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HomeMy WebLinkAboutSWG2022-00276 - SWG As-Built - 9/11/2023r_ ._.. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00276 Parcel # 22105-51-00074 Applicant Name RAY C/O B-LINE CONST. Subdivision (Name/Div/Block/Lot) Applicant Address 2971 E PHILLIPS LK LP RD City, State, Zip SHELTON, WA 9858 Installer Name B-LINE CONST. Site Address 3240 E MASON LK DR W Designer Name TOBY TAHJA-SYRETT INSTALLATION CHECKLIST ❑ Full System Installation 0 Tank(s)Only ® Drainfield Only ❑Repair 0 Other System Type PRESSURE Pretreatment Type NUWATER >5 ft. from foundation? - - ❑ N/A ❑ YES ❑ NO >50 ft. from wells? - - ❑ ❑ ❑ Z >50 ft. from surface water? - - ❑ ❑ < Cleanout between building and tank? - - ❑ 0 ❑ U Tank baffles present? - - ❑ ❑ ❑ a24" access risers over each compartment?- - ❑ ❑ ❑ W Effluent filter installed?- - ❑ ❑ ❑ U) Septic tank capacity (working) gal Manufacturer C3D-box water level and speed levelers used? - - In N/A ❑ YES El NO 0O Manifold/D-box accessible from surface?- - 0 Q ❑ m-Z Check valves installed? - El ill QQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - El N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - ❑ 0 W >100 ft. from surface water? - - ❑ • ❑ ti. >10 ft. from potable water lines?- - ❑ ❑■ 0 Z > 5 ft. from property lines and easements?- ❑ © ❑ a - W > 30 ft. from downgradient curtain/foundation drains? - - ❑ II ❑ Drainfield level and observation ports present - - ❑ © ❑ ❑ Graveless chambers or El Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO `-� Pump tank capacity (flood) gal Manufacturer Z < 24" access riser(s)and accessible from surface?- - ❑ 0 ❑ aAlarm or Control Panel Installed? - - ❑ ❑ 0 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ M d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a'E Pump Make/Model ❑ Floats or II Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Uptlaled 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# Z-2 t O 5 -Sl - 000 7y ABANDONMENT RECORD Were existing septic components 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 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. tt �T 1 7S f CIeA,.o4A-s CC eA et. �QCv X ra�4, l l l l A cey Ex;51-%� 7+O F LNt- IIIII et,,t 4s exec I I I I I SVo e Ag etc- des is� I , 1 i I It II .(c ' ❑ 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. A I g-IC(-23 0 01 Si atur of Instbller Date41P 4 4 I�1.-r I a vs.e..../ t -,..-P:-.1.fit•, _ _. !V Printed Name of Signee t ,ar'• "c,•F�>♦, MASON COUNTY PUBLIC HEALTH Z +, 5100299 •,�,+$ The undersigned approves this Installation Report and f o TOBYI.TAHJA-SYREIT _"' a Record Drawing on behalf of Mason County Public ����������..... �, IIth: EXPIRES: 06/07/z`( LJ- 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 • • EXT WELL U PROPOSED WELL ----- Z W/RO GLS WlROOTS O MpSDN„Kg DRIVE 0/ES7 •1, I S � W/ROOTS I CO z OEXT WELL O \ EXT Z SHOP J \ m' 75'R 75'R 0 iii. 75'R 1 1' o 1 1 11 ___ 11 i —SOIL LOGS • �i PRIMARY S RESERVE 1 '� - WATER l INF GRAINFIELD AREA - �� ��( A P P R O V E ,� •, SEPTIC.PRETREATMtNT _ �� S PUMP TANKS worrion a ri RE! \ APROX u POSSIBLE N HOME AREA N _l r) AP_.RO XCO _ Q .".ONLINE U u w co6 cm a w c 0 0 90'. H1 N 0 22„ MASON LAKE CY W Y c Q Cc) F r 0 li a 00 z ei \D(JC\ A \- ... IJ3 .___1 /tl 1'i -f'"e-ci D A-ke N6 rY I.) 6 nJ Zti AiU a fry/cs l- (..,1„ilf L Ix Printed From Mason County DMS Printed from Mason County DMS