The URL can be used to link to this page

Home My WebLink AboutSWG2022-00555 - SWG As-Built - 10/7/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00555 Parcel# 32021-59-03048 Applicant Name Derek Floyd Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 Shorecrest Beach Estafest2048 City, State,Zip Allyn,WA 98524 Installer Name Allied Septic Design and Excavating Site Address "` E Kingston Way,Shelton Designer Name Frank Maminko INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Lowridge Technologies Oscar X02 pretreatment Type Aeration in Septic Tank >5ft.from foundation? ----- ---------------------- ❑WA Nys El NO >50 ft.from wells? - -------- ------------------- - ❑ E ❑ Z >50ft.from surface wateR - - ---------------------- ❑ 0 ❑ HCleanout between building andtank? --- ---------------- ❑ ❑ V Tank baffles present? ------- -------------------- ❑ e ❑ a24"access risers over each compartment?---------------- ❑ ® El NEffluent filter installed?--- --- ------ --------------- ❑ ❑ Septic tank size 1000 dill Manufacturer Hagerman Pre Cast 0 D-box water level and speed levelers used? --- - ----------- EWA ❑YES NO O0 Manifold/D-box accessible from surface?------ ----------- ❑ e ❑ rQ= Check valves installed? ----------- -------- - -- --- - ❑ ❑ o< Y Transport Line Sae 1' Schedule/Class Sch 40 Bedrooms installed(check one) ❑2 e 3 ❑4 ❑ 5 ❑6 ❑CommorciaVOlher >10 ft.from foundation?-- -------- --- --- - --- ----- - ❑ WA ®YES NO >100 ft.from wells?---- ------ ----- - ❑ ® ❑.. m >100ft.from surface water? ----------------------- - ❑ ® ❑ LL >10ft.from potable water lines?---------------------- ❑ N ❑� aZ >5ft.from property lines and easements?- --------------- ❑ N ❑ I _9 R' > 30ft.from downgradient curtain/foundation drams?---------- ❑ e ❑ Drainfield level and observation ports present ------ ❑ e ❑ e Graveless chambers or ❑ Clean gravel used? (check one) �= > Proper cover installed over drainfield?------------------- ❑ 0 ❑ }� CD O W �C Pump tank setbacks consistant with septic tank?- ------------ ❑ wA ® vm ❑ ro tt I t/1 Y Pump tank size 1000 dal Manufacturer Hagerman Pre Cast - Q24"access dser(s)and accessible from surface?------------ - ❑ ❑ i l C aAlarm or Control Panel Installed? --------------------- ❑ E ❑ i Control Panel equipped with Timer/ETM/Counter---------- - ❑ 0 ❑ ss e- Pump installed in M Bucket or ❑ On Block or ❑ Other gPump Make/Model McDonald/Lot 30 0 Floats or ❑Transducer a Tank draw down NA in/min Pump capacity 30 gpm Squirt Height NA ft Pump on time 32 sec pump off time 3 min 28 sec Daily flow set at 360 gpd Ig0Yf W W O Mason County OSS Installation Report pg. 2 Parcel# 32021-59-03048 AEIANDONMENT RECORD Were existing septic components abandoned as part of this project? --- ❑ YES ® NO If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? --- ---- - ❑ YES ❑ NO RECORD DRAWING ml.I..pendant rwN and roust M aswre•am CxNpew eneude to ra- mft In use need er maliamwo smileless and Nhxe d...luym mL Trolcal Remrd orevMpa oral Dnlnn.w S mmnua Brand.n IryM,samidpomo lam I.W..W,th amw.—.,a drelr?wW,..am,aM ard,led mahli, loraum awen..wabnma.. wells,omenwaum dons,tl-rand ,and man mainderame a aisl peal. lnmmplele Ramra Drawmpa mar oeale eaefJonal ealays menm m.lanalbn eppmv.leM relelea pennna. ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certity 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 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 myselfand 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 BY information contained on this form and attacheM Dry+- is accurate. form and attached Record wing is accurate. 10/01/24 Signature of Installer Date �P 1 e Frank Marcat S Pentad NameName o/Signee MASON COUNTY PUBLIC HEALTH ! ZOIonfi99 F The undersigned approves this Installation Report and Frank A.M::ronko Record Drawing on behalf of Meson County Public LICENSED DESIC-'.ER Health: Signature ofEnvironmenlal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVNLAHLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE udea.eamnola Y Record Of Construction \l El+D' '00 APPROVED }a 1 OCT 07 2024 MASON COUNTY ENVIRONMENTAL HEALTH EI+3' a� RET A\�a % ;•• •C' tic' ` L# 1 .f ¢ SL#2' x 4 20700E"9 g, Q EI+2' F *K K'sonko .L LICENSED Dr SIGNER DPo.lila El+4' Septic ROC Name:Floyd Tax Parcel: 32021-59-03049 Scale= I"= 20' Address: `a` E Kingston Way,Shelton ' nth l[�a16[4MnBOmPertyRS/1faYlldirCS IBYa EeaOdempmtraY¢d bYl�o»rPrnl yd/af eRif l91:n1(a an-Site Septic Design I Allied Septic Oesign and Excavating