HomeMy WebLinkAboutSWG2018-00420 - SWG As-Built - 7/10/2025 I
.,Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2018-00420 Parcel # 32109-50-00101
Applicant Name Kevin Oakley Subdivision (Name/Div/Block/Lot)
Applicant Address 40 E Rhododendron Ln
Alderbrook G&Y/ Div 5/Lot 101
City, State, Zip Union, WA 98592 Installer Name Mason County Excavating
Site Address same Designer Name Arrow Septic Designs, Inc
INSTALLATION CHECKLIST
Drainfield Only ❑ Repair ®Other 500 Gal Pre-Trash
E] Full System Installation ❑Tank(s)Only E] NuWater BNR-500
System Type Subsurface Drip Pretreatment Type
>5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO
>50 ft. from wells? - ❑ ❑ ❑
• >50 ft. from surface water? - ❑ 0 ❑
Z El ❑
< Cleanout between building and tank? - ❑ ❑
U Tank baffles present? - ❑ ❑
d 24" access risers over each compartment?- - ❑ ❑ I
W Effluent filter installed?- so�_
❑ Elu) Infiltrator
Septic tank capacity (working) NuWater 500 gal Manufacturer
0 e
D-box water level and speed levelers used? - - ❑ N/A [I] YES ■ NO
i�!` -
❑ I Elks
�O Manifold/D-box accessible from surface?- � 0
u.
mZ Check valves installed? ❑ 0 ❑
0Q 1" Schedule/Class 40
2 Transport Line Size
Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- _Ste_ °-'` — - ❑ N/A ❑ YES 0 NO
CI >100 ft. from wells?- - ❑ I ❑
W
>100 ft. from surface water? -
❑ El ❑
ly. >10 ft. from potable water lines?- - 0 I 0
z > 5 ft. from property lines and easements?-
Q - 0 0 0
IY > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑
C 0
Drainfield level and observation ports present 0 0
Proper cover installed over drainfield?- - ❑ 0 0
Pump tank setbacks consistent with septic tank? - - ❑ NIA 0 YES ❑ NO
Pump tank capacity (flood) 1,060 gal Manufacturer Infiltrator
2 24" access riser(s) and accessible from surface"- - -- - f liir EJ
h-
a Alarm or Control Panel Installed? - - ❑ I. ❑2 Control Panel equipped with Timer/ ETM /Counter- - ❑ It 0
D
a. Pump installed in ❑ Bucket or ❑ On Block or 0 Other on bottom of tank
E Pump Make/Model 115v 19gpm Zoeller-Clarus 5031-0005 0 Floats or 0 Transducer
a.
a Tank draw down 1" in 10 min in/min Pump capacity 2.5 gpm Squirt Height -- ft
Pump on time 12 min Pump off time 1.9 hr Daily flow set at 360 gpd
l,pc;ac.-a e,21;7, a
Parcel#�—
Mason County OSS Installation Report pg. 2
ABANDONMENT RECORD
. E YES ® NO
Were existing septic components abandoned as part of this project? -
I`yes, please describe: D YES D NO
Were all components pumped out and properly abandoned per WAC246-272A-0300?
RECORD DRAWING
pical Record
This isn a permanent record man ld onentation&layout.Sep c'pump tank location.st be accurate and descriptive enough to I North arrow•reserve dra;nfi&d.existnq and proposed buildings,ocate in the need of maintenance activities and location of welre development l.waterlines,
Drawn95 contain: Drainfeld&manifold in final installation approve)and related permits.
wells.observaoon ports,deanouts,and other maintenance access points. Incomplete Record Dray.in s may create additional delays
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a—" L .V3c-A/ Ci , 20 1Ct — 2.021 t 7 S-+�
® 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 all information contained on this i further certify that all information contained on this
form and atta bed Record Drawing is accurate. form and attached Record Drawing is accurate.
Signature of installer Date
P-c'.`,GAY; VlirN4. 04 V '
Printed Name of Signee 1' .o• ` :'\
�t
MASON COUNTY PUBLIC HEALTH ,r r '�t,' `1}
The undersigned approves tins Installation Report anti Stv... ,
Record Drawing on behalf of Mason County Public i O� PAULA JOY JOHNSON , �({
Health: 7/(elPS— LfC lA JCAir81.Na I..
(o —2?— 25
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upeatea e212ot8
Keg:
0 Audio-Visual Alarm
10 Cleanout
O500 Gallon Pre-Trash Tank
ONuWater BNR-500 Pretreatment Tank
• 0 1,000 Gallon Pump Chamber
66 Subsurface Drip System Headworks i
r T LAC,
/ / ?ATtO I / �
k_ i ~i 4/
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0 \--2 z-.5 fy 1 °II°I 6 g ,,ROi='OSED BUILDING\ —
\. V"S'Iti \: 2-L,54..1.4-QA-17 1 g&\ \ \
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.UL BUSH atrilit'a.c5f81.1a°rNft..::
'ENYIRONMENZALU s
MASON COUNTY ,b ��S:C a
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