HomeMy WebLinkAboutSWG2022-00124 - SWG As-Built - 6/28/2023 CLEAR FORM
Mason County OSS Installation Report pg. 1 C,�, MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG -2022-00124 Parcel# 320065001058
Applicant Name TBC ENTERPRISES Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2503
City, State, Zip GIG HARBOR WA 98335 Installer Name JACK JOHNSON
Site Address 1901 E ISLAND LAKE DR Designer Name JIM ZIMNY
INSTALLATION CHECKLIST
111 Full System Installation ❑Tank(s)Only ❑Urainfreid Only ❑Repair u Other
System Type PRESSURE BED Pretreatment Type
>5 ft. from foundation? - - 0 N/A 111YES ❑ NO
>50 ft.from wells? - - 0 IN 0
>50 ft.from surface water? g�
Z -
' -� El❑ III ❑li ❑
Qt— Cleanout between building and tank? -----
U Tank baffles present? - - r k--ft2_ 0 I ❑
1= 24"access risers over each compartment?- - 0 ® 0
a ® ❑
W Effluent filter installed?- 13311:- —❑
cn HAGERMAN
Septic tank capacity (working) 1200 gal Manufacturer
CI D-box water level and speed levelers used? - - ® N/A ❑YES ❑ NO
0
�O Manifold/D-box accessible from surface?- - ❑
oil Z Check valves installed? - - 0 ❑ III
ci a g Transport Line Size 2" Schedule/Class SCH 40
Bedrooms installed (check one) ❑ 2 ®3 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ NIA ® YES ❑ NO
G >100 ft.from wells?- - ❑ ® ❑
W El ® El
ft.from surface water? - -
u. >10 ft.from potable water lines?- - 0 I ❑
1 -g > 5 ft_from property lines and easements?- - 0 I Eld >30 ft.from downgradient curtain/foundation drains?- - ❑ I ❑
CI
Drainfield level and observation ports present - - ❑ In 0
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfiekt?- - 0 1 0
4 Pump tank setbacks consistent with septic tank?- - ❑ N/A ® YES 0 NO
Pump tank capacity(flood) 1200 gal Manufacturer HAGERMAN
< 24" access riser(s)and accessible from surface?- - 0 ® 0
H
a Alarm or Control Panel Installed? - - El 0
2 Control Panel equipped with Timer/ETM/Counter- - 0 II 0
m
n- Pump installed in 0 Bucket or In On Block or ❑ Other__
a Pump Make/Model LIBERTY L 280 Floats or ID Transducer
2 a. Tank draw down 2 in/min Pump capacity 40 gpm Squirt Height
5' ft
a
Pump on time 1MIN 5 SEC Pump off time 4 HR Daily flow set at 270 gpd
Updnud 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel#_ 1`BOO (D 5 00 ( GS
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - ❑ YES -R-14°
if yes,please describe: .
Were all components pumped out and property abandoned per WAC246-272A-0300?- - 0 YES ❑ NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to adocab in tie teed of Matalmence activities and Muni development TYpd Rcaord
Drawings contain: Druin?eld&manifold ofientaton&Iayo t,Sesain`pomp t.tnk bustion,Hada mane,reserve*wade, and pa:posed bu9d ngs,bcatan of saes.vas.
walls.observation puns.deanouts.and otiter mairtenarce a:cess infr t eRamNccf=Rocud tbawings trey Craft 110960rd debts ir 5nsl vn1a1 stun approval and rde ell PerMitt
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 acco-
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 rneet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I furthercertly that all information contained on this
I . - •nd a l r tied Record Drawing is accurate. form and attached Record Drawing is accurate.
rrir
': of Installer Data ��
�JG~c Lr1Sn t►rir ,f
Printed Name of Signee E . V ft
.t
i( ��,. _
MASON COUNTY PUBLIC HEALTH ,x�.. it
The undersigned approves this Installation Report and = "` �' R r
Record Drawing on behalf of Mason County Public eqIr.eesmi- _ %tr
Health:
l'''Iq- CC(2-?/Z3
Signature of Environmental Health SpeciaJ+st Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON TIE MASON COUNTY WEB SITE 1)03724il•2114/8
•
/
i
\
/1 5 0' ,' \
,I \
,/ \
It \
•
iI \
� \
0 I 1
O I
rD I � 1�*
PO
= 1 ;
VI N' 1
1 \ i
\ \, l
\ \ 1 \ i
\\ \ \ 1 N.i
\ \ N 1 ,--
\\ \ .
D. : ,
0 e7T Radh4s
•
.. 1 • •�, 1v
� 1 °o
D
APPROVED `00
,
0 ► O C
JUN 2 8 2023 1 °
-, 1
MASON COUNTY ENVIRONMENTAL HEALTH 7 i
7 •
RET CDI
I
I
I
I
I
I
I
I
I
I
0
I
i
I
I
I fD = N
I Itil E
1 fD
I
i
i
I
i
a��, Put\s13
a
G
731 su A% �y. ---jJ "0 Ai J 'CI 'D -.I ttt rD O
up ,-r �_ r ^r,t t
N (D (D M N N n ('1 8p' N '`"'•�i7f�t�_ G
II 1..-, o w H i
fn a) •m itt
m 5-
0 CZ'
0 gli -0 •O n• Owo - O Vi7� 5.'� '—'
ofD N c. rr-' ;p -- 0
o 6 z s_
VI tit I R 1 1