HomeMy WebLinkAboutSWG2022-00385 - SWG As-Built - 7/19/2024 r
Mason County OSS Installation Report pg. 1 N ASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMA7 1ON
Permit Number SING 2022-00385 Parcel if 22017 5100069
Applicant Name TBC ENTERPRISES LI-C. Subdivision INA melDiv/61ocIdLot)
Applicant Address P O BOX 2503 TIMBERLAKE f9 rR 69
City, State, Zip GIG HARBOR WA96335 Installer Name Jim Zlrnnv
Site Address 30 E Park Or Designer Nam Jack Johnson
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑Drainfield Only ❑R pair ❑Omer
System Type Pressure Distribution Pretre nt Type
>5ft.from foundation? ----- ---------------------- ❑wA Eyes ❑ NO
>50ft.from wells? ----- ----- ------------------- ❑ ■ ❑
Z >50ft.from surface water? - -- --------------------- ❑ 0 ❑
Q Cleanoul between building and tank? ------------------- ❑ ® ❑
() Tank battles present? --- ------------------------ ❑ ® ❑
1- 24'access risers over each compartment?--------------- - ❑ ❑
ul Effluent fitter installed?- ----- -- - - --- --- - -- ------ - - ❑ E ❑
rn
Septic tank capacity (working) 1200 hat Manufacturer Hagerman
0 D-box water level and speed levelers used? -- -- ----------- E" ❑ yes NO
00 ManifokVD-box accessible from surface?----------------- ❑ ® ❑
dl LL
z Check valves installed? ---- - - - ------------------- ❑ ❑
0.1
f Transport Line Size 2- Schedule/Class Son 40
Bedrooms installed (check one) ❑2 ®3 ❑4 ❑5 06 ❑Commercial/Other
>10ft.from foundation?-- - -- --------------------- ❑ NIA ■ yes NO
t] >100fl. fromwells?-- -- - ------- - -------------- ❑ ❑
w >100 ft. from surface water7 -- ---------------------- ❑ ❑
LL >10ft.from potable water lines?- ---- -- --- ------------ ❑ ❑
Z > 5ft. from property lines and easements?---------------- ❑ ❑
Q
K >30ft.from tlowngratlient curtainttouMation drains?---------- ❑ e ❑
Drainfield level and observation ports present --- -- - ❑ ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfield?------------------- ❑ ® ❑
Pump tank setbacks consistent with septic tank?------------- ❑ N/A ❑ yes ❑ NO
Y Pump tank capacity(flood) 1000 at Manufacturer Ha erman
Q24-access riser(s)and accessible from surface?------------- ❑ ❑
H
a Alann or Control Panel Installed? ---------- ----------- ❑ � ❑
Control Panel equipped with Timer/EIM/Count"----------- ❑ ® ❑
tL Pump installed in ❑ Bucket or ® On Block or ❑ Other
C Pump Make/Model Libeny 290 0 Floats or ❑ Transducer
Q. Tank draw down 2 in/min Pump capacity 40 opi i Squirt Height s' n
Pump on time 1 Min 16 Sec Pump off time 4 Hra Daily flow set at ??n gPd
omam vnrmie
Mason County OSS Installation Report pg. 2 Parcel N2261 odU
ABANDONMENT RECORD
Were emsbng Septic components abaMoned as pan of this Plolect? - - - -- - - - - - - - - - ❑ YES 51 No
It yes, please descrtbB'
Were all comporents pumped out and propedy ab md pe anciorr WAC246-272A-03DO.. . ---- . ❑ YES ❑ NO
RECORD DRAWING
wT..,.,a... u...,s.«� .�, a. .m..,ei•,w.s.w�,..m�..a..... wm...�. �..:a« >b waa..anr..m.r,b.aw,..a...+.
Record Drawing Attached
CERTIFICATION OF INSTALLATIC IN
INSTALLER DESIGNER/E INEER
I certify that I installed the system in amnNarnce with I ,rtdI that the s slom has been installed in accor-
the septic design stamped`APPROVED'by Maser dance with the So Fik design stamped'APPROVEO'by
Coady Public Health and that any deviations shown Mason County Pt blic Health and that any deviations
here have been cleareNapproved by botlr the designer shown here have been cleared/approved by both
Simi Mason County Public Health and moot NI State myself and M County Public Health ail meet all
and Mason County Codes. State and Mason Cotmty Codes
I fadher teddy that all information,contained in this 1 further certify M. t aft rnfornahon contained on this
(o/rnard allaghed Recod Drawing is acia rate. form mW attaGa Rocord Drawing is attwale.
Ill(/-�l}rGYA il^ (0 - it&Z
SiDWsi,of Installer Dale
Pmrted Name of Sgnee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Region and .
Record Drawing on behaP of Mason County Mlblic
Health
Slgnatl..sor Healh Spaueist Dale (a tamp.signature and date)
THIS FORM MAY BE SCANNEOAND AVAILABLE FOR PUB-IC%EWONT MASON COUNTY BSITE MauMbxrN�e
E
Z n 0
73T o
.a o 0
`w
O N d .� q x y a a m N N OI V ti
N
W
� gAA'Q
rs oycoGy�Ftil/y O��
m
R O Q
m
m
ti
v �
pM
W N
E
E
0
0
v`
W in
m iD
Z*V
m
N
Q
^ IA
'-I
O
N
9 e-1
a