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HomeMy WebLinkAboutSWG2023-00501-ASBUILT - SWG As-Built - 8/10/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPUCANT1 PERMIT INFORMATION Permit Number SWG 2023-00501 Parcel# 22019-11-04010 Applicant Name METCALF C/O B-LINE CONST. Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILLIPS LK LP RD City, State, Zip SHELTON,WA, 98594 Installer Name B-LINE CONST. Site Address 5626 E AGATE RD Designer Name TORY TAHJA-SYRETT INSTALLATION CHECKLIST II Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type PRESSURE Pretreatment Type N/A >5 R. from foundation? -- -- -- -- ? p� ,' ❑ WA AYES NO >50 ft. from wells? -- - - - - - I{arr- r i +l `; ❑ e ❑ Z >5oft. from surtace water? --- - - - - - i.�'rr ___ TH1j ❑ ■ ❑ Cleanout between building and tank? -- -='il- '-� ZQTh- I ❑ ❑ U Tank baffles present? - - - - - --- -- ❑ ❑ a 24"access risers over each compartment?re+ - „- ?:1—_ � ❑ U ❑ W Effluent filter installed?- - -- -- - - - - -- - - - -- - - ❑ ■ ❑ N Septic tank capacity (working) 1200 gal Manufacturer SOUND PLACEMENT O D-box water level and speed levelers used? - - -- - - --- - --- " - TWA DYES NO GW J Manifold/D-box accessible from surface?---- --- -- ---- ❑ ❑ ■ ❑ mz Check valves installed? -- - -- -- - - -- - -- ----- - - ❑ C< Transport Line Size 2" Schedule/Class 40 S Bedrooms installed (check one) 112 ❑3 ❑4 ❑ 5 ❑6 ❑Commerda110ther WA . YES ❑ NO >10ft.from foundation?-- - ---- - - -- - - - ---- ❑ ❑ >100 ft.fromwells?-- - - -- --- --- --- --- - ------ -- -- ❑ 0 >100 ft,from surfacewater? -__ __ _ ___ __ _____ __ _ ____ - ❑ e ❑ W LL >10ft. from potable water lines?-- -- - -- --- - - > 5ft. from property lines and easements?- - - - - -- - ----- - ❑ > 30 ft. from downgradient curtain/foundation drains? -- - ----- - ❑ e ❑ Drainfield level and observation ports present - - - -- - 0 ❑ ❑ Graveless chambers or 5 Clean gravel used? (check one) ❑ Proper cover installed over drainfield?-- -- -- - ----- - ❑ Pump tank setbacks consistent with septic tank?------ - ------ ❑ NrA DYES NO SOUND PLACEMENT ZPump tank capacity(flood) 1475 oal Manufacturer Cl R 24" access riser(s)and accessible from surface?- ---------- -- ❑ UI ❑ ~ Alarm or Control Panel Installed? --- - ---- --- -- -- - -- -- - ❑ a ❑ f Control Panel equipped with Timer/ETM/Counter- -- - - - - -- - - ❑ Pump installed in ❑ Bucket or ❑ On Block or Q Other PUMP VAULT a Llh Inv Floats or ❑ Transducer a Pump Make/Model ec 7 ain/min Pump capacity 3S gpm Squirt Height 3 1t Tank draw down � .W Pump on time I q YL Pump off time Daily flow set at I6gpd upd91eE W21 18 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were eldsting septic components abandoned as part of this project? -___ Yes NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? ' --- - --- ❑ YES ❑ NO RECORD DRAWING ml.I.a p.wn.nenl r.co, .na,noh be ace r.n ma a..edpl.e..worn to n.l.ub m the noa of me ibn.ly activllN..na town eweplora. typal Rxoia role bc94oh NOM snow,soave dlelnfa .w1W and papaw pWlrec.talon otww1..waealnw, wsls.q..rv.n: ods d., culLSd and oriaMelMBWw.SWs pct a.au.auui delays in fret nwuetion ewnw and rated pelrMs. wells,oEwrvWm pods deenaW and aMermeW �w. n papa. Imm�wl.w RawE nreM9.may Gw1r� Clea..Oa.1s ^ Ud l >�C2o09A1 y I �a;n x : Le 4L \ - f 5 ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNERI ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in actor- 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. � `fZN Sig ture of Installs Date T(sr 41 Printed Name of Slgneef I MASON COUNTY PUBLIC HEALTH } Slop2p, ss The undersigned approves this Installation Report and . 7O'6 IMJA.VI1T. LICENSED DESIGNER Record Drawing on behalf of Mason County Public EXPIRES: 0610712j Health.: Signature of Environmental Ibealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED MD AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE llpdpw a2lllele I / / � �_ NEW ORIVFJ PARK NG �bfIOPOSED / -- PROPOSED SHOP p INFIELD a PROPOSED TANKS WELL O I ' � I II 3 • I /^ j IQ OR EX GARAGE — \ �I EXISTING I H m HOME i i i j I JY IACOtS4 p 1 J U 2'. / /1r WSED SIGMA .--z --•-ii � ..��.. •-` 9RE PLAN -OVERVIEW FOR: METCALF J0B #: IAN 0 5 2124 PARCEL 9: 22019-11-04010 DATC'. 24 NOVEMBER 2029 BY: TJS DESIGN PAGE S OF t.„iLF :CC5if:5iA �'S�'ALP�r'LT4 NORTH ARROW: SCALE: V = 60' DJA O �• .1 160' I, © B-LINE CONSTRUCTION, INC.