The URL can be used to link to this page

Home My WebLink AboutSWG2024-00089 - SWG As-Built - 12/19/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00089 Parcel # 32227-54-00040 Applicant Name Romana Hatfield Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 14 SHOREBROOK TR 40, S 47/112 City, State, Zip Tahuya, WA 98588 Installer Name South Shore Construction Site Address 91 NE Spar Tree Dr, Tahuya Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Bed Pretreatment Type Nuwater BNR-500 >5 ft. from foundation? - - N/A El YES ID NO >50 ft. from wells? - (} Ec-Pqwl El ❑ Z >50 ft. from surface water? - 0 ElU - < Cleanout between building and tank? - - - - -DEC -1-7- 20-25- - 00 U Tank baffles present? - - ❑■ ❑ F- 24" access risers over each compartment?- B - - - -_ ❑ ❑ W Effluent filter installed?- y , - - - El 0 — Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 9 D-box water level and speed levelers used? - El N/A ❑ YES ❑■ NO )<O Manifold/D-box accessible from urface?- - ❑ 0 Elm Z Check valves installed? - - - ❑ El ❑ 0 Q 40 2 Transport Line Size 2" Schedule/Class Bedrooms installed (check one) 0 2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A El YES ❑ NO >100 ft. from wells?- - ❑ 0 ❑ WEl>100 ft. from surface water? - - ❑ 0 iz >10 ft. from potable water lines?- - ❑ El ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q El ® LI re > 30 ft. from downgradient curtain/foundation drains? - - C Drainfield level and observation ports present ❑ MI E ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A • YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - ❑ © El I— a. Alarm or Control Panel Installed? - - El El ❑2 Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ D n- Pump installed in ❑ Bucket or 0 On Block or ❑ Other d Pump Make/Model Liberty 280 ❑■ Floats or ❑ Transducer a_ a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 7 ft Pump on time 1.5 min Pump off time 6 hr Daily flow set at_ 240 gpd ,,odatea 82'2C t a Mason County OSS Installation Report pg. 2 Parceut 32%1 0° . r ABANDONMENT RECORD • • Were existing septic components.abandoned as part of this project? - El YES 111 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? • - 0 YES 0 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. Typl Record Mineral=tam DnfokS&marldold(=dentin=&layout.Sephdpump oink tocation.North annw.reserve Grainfield.existing and proposed bins.location dwells,neternes, webs,observation pats.cleanouis.and other maintenance access points. Incomplete Record Drawings may create additional delays in final iristarisfoxi approval and related penrits. • • A3cck.cii\lek• • • • • • • • • a Record Drawing Attached ; • _-_CERTIFICATION OF INSTALLATION - INSTALLER DESIGNER!ENGINEER I certify that I installed the system in accordance with 1 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 cleated/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 /further certify that all information contained on this I further certify that all information contained on this fo n atta ed R rawing is a rate. form and attached Record Drawing is accurate. Signature of Installer Date 4• cZJe)VOL-10t9L, 5tf;& ., Printed Name of Signee 74" MASON COUNTY PUBUC HEALTH The undersigned approves this Installation Report and 741,w Jit• ., .7. • PP ••''•t. Record Drawing on behalf of Mason County Public 6lort •••• PAULA JOY JOHNSON 7\ Health: . gszl\e`ti1...M14 • R;k-ii\cLifyy Cb117) \24 . t7S— EXPIRES Wig Signature of Environmental H Specialist Date (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUC VIEW ON THE MASON COUNTY WEB SITE Used 81212°18 • 5 wt i.et C vVit.tWk 0 0 Wireiain I--;ne- .., • .0-t------>1 .___ _ _ ---: ..4 ,df% './ t Ofag • . r- — . — f ,15 11 I 15 t 000 0 1 ' 0-17. 5 Lot'' :I i .. I. R a . . rN, oe 0 i -, i . i . Z. vi EV i . 411 8' I x 6 t.11: El . E t 30 S i•<-e k bv1,1 .. H°k'S-C ;0 IL I- 1 if i .. 1 I La. F . i CPI 1' , . .•• Db.-%ve.u../01 I I 1 Cnirole , 1-1.1 1 ,! • i ...1, __:----_ _. .. SIN.s, '7". r• P' a e,ie. :0 r al- ,...v....• 11 T t 0 i•••:; 2.-:: E:i= :',•:' . AS-bc-ti L-i. Kcmkt1/41A Hiss:TF .1--17 K PAR.,.-,-,a-L -32).1-1-51--000io Key: O. Audio-Visual Alarm , . 0 Cleanout APPROVED 0 NuWater BNR-500 ATLI Tank DEC 19 2025 0 1,000 Gallon Pump Chamber MASON COUNTY ENVIRONMENTAL HEALTF, RET ...5 ,,..6....:464 AD.. ,:stk ::- rAfir, ui Dirsi. -.... .. .L. ,... fl..: • '.5'W:t, 51i..349 •-4; •.„, PAULA Joy Jo HNSON .•. (1, 'IZI __ 'Apliiplat4nV**,;(,)1 .:.