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SWG2022-00378 - SWG As-Built - 8/13/2024
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00378 Parcel# 32104-54-00050 Applicant Name AS Fine Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address 871 E Beach Dr Alderbrook G&Y/Div 4/Lot 50&Pm 51 City, State, Zip Union WA 98592 Installer Name Hanson Excavation LLC Site Address 190 E Paint Brush Ln Union Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tani Only ❑ Drainneld Only ❑Repair ❑Other. System Type Shallow Pressure Pretreatment Type >5 ft.from foundation? -- - --- -- - --- - -- - -- - - -- --- -' ❑NIA ® YES ❑ NO >50ft.from wells? --- -- ---- - -- - -- - - - --- - -- - - - -- ❑ ❑ Z >50ft.from surface water? --- -- - - - -- - - - - - -- - - - -- -- ❑ ❑ F Cleanout between building and tank? - - - - - -- - --- --- - - -- - ❑ U Tank baffles present? - - - -- - - - -- ---- - -- - --- - - --- - ❑ ® ❑ r- 24"access risers over each compartment?-- - - - -- - -- - - ---- ❑ ❑ Cl 11. ❑ ® ❑ w Effluent filter installed?----- ------ - - - - - - - - - - - - --- ' N Septic tank capacity(working) 1200 cal Manufacturer Hagerman 0 D-box water level and speed levelers used? ---- --- - -- --- -- ❑ NIA ❑ YES ® No �O Manifold/D-box accessible from surface?------ - - - - - - - -- -- ❑ O ❑ dpZ Check valves installed? - ----- ^�At°-- -- - - - El ® ❑ 04 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - - --- - ----- - ---- - - --- - ❑ NIA YES , NO t] >100 ft. from wells?-------------------- - ---- - - - - ❑ ® c -u >100 ft.from surface water?- - - --- ---- -- - ------ - ---- ❑ ® c ,�,� w EL >10ft.from potable water lines?- - - - ---- - -- ------ - ---- ❑ ❑� `� �] z > 5ft.from property lines and easements?---- - -------- - - - ❑ © - K > 30 ft.from downgradient curtaintfoundation drains?-- --- - -- - - ❑ O s Drainfteld level and observation ports present - - --- - - - - ---- - ❑ � E� ❑ Graveless chambers or F Clean gravel used? (check one) Proper cover installed over drainfeld?--- - - ----- -- ---- - - - ❑ Pump tank setbacks consistent with septic tank?-- ---- - ----- ❑ WA ® YES ❑ NO 5C Pump tank capacity(flood) 1,000 cal Manufacturer Hagerman Q24"access riser(s)and accessible from surface?---- ---- -- --- ❑ © ❑ H a Alarmor Control Panel Installed? - - - - -- - - - - - - - - - - - -- -- ❑ 2 Control Panel equipped with Timer/ETM/Counter-- --- --- - - - ❑ ❑ 7 a Pump installed in ❑ Bucket or 0 On Block or ❑ Other c- Pump Make/Model Liberty 280 ® Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 7' ft Pump on time 2.3 min Pump off time 6 hr Daily flow,set at 360 gpd J".a 6 'W. 3 S-+ - D�fl;ro Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD Were existing septic components abandoned as part of this project9 - - - - - -- - YES NO If yes, please describe'. YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300- -- -- - - -- ❑ RECORD DRAWING ra<cN and must be accurate and aesoap4ve enough m reJou[e'm ma need or mamtamna acrrmae one metre sevelopmanl Trplrsl 3ecoN rhbnscenue brands, neeralnnela.eal5.lnaandWWosM tmldlnaa.location Mwell�.watenmez. —,,aDum aa..I.n o med..a.. ffuldand tim,monallm"-ea .s mi,mump unk Uses emad snow.ssr is wells,�semaon pone.Geanoun,and oMer mainbnance a¢eu poinb. Inwmpkte Rewrtl Orarngs cosy a eats adanlonai delays in nnm Insmaron eppm.al and maud perm ® 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 1 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 accurate. ruzae"t- 8-("- 2v Sig ure of Installer Date . Jared Hanson Printed Name of Signet oa •r MASON COUNTY PUBLIC HEALTH .tls The undersigned approves this installation Report and N stLw Record Drawing on behalf of Mason County Public • A ULA JOY JOHNSON INN i Health: c� awyl0�/� CJ1 oki-( rxrl p Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAYBE SCANNED ANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upmr.d srzrrzme 145• C v I o t go L� l _ y NiWFft yet i (3) 3'x5o' pr'°v any afa+nfieIJ 4rehcvuS @ 5 oiJ. w) neServe below. PtS— S n�C ,6 -T< St H o!{ PCav; AS I im Homtf 41- 4V LS -'ro0s i'o O Audio-Visual Alarm porC-0 -if 32101-sy_00050 ,µµ�CompaClion. © cleanout 190 E PAi�,t B(VS[i Lvl Zl�"f35°ULS 163i1I ® 1200 Gallon Septic Tank z-Compartment with Effluent Filter (f © 100( Gallon Pumpp Chamber yj u+rtc-Stprw 0 5 3 0 y 5 L P Valve Contml Hox c vs gppROVED AUG 13 N24 a MASON COUNTY ENVRONMENiALHFALTH PAULAJOY3JOHNSON REi X b ' M