HomeMy WebLinkAboutSWG2020-00135 REVISED - SWG As-Built Mason County OSS Installation Report pg. 1 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 Seebeck,WA 98380 Installer Name F Marcinko Allied Septic Design an
Site Address 797 NE Blacksmith Dr, Belfair Designer Name Frank Marcinko
INSTALLATION CHECKLIST
Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other
System Type Pretreatment Type
>5 ft. from foundation? - - - - - - - - - -- - - - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO
>50ft. from wells? . - _ - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® El
Z >50ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
Cleanout between building and tank? - - - - -- - - - - - - - - - - - - - ❑ ® ❑
U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 El
24'access risers over each compartment? - - - - - - - - - - - - - - - ❑ ® ❑
W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑
N
Septic tank size 125O gal Manufacturer Hagerman Pre Cast
C D-box water level and speed levelers used? - - - - - - - - - - - - - - - ® NIA ❑ YES ❑ NO
0O Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ 0 ❑
mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ El
OQ
2 Transport Line Size 2" Schedule/Class Son 40
Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10fl. from foundation?- - - - - - - - - - - - - - - - -- - - - - - - - - ❑ NIA ® YES ❑ NO
a 1100ft from wells?- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® El
m >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
LL >1oft. frompotablewaterlines?- - -- - - - - - - - - - - - - - - - - - - ❑ ® ❑
QZ > 5ftfrompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ ® ❑
> 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - ® ❑ El
Drainfield level and observation ports present - - - - - - - - - - - - - -
• Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed overdrainfield?- - - - - - - - - - - - - - - -- - - ❑ 0 ❑
Pump tank setbacks consistant with septic tank? - - - - - - - - - - - - - ❑ NIA ® YES ❑ NO
Pump tank size 1OOO gal Manufacturer Hagerman Pre Cast
F24' access riser(s)and accessible from surface?- - - - - - - - - - - - - ❑ N ❑
C Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - El 9 El
f Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - - - ❑ E ❑
7
0- Pump installed in • Bucket or ❑ On Block or ❑ Other
IL Pump Make/Model Liberty 280 e Floats or ❑ Transducer
Tank draw down 1 314 in/min Pump capacity 35 gpm Squirt Height 4 ft
Pump on time I min 40 sec Pump off time 4 hours Daily flow set at 360 gpd
Updated moots
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? - - - - - -- E YES NO
RECORD DRAWING
Thus is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development. Typical Record
omwmgs contain: oram0ela a manifold orientation a layout.Septcpump lank location North arrow.reserve d2mneld.exiling and proposed buildings location of wells.waterlines.
ells observation pods cloanoule and other maintenance access points. Incomplete ReCad Drawings may create additional delays in final installal,on approval and related permits.
eY( c fP 1 R ®C
® 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
l further certify that al/information contained on this 1 further certify that al/information contained on this
form and attached Record
Drawing is accurate, form and attached Record Drawing is accurate.
08/13/26
Signature of Installer Date
Frank Marcinko -, \
Printed Name of Signee d ,
MASON COUNTY PUBLIC HEALTH �e
The undersigned approves this Installation Report and �gC} 201ODBOO
Record Drawing on behalf of Mason County Public ? FrnkA I .M...
Health: LICENSED DESGIER
O
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updnen erzt.In
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Building Site Plan Name: Marcink0 Tax Parcel: 22310-79-90663 F �i
Scale = I" = 40' Address: 797 NE Blacksmith Or, Belfair P�' A;my
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40100609 F
Frank A.Matdnko
LICENSED DESIGNER
0 13 26