HomeMy WebLinkAboutSWG2022-00388 - SWG As-Built - 7/11/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00388 Parcel # 320215502034
Applicant Name TBC ENTERPRISES LLC, Subdivision (Name/Div/Block/Lot)
Applicant Address P O BOX 2503 SHORECREST TERRACE 2ND ADD BLK:2 LOT:34
City, State, Zip GIG HARBOR WA98335 Installer Name Jack Johnson
Site Address 41 E Yew Pl,Shelton Designer Name Jim Zimny
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑Repair ❑Other
System Type Pressure Distribution Pretreatment Type
>5 ft.from foundation? --------- ------ --- ------- -- ❑NIA Eyes ❑ No
>50 ft. from wells' - ---- ------ ------- --- -------- ❑ e ❑
Z >50ft.from surface water? ---------- -- -- -- - - - - ---- ❑ ® ❑
F Cleanout between building and tank? ------------------- ❑ ® ❑
V Tank baffles present? --- --- - ------------------ - - ❑ ■ ❑
e 24"access risers over each compartment?---- ------- ---- - ❑ ❑
rW Effluent fifter installetl?- ---- --- --- --- ------- ---- -- ❑ ® ❑
Septic lank capacity(working) 1200 Oal Manufacturer Hagemnan
0 D-box water level and speed levelers used? ---- --I ❑ WA ❑ YES ❑ No
p0 Manifokl/D-box accessible from surface?--- -- ------------ ❑ ❑u.
❑
GG Check valves installetl? -- - -- ------ - ---- -- -------- ❑ ❑ ❑
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercia"her
>10ft.from foundation?-- --- -- ------ ------------- ❑ NIA . yEs NO
O >100 ft.from wells?---- ---------- -- --------- -- -- ❑ ❑
-u >100 ft. from surface water? ---- -- ------------------ ❑ e ❑
W
LL >10 ft.from potable water lines? ❑ ■ ❑
QZ > 5 ft. from property lines and easements? ❑ E ❑
R >30 ft.from downgradient curtain/foundation drains?--------- - ❑ e ❑
O Drainfieki level and observation ports present ----- -- --- ---- ❑ e ❑
■ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- ❑ ® ❑
Pump tank setbacks consistent with septictank?------------- ❑ N/A . yes NO
Y Pump tank capacity(goad) 1000 Oal Manufacturer HAgerman
Q24"access riser(s)and accessible from surface?-- --- --- ----- ❑ ® ❑
aAlarm or Control Panel installetl? ------- -- ❑ ® ❑
Control Panel equipped with T-aner/ETM/Counter--- - - - - -- -- ❑ e ❑
0- Pump installed in ❑ Bucket or e On Block or ❑ Other
0" Pump Make/Model liberty 280 e Floats or ❑Transducer
E
yTank draw down 2 n/min Pump capacity 30 gpm Squirt Height 6' ft
Pump on time 1.15 secs Pump off time 4 his Daily flow set at 270 dpd
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Mason County OSS Installation Report pg. 2 Parcel a 3 20z SSO TO 3 7
ABANDONMENTRECORD
Were existing septic COmpnnents abandoned a5 pad of this project? -- -- ---- -- ----- ❑ YES Or NO
If yes, please descnbe. _
Were all components pumped out and properly abandoned per WAC246-272A-03001 ❑ YES ❑ NO
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system w accordance with I certify that the system has been installed in accor-
the septic design stamped'APPROVED'by Mason dance with the septic design slamped'APPROVED'by
County Public Health and that any deviations showu Mason Courtly Public Heath and that any deviations
here have been cleared/approved by boll,the designer shown here have been cleared/appreved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason Co my Codes Stale and Mason County Codes
I further certify that all information contained on this I further certify that all information contained orn this
for/�/N�a�n f ail d Rd Record Drawing is accurate. form and attached Record Drawing is accurate.
Si ..oflnslwler Date
TcL .�D�nSn�
Pdn(ad Name of Signeir >�
MASON COUNTY PUBLIC HEALTH
The undersgned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Hea1111:
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Sig lure of Environmental Plealth Specialist Dale (stamp.Signature and date)
THI S FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uia^Iw enmie
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APPROVED Bo
JUL 11 2024 _
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