HomeMy WebLinkAboutSWG2021-00459 - SWG As-Built - 1/20/2023 , ,I N" d rye
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021t0I R 00 iS' Parcel # 22223-51-04034
Applicant Name TBC Enterprises Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2503 Trails End
City, State, Zip Gig Harbor Wa 98335 Installer Name Jack Johnson .
Site Address 34 E West Dr, Beltair Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair 0 Other
System Type Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ®YES 0 No
>50 ft. from wells? - - ❑ ® LI
Z >50 ft. from surface water? - - ❑ Ell ❑H Cleanout between building and tank? - - El ® 0
U Tank baffles present? - - 0 IN ❑
1- 24" access risers over each compartment?- - 0 ® ❑
tZ
W Effluent filter installed?- - 0 IN 0
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Septic tank capacity (working) 1200 gal Manufacturer Hagerman
5 D-box water level and speed levelers used? - - ® N/A ElYES ElNO
DO Manifold/D-box accessible from surface?- -
El II Elm z Check valves installed? - - ❑ I ❑
oQ 2" Schedule/Class Sch 40
� Transport Line Size
Bedrooms installed (check one) ❑ 2 Q 3 ❑4 0 5 D 6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA ® YES ❑ NO
>100 ft. from wells?- - ❑ ® ❑
W CI II El>100 ft. from surface water? - -
>10 ft. from potable water lines?- - 0 ® ❑
Z > 5 ft. from property lines and easements?- - El MO
Q El MI El
• > 30 ft. from downgradient curtain/foundation drains? - -
Drainfield level and observation ports present - - 0 ® 0
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ I ❑
Pump tank setbacks consistent with septic tank? - - 0 N/A III YES ❑ NO
• Pump tank capacity (flood) 1200 gal Manufacturer Hagerman
Q24" access riser(s) and accessible from surface?- - ❑ ® ❑
I-
d Alarm or Control Panel Installed? - - ElI 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ 11 ❑
D
a- Pump installed in ❑ Bucket or in On Block or ❑ Other_
a' Pump Make/Model Liberty 280 IN Floats or 0 Transducer
n
0_
a Tank draw down 1.5" in/min Pump capacity 30 gpm Squirt Height 5' ft
Pump on time 1 5 min on Pump off time 4 hrs Daily flow set at 270 gpd
Updated 8/21r2018
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Mason County OSS Installation Report pg. 2 Parcel# ��ZZ_ > - / f
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - -- - 0 YES 0 NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300?- - ❑ YES 0 NO
RECORD DRAWING
This is a permanent rocord and must ha accurate and dose iptive enough to re-locate in the need of malnteeancs activities and future development. Tyrocal Record
Drawings centainl OrainSefd&ma+tto9d wits-Aaiun&loyeul.Septrv'pwr•p tar*tecaax.Nsth xsto:+.reset ve Orairtnett exiyk'q arid pro3s"-e hkrilia'*3s
button of wets.wi gOnes.
wells.observation ports.dearcuts.and other rnairlerarce access points tnc snplele Reard�rarbngs may:mate axrteanat de:ay$In Mal insteattn arproval and relatmf pl.,.ma,
APPROVE ,JAN 20 2023
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MASON-COUNTY ENVIRONMENTAL HEALTH
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aRecord 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 nd art hed Record Drawing is accurate. form and attached Record Drawing is accurate.
- /6- li - -tea._
Sig t ureo f installer Date
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,J�`�. ,�JkVy, nY� i'f�11
Printed Name of Signee p.
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MASON COUNTY PUBLIC HEALTH ; #•
The undersigned approves this Installation Report and S 4' �I
Record Drawing on behalf of Mason County Public 2o.z;,•
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tic i t5E•�• StONER
IN j(r )41 1�
Sipot f Environmental Health Specialist Dale (stamp. signature and date)
_ i updalvdttatrzota
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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