HomeMy WebLinkAboutSWG2022-00352 - SWG As-Built - 11/16/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2022-00352 Parcel # 32104-54-00067
Applicant Name AB Fine Homes Subdivision (Name/Div/Block/Lot)
Applicant Address 871 E Beach Dr ALDERBROOK G &Y#4 LOT:67& PTN 66
City, State, Zip Union,WA 98592 Installer Name Hanson Excavating
Site Address 41 E Paintbrush Ln, Union Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ❑ Other am gallon pre-trash lank
System Type Shallow Pressure Pretreatment Type (J1/14.1AfW &n -6 C-)
>5 ft. from foundation? ❑ N/A . YES ❑ NO
>50 ft. from wells? 0 ❑ ❑
2 >50 ft. from surface water? - 0 ❑ ❑
H
Cleanout between building and tank? �-Z La_i_ . Di 0 ❑
U Tank baffles present? - - ❑ ❑
a24" access risers over each compartment?- IP- ❑ 0 ❑
IL Effluent filter installed?- - ❑� ❑ ❑
u)
Septic tank capacity(working) NuWater BNR gal Manufacturer Hagerman
a D-box water level and speed levelers used? 0 N/A ❑ YES ❑ NO
oJ
O Manifold/D-box accessible from surface? ❑ ❑� ❑
mZ Check valves installed? - ❑ 0 ❑
OQ
2 Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft from foundation'- ❑ N/A 0 YES ❑ NO
O >100 ft.from wells? 0 ❑ ❑
W >100 ft. from surface water? - - ID ❑ ❑
LT >10 ft. from potable water lines? ' ❑ 0 ❑
Z > 5 ft from property lines and easements?- - ❑ 0 ❑
K > 30 ft. from downgradient curtain/foundation drains? ❑ [F] ❑
Drainfield level and observation ports present ❑ 0 ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- ❑ 0 ❑
Pump tank sebacks consistent with septc tank? - ❑ N/A 0 YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
< 24"access riser(s) and accessible from surface' - - - - ❑ I] El
F-
a Alarm or Control Panel Installed? - ❑ El ❑
j• Control Panel equipped with Timer/ETM /Counter- ❑ • ❑
a. Pump installec in 0 Bucket or I. On Block or ❑ Other
6• Pump Make/Model Liberty 280 0 Floats or ❑ Transducer
O.
a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 5 ft
Pump on time 2.33 Pump off time 6 hr Daily flow set at 360 qpd
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Mason County OSS Installation Report pg. 2
Parcel# 'Z IA - 54 °can
ABANDONMENT RECORD
❑ YES NO
Were existing septic components abandoned as part of this project',
If yes please describe. ❑ YES ❑ NO
Were all components pumped out and properly abandoned per WAC246-272A-03007
RECORD DRAWING
This permanent d and must be accurate and Ocets enoughrelocateinthe a r . and r . a p Try l R d
Drawings contain orenfiNaroman manifold orientation yout.S pi o' P e r ld existing p emy I . ai n a
wells.ooseryalto-ports cleanows,and agar maintenance access points m. Record amay create aa! o.ale v in finer ostallation approva and relatedpermits.
1
ecord 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.)y both
and Mason County Public Health and meet all State myself and Mason County Public Health aid meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accyrete.
�!i�iRG7 �C�rI,66rG 10/30/z3
Sig ore of Installer Date
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Jared Hanson ���r����,,,��yyy����_
Printed Name of Signee a4Dr ,Y^.4 g1:.}.
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MASON COUNTY PUBLIC HEALTH ;,: a r.
The undersigned approves this Installation Report and >5'PAULA ,� v vson -�
Record Drawing on behalf of Mason County Public �o- or.rA ii it NL{S`
Health: Sul �R
IXP.na :Lis
YP D' l II (IC (1-3 I c- 2- 2S
Signature of Enmionmenta. earth Specialist Dare (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE .,00arm 3'2'12°18
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