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HomeMy WebLinkAboutswg2024-00066 - SWG As-Built - 3/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00066 Parcel# 32104-54-00120 Applicant Name Olive Homes LLC Subdivision (Name/Div/Block/Lot) Applicant Address 210 Emerald Lake Or W ALDERBROOK G&Y#4 TRACT 120 DIV.4 City, State, Zip Grapevlew WA 98546 Installer Name TJ's Excavating Site Address 21 E Country Club Dr N Union Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑Repair ■Other W pill pn-✓ash System Type NuWater ent Type NuWater BNR-500 >5 ft,from foundation? -- -- -- - - - - ❑ NIA ■ YEs NO >50 ft.from wells? - - - - - - - - - - -- -MAR Y1 - ❑ ® ❑ 2 >50 ft,from surface water? -- - -- - - - - - - El © El FCleanout between building andtank? - - Illy-- - -- - - --- ❑ ■ ❑ V Tankbaffiespresent? --- - - - - - -- - --- ❑ ® ❑ a24"access risers over each compartment?-- - - - -- - - - -- -- -- ❑ N Effluent filter installed?-- - - - - - - - - - - - - -- ---. ❑ ❑ gg0�J3 - - -- Septic tank capacity(working) NUWater600 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - -------- ❑ NIA ❑ YES ® NO DO Manifold/D-box accessible from surface?--- - °' -S ---- ❑ ■ ❑ IQZ Check valves installed? - - -- ---- - - - - -- - - - --- - - -- - - El ■ ❑ 0 Transport Line Size 1" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 M 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - ----- - ---- -- -- - --- - - --- - ❑ NIA ® YES NO 1 >100 ft.from wells?-------- ------------ --------- ❑ W >100 ft.from surface water?-- - - - ------- ------------ El © ❑ LL >10ft,from potable water lines?- - - - -- - - -- ---- - ----- -- El El Z > 5ft.from property lines and easements?---- - - - - ---- - - - - ❑ ■ El Q ❑ 0 ❑ G >30 ft.from downg2tlient curtainRoundalion tlreins?- -- - - - - - -- Drainfield level and observation ports present - - --- - -- -- - - - - ❑ ® ❑ _B Brinell she liters *1 8 all illmoel wall (allest one) Proper cover installed over drainfield?---- - - -- --- - --- -- - ❑ ■ ❑ Pump tank setbacks consistent with septic tank?------- ---- -- ❑ WA ® YES ❑ NO `L Pump tank capacity(flood) 1060 gal Manufacturer Infiltrator 24-access riser(s)and accessible from Surface?--- -------- -- ❑ IM ❑ ~a Alarm or Control Panel Installed? -- �-W--,�-` - - - -- ❑ ❑ ■ 2 Control Panel equipped with Timer/ETM/Counter- - - - - -- -- -- ❑ o ❑ 7 a Pump installed in ❑ Bucket or ® On Block or ❑ Other R Pump Make/Model AY McDonald E-30 IN Floats or ❑ Transducer a Tank draw down — in/min Pump capacity 30 gpm Squirt Height — ft Pump on time 22 sec. Pump off time 3 min.44 sec. Daily floe set at 360 gpd Vgla,atl 0(11 RO1B • 321��F -�- oo �z� Parcel# Mason County OSS Installation R ABANDONMENT RECORD ---------- ❑ YES NO Were existing septic components abandoned as part of this project? ----- ® if yes,please describe: NO Were all components pumped out and pmpenY ---abandoned per WAC246-272A-0 -- YES RECORD DRAWING This v D��°Mr�'ne aM muN Y accunv°ne da .mw9h v Mwb i�Ma nee at m�inlam�ce seavieu uW NNn eavelWmv�t TYPVI Rwre vnklaaean.NVN artow.,e.ern e�maae.ens4n9 eM PTOmvI WMYpS IWeon of xtL5.M1eNK5. pvvly°anlein: ONMae6nWdbtl cnemaem8 Wu45WAVAm9 Remee drMin9s msYaeYe MENanl Earys infinN catelevn yy.Tnle�v mwea Pv^� .wc,oe+e..eoe w^^.w•"'a•e"e mna inmwnmaass wiim. Irmnplme ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER i certify that I installed the system in accordance wllh I certify that the system has been installed in accor- the septic design Stamped'APPROVED"byMasoo 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 /further certify that all information contained on this form and attached Re rd Drawing is accurate. form and attached Record Drawing is accurate. Signature first ller Date -T-j Printed Name of Signee N MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report ap® Record Drawing on behaKof Masordpunty Public H . s+o aae PAULA JOY JOHNSON Heett 0Gyry'��90, _ I .. Signature of Environmental Health Specialist � ��``1�- �,% (stamp, signature and date) THIS FORM MAY BE SCANNED AND AV BLlgryR PUBLIC VIEW ON THE MASON COUNTY WEB SITE uoew.e erzimi° 4Fq y 10 3o 40 I� by � t'Oltv� H2o1M�A.SY�A�crt /�^ Yaor El.'i�JL..,�K-J't��VI LV %O1 2\ E- ll' T O oa 0 Xa . OO �fl05 \ a MM tj -E JAC'k PINE Lk- Key., Ol Audio-Visual Alarm 02 Clea APPROVED 00 Galt 5 ' 00 Gallon Pre-Trash Tank MAR 0 7 2025 (3 Nuwater BNR-500 Pretreatment Tank 1,0oMASON COUNTY ENVIRONMENTAL HEALTH S1UU3�8 OO pump Gallon Single Compartment '., � Pump Chamber/Clarifier Tank DJA �' PAULA JOY JONNSON', CIC SE " gj N O6 OSCAR Mound Drainfield ¢xnnEss i 3-If-r,S