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HomeMy WebLinkAboutSWG2026-00224/ASBUILT - SWG As-Built - 9/4/2026 llllll� Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2026-00224 Parcel# 22217-50-00014 Applicant Name Richard Arena Subdivision (Name/Div/Block/Lot) Applicant Address 110 NE Belaire Dr Bel Aire Cove, Lot 14 City, State, Zip Belfair,WA 98528 Installer Name Maples Excavating&Septic Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST • Full System Installation ❑Tank($)Only ❑ Drainfield Only Q Repair ❑Other System Type OSCAR X02 Pretreatment Type OSCAR X02 >5 ft.from foundation? ------- --- p'slni {pf'A1 I�,p+ DNA DYES NO >50 ft.from wells? -- -- - --- - -- - I'I � -L U ❑ x ❑ Z >50 ft.from surface water? -- - - - - SEP�32926 N JII ®1Il1 ❑ ❑ F Cleanout between building and tank? - - - - ---3--- - - ❑ ® ❑ ii Tankbafflespresent? -- - --- ---- - -- --- ❑ ® ❑ d24"access risers over each compartmen?"y - ❑ ® ❑ w Effluent filter installed?- --- - - - - - - - - ❑ ❑ N Septic tank capacity(working) 1.000 gal Manufacturer 2-Comp Hagerman Traffic Rated 0 D-box water level and speed levelers used? -- ------------ - O NIA ❑ YES ® NO DJ O Manifold/D-box accessible from surface?--- - - - -- --------- ❑ ❑ gi Check valves installed? -- -- - - ----------- -------- - ❑ ® ❑ 2 Transport Line Size 1 Schedule/Class 40 Bedrooms installed (check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑CommercialiOther >10 ft.from foundation?---- - - - -- - - - - - ❑ NIA YES ® NO >100 ft.fromwells?---- ---- - --- - ------- - ❑ ® ❑ W >100 ft.from surface water?- - - - - - --- - - - - ------ - --- - ❑ ❑ a 110ft.from potable water lines?- -- - -- - -- - - ❑ ❑ > 5ft.from property lines and easements?- - -- - - - - --- - ---- ❑ ❑ K > 30 ft.from downgradient curtain/foundation drains?- ❑ ® ❑ Drainfield level and observation ports present - --- - ❑ ® ❑ Q-33 Sa.J` Proper cover installed over drainfield?--- ---- -- ❑ IN ❑ Pump tank setbacks consistent with septic tank?-- ----- ------ ❑ WA N YES ❑ NO Y Pump tank capacity(flood) 1.000 gal Manufacturer 2-Comp Hagerman-Traffic Rated a24"access risers) and accessible from surface?-- --- ---- ---- ❑ ® ❑ ~ Alarm or Control Panel Installed? - - -- ---- - - - -- - - - - - - -- ❑ Q ❑ 5 Control Panel equipped with Timer I ETM/Counter-- - -- -- - - - - ❑ SI ❑ Pump installed in ❑ Bucket or ❑ On Block or Q Other on bottom of tank Pump Make/Model AYMcDonald E-30 30gpm,1/2hp,115v ® Floats or ❑ Transducer D —Tank draw down in/min Pump capacity 30 gpm Squirt Height — ft Pump on time 30 sec Pump off time 3 min Daily flow set at 240 gpd Vrd•W 812112018 Mason County OSS Installation Report pg. 2 Parcel# 2"1 x-11- St - 0©oN- ABANDONMENT RECORD NO Were existing septic components abandoned as part of this project? - ---'-"- ----- -" 5 YES if yes, please descdbe'. Q(& �mod }rt *, U t.t Were all components pumped out and properly abandoned per WAC246-272A-0300? '--'-- -" ■ YES ❑ No RECORD DRAWING This is e fltrnalwat.,PP and must de accurate and aasen$dee enough to relocate in the need of maintenance ae6vtes and Noun,aeveopment Ty I Reat Drawings contain: Drain&d8 manifold onentatiM B layout.septicNump tanx lcmdon.NmC:arrow.resrne cran1eld.e,dstn5 and proposed Wilding;Iowton olweas,wa vtas.Mserreoon porn.demvatx and o4er maintenance accepts points. Intlampee Rama Drawings may agate adNdonal ddap in fin insth1tm apptmal and tasted Pe^mss. . C� ('0.`A-ed 4^ s o , 3o CO C i S4 S c S - l t As-o s -e kSa -fir P °v 5 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that!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 I further certify that all information contained on this form and attached Record Drawing is accurate, form and attached Record Drawing is accurate. Signature of Installer Date Slate we Ygt I Printed Name of Signee r r Fls MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public 51COJag ':g�'. PADU JOY JOHNSON '��It Health: p ' .tl 7 C8b15d NCH- SignatugofEnvronmental H Ith Specialist Data (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE UWnmaatrzme ScE : 1 , , o w W • 2 it, Ae� 1ck (�s7 rt2ErJA _�°3 S4`2E D �RACEL 221'1 O 00o t4 f'%i5' �-^A�- 110 NF 13 E+-FrlRr Drt �F. ��1R WTI eIj;� D - ,fi -- ' A -rI;ST 4tvLE 6P3Cr FKISTItiv 2 Biç I CCPSR.S£ ` A} Dl Zs-3E Cp� �L y N1Efl tsJ Ada s 5 1 i� w ' '° N PATID DECK • .IS` S C,0 9 X62 N -10 RecK BO�K t1 EfuD •�� rn N On p N o rrf 9P Control Panel with Audio-Visual Alarm cieanout ^�J O3 1,000 Gallon Septic/Aeration Tar-k TY'm�„�with u diffuser **Note to installer*' O4 1,000 Galion Clarifier/Pump Tart Sleeve waterline when within 10' 2-Comparth1ent cV+A4c'-M.44 of septic transport line. Maintain 10' minimum between water Headworks line and septic tanks/drainfield. O6 OSCAR XO2 Mound Dxai d tkS4` • Old 1� r • N ®%ClY �Pd K -fin- P.�'' °•' � .li,f6 J¢ • t6-".S. WAS' • !� PAULA JOY JOHNSONK&�'•.>{ G •4. ICEl 1:tl GKS16NEit._ . . Ka la Milam From: DO NOT REPLY <noreply@masoncountywa.govi?, Sent: Monday, August 24, 2026 10:52 AM - . -.. To: Environmentalhealth Subject: OSS Inspection request for Richard Arena -SWG2026-00224 Submittal request for: Richard Arena Site Address: 110 NE Belaire Dr. Permit Number:SWG2026-00224 Parcel Number: 222175000014 Installer Name: Shane Maples Jn) M Installer Phone Number:3602293043 u�, AUG2y2026 Installer Email Address:maples excavating@hotmaii.com By Designer Name: Paula Johnson Designer Email Address: paulaj@hctc.com Inspection Request Date:2026-08-24 Inspection Type: Full System Comment\Notes: submitting your final install request.The install should be complete and ready to inspect on the Inspection Thank you for d remain uncovered forthree business days to allow staff time to inspect. Poor weather situations may Request Date' an be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation kfill of system components. If no contact is made by the health department within the three approval prior to bac of notice,the installer may cover. Mason County Asbuilt Form, Record Drawing,and Installation fee must business prysd for final installation approva be submitted l. MASON COUNTY Public Health & Human Services FINAL INSPECTION: 5WG2026-00224 ADDRESS: 110 NE Belaire Dr PARCEL: 222175000014 DATE: 8/25/2026 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE