Loading...
HomeMy WebLinkAboutSWG2025-00127 - SWG As-Built - 2/4/2026 , 1:1P, =MI VZ7 NI JAM 3 0 2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICI8WL _ERMIIJNEO MATI0N Permit Number SWG 2025-00127 Parcel# 32022-23-00010 Applicant Name Jami &Jimmy Kaneshiro Subdivision (Name/Div/Block/Lot) Applicant Address 301 E Hillcrest Dr City, State, Zip Shelton, WA 98584 Installer Name County Line Development, LLC Site Address same Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST U] Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ Z >50 ft.from surface water? - - El ❑Q ❑ H El between building and tank? - - ❑ 0 U Tank baffles present? - - ❑ 0 ❑ d24"access risers over each compartment?- - ❑ 0 ❑ W Effluent filter installed?- ❑ ❑ 0 co 31.1R- Septic tank capacity(working) NuWater 500 gal Manufacturer Sound Placement 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES 0 NO DO Manifold/D-box accessible from surface?- - ❑ 0 ❑ mZ Check valves installed? - - ❑ ■❑ ❑ caQ 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- � _ - I=I N/A 0 YES ❑ NO • >100 ft. from wells?- �5 W W°`^�� ❑ ❑ El W >100 ft. from surface water? - - O 0 ❑ IZ >10 ft.from potable water lines?- - ❑ 0 ❑ dZd > 5 ft. from property lines and easements?- - O 0 ❑ d > 30 ft. from downgradient curtain/foundation drains? - - ❑ 0 ❑ Drainfield level and observation ports present - - ❑ 0 ❑ O Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A 0 YES ❑ NO • Pump tank capacity (flood) 500/1000 gal Manufacturer Sound Placement-combo tank < 24"access riser(s)and accessible from surface?- - ❑ IN ❑ ~ Alarm or Control Panel Installed? - - ❑ ® ❑ a • Control Panel equipped with Timer!ETM/Counter- - ❑ © ❑ d Pump installed in ❑ Bucket or 0 On Block or ❑ Other a" Pump Make/Model Zoeller N152 ❑I■ Floats or ❑ Transducer d Tank draw down 2 in/min Pump capacity 40 qpm Squirt Height (o.5 ft Pump on time Z.25m',n. Pump off time 6 hours Daily flow set at 360 gpd Updated 8/21/2018 Parcel# 1202-2— 23- COO \ 0 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD ;: E2 No Were existing septic components abandoned as part of this project? - - O YES If yes, please describe: Were all components pumped out and property abandoned per WAC24fr272A-0300? - - O YES O No 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 ants location,North arrow,reserve drainfeld.E=xisting and proposed buildings,location of wens,waterlines, Drawings contain: Drainfieid&manifold orientation&layout,Septic/pump� wens,observation ports,r4+anouts,and other maintenance acbess points. Incomplete Record Drawings may create additional delays in finat installaPon approval and related permits. S-12--(2-- 1 bli Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I 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 fu er iffy that all information contained on this I further certify that all information contained on this fo attached Record Drawing is accurate. form and attached Record Drawing is accurate. \ 01122/Z(0 Signature of Installer Date •MICHAEL LOVELY liZ` r'?U Printed Name of Signee rGbo, r - r, .. MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report an i9 AA P it-rid •' stooaaa I Record Drawing on behalf of Mason County Public ., PAULA�00 JOHNSON• Health'/ /CC� °' l' S_ rGidr 776(( zaz 6 AS�NCOC/vry 0 4 9f) 2EXPIRdS s-z� Sig re of Environmental Health Specialist Date R,,yIweilqle (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC 4421q.!THE MASON COUNTY WEB SITE uptated 8121/2°1e w r {a k7 ar ✓', •A . ./6\6 , S. -i1Z-1-4-1 ...;..-..;r1--:- , N . . 5 i4E7_,-..---,,:. 1,1A- ..r;:.-- 4 a i. 25',c2) 1 0 (�) 35' 'r' max y D.F. 4i C 7,2 s._,i c-k<-15 1-r e,„,j,-,es 6 5' 0.6.• v.); --‘4" r-ese_y 4- 1 b4...1Bw - 2a° LP t 3 t / - / 1 ittlt. C.fre-- // i • ..rt ; ff �.►s, ^sT4 �y LY ` \ # ek 1;: 4-c--i-P4-r:%`"f.‘ I 1 a , , 9—,-.6 _14 I .4.4r o 1? j /'SBR• 0 • , fr e 5 ,S ° • •1- A-. :.ec ---e- pp ?% .mss;!c 1 1 Key: 1 OAudio-Visual Alarm O2 Cleanout A . •3 NuWater BNR-500 ATU Tank C ° t%rre,= Sk S8 a O , O 4 1,000 Gallon Pump Chamber MAa ! `s e �h O5 Valve Control Box 4A `(' ', 51003 .Y.i�h • APPROVED• PAULA JOY JOHNSON . ,,� • ' •SCE tSKti'd 5iai EXPIRES 1 6 FEB 0 4 2026 i -1s-Zt MASON COUNTY ENVIRONMENTAL HEALTH • DJA •