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HomeMy WebLinkAboutSWG2021-00350 - SWG As-Built - 6/23/2022 CLEAR FORM Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG -2021-00350 Parcel# 220185300126 Applicant Name TBC Enterprises Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2503 Timberlake Div 5 lot 126 City, State, Zip Gig Harbor, WA 98335 Installer Name Jack Johnson Site Address 201 E Stavis Rd, Shelton Designer Name Jim Zlmny INSTALLATION CHECKLIST II] Full System Installation ❑Tank(s)Only ❑Drainfield Only 0 Repair ❑Other System Type Gravity Pretreatment Type >5 ft. from foundation? - ❑N/A III YES 0 NO >50 ft.from wells? - - - 0 ® 0 Z >50 ft, from surface water? - - El ® 0 < Cleanout between building and tank? - - 0 ® 0 U Tank baffles present? - 0 II 0 F=- 24"access risers over each compartment?- 0 ■ 0 a. W Effluent fitter installed?- - 0 ® 0 cn Septic tank capacity(working) 1200 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A IN YES ❑ NO J p� ❑ © 0 Manifold/D-box accessible from surface?- - mZ Check valves installed? - - 111 0 0 OQ 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) 0 2 [3 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ NIA ® YES ❑ NO 0 >100 ft.from wells? - 0 IN ❑ W >100 ft. from surface water? - - 0 IN 0 a: >10 ft.from potable water lines?- - 0 ■ ❑ Z > 5 ft, from property lines and easements?- - 0 S 0 > 30 ft. from downgradient curtain/foundation drains?- - 0 II 0 © Drainfield level and observation ports present - - 0 I 0 ❑ Graveless chambers or I Clean gravel used? (check one) Proper cover installed over drainfieid?- - 0 II ❑ Pump tank setbacks consistent with septic tank?- - MI N/A ❑ YES ❑ NO • Pump tank capacity(flood) gal Manufacturer < 24" access riser(s)and accessible from surface?- - 0 0 0 H CL Alarm or Control Panel Installed? - - 0 0 El 2 Control Panel equipped with Timer/ETM 1 Counter- - 0 0 0 D gl- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other, 0'• Pump Make/Model - 0 Floats or 0 Transducer Ct. Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8r1f2018 Mason County OSS Installation Report pg. 2 Parcel# /J G'C)1 ), ., '�-`(< (r"\ ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? -- - © YES . i If yes,please describe' �"_. - Were all components pumped out and properly abandoned per WAC246-272A-0300? -- -- -`- 0 YES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate in Me need of maintenance activities and tuhere dereiopmenl. ryps'al Record Drawings contain: Orae id&nrao.lotC nor 4al+x+i.41mA,s«vbcijee*ee l.xrtr focaiea,Nomt dxr ow.,riser ve ck="11*-0, tsing srvi peK�sfAl fkiibt"iri'kx;"'of eeeps,uaU'e r. welts otzservrtion rrnet rk armaals.:end oSrer mairatmsarxr-at.dexss warts lammm fete Renm c <D(aa r.s may create addeemat rl*rays ro*nal installation apc*ral at,.i nr€atcr.F ,, 4 ..Record Drawing Attached . . . . CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with /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(Jeered/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 r further certify that all information contained on this I further certify that all information contained on this foriwand all hed Record Drawing is accurate. +� form and attached Record Drawing is accurate. Sig) ore of Installer { t Date Printed Name of Signer: e MASON COUNTY PUBLIC HEALTH f It rf/P 1+t4.� r Tlnfl undersigned approves this Installation Report artd �, �„►i� Record Drawing on behalf of Mason County Public S� �` N . t 1 ,rt ;� Hec7ftl� r t-1,-, I i rga 0 DESioNER Expires,ft/17/ Signature of Environmen l Health Specialist Date (stamp.signatur izd date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE t,. ts a2 ux le 1 i S `r� i • , , . . a' Ni -. '-I 4-Ed '4:4-6:E.-ric.'45 80-1"1' -------\\:_iti_\:16\3 cl, • Q. ,.i _ ..., \ --..cv- ce if 0- C76 0 el E r\I • -44. i ak. 1,„, — i ...4 3,.. ,... :., „..... , -,- II re .S1....v.,),., `...k, ::S. C7 0., 5..... .;,,,,-, ..... tjrj .... C r.-1 .'•,., ,Y) cifl%%. --'4°4-, -. ._4,2_ t,.. 4) .,.. ...4 'ci5 CD ..- -- c 141i, -Mit a C . t., '') tt >" 11% -,....,,_4 0, CS)tcl C.) "° ).., c7) td:s rt kn c 7 k‘w ,f)tt, i 1 sz,-, Er1P -ci ° -14, , a, 0. 0 a tX) 0 r\I E 0) % ve w. c z, ..: i7.-," ,,,,) < I 0 ;....) 61A1' ri a) ::r... a) > a) a vs . , 0 (1) ; r—i PIC. 4ge CU" VI .:". ........ X CS IIIIIIIIIMMsmrj:"*aillMMIIIIIIIIMIIIMIIIIMIIi"IM2- 0 is rn ii) 0 s Ni 9 a) o APPROVED E JUN 2 3 2022 0 o MASON COUNTY ENVIRONMENTAL HEALTH 6- RET 00 Ni en .. ... ,....i an . % 01 CL 1 cal al 1 4-•1 rzs 1 0 i ,I S