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HomeMy WebLinkAboutSWG2022-00123 - SWG As-Built - 2/22/2023 CLEAR FORM FEB 2 1 2023 r✓ Cf--) . Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ l 'E 2MI-T-INFORMATION Permit Number SWG 2022-00123 Parcel# 320065001057 Applicant Name TBC Enterprises Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2503 City, State, Zip Gig Harbor Wa 988335 Installer Name Jack Johnson Site Address 1891 E Island Lake Dr, Shelton Designer Name Jim Zimny INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only El Drainfield Only ❑Repair ❑Other System Type Pressure Bed Pretreatment Type >5 ft. from foundation? - - 0 N/A EYES ❑ NO >50 ft. from wells? - - ❑ ® 0 Z >50 ft. from surface water? - - 0 E 0 H Cleanout between building and tank? - - ❑ ® ❑ U Tank baffles present? - - ❑ E 0 n~. 24"access risers over each compartment?- - ❑ E E] W Effluent filter installed?- - ❑ ® El co Septic tank capacity (working) a—DO gal Manufacturer a-}-45W V CA_V\ CID-box water level and speed levelers used? - - ® N/A ❑ YES ❑ NO 62 Manifold/D-box accessible from surface?- - ❑ 0 ❑ co Z Check valves installed? - - ® ❑ ❑ 6Q Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) 0 2 ©3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - El N/A E YES ❑ NO CI >100 ft. from wells?- - ❑ E ❑ u.1 >100 ft. from surface water? - - CI III CI LT. >10 ft. from potable water lines?- - ❑ ® 0 QZ > 5 ft. from property lines and easements?- - ❑ ® ❑ R > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑ ci Drainfield level and observation ports present - - 0 E 0 ❑ Graveless chambers or MI Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 E ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A E YES ❑ NO • Pump tank capacity (flood) 1200 gal Manufacturer Hagerman Q 24" access riser(s)and accessible from surface?- - ❑ ® ❑ ~ Alarm or Control Panel Installed? - - 0 IN ❑ a 2 Control Panel equipped with Timer/ETM/Counter- - 0 E ❑ D a- Pump installed in ❑ Bucket or E On Block or ❑ Other a'g Pump Make/Model Liberty 280 INFloats or 0 Transducer LL - • Tank draw down 2" in/min Pump capacity 30 gpm Squirt Height 5' ft Pump on time 1 min 10 sec Pump off time 4 hrs Daily flow set at 270 gpd ;Jrrlatad a/21/201a 1 Mason County OSS Installation Report pg. 2 Parcel#_321)0 j9 e OC_S16,s. ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - 0 YES ,.Er-NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300?- - 0 YES Ei NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-tousle in the need of maintenance activities and future development Typecat Record Drawings contain. Drainiekt&manifold Onentaoon&layout,Septac,phsnp tank location_firth arrow,reserve dramre'd epastrg and proposed bungs.bcaton of was.eraterhws. wells.observation ports.cfeanoh/S.and other maintenance access ponds Incunpfete Record Dramngs may create ahxronal delays in final installation approval and related permits. [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 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 1 further certify that all information contained on this I further certify that all information contained on this fo nd aft hed Record Drawing is accurate. form a►d attached Record Drawing is accurate. -44 _l-ZJZS Sig re of Installer Date : Jack. 14 ilS me-) 'rl Printed Name of Signee :. : < ° #r MASON COUNTY PUBLIC HEALTH f ' /2ol r r. �`.., .roThe undersigned approves this Installation Report and ,1,�L`�` r DESIGNER + Record Drawing on behalf of Mason County Public Expires;6/17y, - A Health: Min 1 OM �1�1Z'S Signature of Environmen -1 Health Specialist Date (stamp.signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UloateJ 8 1 2d18 • / / \ i / \ / / / \ / // I tp' / ! / ! / // ,��- -� f � \ / \ / ,� y N I \ / N I \ / \ 1 '+ / 1 \ _ 1 1 \ 1 \ N 1 O 1 \ + •: :=: : pi.. snipe j IIaM ,OS �\ \ / :•.g - ! \ A\ / \ snipe UaM ,OS / ` O MASONCo FEB ?? 2023 ; sntp.r)1 tiaM .001_ UN .NTyEN� 1 NR0NMENTAC b z REr HEALTH o y Lo vi N snlp�21 IiaM AOZ °° y i �:i c rD i — i �fj i OI� v �� i r.& r+ FEB 2 1 2023 ' r i BY: I i i i 1 i i I I 0 0 rr i AA i 4 .A I v, - v, rD - lkirS• I `D w I � I I I j •I i 50' i I i �1-e1 pu.e`5\3 A� n W — CO 'O 2 — `0 " rD n) I rD N n - a 0 , C7 No `^ N llI r �'.. r f1 O O W ,_. rD 7' C 00 .ty f m3 5; 1 In to n a