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HomeMy WebLinkAboutSWG2024-00337 - SWG As-Built - 5/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLI AIVT/ PERMIT iNFOR[VIATI N Permit Number SWG 2024-00337 Parcel# 32232-50-78011 Applicant Name South Shore Enterprises LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 249 I--c*2- City, State, Zip Union, WA, 98592 Installer Name Arrow Excavating Site Address 111 E Sharpe St. Union,WA Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Oscar XO2 Pretreatment Type XO2 >5ft. fromfoundation? -- ------ - --- - - - ---- --- -- - -- ❑ N/A DYES ❑ NO >50ft.fromwells? - - - - -- - -- ❑ 0 ❑ >50 ft.from surface water? - - - - - -- - ❑ U ❑ Cleanout between building and tank? A -1-Z - ❑ 0 El Tank baffles present? - - - - -- - -- - -- - - - ❑-- -- ■❑ El 24"access risers over each compart nt?-- - - -- - ❑ 0 ❑ W - Effluent filter installed?-- ------ - � - �-��- - --_ ❑ ❑ ❑■ Septic tank capacity(working) 1,000 gal Manufacturer Hagerman 2-compartment 0 t D-box water level and speed levelers used? -- ----- - - - - ---- ❑ N/A ❑ YES ❑E NO xJ ` Manifold/D-box accessible from surface?-- ❑ ® ❑ mZ Check valves installed? -- - - - - - - --- - - - -- - - -- - - -- - - ❑ ❑a ❑ Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >1oft.from foundation?- - - - - - - ---- - - - - - - - - - - -- - - - ❑ N/A DYES ❑ NO >100ft.fromwells?------ -- - ---- --- - --- ------- -- ❑ 0 ❑ >I00ft.fromsurfacewater? - - - - - - - - -- - ---- -- - - - - - - - ❑ u., >10ft.frompo₹able water lines? - - ----- - - -- - --- - - - - - - ❑ Q > 5ft frompropertylinesandeasements?- - - - - - - - - - - -- - - - ❑ ❑ W., > 30 ft.from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - -- - - - - - - --- ❑ ® ❑ Proper cover installed overdrainfield?---- - - -- -- - - ----- - - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?-- -- -- - --- - -- ❑ N/A II YES ❑ No Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman 2-compartment °✓ � ,,:24"access riser(s)and accessible from surface?-- ---- --- - - - - D II ❑ Alarm or Control Panellnstalled? - - - --- - - - - - - - - - -- - --- ❑ © 0 M Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - O ® ❑ a . Pump installed in ❑ Bucket or ❑ On Block or ® Other On bottom of tank 22 Pump Make/Model AY McDonald E-30 U Floats or ❑ Transducer Tank draw down -- in/mm Pump capacity 30 gpm Squirt Height -- ft Pump on time 30 sec Pump off time 3 min Daily flow set at 360 gpd Updated 8/21/2018 I Mason County OSS Installation Report Parcel# AI3ANDONI�IEIVT RECORD ® NO Were existing septic components abandoned as part of this project? ------------- -' ❑ YES if yes, please describe: ❑ NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ------ -- O YES RECORD DRAWING in the need of maintenance activities and development Typical Record This is a permanent record and must be accurate and descriptive enough to re-locate future Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Se-Q ® 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 infor• at/on contained on this I further certify that all information contained on this Irma ttached R orcl Drawi S ccurate. form and attached Record Drawing is accurate. nature of Installer Date . Printed Name of Signee ¢.1 W/A •y . MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �. `o •; ; ' Record Drawing on behalf of Mason County Public ' PAULA JOY JOHNSON Health: L• v'~ N� •, t REs 9 51 L—Zs. Signature of Environment 1 Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8)21/2018 Ine t5 X30 ' 10 T o ZoX�s- 2232-501 001 L R2S2Ne_ r -0.x45• + a;� © Qf'eY"Wa OSCF►r �v iV ��5 7 V O o 0 • APPROVED • . 'QOtc toy • - MAY 16 2026 MASON COUNTY ENVIRONMENTAL HEALTH RED - _ I Visual Alarm Control panel Anaio I2 Clew out 1,000 Gallon SeAe Ptre/ raa � • i ' O 2-CotupaStrnent with air Po'1 4 1,000 Gallon Clarifier/PnmP Tank y 2-COm rtment Headworks 1 O OSCAR XO2 Mound Drain eld 1 a 5c AR Xo 2 Re$e,rJ$ho Slno 'rz SE• .— 301 oF 5100349 J a PAULA JOY JOHNSON PiRt�S 95l� S�LZ-�