HomeMy WebLinkAboutSWG2022-00031 - SWG As-Built - 8/14/2023k
CLEAR FORM
A. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT! PERMIT INFORMATION
Permit Number SWG -2022-00031 Parcel# 320215602030
Applicant Name TBC ENTERPRISES Subdivision (Name/Div/Block/Lot)
Applicant Address PO Box 2503 Shorecrst Terrace 3rd Add lot 30, Blk 2
City, State, Zip Gig Harbor WA 98335 Installer Name Jack Johnson
Site Address 580 E Wood Ln Designer Name Jim Zmny
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other
System Type Pressure Distribution Pretreatment Type
>5 ft. from foundation? - - ❑N/A ®YES 0 No
>50 ft.from wells? - - 0 IN 0
Z >50 ft. from surface water? - - 0 MI
HCleanout between building and tank? - - 0 II
• U Tank baffles present? - - El ® ❑
a24"access risers over each compartment?- - El II El
rW Effluent fitter installed?- - 0 ® 0
Septic tank capacity(working) 1500 gal Manufacturer Infiltrator
inD-box water level and speed levelers used? - - IIN/A ElYES El NO
0O Manifold/D-box accessible from surface?- - Elle ❑
u.
CO Check valves installed? - - 0 ® ❑
oa
2 Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) 0 2 1113 ❑4 0 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A ® YES ❑ NO
0 >100 ft. from wells?- - 0 ® ❑
11 >100 ft. from surface water? - - ID ® El
u.. >10 ft. from potable water lines?- - ❑ ® ❑
Z > 5 ft. from property lines and easements?- - ❑ ® ❑
Ce > 30 ft. from downgradient curtain/foundation drains? - - El IN ❑
Drainfield level and observation ports present - - El IN ❑
IN Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑ cri
Pump tank setbacks consistent with septic tank? ❑ N/A III YES 0 fro D
P g
ZPump tank capacity(flood) 1500 gal Manufacturer Infiltrator i o
< 24" access riser(s) and accessible from surface?- El ® 0 I
~ Alarm or Control Panel Installed? - - El IA 0 1 .3 c
Control Panel equipped with Timer/ETM/Counter- - 0 IF 0 i `'' l4'
m
a. Pump installed in 0 Bucket or NI On Block or ❑ Other
r'L Pump Make/Model Liberty 280 ® Floats or ❑ Transducer
Ilk Tank draw down.____1.1._._.in/min Pump capacity , 40 gpm Squirt Height 5' ft
. Pump on „Ittliri 25 s Pump off time h►'s Daily flow set at 270 qpd
Upiatoi W?/2018
Mason County OSS installation Report pg. 2 Parcel#_ J�ri`Z% ,6ZO30
ABANDONMENT RECORD
Were existing septic components abandoned as part of this protect? - ---- - 0 YES ,Iiii "NO
if yes. please describe:
Were all components pumped out and property abandoned per WAC246-272A-0300? 0 YEs ❑ NO
RECORD DRAWING
Tills Is a perman.nt record and must be accurate and Mac pbm enough to re.tocala fn the need of matn4+unce acINnles and faux,development. Typd R000d
Drawlnys corten. Or afnrrNJ&11,2VvkaAd ooertaoon&layout.Sete,putup Vine locaeor•.Noe,orrow.MAR*era.aest,car g;Inn proposed a dc&gs,ac:rodn ot..aes.o a4eru1es,
netts.otl5ermlaon lots.cfeerOuts.and other endiOlendrte avows roen-, Incomplete Reccad D1aautgs may Oeate a:lex:m i de!ar.L'I Ord,nd&et1 approval end related om"ats.
APPROVE :
AUG 14 2023 j''''
MASON COUNTY ENV!RON1MENTAL HEALTH
,.
.LBW
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 State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that ail information contained on this t further certify that all information contained on this
loan nd aft hed Record Drawirxt is accurate. form and attached Record Drawing is accurate.
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Sly are of Installer Date t,
� n .0 C- -- IA lee°.?nit-i : .., ter,..
Printed Name of Signee K °1
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MASON COUNTY PUBLIC HEALTH ct ; �jr1'
The undersigned approves this installation Report and ,..' . `' R
R Pawing on behalf of Mason County Public ±�r
Health:
6\eve} ....„ q--Iii3
St alu a -• Health Cpw� d Date _.
(stamp,signature and dale)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tatted a?"'
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