcel # 32310-50-02005 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 Site Address 32940 N US HWY 101 Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ■❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5ft. fromfoundation? - - -- - -- - -- - - - - - - - - - -- - - --- ❑ N/A ■❑YES ❑ NO >50ft. fromwells? - - - - - - - - - - - - - - - ❑ UI ❑ Z >50ft. fromsurfacewater? - - - - - - - - - ❑ ❑■ El Q ( Cleanout between building and tank? - - - - V ITankbafflespresent? - - - - - - - - - - - {- 7 --- - - , ❑ 0 El O P 24"access risers over each compartment? - --- - - - - - - - I ❑ 0 ❑ WEffluentfilterinstalled?- - - - - - - -- - - -- -- I Septic tank capacity (working) 1100 gal Manufacturer INFILTRATOR D-box water level and speed levelers used? - - - - - - - -- - - --- - - 0 N/A ❑ YES ❑ NO. DO Manifold/D-box accessible from surface? - - - -- - - - - -- - - - - - ® ❑ ❑ 19Z � Check valves installed? - - - - - - - -- - - - - - - - - - - - - - - - - - ❑■ El ❑ DQ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 ❑3 N 4 ❑ 5 ❑6 ❑Commercial/Other I.>10 ft. from foundation?- - - - - -- - - - - - -- - - - - - - - - - -- - ❑ N/A El YES O N >100ft. fromwells?- --- - - - - - --- - ----- - --- --- - - ❑ ❑ ❑ W >100ft. fromsurfacewater? - - - - - - - - shy - - -- ❑ ❑ ❑ tL >10 ft. from potable water lines?- - -- - - - - - -- - -- - - - - -- El ❑ ❑ Z > 5 ft. from property lines and easements?- - -- - - - - - - -- - - - - El El El > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - El El ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ El ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Propercoverinstalledoverdrainfield?- - - - -- - - - -- - - - --- - - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? -- - -- - - --- - -- El N/A El YES ❑ NO ZPump tank capacity (flood) gal Manufacturer Q 24" access riser(s) and accessible from surface?-- - - - -- --- - - - ❑ ❑ ❑ ~ a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑ ❑ Control Panel equipped with Timer/ ETM/Counter - - - - - - - - - - ❑ ❑ ❑ � f ' a j Pump installed in ❑ Bucket or ❑ On Block or ❑ Other Pump Make/Model ❑ Floats or ❑ Transducer d I Tank draw down in/min Pump capacity gpm Squirt Height ft i Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 32310-50-02005 ABANDONMENT RECORD Were existing septic components se tic abandoned as art of this project? -- --- -- -- - - - - - - YES ❑ NO If yes, please describe: (�l . t" L\ ,n 1F— Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - ----- RA 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. 1S �Q�k �o wader "� lOo r4k • Record Drawin Attached 9 CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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. Z7-Z� Sig ture of install, r" Printed Name of Sign MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: (ftM/2 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 8/21/2018 :4P SOIL LOGS: PEHAPPROVED .2 0-60„+GLS Tank to maintain 50' setback 4 bd septic system= Rhonda Thompson 03/12/2024 to all private wells and 5 from 2bd main home and OWHM foundation 2bd ADU EXT SHED EXT WELL -100'R 100'FROM OHWM I EXT WELL - I I a T. ,IL < ,° f -e, row J- - - . WELL I SLOPE 0% I ff I f ff HOOD 10X30'BEDS f CANAL (PRIMARY) f 10X30 BEDS �4R t (RESERVE) EXT WELL 100+ 100'+ O z A �v �r EXTPOND '=i. Crossing water line mitigation: g SITE PLAN: Installer to maintain 1 Oft setback ��. r1 ?a+;��.cvrrrr FOR:CHAMPOUX JO B#: between water line and septic .S � :;:� ;� ;:Salt Ky PARCEL#: 32310-50-02005 DATE: 01 DECE R2016 transport line. Waterline will be EXPIRLS: 06;071 BY:TJS DESIGN PAGE OF double encased at crossings and NORTH ARROW: 4 ALE: 1"- 50' whenever within 1 Oft of eachother. 0' ' 100' © B-LINE CONSTRUCTION, INC.