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HomeMy WebLinkAboutSWG2023-00349 - SWG As-Built - 8/26/2025 gromoriimmillemilb 1 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00349 Parcel # 22127-43-00000 Applicant Name Charles& Nancy-Anne Butros Subdivision (Name/Div/Block/Lot) Applicant Address 342 SE Nelson Rd GOVT LOT 3*AND TAX 173* City, State, Zip Shelton, WA, 98584 Installer Name TNT Excavating Site Address 728 E Sunset Hill Rd, Shelton Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only 0 Drainfield Only 0 Repair ❑ Other 500-Gal Pretrash Tank System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - ❑ El ❑ Z >50 ft. from surface water? - - ❑ ❑■ El 1-- Cleanout between building and tank? - - El ❑ U Tank baffles present? - - ❑ 0 ❑ P. 24" access risers over each compartment?- - ❑ I a N ❑ ❑ 0 Effluent filter installed?- B�� -- Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0NO DO Manifold/D-box accessible from surface?- - ❑ 0 El 002 Check valves installed? 0.k itpwrsf "`k - ❑ ❑■ ❑ OG 40 2 Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑ 3 0 4 Li 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- a - �,.r,t,;_• ❑■ YES ❑ Ittl �`' o CI >100 ft. from wells? L., ❑ ❑ W >100 ft. from surface water? - • .- - -AUG 2-b-11J25 - Ir s'i 0 ❑ = c ET- >10 ft. from potable water lines?- - Se" El ❑ cat Z MASON COUNTY ENVIRONMENTAL E).-" ■ I` > 5 ft. from property lines and easements?- ❑ ❑ a ? ❑ ❑ re > 30 ft. from downgradient curtain/foundation drains? -J$lAl� -• Drainfield level and observation ports present - - ❑ I ❑ ❑ Graveless chambers or © Clean gravel used? (check one) 1 , CZ Proper cover installed over drainfield?- - ❑ © ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ ❑ I— a. Alarm or Control Panel Installed? - - ❑ • ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ © ❑ m n- Pump installed in ® Bucket or ❑ On Block or ❑ Other 0- Pump Make/Model Liberty 280- 1/2hp 0 Floats or ❑ Transducer a. Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 3 ft Pump on time 2.7 min Pump off time 6 hr Daily flow set at 480 gpd Jpcate.c 5r2 .2)t e Parcel Mason County OSS Instailatlon Report pc• 2 ABANDONMENT RECORD Were eXistinc septic wcrnpon•ent5 abandoned as par: ''S c...leit' .'__.. Y=G 7r NO E I'yes. please describe R i - � YES �i t Were all components pumped cut and praperiy ebandcrec per:n:•A�.24e—[-?i+-...'.:. RECORD DRAWING an:must be accurz a a e.eescrIptive enou a:e-locate if..the ^?EC sz.^craze^brce zc�.•::iew and:azure ec..e:opmen:. 'Y:1ca:4ou:re This a Perteanent reran: . •:a•., zw. ese^:e L:a:::`ie::.ex•sars are=c;.oSeC ;. ,; ,.-e^;a5ar.5 ..St•�^oau.^p z-;.c:x:.;. . a" _ r:*aa� a.^s. ,.,4,^gs erfatc: ors,c.:zic ma^:'oic^. --- _ - :+ate a.._.:..-ai!clays R,.r..a a>.�n ar='e,a:an:, a 'J/bhr.abSer159C�;ors,u:zna;:t$, Sep- P PROVE AL•M/sQ, COUNTY ENVIRONME NT HEALTH I • Jawt • g Record Drawing Attached d CERTIFICATION OF INSTALLATION • ,INSTALLER DESIGNER/ ENGINEER the system ac�Grf e . . that ne system has been installed it?Bccor- 1 certify that I installed a ..� :.`� : ...,'::� •. `r�,1�P:�V✓ a'^.''by A,r;P CV_r° % canoe . t: S rstamped design stamped ,2�'::^. ?. •;r:;,�"the Er`iiC design 2:.ped the septic des -- by . PublicCounty Health and thatot` any Ce✓iaiiors Sh :' Mason County Public Health and that eny deviations here have been cleared/approved by both the designer , she here have been cleared ac;oroved by both and Mason Countyr' Health Uvtic end d meet c.:Sae i :c: arc, Vasor" County PF:bilc"lea,th and Mast ail Mason es. e:d as:r County Codes I and County Cod _ nr fy r ir'Gr^aCion :orrtair ec 0' :his tr iu'-nag( e!'i y' : a;: nf✓ ation containe..C. 1 l further certify that a%: S ring is accurate t nz'az:ac'eo Decor awing is accur ate. d fore and 2 ached Record s; a i I r i • %Signature c'. 1\1\42%)‹ i\iii0J+.. li.!:-' i 0,;,, . 4 , Printed Name c;=Sigr:ee. I .P1 di*tr, O. "" MASON COUNTY PL'SL'.0 ?FALTH 1 0 7:::-(44‘ 4 The urde.�slgne approve 1: 0 s. ..`S .'^SIB!at!Q'' ter; StCO 4p PAULA JOY JOiiNSON' � . agrtF. 1 4-2(e25 8-(s--ZS �I' - stamp;, signature anO date; S FOR PUB_ - ASC\ . =_a -=(S FORM�1i+�!3c SC=,!\i\2 :.VG;ivi•+1i..43L _ .._.. _ _ ..�. �t l . \�� % •;, p-;,,,%a r„t J 1 1 C . N. 49\ �-- i 00} t S• X la0 U SCGY ,,•i f\ J- b % i 4Q� 1 -� fits 'p i ��r3 L- � u3c Tae. �F t g C Kev: �yc. key _ cel-e. K O Audio-Visual Alarm _fillithibk 2 Cleanout N 3 500 Gallon Pre-Trash tank TQ„z e.t cfl-r•vQ G 0NuWater BNR-500 ATU Tank � � ! Chamber q PO 1,100 Gallon Pump S O Valve Control Box 3eo-sov,at rw�c-r� S � pp , A f Ro v } �� MgSON UOUNTUG ?b ,, f.; ✓L- r FN1/1RO Je M-^P44,.,.644 Th 1,4L3' SCALD- 1"=6p, L. TeST 'rkOL. f 1. AS-built � y 1 CYi &LES gU1 &QQS damp corrtpa�'Cc1ts. • . 9 .1 ?i�:z� 2- -43-00000 „,'0-34k 15 wifi��rC `. • ��►. 1 2.8 E sE'� ill. ' .P Sf>r lACAure l 3 '54. 5100342 4UJOYjN W 15:s- NE.. omits T W f22 $-fs-Zr kAzP