HomeMy WebLinkAboutSWG2022-00457 - SWG As-Built - 1/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00457 Parcel# 32214-50-04009
Applicant Name Andrea Baker Subdivision (Name/Div/Block/Lot)
Applicant Address 2119 Viking St W Maggie Lake ADD#1 BLK 4 Lot 9
City, Stale, Zip Bremerton,WA 98312 Installer Name Allied Septic Design and Excavatin,
Site Address 30 NE Lake Place,Tahuya Designer Name Frank Marcinko
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Lowddge Technologies Oscar 11 TLC Pretreatment Type
>5 ft.from foundation? ----------- �=4 IpI;1l�tI7-Ifs NIA BYES ❑ NO
>50 ft.from wells? ------------- i`-ut-Id IR e ❑
Z >50 ft.from surface water? -------- {� -- ❑
1AN-{0 2�25
Cleanout between building andlank? --- - -- e ❑
V Tank baffles present? - ---- ------- -- - -- D e ❑
6 24"access users over each compartment? ® El
NEffluent filter installed?- ---------------- - - - ---- -- - ❑ ❑
Septic tank size 1500 gal Manufacturer Hagerman Pre Cast
0 D-box water level and speed levelers used? --------------- NIA ❑YES NO
OLLMan'rfold/D-box accessible from surface?----------------- ❑ ■ ❑
r4Z Check valves installed? - -- - ---------------------- ❑ ❑
02 Transport Line Size 1" Schedule/Class Sch 40
Bedrooms installed (check one) ❑2 ■3 ❑4 ❑5 ❑B ❑Commercial/Other
>10ft.from foundation?-------------------------- ❑ WA YES NO
>100 ft.from wells?----------------------------- ❑ ❑
W >100 ft.from surface water? ------------------------ ❑ ® El
LL >10ft.from potable water lines?---------------------- ❑ ❑
ZQ >5ft.from property lines and easements?---------------- ❑ e ❑
0: > 30 ft.from downgredientcurtain/foundation drains?---------- ❑ e ❑
Drainfield level and observation ports present - ---- ❑ e ❑
L Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?------------------- ❑ ❑
Pump tank setbacks consistant with septic tank?------------- ❑ WA EYES ❑ NO
Y Pump tank size 1000 at Manufacturer Hagerman Pre Cast
Z
Q 24"access dser(s)and accessible from surface?---- --------- ❑ 0 Ela Alarm or Control Panel Installed? --------------------- ❑ E ❑
f Control Panel equipped with Timor/ETM I Counter----------- ❑ ® ❑
7
a Pump installed in a Bucket or ❑ On Block or ❑ Other
IL Pump Make/Model McDonald/Lot 30 ® Floats or ❑ Transducer
y Tank draw down NA in/min Pump capacity 30 gpm Squirt Height NA ft
Pump on time 22 sec Pump off time 3 min 38 sec Daily flow set at 360 gpd
VrNtlYl1R018
Mason County OSS Installation Report pg. 2 Parcel u 32214-50-04009
ABANDONMENT 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
mh Is a pemaMrR ntatl and mut ad amunb and eavion tlw anagx to nJaceY In ew road or maintenance stlMdw and Nma development Tym al RemM
DmMrgs mmaln'. Dminma It menXgd onemabon n lay",seoti my bnk lotion.Nan,merve dmFANd,eeMtlnp eM aopmtl Eulaa,v Iwn'nn M neue.aabmros.
well6,aEsemWn IroN,deeroW.aM mMrmeHlwa�ecceee ptlme. mwmplele WwN Dmtinaz maY veele ad]Itlpwl aelm In awl lnedllm'on.ppmnl eM m4kd pemfw.
0 Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I 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
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been c/earedyapproved by both the designer shown here have been cleared/approved by both
and Mason 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 Machad/,t7�aa Ord D/raaww. is accurate. torn and attached Record Drawing is accurate.
�,pr.�: 7l�r�s+o" 01/02/25
Signature of Installer Date Q, A
Frank Maminko P 9Fi
Printed Name of Signeeal
P 'e
MASON COUNTY PUBLIC HEALTH 3
The undersigned approves this Installation Report and p pia
lf Record Drawing on beha of Mason County Public F�q�o
Health: LICENSED DESIGNER
Im
Signature ofture of Envilth Specialist Date (stamp, signet re and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Dpdmed aandm
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