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HomeMy WebLinkAboutSWG2022-00387 - SWG As-Built - 10/9/2025 I • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00387 Parcel # 32104-59-00040 Applicant Name Nathan &Jana Peterson Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 474 ALDERBROOK G&Y#10 City. State, Zip Belfair,WA 98312 Installer Name Mason County Excavating Site Address 50 E Blackberry Ln, Union, WA Designer Name Arrow Septic Designs INSTALLATION CHECKLIST © Full System Installation ❑ Tank(s)Only ❑ Drainfield Only 0 Repair 0 Other System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft.from foundation? - ❑ N/A a YES ❑ NO >50 ft. from wells? - , \\-1-7.. ❑ ® I:Y >50 ft. from surface water? - `_'i, ❑ ❑ z Q Cleanout between building and tank? ;�- - t-- I— ,111 U Tank baffles present? - ❑ 0 0 a24- access risers over each compartment?- - - - - - �!- ❑ a ❑ W Effluent filter installed?- --- - - ❑ ❑ 0 N Septic tank capacity (working) NUWater BNR gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ NIA ❑YES 0 NO �O Manifold/D-box accessible from surface?- - ❑ IN o0Z Check valves installed? - - ❑ ® ❑ CaQ 2 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ■❑ 3 ❑4 0 5 ❑ 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ NIA 0 YES ❑ NO 0 >100 ft. from wells?- - ❑ a 0 w >100 ft. from surface water? - - ❑ 0 ❑ EC >10 ft. from potable water lines?- - ❑ a 0 z > 5 ft. from property lines and easements?- - ❑ a ❑ a CI R ❑ � > 30 ft.from downgradient curtain/foundation drains?- - 0 Drainfield level and observation ports present - ❑ 0 Crevc4eee c+rernbers or E} C-itwan grevcl u3cd? (check one) Proper cover installed over drainfield?- - ❑ 0 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z H 24" access riser(s) and accessible from surface?- - ❑ II 0 a Alarm or Control Panel Installed? ❑ I ❑ 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ m a Pump installed in 0 Bucket or ❑ On Block or pi Other on bottom of tank a'• Pump Make/Model Pentair Sta-Rite Step 20, 1/2 hp 115 V ❑■ Floats or ❑ Transducer d Tank draw down 1.5 in/min Pump capacity 2.9 gpm Squirt Height — ft Pump on time 10 minutes Pump off time 1.84 hours Daily flow set at 360 gpd JP•CateC 821,20'.8 Mason County OSS Installation Report pg. 2 Parcel# 32' 1 (4— S9 (X)040 ABANDONMENT RECORD - ❑ YES NO Were existing septic components abandoned as part of this project? If yes, please describe: ❑ YES ElNO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING This isn a permanent Dr record a must rie accurate and entation&layout,SepttiJP mp tank location,escriptive enough to North arrow.cate in eeseerve dra d of maintenance epsOng and proposed future buildings.location of wells.'cal wwaterl es wrawings contain:n. Orts. e d manifold& rido wells,observation ports.deanous.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. 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 hed Record Drawing is accurate, form and attached Record Drawing is accurate. 11k Signature of Installer ..ate - F-,,' \ ck\(\ ,4‘Y"\(_. 00 .4%) Printed Name of Signee •o1 7 `1•r _'�, 1. .. �+ `� MASON COUNTY PUBLIC HEALTH i e'• ''•1 The undersigned approves this Installation Report and �.,(0.l. stoo3aa • Record Drawing on behalf of Mason County Public N- c• PAULA JOY JOHNSON t Health: L'iC S pe::.-ION y V.,tNni)NtiSalV) (i 6(ct it? C EXPIRES Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE �paated 812'2C78 LlamarS h fir 1 3Z10u-��+ . __5L_Lg_ fC1c1c nry_12-1 _ if-is. 0.-1 0.. , \\5 5crtle: I = 3o <• 5 a !S 3o y s �° �'� 1'X�S * .� © (� P- ---'.\ Q�I.. _D.),, . \ ,J 1-7:::>, Cxps.\\t) Nt'''° \1 0 % " ' Q�, • w ce L \\ ( iii2i111i cal*)Nfk Ng.s i j 0 Audio-visual Alarm k---- i Ij 0 Cleanout I I ' 00 NuWater BNR-500 Pretreatment Tank e'K c\) A. I I ,6. O 1,000 Gallon Pump Chamber 4 a \ 5 Subsurface Drip System Headworks ,,,,,...A, ,-4-A_, s/ ' pi"•.A.,,- P ' 1 `11 �,k„, if, t!2, 51049 ?" ' ..L"P lE .3 AULA JOYtJOSHiNSGlyON . • APPROVED /0`$-Ls OCT 0 9 2025 MASON COUNTY ENVIRONMENTAL HEALTH RET