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Home My WebLink AboutSWG2022-00228 - SWG As-Built - 6/6/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00228 Parcel# 32021-58-04028 Applicant Name Jerry Loudon Subdivision (Name/Div/Block/Lot) Applicant Address 7754 SE Monte Bella PL Shorecrest Beach Estates/Div 1l Blk 4/Lot 28 City, State, zip Port Orchard,WA 98366 Installer Name Ron Hemley Septic Installations Site Address 21 E Fir PL,Shelton,WA 98584 Designer Name Frank Marcinko INSTALLATION CHECKLIST e Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? ------------- J..[�IU�a�g}fL�Iy�LS V NIA eYES ❑ NO >50 ft.from wells? ---- -------- e ❑ e >soft.from surface water? ------------ �}q(�� Y q ❑ FCleanout between building and tank? ------------------- ❑ ❑ V Tank baffles present? - ---- -----------Bx++r:==—==--_� ❑ 1- 24'access risers over each compartment?---------------- ❑ e ❑ Q. Effluent filter installed?--------------------------- ❑ Cl N 50 Hagerman Pre Cast Septic tank size 12 gel Manufacturer 0 D-box water level and speed levelers used? --------------- ❑ WA eYES NO �J O Man''rfoldlD-box accessible from surface7-------- ❑ 19Z Check valves installed? ----- ---------- -- e ❑ ❑ 042 Transport Line Size 4" Schedule/Clan 3034 Bedrooms installed(check one) ❑ 2 W 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?--------------- -- --- ❑ WA eYEs ❑ NO 0 >100 ft.from Wells?----------------------------. ❑ e ❑ W >100 ft.from surface water?------------------------ El e LL >10 ft.from potable water lines?---------------- ❑ ❑ E.0.51 ve K >5 ft.from property lines and easements?---------------- ❑ e ❑ >30 ft.from downgradient curtain/foundation drain?---------- ❑ e ❑ 0 Dreinfield level and observation ports present ---- ---------- ❑ e ❑ e Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over dminfield?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?------------- a WA ❑ YES ❑ NO Y. Pump tank size gal Manufacturer Q24-access riser(s)and accessible from surface?------------- ❑ ❑ ❑ aAlarm or Control Panel Installed? ---------- ❑ ❑ ❑ rL Control Panel equipped with Timer/ETM/Counter--- ------ -- ❑ ❑ ❑ 7 a Pump installed in [I Bucket or ❑ On Block or ❑ Other fPump Make/Model ❑ Floats or ❑Transducer a Tank draw down—in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gPd upw.avtvmre Mason County OSS Installation Report pg. 2 Parcels ABANDONMENT RECORD Were existing septic components abandoned es pan of this project? - -- - - - - - - - - - - ❑ YES ® NO If Yes, please Cesalbe'. Were all Components pumped out and properly abandoned per WAC246-272A-03007 - - -- - - - - ❑ YES ❑ No RECORD DRAWING Tna Is a P.m• .m recoml me remr a.e N r. .W eocHpnw.naapn io reawxa w M.n.w.r m.Inbruirc..e�Nxaw..d NI..e...lopwao Ty R— ow,vm.wnisR�IMsmW I m.e m.naron a Ivan. s—.. sss.a.NMe..mmP.ae w P.w°ma..wamn a.nM..raam.., mil..ee.a.enm Pon.Wwan..a.e near menronmw.cw.pdro. Iricamplea R.npe Ora'Mry.m.y re.a..vemnsl e.lry.In ma N.M.EOP.Pge.a ale iWaa pmna. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 certify that 1 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/epproved by both the designer shown here have been c/e ted/approved by both and Meson 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 I further certify that all information contained on this form and attached Record Drawing is accurl form and attached Record wing is accurate. ZI\ CCPISC � t' natur ofins Ile Date Printed N e of gnee MASON COUNTY PUBLIC HEALTH to ufr The undersigned approves this Installation Report and 20100609 Record Drawing on behalf of Mason County Public Frank A.Marpnko LICENSED DESIGNER Health os Signature of Environments Health Specialist Date (stamp, signature end date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UpOgiepR1n010 Record Of Construction 64' +- N 5' X SL#3 15'X 50' 100%Reserve Area APPROVED 26'8-x,,Manofacb JUN 06 2024 "-Me ea b- MASON COUNTY ENVIR044ENTAL HEALTH t RET + r b , 7B.. ft i I i Sleeved WaterLinesery i 3P F9a 64' +- mtaoeos m� 40'ROW E Fir Place Frank A.Mamnko 1 LICENSED DESIGNER Septic ROC Scale = 1" = 20' Address: 21 E Fir Place, Shelton Tax parcel#32021--%-04028 Name: Loudon he.net n ewvepall proyertY llnee/boundanes knee been demonstrated by lke f eneds)and/or their Agent(s). Dn-She Septic Design I Allied Septic Design and Excavating