HomeMy WebLinkAboutSWG2021-00611 - SWG As-Built - 2/21/2023 L.J__*u won
CLEAR FORM 8" 0
u FEB 2 1 2023
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION BY:
Permit Number SWG 7_(j Z(." 0D6. ( 1 Parcel # '117,2,0 2I - 5—S-- Q 2 0 ( J
Applicant Name TBC Enterprises Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2503 Shorecrest
City, State, Zip Gig Harbor Wa 988335 Installer Name Jack Johnson
Site Address 80 E Ashwood Shelton Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type ATU to Pressure Trenches Pretreatment Type Nuwater
>5 ft. from foundation? - - ❑N/A ®YES ❑ NO
>50 ft. from wells? - - El ® 0
Z >50 ft. from surface water? - - 0 ® 0
H Cleanout between building and tank? - - ❑ II El
U Tank baffles present? - - ❑ ® 0
FL 24"access risers over each compartment?- - CI NI CI
LU Effluent filter installed?- - ❑ ® El
Septic tank capacity (working) gal Manufacturer
0 D-box water level and speed levelers used? - - pmN/A ❑ YES ElNO
DO Manifold/D-box accessible from surface?- - ElPE El
u.
mz Check valves installed? - - II ❑ El
oQ
2 Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES ❑ NO
CI >100 ft. from wells?- - El IN El
W >100 ft. from surface water? - - ❑ PI CI
IL >10 ft. from potable water lines?- - El ® El
Z > 5 ft. from property lines and easements?- - 0 ® El
> 30 ft. from downgradient curtain/foundation drains? - - El ® ❑
Drainfield level and observation ports present - - ❑ MI El
❑ Graveless chambers or UI Clean gravel used? (check one)
Proper cover installed over drainfield?- - El II El
Pump tank setbacks consistent with septic tank? - - ❑ N/A It YES ❑ NO
• Pump tank capacity (flood) 1200 gal Manufacturer Hagerman
< 24" access riser(s)and accessible from surface?- - El ® El
1—
0. Alarm or Control Panel Installed? - - ❑ IR El
E Control Panel equipped with Timer/ ETM I Counter- - El UI ❑
D
a Pump installed in ❑ Bucket or ® On Block or El Other
a• Pump Make/Model Liberty 280 IN Floats or 0 Transducer
a
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
Upna;P<1 8121/2018
a a15 /1 5"i ,'•.
Mason County OSS Installation Report pg. 2 Parcel# 2C) I 5S62'C I
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES ,1ko
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 record and must De accurate and descriptive enough to re-locate in time need of maintenance activities and future development Typical Record
Drawings col-tan. Draintreld&manifold oner abon&layout.Sepecipuinp tank locatan.North arrow,reserve drae Geld.existing arcl proposed twitl.nps,location of eels.watednes.
wells.observation ports-deanouts.and other maintenance access pants Incomplete Record Dra,..iys may create adhdona delays in final installation approval and related permits.
[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 Slate 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
fo :nd all hed Record Drawing is accurate.
0 form and attached Record Drawing is accurate.
r#,
Si.r- re of Installer Date . #
�'---^ ram` , i ;f## /
Jc,c1C Jo k'is ##
Printed Name of Signee Sr': o#.r
rr ,
MASON COUNTY PUBLIC HEALTH �r #t
The undersigned approves this Installation Report and •: DESIGNER #
Record Drawing on behalf of Mason County Public Expir.ean7r Z S•,
Health:
Signature of Env' ental Health Specialist Date (stamp.signature and date)
-
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated&Dram
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