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HomeMy WebLinkAboutSWG202-00676 - SWG As-Built - 6/7/2024 e Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00676 Parcel # 22213-78-90074 Applicant Name Costello Pacific LLC Subdivision (Name/Div/Block/Lot) Applicant Address 6223 Mount Tacoma Or SW Lot D-713 City, State, Zip Lakewood, WA 98499 Installer Name South Shore Construction Site Address 3110 E Rasor Rd West, Belfair Designer Name Frank Marcinko INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Orainfield Only ❑Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? - --- -- -- - -- --- --- --- -- -- -- - ❑ N/A ®YES NO >50 ft.from wells - ---- -- - - - - - - - - n ���n-Tm Z water?>50 ft.from surface water? - -- - - -Q Cleanout between building and tank? --- - - ❑ I -J - -- - - - -- fJ Tank baffles present? -- - - - - - - - - - - - -- -- - - - - ■ ❑ S24"access risers over each compartment?-- ----- - -- -- -- - ❑ yEffluent filter installed?-- - - - - - - - - - - - By E El Septic tank size 1250 call Manufacturer Hagerman Pre Cast O D-box water level and speed levelers used? - - ----- - ❑ NIA YES ❑ No G0 Manifold/D-box accessible from surface? ❑ E ❑ OPE Ca Check valves installed? - -- - - - - - - - -- - -- - -- -- - - --- - ❑ El 2 Transport Line Size 4" Schedule/Class 3034 Bedrooms installed (check one) ❑ 2 N 3 ❑4 ❑ 5 ❑6 ❑CommerclagOther >10ft.from foundation?--- - - - - - - - - ---- -- --- - - - --- ❑ NIA EYES E] NO >100 ft. from wells?- -- - - -- -- -- - - ❑ E ❑ W >100 ft.from surface water? --- -- -- - -- - - - - -- -- -- -- - - ❑ ❑ IL >10ft.from potable water lines?- -- - - - -- - - - --- -- -- -- - - ❑ E ❑ QZ >5 ft.from property lines and easements? - ❑ e ❑ C >30 ft.from downgradient curtain/foundation drains?- - - - - - -- - - ❑ S ❑ Drainfield level and observation ports present --- - - ❑ ® ❑ E Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- --- -- -- - - -- -- - -- -- ❑ E ❑ Pump tank setbacks consistant with septic tank? E NIA ❑ YES ❑ NO Y Pump tank size gal Manufacturer Q24"access riser(s)and accessible from surface?-- --- --- --- -- ❑ ❑ ❑ dAlarm or Control Panel Installed? - - - - - - -- - --- --- --- - -- ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump MakelModel ❑ Floats or ❑ Transducer ILTank draw down in/min Pump capacity ppm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Mason County OSS Installation Report pg. 2 Parcel u 22213-78-90074 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? • ----- ---- - -- -- ❑ TES © No If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-0300? --- --- -- ❑ YES ❑ NO RECORD DRAWING tba 1.a amnn.na cam,and must b..ocunl•and dasalpeas eneupb m moms e,dx nand a manlaraca saeamna and bnun a.vido"ea. Typical t rd Umdr,a ad.ain_ anlndae a meneaN oeleMeeon a lgeul8pedpump Ya[bmtlon,NOIIb emw,neerv.eMnpdd,.,nMp W weemed bull0liea,boson a Wlx,wepNnea. delta,obadaunn pab,daanous,aM~maem.no...dd poets. ,.pI.W ,aa,Dnd,n . eeaW atldllael de%sbeNllMeWdnappvre1.nd Mcrae pannaa. Q Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 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 clearedlapproved 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 to= nd a ched R rdmay accurate. form and attached Record Drawing is accurate. 05/28/2024 Signature of Installer Date RICHARD MOORE-SOUTH SHORE CONSTRUCTION P Printed Name of Signed MASON COUNTY PUBLIC HEALTH 3 i The undersigned approves this Installation Report and 2010M Record Drawing on behalf of Mason County Public Frank A Meldnko . Health: LICENSED DESIGNER V IN e' � p /lSozy Signature of Environmental Heath Specialist Dete (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE c.mla.rzrrsae El a0' Record Of Construction E' 7 6 party e public 0 3? well on Parcel N 22213-78-00060 _ ® (Upslope Of Proposed DF) V 41 w' a ko E m :. ....:T.wy ........ ...... Observation eptic Ports(4) ank lory 3 m •mo 56' 0 3 Bedroom % C Manufactured Horne ( �, w.tee_Len, _ --————— 3 -4---="r Ja ----�---- -- — IN El♦20 m wanewns.t 88.63' r ER El+21'_.__...._...--. EI♦18 60'ROW __-2--------------------------------- Septic RUC Name:Costello Tax Parcel: 22213-78-90074 Scale = I" = 50' Address: 3180 E Roger Rd West, Selfeir,WA a 6 Thh sm b not eve,ellymeeny line✓bounderes haw been downstretedbythe annerfe nahr1hPir Agemisl. P 7� A ww„ 3F On-Site Septic Design I Allied Septic Design and Excavating s i ? 20100809 6 Frank A.Marcinko LICENSED DESIGNER Ob J 3�z