HomeMy WebLinkAboutSWG2023-00007 - SWG As-Built - 3/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMI' iNFORMAT1ON
Permit Number SWG 2023-00007 Parcel # 22007-50-00020
Applicant Name Bob Bryson Subdivision (Name/Div/Block/Lot)
Applicant Address 819 S. Jackson Ave Timberlake Div. 7 Lot 20
City, State, Zip Tacoma. WA 98465 Installer Name T.J Goos
Site Address 31 E. Iron Wood PI., Shelton Designer Name Dale L. Tahja
INSTALLATION CHECKLIST
it Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure Trench Pretreatment Type
>5 ft. from foundation? C 'e--' - ❑ N/A ®YES ❑ NO
>50 ft. from wells? - •- El IN ❑
Z >50 ft.from surface water? - ____________.� III CI
Q Cleanout between building and tank? - i-%II-4 A ® ❑
1--
- V Tank baffles present? - - ® ❑
a24" access risers over each compartment?--- --LZ-Q a 202.3- MI ❑
N Effluent filter installed?- - - - .- ® CI
Septic tank capacity (working) 1,250 Hagerman
OD-box water level and speed levelers used? - - ft NSA ❑ YES El NO
DO Manifold/D-box accessible from surface?- - CI IN El
mZ Check valves installed? - - ❑ ® ❑
oa
2 Transport Line Size 2 inch Schedule/Class Sch. 40
Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ® YES El NO
Ca >100 ft. from wells?- - El Li Cl
W >100 ft.from surface water? - - ID in CI
ti. >10 ft.from potable water lines?- - ❑ ® ❑
ZQ > 5 ft. from property lines and easements?- - 0 ® ❑
2 > 30 ft. from downgradient curtain/foundation drains? - - ❑ If ❑
ca
Drainfield level and observation ports present - - ❑ ® ❑
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistent with septic tank? - - El N/A It YES ❑ NO
ZPump tank capacity (flood) 1,000 gal Manufacturer Hagerman
< 24" access riser(s)and accessible from surface?- - ❑ ft ❑
a
Alarm or Control Panel Installed? - - ❑ M ❑
2 Control Panel equipped with Timer/ETM /Counter- - ❑ PO ❑
D
a Pump installed in ❑ Bucket or ® On Block or ❑ Other
d Pump Make/Model Liberty 280 El Floats or ® Transducer
Ci, Tank draw down 1.75 in/min Pump capacity 36 gpm Squirt Height 6 ft
Pump on time 3 Pump off time 5 hrs 57 min Daily flow set at 270 gpd
Updated 8/21/2018
Mason County OSS Installation Report pg.2 Parcel# Z(&-- -.1Ci ."-EXTh
ABANDONMENT RECORD
Were existing septic components abandoned as part of this protect? - - 0 Yes No
If yes, please describe: Q
Were all components pumped out and property abandoned per WAC248-272A-0300? - - 0 YESNO
RECORD DRAWING
rids le a permanent record and must be accurate and descdpeke enough M rriocata in Ms need of maintenance activities and future development. Vital Record
Drawings contain: DnMI eid d manifold orientation&layout,6epddprmnp tank kcsdon,North arcw.roserve drandfeld e>dMing and Proposed holdings.(oredm of wails,wateitines,
walla observation ports;,deanouta,and other maintana me access paints. Incomplete Record Drawings may create additional delays In tfiel Instaibilion 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 Meson County Public Health and that any deviations
hem 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 and attached Record Drawing 1s accufate. form and attached Record Drawing is accurate.
- '-': ..,/-- -e-T-
01.
Signature of Installer + Date -N� q.. ••
1-3 (''►CSC'' S • ,.� oE '.h tit
Printed Name of Signet fi c
MASON COUNTY PUBLIC HEALTH ''`j�-if
�'"~ �V''' S1W214 `��`i�
The undersigned approves this Installation Report and ��
Record Drawing on behalf of Mason County Public „i O'� DALE L.TAHJA ii�
A' LICE..I45E_) DESIGNER s
Health: ..`.sage. €., `, ::=`• a..e.�����. r,
P --r(L-ttti\ ✓ �,✓] �_Zz/2 3 EXPW:}: . -
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UPdabla 8121ao18
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