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SWG2022-00037 - SWG As-Built - 10/30/2023
n • OOi �`ir 3 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLI THGI01,7 APPLICANT/ PERMIT INFORMATION .O Permit Number SWG 2022-00037 Parcel# 22223-51-06007 Applicant Name Nicholas Costello 401K Subdivision (Name/Div/Block/Lot) Applicant Address 6223 Mount Tacoma Dr SW TRAILS END DIV#2 BLK: 6 LOT: 7 S 51/98 City, State, Zip Lakewood, WA 98499 Installer Name South Shore Construction Site Address 100 E Olympic View Dr, Belfair Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • E.III System Installation ❑Tank(s)Only ❑ Drainfeld Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? ❑ NIA Q YES ❑ NO >50 ft. from wells? - .1 ❑ 0 Z >50 ft. from surface water? ID ❑ Q Cleanout between building and tank? - - ❑ 0 ❑ ~ ❑ El ElU Tank baffles present? F 24" access risers over each compartment?- _ - ❑ • ❑ a. W Effluent filter installed? ❑ El D co Septic tank capacity (working) 1,250 gal Manufacturer Hagerman D-box water level and speed levelers used? - 0 NIA ❑ YES ❑ NO oJ O Manifold�D-box accessible from surface?- - ❑ ❑ m2 Check valves installed? - -- ❑ • ❑ 04 40 2 Transport Line Size 2 inch Schedule/Class Bedrooms installed (check one) ❑ 2 03 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation? ❑ N/A • YES ❑ NO O >100 ft. from wells? ❑� ❑ ❑ W >100 ft. from surface water? - - ❑] ❑ ❑ a >10 ft.from potable water lines?- ❑ ❑ ❑ Z > 5 ft from property lines and easements?. ❑ I ❑ Q 0: > 30 ft. from downgradient curtain/foundation drains? © ❑ ❑ o Drainfield level and observation ports present - ❑ 0 ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? ❑ . ❑ Pump tank setbacks consistent with sept.c tank? ❑ NIA ® YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q 24"access riser(s) and accessible from surface" - ❑ B ❑ a. Alarm or Control Panel Installed? ❑ El ❑ a • Control Panel equipped with Timer/ETM /Counter - ❑ ❑ 7 C Pump installed in 0 Bucket or . On Block or ❑ Other a 7 Pump Make/Model Liberty 280 0 Floats or ❑ Transducer 0- a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 3.5 ft Pump on time 2.33 min Pump off time 6 hours Daily flow set at 360 gpd ae=Elaaia Mason County OSS Installation Report pg.2 Parcel# 22223—5 i—0 600 7 ABANDONMENT RECORD �r - YES n( NO Were existing septic wmponents.abaidcned as part of this project? - ff If yes,please describe: 0NO Were all components pumped out and properly abandoned per WAC246-272A-03007 ' 0 YES RECORD DRAWING This Y.pencoram resod and nun e..ccwu cod warps...cadge to.wmu In the need of maintenance=ban m6 future 4rv.npdra SWOP Slord . pµy.Condo:txs sd&mstIdaW Wm 6 Inca.Se wpwro tint Rmtal Neillumw.inmre nsbhtl.m'1Nng End pransad. Ou6T.gsMca� s old MINp.m .. wantdamnatonpan•dsww,as ram'mint/novason pdnla Imn•YM Rend DrwMnga nay ante SMisdrol Bela at6W hist naymal tkRecord Drawing Attached '.`.CERTIFICATION OF INSTALLATION ':' "--i`1 ' 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 y ae faaand n Mason aso CCount Codes Health and meet all. and Mason County Codes. 1 further certify That all information contained on this 1 further certify that all information contained on this a ed R rawur?gis aerate. form and attached Record Drawing is accurate. DDittj ��t Signature of Installer Dale 4 Printed Name of Signee 4 be At��,. ti MASON COUNTY PUBLIC HEALTH tr g �1` The undersigned approves this Installation Report arACfCr 4r.4 pnuu Jcrlo NNSON t`� Record Drawing on behalf of Mason Cori rtO Public U P sK nESr 'r e023 Evcz» z — Health: • q���y -"vr1 r. : 6xMBoTi r alist Date fAl I"I (stamp,signature and date) Signature of Environmental Health Sped THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Dy+tl6avlmg As u\\-c Costello FeAciCi c Parcel -f-ZZZz3-5 fro(for 0 boo f pyniric view Pr 5lalr :/"- 20, t 1p 20 30 yo sla\ tab-3QCS--- '2. 25i i • $. _ _ __ _ S�z4 O 1..IL, / ® NI 110 Er 7 \ \ \\ \ oo : 3 ' I \ ` „ tete \\\ \ \ lMs.. M � ' o \ ` \ E cmy 2cl C I let e 3p (t) 3 x25 (Z.-) X50 On1y 1So ti .fr .eyp; .d gm;C. 1 zj x�s ) �'. 3 X Lc ED Audio-Visual Alarm Prl vide-vs) D.F. T'e.tieJn e5 3 cleanout at S 1 e C. W T'}01 (C'tc 1200 Gallon Septic Tank � A...,' 2-Compartment with 4 + ,5.�, � Effluent Filler i e9j• O4 1000 Gallon Pump Chamber 4 ! nn n`q pp Fr t`{ t • irk 5 Valve Control Box N a Jr i @ l:! [,:.0 bAoi. ,inn, O i OCT 3 0 2023 -PAULA_at;9PNsor'' A elICF. kil�E '1)�.SiGN�I MAS 4 . I L".,i 0� E6?AL HEALTH orrhees Si HA to -e..`f'-4,Mi