HomeMy WebLinkAboutSWG2022-00313 - SWG As-Built - 9/13/2024 Mason OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-0313 Parcel# 220175000043
Applicant Name TBC Entwpnses Subdivision (Name/Div/Block/Lot)
Applicant Address P O BOX 26M GIG HARBOR WA 98335 TIMBERLAKE#2 LOT 43
City, State, Zip GIG HARBOR WA 98335 Installer Name Jack Johnson
Site Address W a iAKESHORE DR e.SHWL 98584 Designer Name Jim➢mny
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑Drainfield Oniy ❑Repair ❑Other
System Type Pressure Distribution Pretreatment Type
>5 ft. from foundation? -- --- ------- ------- -------- ❑NIA E YES ❑ NO
>50ft.from wells? - -- - -- --- - --- --- --- -- - - --- --- ❑ ■ ❑
hd >50ft.from surface water? - - - - - - - -- - - ---- --------- ❑ ❑
H Cleanout between building and tank? ------ ----- -- - ----- ❑ 0 ❑
U Tank baffles present? - --- -- - - - - -- - - - - - -- - - - - - --- ❑ ❑
a24-access risers over each compartment?--- ------- ------ ❑ ❑
NEffluent fitter installed?-- - -- - --- ----- ----------- --- ❑ ❑
Septic tank capacity (working) t200 gal Manufacturer Hagerman
0 D-boxwaterlevelandspeedlevelersused? - --- -- - --- --- -- EN/A ❑ YES ❑ No
pLLMani(old/D-box accessible from surface?- - --- --- ---- ---- - ❑ ® ❑
Check valves installed?
act
-- - - - -- -- - - - -- -- - - - -- -- - - - ❑ ❑
f Transport Line Size 2" Schedule/Class Sch 40
Bedrooms installed (check one) ❑ 2 ®3 04 ❑ 5 08 ❑Commercial/Other
>10ft.from foundation?-- - - --- -- - - - -- -- - - ----- - - - ❑ NIA ■ YES ❑ NO
0 >t 00 ft. from wells?- - - - -- -- -- -- - - - - -------- -- -- - ❑ 0 ❑
W >100ft. from surface water? --- ---- --- ------ -- ----- - ❑ ❑
LL >10 ft. from potable water lines?- ------ - ---- -- -- ----- - ❑ M ❑
Qz > 5 ft. from property lines and easements?- --- - - ------ -- - - ❑ 0 ❑
C > 30 ft, from downgradient curtaintfoundation drains?---- - - -- - - ❑ ❑
Dminfield 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?- - ---- - ----- - ❑ NIA EYES ❑ No
Y Pump tank capacity(flood) 1200 gal Manufacturer Hagerman
Q24-access riser($)and accessible from surface?---- --- - -- -- - ❑ E ❑
aAlarm or Control Panel Installed? ---- - -- - - - --- - --- - - - - ❑ 0 ❑
Control Panel equipped with Timer/ETM I Counter- - - -- - - - - - - ❑ ❑
a Pump installed in ❑ Bucket or e On Block or ❑ Other
a Pump Make/Model Liberty 1280 0 Floats or ❑ Transducer
a
Q.
Tank draw down 2" in/min Pump capacity 40 gpm Squirt Height 5' ft
Pump on time i f0 Min on Pump oft lime 4 hm off Daily flow set at 270 gpd
Mason County OSS Installation Report pg. 2 Pane. a Z Z 01 7 !;- 000y 3
tic
ABANDONMENT RECORD '
tigers existing sep ewnponanb abandoned as part of Us ct9 e proja - - - - ---- ------• ❑ YES 4d' ^0
If yes,pease describe' —
vvere aN cmnporwe nts pumped Out and properly abandoned per WAC24&2y2A,0300T. -- -_-- . ❑ YES NO
RECORD DRAWING
Taw w•r..x�,�,l,maa.xe,.,r r�,.r..m a..a.:q�+..ro,gl,m m+..w o r,»w nl».Im»,.,...,.x.n,«..a Iwx.en.l.m..m. .wval rwao,a
.m�...mwu..,..e:»...aau.:.rm,.<..a...w::, wz».a.»e�.ea..-.n:.,...».,..........,,.,w.,,.,,..u..».: ,.,a ,a.l.l m.,,n•
-Wcord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER OES-IGNER/ENGINEER
/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
COunly Public Health and that any deviations shown Mason Counly Public Health and that any deviators
here have been cleareansuproved by both file designer shown here have been cleareNepproved by both
and Meson County Public Health and moot all State myself and Meson Cormly Public Health mid n*0 all
and Mason County Cases. State and Mason County Codes
I hotharcadMy,that all inlormaton contained an this I further caddy Mal all adamafion comigned on this
to no all Record Drawing Is accurate. toms are/attached Recital!Drawing is accurate.
I 8-2 y-2y
Si ollnaalor Date
\M E� N�✓1S(iYl
Pointed Name W Sigrlee
MASON COUNTY PUBLIC HEALTH �q
The undersigned approves this Installation Report mid '� n
Record Drawing at bshaf of Mason County Public en ?a
Health
Srgnauro of Envi nm fat Hear SPecrabsf Dare (3lemp,signature Mid Clete)
THIS FORM MAY BE SCANNED AND AVAIIABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE.
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APPROVED
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SEP 13 2024
k,AASON COUNTY EWR0F4ENTAL HEALTH
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