HomeMy WebLinkAboutSWG2024-00309 - SWG As-Built - 5/27/2025 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00309 Parcel # 32104-50-00091
Applicant Name AB Fine Homes LLC Subdivision (Name/Div/Block/Lot)
Applicant Address 871 E Beach Dr. Alderbrook G&CC/Lots 91-92
City. State, Zip Union, WA 98592 Installer Name Hanson Excavation
Site Address 141 E Jack Pine Ln, Union WA Designer Name Arrow Septic Designs Inc.
INSTALLATION CHECKLIST
• Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ®Other 500 gal Pretrash
System Type
Shallow Pressure ' - =-tment Type NuWater BNR-500
A�►�>5 ft. from foundation? - - �} ❑ NIA YES NO
>50 ft. from wells? - �V' 0 El• E
• >50 ft.from surface water? - q - - - -rS 1515- -
Z '� - a ❑
I—
< Cleanout between building and tank? - - - ,� - - -
Tank baffles present? - � v; - - 0 ❑
I- 24' access risers over each compartment?- - — -
W Effluent filter installed?- Vil ` � ❑ ❑ 0
f/) BN Hagermen
Septic tank capacity (working) NuWater 500 gal Manufacturer 9
O D-box water level and speed levelers used? - - ❑ NIA ❑ YES 0 NO
J
X0?O Manifold/D-box accessible from surface?- - ❑ IDZ Check valves installed? - G et-- y ❑ 0 ❑
0< 2" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) ❑ 2 0 3 ❑4 0 5 ❑6 0 Commercial'Other
>10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO
C1 >100 ft. from wells?- ❑ X ❑
—) >100 ft. from surface water? - - ❑ El ❑
w
LT_ >10 ft.from potable water lines?- - ❑ 0
Z > 5 ft. from property lines and easements?- - ❑ I 0
rt > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑
ca
Drainfield level and observation ports present - - 0 ® ❑
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ a
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑■ YES ❑ NO
• Pump tank capacity (flood) 1,000 qal Manufacturer Hagermen
<• 24" access riser(s)and accessible from surface?- - ❑ KI CIH
a Alarm or Control Panel Installed? - ❑ 0 0
2 Control Panel equipped with Timer/ETM/Counter- - ❑ I. ❑
D
a- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
Cl. Pump Make/Model Liberty 280 0 Floats or E] Transducer
a
E 5 ft
Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height
Pump on time 2.3 min Pump off time 6 hr Daily flow set at 360 gpd
Up.ated 812'.'20'3
Parcel# 3Z off
Mason County OSS Installation Report pg. 2
SD - OOC7`� �
ABANDONMENT RECORD
❑ YES ® NO
Were existing septic components abandoned as part of this project?
If yes, please describe: El YES NO
Were all components pumped out and properly abandoned per WAC246-272A-0300' -
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development Typical Record
ank
.North arrow,reserve
ld.
and
posed
Drawings s contain: le &utsnand otherifold ,maito layout.
access points.r tIncompletenReco d Dra`"rings may create additional delays elays ino final installation approvalngs, vn of andrils.elated,petrm s.
wells.observation pods,Geano
Sr.Q
il 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
I further certify that ail information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
G 'LdBNi 5.-$"Z,S ASig Lure of installer Date y
r `tt�j
Jared Hanson 4 �:��
Printed Name of Signee o< WA '$,.
st.. .. n
MASON COUNTY PUBLIC HEALTH yC rj ~, ;,f :N
The undersigned approves this installation Report and . �' 510:349
Record Drawing on behalf of Mason County Public " ' PAULA JOY JOHNSON 'x''`?'
Health: g.``�07 i4f:
EXAMS f�
C3)
0� ch7lz 5—c3—. S
Signature of Environmeiital Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 872120t8
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0 500 Gallon Pre-Trash tank
3 NuWater BNR-500 ATU Tank
55 1,000 Gallon Pump Chamber
c,J FNN, o.j..tc- 5 T PA.o.",
3 Valve Control Box