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HomeMy WebLinkAboutSWG2024-00359 - SWG As-Built - 6/24/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00359 Parcel # 32232-50-12003 Applicant Name Cindi Amadio Subdivision (Name/Div/Block/Lot) Applicant Address 61 SE Arcadia Point Rd Union Hood Canal Land & Imp/Blk 12/ • 3-4 City. State. Zip Shelton, WA 98584 Installer Name TJ's Excavating Site Address 103 E 2nd Street, Union, WA Designer Name Arrow Septic r esi. . c�� INSTALLATION CHECKLIST RF ,?1U2‘ C4 © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair III Othe- ",000 gallon p. l':nk System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - -q-1' ❑ N/A ❑ YES El No >50 ft. from wells? IECE9W-17 ❑ ❑Z >50 ft. from surface water? - ❑ ❑■ ❑HCleanout between building and tank? - - - -I 1 -NC IV- 2�20-24 - -i� ❑ 0 ❑ U Tank baffles present? - 4`` ❑ ❑■ ❑ E- 24" access risers over each compartment?-n - - - - El El ❑ W Effluent filter installed?- Y ---- ❑ ❑ 0to $[J(Z- Septic tank capacity(working) _ NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ElN/A ❑ YES • NO 0O Manifold/D-box accessible from surface?- - ❑ 0 ❑ QQ Check valves installed? - � evaN•lo - ❑ El ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - ❑ CI ❑ W >100 ft. from surface water? - - El 0 CI u. >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q W > 30 ft. from downgradient curtain/foundation drains?- - ❑ W ❑ ci Drainfield level and observation ports present - - ❑ © ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ Q ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - Ell © I �p Alarm or Control Panel Installed? - S� - �` , - 4 ❑ „,0,3 a ❑ E Control Panel equipped with Timer/ETM/Counter- - El ` n _a Pump installed in ❑ Bucket or 0On Block or ❑ Other aLS C- Pump Make/Model Liberty 2500 Floats or ❑ Transducer a Tank draw down 2" in/min Pump capacity 38 gpm Squirt Height 3.5 ft Pump on time 2.33 min Pump off time 6 hr Daily flow set at 360 gpd ;.:atec 5.27:7J'8 Mason County OSS Installation Report pg. 2 Parcel# S 2-23 2-SC - 12O0 ABANDONMENT RECORD - ❑ ems ® No Were existing septic components abandoned as part of this project? If yes, please describe: ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - ❑ YES RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record Drawings contain: Orainfieid&manifold orientation&layout.Septidpump tank location,North arrow,reserve drainfield.existing and proposed buildngs,location of wells,waterlines, wells,observation ports.dear:outs,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. r.-QS)....., Mici---a...6".Q..1-, ® 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 I further certify that all information contained on this form and attached Re rd Drawing is accurate. form and attached Record Drawing is accurate. ,. t 1 ,• �> T Signature%f Installer Date i } j: '7ccsof ? Printed Name of Signee `oti Ili,i,MASON COUNTY PUBLIC HEALTH � .. #�' ` The undersigned approves this Installation Report and , ? `p.) ,•-�}, G 349 •S.3,..: • Record Drawing on behalf of Mason County Public Y P.AULA JOY JOHNSON ..1 Health d ip -l�SL�I�17 GfVI±"-S-2 EXR@ES lts�� ��'Y( � 2`( IZS f < <—Z(0 Signature of Environmen I Health Specialist Date I (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE '4'd3Se1812112.'8 I Zo r. b iv• SI.bPE I1i o I o I - (3) 3 xCv? PRiMR o. r . i D e cV �. _ 0 —T @ 4 D.G. w ►rat v , -b 0 1 paa�� RESERvE 1N 13E.tuiEEK D cv. tz © ► _/ 8 3 � -1� A ,- 46':U, 6..-. ; . i -..' :IFS R i v,„ 4--7 li .� 1 ... ,ill .s q` N . . IDRtc 3Eu {l PARAi MG IT Kev: A-c.ci2- .. - !, ► Q cJ�-P1LE (3 - Z O 0 Audio-Visual Alarm 0 to Z.o 50 40 5 _ E. L 0Cleanout C 1 ND 1 P.Nil Pt D l O 3 1,04 Gallon Pre-Trash tank O PftRCEL 32232- SO- 12op3 0 NuWater BNR-500 ATU Tank L 0 3 6_ Z►mod` S+r9_e - O 1,000 Gallon Pump Chamber U K) t6tV ) \ZA `i 8 5R2 w; u"^*:. szo..0r OValve Control Box APPROVED -ex: AN%.,.'... *.--1:0,-. [7- 1 !zs ;- Ft (0,1 ,lj-.,4, MASON COUNTY ENVIRONMENTAL HEALT1. 5t00'49 •`a;? /It :IULA JOY JO- JNRET C .wp )1 pt.giEXPIRES Opthit‘ei.1\ 1 (- Z6-V4'