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HomeMy WebLinkAboutSWG2022-00359 - SWG As-Built - 12/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00359 Parcel# 32109-50-00065 Applicant Name Smart Build DSS,LLC (Melnychuk) Subdivision (Name/Div/Block/Lot) Applicant Address 4923 40th St NE ALDERBROOK G &Y/ Div#5/LOT 65 City, State, Zip Tacoma, WA 98422 Installer Name TJ's Excavating Site Address 850 E Vine Maple Ln, Union, WA Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s) Only ❑ Drainfield Only ❑ Repair ❑Other 1,000 Pre-Trash Tank System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - M-U-W, ❑ 0 ❑• >50 ft.from surface water? - - ❑ ❑■ ❑ ZHCleanout between building and tank? - - - - - .1-Z-�§ - ❑ 0 ❑ U Tank baffles present? - - - - ❑ ❑■ ❑ d24"access risers over each compartm-nt� - - - - - - - - ❑ 0 ❑ W Effluent filter installed?- QtJ t- - - ❑ ❑ 0 Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ■❑ NO �O Manifold/D-box accessible from surface?- - ❑ ❑ ❑ m Z Check valves installed? - - ❑ ❑■ ❑ 0< 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 C1 >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ X ❑ u.. >10 ft. from potable water lines?- - ❑ 0 ❑ � > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q tX > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ cl Drainfield level and observation ports present - - ❑ 0 ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A E. YES ❑ NO • Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ • ❑ H a Alarm or Control Panel Installed? - - ❑ © ❑ E Control Panel equipped with Timer/ETM /Counter- - ❑ II ❑ M a Pump installed in ❑ Bucket or 1■❑ On Block or ❑ Other a• Pump Make/Model Liberty 250 ❑■ Floats or ❑ Transducer a Tank draw down 1.5 in/min Pumpcapacity 29 Height p y gpm Squirt Hei ht 5 ft Pump on time 3 min Pump off time 6 hr Daily flow set at 360 gpd Updw_d E;7'20'8 r l Mason County OSS Installation Report pg. 2 Parcel# 3Zl o — SO — OD O(0j 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: Drerofeld&manifold orientation&layout.Sepdc1pump tank location,North arrow,reserve drainteld,existing and proposed buildings,location of wells,waterlines, wells,observation ports,creanouts,and other maintenance tic rnss poins. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER l 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 /further certify that all information contained on this form and attached Re rd Drawing is accurate. form and attached Record Drawing is accurate. Signature f lnstSller Date • Printed Name of Signee ,.r y�' MASON COUNTY PUBLIC HEALTH re,.•,* gs '�`' �, The undersigned approves this Installation Report and " #� . :yr Record Drawing on behalf of Mason County Public yF sto a<a °AULA JOY JOHNSON Health: it f r JS>rfi D'E iG•t\1r v EXPIRES 0 /1 • I - Z7--2s 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 updated a/21 2918 Key; 0 Audio-Visual Alarm kAl O Cleanout D m D ^I({ h u K O 1 apGallon Pre-Trash tank Far cr/4 3Zloq- So-oDobS O Nu�,Vater BNR-500 ATU Tank 8 5 0 V i Yid, — Chamber / O 1,000 Gallon P:�mP i- wifi�^ pn�i-Si�ho^ SC i 2 0 O Valve Control Box '-r o to 20 3a yo 5� � it c-- Role_ � C 0 4 2Q25 #"[A, 0.32 ",9s, 3 2- (OZ Sevh;-Camp (+ pick mortfed 315,So m.s. rooi'S _ -7-� --0501�0� i Co osP 6 14- Aio-v-i'ic Ls td fill i Nett / / ( ) 3 'xso' riary / •.�'� u I dial V1 fi t/et tre 1/1C1,u.5. / o o� O.C. wl rpsf live, ',0 ( ,,e 1 • ..t1 sw b� 12L {lNC l 4. ® �( S+ V , ,ev Pa4S o Tiff o I 1pu re+�I �,i V�'aJ tn/ 'y I i t . .4k, tril *tit' ‘I'q• . l 4. •17,.. ... ,,d -1/4-I C -- T: ' Y�, 51C..340 �(�'�')„ CPCA(AS EJb 5JiEO8) k, 390 s `1 op�1U. t. ` J3 Lo S-21-V WATER 1 1 E. V Mold-c i-v" kG.�4.