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HomeMy WebLinkAboutSWG2022-00419 - SWG As-Built - 11/22/20247FApplicant County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION t Number SWG 2022-00419 Parcel# 12228-75-90032 ant Name Costello Pacific LLC Subdivision (Name/Div/Block/Lot) Address 6223 Mt.Tacoma Or SW tate, Zip Lakewood WA 98499 Installer Name South Shore Construction Site Address 221 E Highlander Dr. Belfair 98528 Designer Name Arrow Septic Desgins Inc INSTALLATION CHECKLIST If Full System Installation ❑Tankls)Only ❑ Drainlald Only ❑Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft,from foundation? - ❑NIA ®YES ❑ ND >50 ft.from wells? ------- - - -- - - - D 1Y11=�8�� D ❑ 0 - ElZ >50 ft.from surface water? ---- ---- LS V---- - - ❑ ® ❑ H Cleanout between building and tank? ---:�A- -Tank baffles present? - - ------- - - -"-24"access risers over each compartment --- ❑W Effluent fitter installed?--- ------------- - ❑ ® ❑ N Infiltrator Septic lank capacity(working) 150 g 2al Manufacturer o D-box water level and speed levelers used? -- ------------ ❑ WA ❑ YES NO DJ ❑ ❑ O Manifold/D-box accessible from surface?- -- - - --- - - - ------ 19Z Check valves installed? - - -- --- -- - - - -- - - - - -- --- --- El ® El OQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑3 ®4 ❑ 5 ❑6 ❑CommerciaVOther 110ft.from foundation?-- --- -- ----- - - - - - ---- --- -- ❑ wA ® YES El NO >100ft.fromwells?----------------------------. ❑ ® ❑ J >100 ft.from surface water?----- - - --------------- -- ❑ ® ❑ W a >10ft.from potable water lines?---- - ------------- ----- ❑ ■ ❑ a > 5ft.from property lines and easements?---------------- ❑ ® ❑ R > 30 ft.from tlowngradiem curtain/foundation dreins?---------- ❑ 0 ❑ Drainfeld level and observation ports present - - ------ - ----- ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - -- ---------- -- ❑ ® ❑ Pump tank setbacks consistent with septic tank?-- ---- - - ---- ❑ WA ® YES ❑ No Y Pump tank capacity(flood) 1,480 gal Manufacturer Infiltrator Q24' access risers)and accessible from surface?----------- -- ❑ ❑ ~ Alarm or Control Panel Installed? -- -- -- - - - - -- --- ---- ❑ ❑ 0. 2 Control Panel equipped with Timer/ETM/Counter--- - --- ---- ❑ ® ❑ 7 a Pump installed in ❑ Bucket or ® On Block or ❑ Other a. Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 1.5 in/min Pump capacity 44 gpm Squirt Height 4.5 ft Pump on time 2. rmin Pump off time 6 hr Daily flow set at 480 Dptl UpbIM B(11 R018 i Mason County OSS Installation Report pg. 2 Paroel# I222$ — �lS- g003�- ABANDONMENT RECORD Were exaGng SePtic mmponenm.abandoneo as part of this ProiecCJ .____________,_. Yes NO If Yes,please oesdibe: Were all componerrts pumped out and property ababandoned per WAC24&2R4-03007 ---"-'- ❑ YES NO RECORD DRAWING TN.I..D.mw.�^r w.ne min e..9ana..e a.acngH.«mwn m�+er.e m d»mee a mNnplW9l.:tlNtl...ee ww..a...wom..� *rows aee pmwq.mine: am,eee 6me91Ne anen�sawn.sepacbuno inn auu9n.win�.m..rv.e.Ydxd.�9 ew pr99u.�e�9e.�w awean dxd..wM.r.m. .,aN.m..veea+oea,auiauie.w mi.m.imen.�a®ewnd i�ow wine p.:nw m.r=re.mnar ewr.Hew mv.o.rie..00�.+se weao.m4.. ® Reoord Drawing Attached 77'— _:..:^ y —7 '.CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that i installed the system in accordance with I carb'fy,that the system has been installed in acmf 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 hen;have been c/earediapp—ed 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 certi=nattify that all information contained on this 1 furthercerlify that all information contained on this d R rawingis a curate. form and attached Record Drawing is accurate. lyignatureoser Date 0 -I- Z �"' Q�,Zchan`d, MWfe I C �.. Printed Name ofSignee MASON COUNTY PUBLIC HEALTH The undersigned®Porous$this/nste/ietiorr Report and ; Sr00349 � Record Drawing on behalf of Mason County Public PAULA JOT JOHNSON Health: y�nyn� signature ofFmhonmenta/Health Speciaest Date (stamp.signature and date) ,lS FORM MAY BE SCANNEDANDAVAIIABI.E FOR Pl1aUCVEWON THE MASON COUNTYWESSRE - GosiY�)0 ciiG wn, �arcii#i2Z2�-75 90031 221 II(ahlpndrY Dr \ 140 ' \ r PAULA JOY JOHNSON ors n rcNt a \ aw as i �(5)35'd-(QZS� �t"imary �•� � , 7A 4*Y\ kkS fe5ffvr b� lOw. 'APPROVED m NOV 29-2024 to © Aucfio-T na ,Alarm MAS N COUNTY ENVIRONMENTAL HEALTH © cleanout RET © 12oo CWion Septic Tank ' 2-Compartment with Effluent Filter b9• '— — __.— O4 1200 GiLnon Pump Chamber OS Valve Control Box �YbP eScdl. ze' easwu.nf s� — � rl;gl,ighder Dr