HomeMy WebLinkAboutSWG2024-00087 - SWG As-Built - 6/3/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SING 2024-00087 Parcel# 32234-43-00102
Applicant Name Robert Close Subdivision (Name/Div/Block/Lot)Applicant Address PO Box 517 r 1�
City: State, Zip Union, WA 98592 Installer Name Arrow Excavatin C
Site Address 8XXX E State Route 106 Designer Name Arrow Be tic Des[ his, Inc
INSTALLATION CHECKLIST
® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other
System Type Pressure Bed Pretreatment Type NuWater BNR-500
>5ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA OYES ❑ NO
>50 ft from wells? - - - - - - - - - - - - ❑ O ❑
Z >50 ft from surface water? - - - - - - - - - - - - - - - - - - - - - - - - El ® El
rCleanout between building and tank? - -- - - - - - - - - - - - - - - - - ❑ ® ❑
tl Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑
6~. 24' access risers over each compartment?- - - - - - - - - - - - - - — ❑ O ❑
W Effluent filter installed?- - - - - - - - - - - SNR- - - - - - - - - - - - ❑ ❑
Septic tank capacity(working) NuWater 500 gal Manufacturer Hagerman
❑ D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES ONO
0J
0 Man[fold/D-box accessible from surface?- - - - - - - - - - - - - - - -- ❑ ® ❑
mZ Check valves installed? - - - 02' - - - - - - - - - ❑ ® ❑
0
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) W 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
110 fl from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA OYES ❑ NO
❑ >100 ft. from wells?- - - - - - - - -5tp--- 11DC1A`-Tt-T:- - - - - - - - - ❑ ❑ X
W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - — ❑ ® ❑
5- >10ft.from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑
z
Q > 5ft. from property lines and easements?- - - - - - - - - - - - - - - _ ❑ Q El
K > 30 ft from tlowngradient curtain/foundation drains? - - - - - - - - - - ❑ It ❑
❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ OR ❑
❑ Graveless chambers or ® Clean gravel used? (check on
Proper cover installed over drainfield?- - - - - - - - -- - - - - - - - - - ❑ O ❑
Pump tank setbacks consistent with septic tank? - - - - - - - -- - - - - ❑ NIA o YES ❑ NO
Y Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman
24" access riser(s)and accessible frorn surface?- - - - - - - - - - - - El- ❑
~Q
a Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ ❑
Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - - ❑ K ❑
7
d Pump installed in ❑ Bucket or O On Block or ❑ Other
a Pump Make/Model Liberty 253 ❑ Floats or O Transducer
a
Tank draw down 3 in/min Pump capacity 57 gpm Squirt Height 7 H
Pump on time 1 Minute Pump off time 6 Hours Daily flow set at 240 gpd
Mason County OSS Installation Report pg. 2 Parcel# 31J,?Jft- 43- 00(i
ABANDONMENT RECORD
Were existing septic components abandoned as part of This project? - - - - - - - - - - - - -- - ■ YES ❑ NO
If yes. please describe: G I d to a K f�',w.�-�.red..
Were all components pumped out and properly abandoned per WAC246-272A-030D? -- -- -- -- ❑ YES ❑ NO
RECORD DRAWING
ml:o a Wrmanam around slid must de accurate and d.aalyfve—net,m rn.Ioucmn m me nand d maMauoc.x[Mulaa add m,.,a dmelop.... .u-1 pi
Da. ..—an id. i.
m ms nor..,d. a .,eldi s.o:w m .n, r. r s ._eser .ra .d. .npsnd p,, Asa wm �.. ei.wa ,Ines
urea..rd.ana on pr .. .nd.ne -ance wc—,po rt, n,,,pr,a. .......m....'fnadd rem.ay. ,.. eau- P, xdi 1.1e.o Irms
SEE ATTK"+-tEv
® Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with 1 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
I further certify that all information contained on this I further certify that all informaton contained on this
form and Affected Record n;p S ccurate, form and attached Record Drawing is accurate.
3
Si tare of Installer Date
Pinned Name of Slgnae ue• 'pjA
MASON COUNTY PUBLIC HEALTH as '`n,fir
The undersigned approves this Installation Report and srbodae
Record Drawing on behalfof Mason County Public ";�'' PAULA SOY JOHNSON'�
Health: � LfCK315_E4UE5iGtiEft"
r,KHealth
—� o�ws''3�Ii� s Z�c_
Signature of Environmental He Ih Specialist Data (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ew.me z�cuie
AS omIi'
We \ . E -A 0 io2
io b ela
0 � > t2
h
c�
R P f;;':v eYIA�'. ' P
1GcLcu I —ti � L c�1'1 '�
6
�L)
gG.rWQR Z l�
, ID xlj l
5 p•ir+.ry 1 ,
0 OOO
fL w give r)
�-yam
oac
so'
4
�- / S Van
o �'asa� SUN 03
01 Andio-Pisual Alarm 3r Il
O2 Cleanout �,'°,`
Nu Water 3N-R-500 A':'li
r�
34 1,000 Gallon Pump Chamber o v^uu for JoeNsoh
W: awtt -57VL0' LiCC.e_r:
'C1S 'fir ?Y_CCY�
O Valve Contro! Box_ �x�e, ¢x°I
5-tS-Z4