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HomeMy WebLinkAboutSWG2021-00031 - SWG As-Built - 11/20/2025 R Mason County OSS Installation Report pg. MASON COUNTY PUBLIC HEALTH APPLICANT! PERMIT INFORMATION Permit Number SWG 2021-00031 Parcel # 32124-50-00068 Applicant Name Gary & Cathy Hays Subdivision (Name/Div/Block/Lot) Applicant Address 3180 E Mason Lake Dr W EMERALD LAKE DIV 1 TR 68 Installer Name House Brothers City, State. Zip Grapeview WA 98546 prrn�n� Septic Desians Inc. Site Address 361 E Emerald Lake Dr E Designer Name INSTALLATION CHECKLIST Drainfield Only ❑ Repair III Other 1.200 Pretrash 0 Full System Installation ❑Tank(s)Only ❑ Nu Water BNR-500 System Type Shallow Pressure Prfreatment Type \ : ' ❑ YES NO >5 ft. from foundation? --= r•.,.- . ''3 NIA ❑ >50 ft.from wells? t',:t� a ❑ Z >50 ft. from surface water? 'l,1\ _van 1 \ 0 E FQ- Cleanout between building and tank? - -1 t� ❑ U Tank baffles present? - E3 El El ❑ 0 Eld 24" access risers over each compartment ay- - - - El ❑ 0 W Effluent filter installed? 'N,._�o - Septic tank capacity (working) NuWater gal Manufacturer Sound Placement N/A ❑ YES Q NO 0 D-box water level and speed levelers used? - -JEl m a ��O Manifold/D-box accessible from surface?-AAMP � � - ❑ Z Check valves installed? - k' ❑ ❑ 0Q 2 Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑CommerciallOther El N/A El YES ❑ NO >10 ft. from foundation?- ❑ o >100 ft. from wells?- -- El El >100 ft. from surface water? D E ❑ w Er. >10 ft.from potable water lines?- - ❑ Ell0 ❑ — > 5 ft. from property lines and easements?- - ❑ CC > 30 ft. from downgradient curtain/foundation drains? - ❑ I E]Drainfield level and observation ports present - - El ❑ Graveless chambers or ® Clean gravel used? (check one) ❑ ❑ El cover installed over drainfield?- Pump tank setbacks consistent with septic tank? - - ❑ N/A YES ❑ NO 1,200 gal Manufacturer HB Tanks Pump tank capacity (flood) El 10] El< 24" access riser(s) and accessible from surface?- - 1-- a. Alarm or Control Panel Installed? - 0 El El® ❑ 2 Control Panel equipped with Timer/ ETM /Counter- ❑ D f- Pump installed in ❑ Bucket or © On Block or ❑ Other Q. Liberty 290 0 Floats or 0 Transducer Pump Make/Model 5 ft a Tank draw down 1 in/min Pump capacity 23 gpm Squirt Height Pump off time 6 hr Daily flow set at 360 gpd Pump on time 3.9 min upaated8212018 port pg. 2 Mason County OSS }nsta► atjon Re A Parcel ABANDONMENT RECORD - _ _ _ ID YES I NO Were exist'.ine septic components acarsdcned as par of this project? -- - - - - - 1f yes, pease descrbe: C, cbE•^•�Cr2G�per�'VAC24�272A-030C - - - - -- - � YES No aft components s pumped out and properly RECORD DRAWING _ �„�� re- a;e,n the neo0 or:tta+:+tcnarce activities and to:u'r developmen, yp, t to and e7..-W^'-.'�'SCt^y5..0..�•Cf.Q�wets,V:xC.17!feS. This Is a permanent record and must be accurate and descriFure enous it ca =^xah.'esenE d zd tie .elcx 5 dal ycd elYed ps^ti� 3,.. ens or,r ate•^•a once SeO r RRecxd awnp may:mate aC Yonai delays in`cs 415�ua:xrt aFFr �ravary.csntair.' 7+a:.^•`•¢' ss �:s. {nLCiYi2".0 wells.dbSG'b3A�n ports.dea'a..Ks.ant ctn.-.;.s=,matte acXs F I Record Drawing Attached CERTIFICATION OF INSTALLATION DESIGNER! ENGINEER INSTALLER I certify that I installed the system in accordance with r 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 deyviations here have been cleared/approved by both the designer shown here have been cleared/app + ad and Mason County Public Health and meet ail State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason Counry Codes i further certify that all information contained on s this further certil`y that all information contained on this f rm and attached Record Drawing is accurate. form and attached Record Drawing is accurate. mar •.J,, ai:i2 Q''rlSicrrer gn 2)\f Stee ]'tip . Print ed Name of s . MASON COUNTY PUBLIC HEALTH •c! roves this lnstaliat on Repo and �' 003A9 The undersigned 8FP 1-c PAULA JOY JOHNSON y Record Drawing on behalf of Mason County Public L Hearth: pcpiitES :/r�'Sr[�u Signature of Environmental H aitn Speciarrs Sara (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY Vv'e5 SITE L'xacee ersna'E — E. E.►vura16 Lam Dr E A - bil �. 7Z•53' GQfu t �-�-1�►G bo+ ?� II. 3'r I rn;w +o �arctl 32 t2y-Se-00 8 � �, l�w�. L q Dc E mot • u roc“{y 3 6t E ErAcrat i gi Scat-�: c'� �o J oil (g) 3'X25 ' 6 20 II0 j a& _ _ _ _ Frrc,aCcy D� I -- fir-Cn CAS g S `G C. w t1-\ re s4 c _ _1=-. J - APPROVED -- NOV 252025 3 GQN MASON COUNTY ENVIRONMENTAL HEALTh w ' 28XLII RET I U. s St3o3`F Hem OAudio-Visual Alarm IO 2 Cleanout ��+�, EFcluent Fttec- 1 CD i)200 Gal Ion 2-Camp. ONuWater BNR-500 ATU Tank •�A V O 1,2.00 Gallon Pump Chamber s��0:1�'..p OValve Control Box PosS•A:,le Fu.k-cnre, 5 h o ,...4 be+.th•room LiOt x---10 t Aek, , -.1., .. ..,,,, ,,,..),, ..0., ,,,I,,,,, ..it, , .pit „ StG0349 �! 8,.' PAULA JOY JOHNSON L Its ' tt-2,o-t