HomeMy WebLinkAboutSWG2021-00144 - SWG As-Built - 6/9/2023 Mason County OSS Installation Report pg. 1 ac__ MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00144 Parcel # 32034-50-00011
Applicant Name Derek Johnson Subdivision (Name/Div/Block/Lot)
Applicant Address 10718 Crescent Valley Drive
City, State, Zip Gig Harbor, Wa 98332 Installer Name Pioneer Digging Inc
Site Address 200 SE Picadilly Drive Designer Name Bob Paysse
INSTALLATION CHECKLIST
Eull System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type rU)SLAA"k-- Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ®YES ❑ NO
>50 ft. from wells? - - ❑ ® ❑
Z >50 ft. from surface water? - - ❑ IN 0
4 Cleanout between building and tank? - - ❑ II 0
U Tank baffles present? - - ❑ III ❑
F- 24"access risers over each compartment?- - ❑ IN 0
W Effluent filter installed?- - 0 ® ❑
U)
Septic tank capacity (working) 1 500 gal Manufacturer Infiltrator
9 D-box water level and speed levelers used? - - ► ;_: I1J 2 Ei ❑ NO
DO Manifold/D-box accessible from surface?- 1a I '�� fit', � ❑
m2 Check valves installed? - I; MAy .L �23 ,U CI6Q {
2 Transport Line Size 2" Schedule/Class 1:
Bedrooms installed (check one) ID2 ❑■ 3 0 4 ❑ 5 El6 11 ElmrrJsr Other--
>10 ft. from foundation?- - ❑ YES ❑ NO
CI >100 ft. from wells?- - ❑ MI ❑
W CI>100 ft.from surface water? - - ❑ MI
L. >10 ft.from potable water lines?- - ❑ HI ❑
Q 50 CI
ft.from property lines and easements?- - 0
cc > 30 ft. from downgradient curtain/foundation drains? - - 0 ❑ ❑
ca
Drainfield level and observation ports present - - ❑ ❑ 0
❑ Graveless chambers or Ir Clean gravel used? (check one)
Proper cover installed over drainfield? - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES D NO
• Pump tank capacity (flood) 1500 gal Manufacturer Infiltrator
< 24" access riser(s) and accessible from surface?- - 0 II 0
F-
a Alarm or Control Panel Installed? - - ❑ II CI
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ I ❑
D
a Pump installed in 0 Bucket or ❑ On Block or ❑ Other
a• Pump Make/Model Liberty 280 ❑ Floats or 0 Transducer
0.
a Tank draw down 1 in/min Pump capacity 30+ gpm Squirt Height 24+ ft
Pump on time 1 min. Pump off time 4 hrs. Daily flow set at 360 gpd
Updated 8/21.2018
Mason County OSS Installation Report pg. 2 Parcel # 32034-50-00011
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - m YES El NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q■ YES 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. lyp:cal Record
Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings.location of wells.waterlines,
wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
al Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 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
4 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 and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
(21T6A-151,4P494d-e- --- (2-- 1 7-3
ignature of Installer Date
Robert H. Paysse 1,...
sh• y,Printed Name of Signee % I�' 'r �1
MASON COUNTY PUBLIC HEALTH 1 / �vr fi 4,Nl'1 .
The undersigned approves this Installation Report and S ' w
Record Drawing on behalf of Mason County Public ALE PA� . ��I
Health: .:�IMN�.—. • %%•%N.N.•%�•f.
Signature of Environment I Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21`2018
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SEPTIC TANKS --_----- _
LOCATION
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ASBUILT
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PIONEER DIGGING INC. CUSTOMER: DEREK JOHNSON SCALE I:30 1
ARCEL# 320345000011 TEST HOLE I: TEST HOLE 2 TEST HOLE 3:
SEPTIC DESIGNS ADDRESS: 200 SE PICADILLY DR "3 GLS 0-36 GLS 0-24 GLS
33+TILL 36+TILL 24-40 CMS
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT PAYSSE 40+TILL
OFFICE-360-426-1803 FAX-360-427-2353 DESIGN PAGE ASBUILT