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HomeMy WebLinkAboutSWG2024-00455 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00455 Parcel # 32105-76-90020 Applicant Name Spencer Sheldrew Subdivision (Name/Div/Block/Lot) Applicant Address 5182 Hunters Ridge Way City, State, Zip Hunters, WA 99137 Installer Name Arrow Excavating Site Address 100 E Glenwood Dr, Union Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Otr er 500 gallon pre-trash tank System Type Shallow Pressure ' -treatment Type NuWater BNR-500 >5 ft. from foundation? - ❑ NfA YES ❑ No >50ft. fromwells? ���V-C-1.1-1- - - - - - ❑ 0 ❑ • >50 ft. from surface water? - - - - - 103 - 3 ❑ 0 CI zI— < Cleanout between building and tank? - -S��-' ❑ II CI o Tank baffles present? - ❑ UI ❑ P 24" access risers over each compartme t?- - - - - - - - ❑ N ❑ W Effluent filter installed?- By _ - CI CI Cl, Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman o D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑■ NO J O Manifold/D-box accessible from surface?- - ❑ CI CI O L.L. mZ Check valves installed? - o ` ‘A" - ❑ 0 ❑ th`t 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 El CommerciallOther >10 ft. from foundation?- - ❑ NIA ■❑ YES ❑ NO CD >100 ft. from wells?- - ❑ 0 ❑ WCI 0 El>100 ft. from surface water? - - 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? - - ❑ ® ❑ 0 Drainfield level and observation ports present ❑ IIII CI © Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A 0 YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ ® El H Alarm or Control Panel Installed? - - ❑ • CI a E Control Panel equipped with Timer/ETM /Counter- - CI • ❑ n n. Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model Liberty 280 ❑ Floats or © Transducer a. a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 7.5 ft Pump on time 2.3 minutes Pump off time 6 hours Daily flow set at 360 gpd Jpciatee 8,2112018 Mason County OSS Installation Report pg. 2 Parcel# 321 v5— 1(0— y0G20 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - ❑ YES NO If yes. please describe: ❑ Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES NO 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 Drainfield&manifold orientation&layout.Septic/pump lank location.North arrow reserve drainfield,existing and proposed buildings,location of wells waterlines. wells.observation ports.cleanouls.and other maintenance access points Incomplete Record Drawings may create additional delays in final installation approval and related permits aC..C.--. i yj Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER 1 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 a attached Record Drawing is accurate. form and attached Record Drawing is accurate. a-413012S ' t ��. 4`1 nature of Installer A Date ' Printed Name of Signee ..%.Pl 'ti MASON COUNTY PUBLIC HEALTH d . *O .: ':N"r. %,`�' S10J349 . ''h%� The undersigned approves this Installation Report and Yti^� PAULA J Cd JCHNSCN \ Record Drawing on behalf of Mason County Public (-Q- " :eUC Sk D SGN81 1p Health: EX(4,NAM, R``ZkS ? - Zit-2,,s ignature of Environmen)el Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e 2t.'2C 19 i A-Lto i j 7 I S t !/� / �•! ® . • �`� _ i z �+� i \^ice-wa • t 7 se.-GC 9 .> > '� ® V i~ f-Id • E , p 1= 3 ei.A 1 ‘i.2.0"...t /\� - to?$w 1 i / d:5. I A ,y09-" . ) zce r-A o'sY • `--� S✓.0=r 5i. C1, n C:ems= " • 'k cs = o" LV"''ti��' F. .0 i;,...4 �rv1 �Jd CMG-°Pre= :a-i� or 10. • an 4 • j,�1� . ,U vu\-\ch / . ),, U IV s I. c�, . ° �Vri .4, : PAULA JOY JOHNSON `!1 �7� r �C.V." .�s-v, mot'i:iC �?1D�S� r� -t _c��C ZC s eirsi• �7 ' = 32ti�s�r i -el -1,5 11°° 5Gt' - VC. APPROVED .l w '�'`' SEP 12 2025 � _ Scy' = t = MASON COUNTY ENVIRONMENTAL HEALTH Zs' ;c -1s , � RET