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HomeMy WebLinkAboutSWG2020-00135 - SWG As-Built - 4/12/2023 Mason County OSS Installation Report pg. 1 C - 0, MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00135 Parcel # 22310-79-90663 Applicant Name Frank & Suze Marcinko Subdivision (Name/Div/Block/Lot) Applicant Address 5677 Minnig LN NW Tract 3 of SP#2795 Of#635388 City, State, Zip Seabeck, WA 98380 Installer Name Frank Marcinko Site Address 797 NE Blacksmith Dr, Belfair Designer Name Frank Marcinko INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Pressure Distribution Pretreatment Type >5 ft. from foundation? - - ❑ N/A • YES ❑ NO >50 ft. from wells? - (U� 0 ❑ • >50 ft. from surface water? - -� W. . ® ❑ Z HCleanout between building and tank? - - - - - - - pp-0-3- 7I3 ® 0 V Tank baffles present? - {J I. 0 a24" access risers over each compartment?- - By ---- - 0 ❑ - --'------ Cl)W Effluent filter installed?- - - LI ❑ Septic tank size 1250 gal Manufacturer Hagerman Precast 0 D-box water level and speed levelers used? - - 0 N/A ❑ YES ElNO QO Manifold/D-box accessible from surface?- - ❑ I ❑ OQCheck valves installed? - - ❑ ❑ II 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 0 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ® YES ❑ NO CI >100 ft. from wells?- - ❑ ® ❑ W >100 ft. from surface water? - - ❑ 0 ❑ LI >10 ft. from potable water lines?- - ❑ ® ❑ Z- > 5 ft. from property lines and easements?- - ❑ ® ❑ Q ce > 30 ft. from downgradient curtain/foundation drains? - - ® ❑ ❑ Drainfield level and observation ports present - - ❑ 0 ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A 0 YES ❑ NO • Pump tank size 1000 gal Manufacturer Hagerman Precast Q 24" access riser(s) and accessible from surface?- - ❑ ® ❑ I— LL Alarm or Control Panel Installed? - - ❑ ❑ E Control Panel equipped with Timer/ ETM /Counter- - ❑ 0 ❑ m - Pump installed in ® Bucket or ❑ On Block or ❑ Other a• Pump Make/Model Liberty 280 FI is > ducer a Tank draw down 1 3/4 in/min Pump capacity 35 gpm , yirf y g 1, 4 ft Hr"n I I �U�3 Pump on time 1 min 40 sec Pump off time 4 hours Daily flow set at 360 gpd men LUUN I Y ENVIRONMENTAL HEALTH Updated 8/21/2018 DJA • Mason County OSS Installation Report pg. 2 Parcel# 22310-79-90663 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES Q■ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES p NO RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings.location of wells,waterlines. wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 cleared/approved 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 attached Record Drawin is accurate. form and attached Record Drawing is accurate. -1. *••sZ 03/27/23 i Signature of Installer Date i ,t#1 Frank Marcinko Printed Name of Signee i to. , l MASON COUNTY PUBLIC HEALTH i y �. 2'��yt�l•" The undersigned approves this Installation Re. �n` e.. �� ,� Record Drawing on behalf of Mason County • ��R OV y (01 20100609 VI Heal . p 6 Frank A.Marcinko L/ zo R 1 1 2023 r LICENSED DESIGNER ' ✓S�' nature of Environmental Health Specialist COUNTY E IVIRONMENTAL N`: (stamp, signature b•gpnd dat-) n.lA THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 r 1 Well radius for22 -79-90664 +0' el 184.83' +7' el i / Seasonal Drainage Pocket/ e �� ,T). rilli \ CY VP / A a, 5 II II /... XL#1 / b CJ CU EF-4 Outlet iv. rty : I 2 VB m•/ ' `" Baffle Filter if X 1o6x Pump( / Installed ` • Clean i00°�o i C�anauts/ Sp pt;C Annually �• Obzervabon Ports(4) • nk Reserve `CO Controller/ X / • Alarm SL#3 4,,ee C aJc' 3 Bedroom N ���� Home \ 00 lip t\ A-\e" Envelope V ONO moo° (04) i o- \ I 4-0 in C I Q w c I a�eC ()cc' o _I V v �c v a,� a e� O 3 eaho� Qom 5 73 o Proposed Well 0 V CU faC APPROVED APR 1 12023 MASON COUNTY PER HE.a,l1 +S'el 184.46' +9'el DJA i�,► or t On-Site Septic ROC Name: Marcinko Tax Parcel: 22310-79-90663 Ile.9 441L:t AA sz- Ps # I, / pLL.�EO Scale = 1" = 40' Address: 797 NE Blacksmith Dr, Belfair f .•F/. �, i + t 0l��4� This is not a survey:all property lines/boundaries have been demonstrated by the Owner(s)and/or their Agent(s). ��� I r (pi_ f1 On Site Septic Design Allied Septic Design and Excavating i= 20100609 � It i 0 Frank A. Marcinko ar LICENSED DESIGNER itovolomi000lohmotomwkwo.N.I, " o,reI 0 MI