HomeMy WebLinkAboutSWG2022-00150 - SWG As-Built - 1/13/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00150 Parcel # 222235002026
Applicant Name TBC Enterprises Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2503 Trails End
City, State, Zip Gig Harbor WA98335 Installer Name Jack Johnson
Site Address 850 E Trails End Dr, Belfair Designer Name Jim Zimny
INSTALLATION CHECKLIST
ill Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑Other
System Type Pressure Distribution Pretreatment Type
>5 ft. from foundation? - - ❑ N/A III YES ❑ NO
>50 ft. from wells? - - 0 ® 0
Z• >50 ft. from surface water? - - 0 II El
Q Cleanout between building and tank? - - 0 III
U Tank baffles present? - - ❑ ■ ❑
a.~ 24" access risers over each compartment?- - 0 II
W Effluent filter installed?- - 0 ® ❑
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Septic tank capacity (working) 1200 gal Manufacturer Hagerman
o D-box water level and speed levelers used? - - II N/A El YES ❑ NO
DO Manifold/D-box accessible from surface?- - 0 Ill El
u.
mz Check valves installed? - - ® 0 0
a
Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 0 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA ® YES ❑ NO
0 >100 ft. from wells?- - ❑ IN ❑
W >100 ft. from surface water? - - ❑ NI ❑
ti >10 ft. from potable water lines?- - 0 ® 0
Z > 5 ft. from property lines and easements?- - 0 ® 0
Q
re > 30 ft. from downgradient curtain/foundation drains? - - 0 ® 0
o
Drainfield level and observation ports present - - 0 II ❑
0 Graveless chambers or mg Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 ® 0
Pump tank setbacks consistent with septic tank? - - ❑ N/A NI YES ❑ NO
Pump tank capacity (flood) 1200 gal Manufacturer Hagerman
< 24" access riser(s)and accessible from surface?- - 0 ® 0
~ Alarm or Control Panel Installed? - - 0 4 0
a.
2 Control Panel equipped with Timer/ ETM/Counter- - 0 NI 0
a. Pump installed in ❑ Bucket or ® On Block or 0 Other_
1
e' Pump Make/Model Liberty 280 IN Floats or ❑ Transducer
2
a. Tank draw down 2" in/min Pump capacity 40 gpm Squirt Height 5' ft
Pump on time 'rnn72sec(45GPM) Pump off time 4 Daily flow set at 280 gpd
Uplated 8/21/2018
Mason County OSS Installation Report pg. 2
Parcel# 7"ZZZ 3 S 00 2c. 2,Lc.
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 WAC24S-272A-0300? - - 0 YES 0 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 rsintarn: Drainfie%d&manifold orientation&layout.Sepbcfpump tank location.Noah anon..reserver arnheld,ex sox)acid lxrvyased budwv0s.locat0n o1 wets.vratedines.
:gilts,observation torts.cleancuts and ulbe.r mamleearce access points kK-esnptele Recod Drawings may create aititional de:ays In 4nat installation approval and related permits
APPROVE__
JAN 13 2023
MASON CO•UNTY ENVRONMENTAL HEATH
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Eit 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 Mat 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 Masai County Codes
I further certify that all information contained on this I further certify that all information contained on this
fo nd attr hed Record Drawing is accurate. form and attached Record Drawing is accurate.
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Sig Tore of Installer Dale j"
CAC )in►)s?v-)
Prirllecf Name of Signee r
MASON COUNTY PUBLIC HEALTH i I. .. 4'
The undersigned approves this installation Report and kr it4. `3<s
Record Drawing on behalf of Mason County Public os
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O mar. .rkwri
Health.' Lic s� cne-
a/4,52,_ i. , 3-_23 Expimin. Ai/sz
Sign We Oro/mental Health Specialist Dale (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON IRE MASON COUNTY WEB SITE uta.reaszr2orr
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APPROVE
iAN 13 2023
M�ASOt COUNTY ENVIRONMENTAL HEALTH
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