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HomeMy WebLinkAboutSWG2024-00336 - SWG As-Built - 5/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APP LICANT/ PERMIT INFORMATION Permit Number SWG 2024-00336 Parcel# 32232-50-78013 Applicant Name South Shore Enterprises, LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 249 City, State, Zip Union,WA, 98592 Installer Name Arrow Excavating Site Address 101 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 >5 ft. from foundation? -- --- - - --J - -f' - -ft - - ❑ N/A Q YES ❑ NO >50 ft.from wells? -- - - - ❑ 0 ❑ >50 ft,from surface water? - - -- y - ' ❑ UI ❑ Cleanout between building and tank? - a- - ---T------- - - ❑ UI ❑ Tank baffles present? -- - --- - - - - - -- - - - -- - - -' ❑ III ❑ 24" access risers over each compart - - - - - - ❑ ❑■ O W Effluent filter installed?------ ----- - - - --- - - - - - - -- - - ❑ ❑ • 111 Septic tank capacity(working) 1,000 gal Manufacturer Hagerman 2-compartment D-box water level and speed levelers used? ------- ❑ N/A ❑ YES • NO Manifold/D-box accessible from surface?--- -e - - - ---- ❑ UI ❑ ;O „ Check valves installed? - - - - - - - - - - - - - - - - - - - - - -- - -- ❑ ❑■ ❑ Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 UI 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >1oft.fromfoundation?- - - -- - - -- - - - - - - - - --- - -- -- - ❑ N/A ■❑ YES ❑ No C1 >100ft.fromwells?---- ---- - ---- ---- - -- ---- --- -- ❑ I ❑ >100ft.fromsurfacewater?- - - - - - -- -- - - - - --- - - - -- - - ❑ UI ❑ u, >10ft.frompotablewaterlines?- - - - -- - ---- --- --- -- - - - ❑ 0 ❑ > 5ft.frompropertylinesandeasements? - -- - - - - - -- - - - - ❑ 0 ❑ Oir > 30 ft.from downgradient curtain/foundation drains?- -- - - - - - -- ❑ © ❑ Drainfield level and observation ports.present - - - -- - - - - -- - - - ❑ ® ❑ r ; Propercoverinstalledoverdrainfield? -- - - ----- - - --- - - - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?-- ---- - --- - -- ❑ N/A 0 YES ❑ NO Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman 2-compartment 24"access riser(s)and accessible from surface? - - - --- - - - -- ❑ ❑ . AlarmorControlPanellnstalled? - -- --- - - - - - -- - - - - - - - - ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter - - - - - --- -- ❑ ® ❑ ;: Pump installed in ❑ Bucket or ❑ On Block or ® Other On bottom of Tank Pump Make/Model AY McDonald E-30 UI 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 812112018 2, ?Mason County OSS Installation Report pg. 2 Parcel# �Z. ✓ O t� ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ------ ----- ❑ YES If yes, please describe: ❑ NO Were all components pumped out and properly abandoned p&WA ----- ' ❑ YES 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: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,re"serve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may creme 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 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 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 info ation contained on this /further certify that all information contained on this forma ttached R//0�fyd Drawl s ccurate. form and attached Record Drawing is accurate. nature of installer Date Printed Name of.Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and �: .. � • Record Drawing on behalf of Mason County Public PAULA JOY 3IOHNsoN " Health: L'tCtE 7�t� i�1Lt" .. , o S—f z-u Signature ofEnvironmenta/ ealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 82112018 2 . bAx c z os Ol Control Panel with Audio-Visual Alarm 30 O2 Cleanout � � 1,000 Gallon Septic/Aeration Tank pQ,^ 35 2-Compartment with air diffuser QISL�I' L� 1,000 Gallon Clarifier/Pump Tank O4' 2-Compartment Headworks S O OSCAR X02 Mound Dminfield APPROVE I / MAY 18 2026 \ MASON COUNTY ENVIRONMENTAL HEALTH RED S�,a .St 5 Vow AS-_bv�:1� • - sbo-rt+ Sth -rPf�iSES S � 22.3Z- PAULA JOY JOHNSON" k EXPIRES 1 5l