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HomeMy WebLinkAboutSWG2022-00082 - SWG As-Built - 7/2/2026 S Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00082 Parcel# 22330-50-00332 Applicant Name Alder Creek Custom Homes Subdivision (Name/Div/Block/Lot) Applicant Address 5320 138th Dr SE HAVEN LAKE TR. 332 City, State, Zip Snohomish, WA 98290 Installer Name Trinity Excavating Site Address 680 NE Haven Lake Dr, Tahuya Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other 500 gallon pre-trash tank System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? -- - - - - - - n�; j r'�'<; J - - ' ❑ NIA Q YES ❑ NO >50ft. fromwells? - - - - - - - - - >50 ft.from surface water? -- - - - -'-+='- - ■ ❑ z �t11�2 2826- ❑ Cleanout between building and tank? -LPL+ - - - - - -- ----I- ❑ ❑■ ❑ Tank baffles present? - - - - - - - - - - -�t- - - - - -- ❑ ❑■ ❑ a 24" access risers over each compart - - - -- - - - ❑ ❑ ■ W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ � BIJR- Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman a D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES ❑■ N0 X0? Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ ❑ U3 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ c < 5 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑ 3 4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA © YES ❑ NO >100ft. fromwells?-- - - - - - - - -- - - --- - - - - - - - - - -- - - ❑ Ii ❑ W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ U: >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ Q > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ UI ❑ C > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - -- - - ❑ I ❑ W Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - - - -- - - - - - - - - - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?- - - --- - - - -- -- ❑ N/A ■❑ YES ❑ NO Y Pump tank capacity (flood) 1,250 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?- - - -- - - - - - - - - ❑ 0 ❑ Er a ' Alarm or Control Panel installed? - - - - - - - - - - - - - - - - - - - - - ❑ © ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - ❑ © ❑ a Pump installed in 0 Bucket or ❑ On Block or ❑ Other 0- Pump Make/Model Liberty 290 ❑■ Floats or ❑ Transducer d Tank draw down 2.25 in/min Pump capacity 52 gpm Squirt Height 2 ft Pump on time 2.3 min Pump off time 6 hours Daily flow set at 480 gpd Updated 8/21/2018 ASGU LT AA ii He Lq J'(�� I�LDEi4 ���• C•USTot�l }��-t�� of 33z) ( t, 5�' 333) Parctl# 2233�50-o033Z ,5 • tOV �� f�avCh Lq�t �r 5• " t S Cad�-01 : yO r o Zo Yo ,o go s. 2"10 L✓F * - _ I3 .il weu ? -3 ' as a / / 1 L ' Y QSe-Y�e j ,\euJ / ,�� 1 APPROVED s yoy, JUL 02 2026 o M M M S' J COUNTY ENVIRONMENTAL HEALTH RFT A . Key: Audio-Visual Alarm 3 O Cleanout n 500 Gallon Pre-Trash tank '`/ c 4 NuWater BNR-500 ATU Tank _. ... ��� O O ( 2-5 Gallon Pump Chamber a �" k ... a.d�-,- „ ?- t dam° 1 6 Valve Control Box �O.vSGS A Ey�Y} � 1.tvt5 waa ?i`J` t� 57G0348 (1� 1 Y�L 1 G!""� 17 PAULA JOY JOHNSON k Mason County 0SS installation Report pg. 2 Parcel 2 J0 O -OO3'3 2. ABANDONMENT RECORD ------ - O YES NO Were existing septic components abandoned as part of this project? -- --- - -- `777"" If yes, please describe: - ❑ YES ❑ NO Were all components pumped out and properly abandoned per WAC246 RECORD DRAWING permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development Typical Record This is a buildin s,location of wells,waterlines, Drawings contain: Drainfield&manifold orientation&layout,SeptidpumP tank location,North arrow,reserve createeld,existing and proposed g and related permits. wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create addit oval delays in finzt installation approval Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that!installed the system in accordance with /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 1 further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. vQ 2c d . Signature of insta er Date Printed Name of Signee e L MASON COUNTY PUBLIC HEALTH 2� The undersigned approves this Installation Report and 5100349 `•PAULA )0Y J0HNS0N \(J1� Record Drawing on behalf of Mason County Public . � tl�lEtib��i ivLFt" Health: Sign ture 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 821/2018 •II � t 1 . - -- p. y { � J