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HomeMy WebLinkAboutSWG2022-00389 - SWG As-Built - 3/20/2024 CLEAR FORM - Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00389 Parcel # 220185000070 Applicant Name TBC; Enterprises Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 2503 TIMBERLAKE #1 LOT: 70 City, State, Zip Gig I larbor WA 98335 Installer Name Jack Johnson Site Address 800 E Lakeshore Dr West, Shelton Designer Name Jim Zmny INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair 0 Other System Type ATU to Pressre distribution Pretreatment Type Enviroflo BNR 500 >5 ft. from foundation? - - ❑N/A ® YES ❑ NO >50 ft. from wells? - - ❑ ® ❑ Z• >50 ft. from surface water? - - El ® ❑ Q Cleanout between building and tank? - - 0 II o Tank baffles present? - - ❑ © ❑ a24" access risers over each compartment?- - El ® 0 LU Effluent filter installed?- - ❑ It ❑ co Septic tank capacity (working) 500 gal Manufacturer Hagerman Ct D-box water level and speed levelers used? - - ElN/A ElYES ❑ NO oO Manifold/D-box accessible from surface?- - ❑ III ❑ CO Z Check valves installed? - - ❑ ® 0 6Q 2 Transport Line Size 2" Schedule/Class Sch 40 Bedrooms installed (check one) ❑ 2 E 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ NIA ® YES ❑ NO • >100 ft. from wells?- - 0 ® 0 W >100 ft. from surface water? - - ❑ it LL >10 ft. from potable water lines?- - ❑ ® ❑ z > 5 ft. from property lines and easements?- - ❑ IC d > 30 ft. from downgradient curtain/foundation drains? - - ❑ NI ❑ • Drainfield level and observation ports present - - ❑ ® ❑ ti Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ gi 0 Pump tank setbacks consistent with septic tank? - - El N/A II YES ❑ NO • Pump tank capacity (flood) 1000 gal Manufacturer Hagerman Q 24" access riser(s)and accessible from surface? - - ❑ ® ❑ 1-- Alarm or Control Panel Installed? - - ❑ 0 ❑ a 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ a ❑ D a• Pump installed in ❑ Bucket or II On Block or ❑ Other a. Pump Make/Model Liberty 1280 IN Floats or ❑ Transducer 2 a Tank draw down 2 in/min Pump capacity 40 gpm Squirt Height 5' ft Pump on time 1 min 10 scs on Pump off time 4 hrs Daily flow set at 270 gpd Updated 8.121r2O18 Mason County OSS Installation Report pg. 2 Parcel# 0000 20 ABANDONMENT RECORD Were existing septic components abandoned as part of this protect') ❑ YES L1 NO If yes, please describe ---------__ -.. ----.--__---- Were all components pumped out and properly abandoned per WAC246-272A-0300? - - -- - - - ❑ YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development. ryl.:.:d firrnrn I k.nvetgs roman ikannheid b manifold onerta t on d layout.Soo bclgmp tank location.Not anion. rt-ctvve&ae4,Mt existing ant tecnc cnC to.k 1 ogc Iy:Akio of*Ai..eral.iInes. obseivaIa t'prsts.!k'.i,tNA:ii,attil nein maintenance-access pries ktctJsThrdt Ie Recoil(kave'os may create ah detnal nalays in final nsi iahrn arrrrwat aryl rglilml p.vn.lc aRecord Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 certify that I installed the system in accordance with 1 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 all information contained on this 1 further certify that all information contained on this lout 'Ind aft bed Record Drawing is accurate. form and attached Record Drawing is accurate. 1/147\ 3 - l - Z y --- Sig t era of Installer Date Jet tr,Vi s3 ' Printed Name of Srgnee '•�tj MASON COUNTY PUBLIC HEALTH '- The undersigned approves this installation Report and Record Drawing on behalf of Mason County Public fSsx, r;. _> Health 3 Z ,Z U (z Sign ure of Environmental Health Specialist Date (stamp, signature and(late) w.ta:"1 8 .511A THIS FORM MAY fit SCANNLt7 AND AVA! AftE FOR PUBLIC ViEW ON 1HE MASON COUNTY WEB SiTE 1t M aQ aaogsapi rip LnI I ~ o 11 q:/0 CO 1 0 °? l nl 1 Q 1 LI a) a 1 n ` . i' i w 1 1 1 1 1 O El O 1=� i 1 CD awoH wooapaq E p 2 1 (--, G 7D O O ril d fi S y, rn ru — Lo O 01 rn n a) 70 w J 5 N V v, I ro ��/ II o0 7- D on o r) ' �" I NJ 0 2 9 n O •r "•' ��1 < 5,___7 7'4 7`' , L 1 -