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HomeMy WebLinkAboutSWG2023-00031 - SWG Application / Design - 4/6/2026 r � Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH p►PPLoCANT PERtIQIT INFORMATION.. . ...:... ....:.:: Permit Number SWG 2023-00031 Parcel# 320357590052 Applicant Name Jim Belleville Subdivision (Name/Div/Block/Lot) Applicant-Address PO Box 3158 City, State, Zip Shelton,WA 98584 Installer Name Bay Shore Construction Site Address 160 SE Ashley Rd,Shelton Designer Name Adam Hunter INSTALLATION CHECKLIST .: ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only O Repair ❑Other System Type OSCAR II ....rf11 treatment Type . NA >5 ft.from foundation? ------------ -- ❑NIA YES ❑ NO >50 ft.from wells? -------- _ � --- - ❑ ® ❑ . >50 ft.from surface water? •--- -----��� ❑ ® ❑ Q=.: Cleanout between building and tank. - - - ----- ❑ ® ❑ Tank baffles present? -------- -\ ------ ❑ ® ❑ H . 24"access risers over each compartm nt?------ - ❑ ® ❑ W Effluent filter installed?--------- - ---------•. ❑ ® ❑ Septic tank capacity(working) 12 gal Manufacturer INFILTRATOR D-box water level and speed levelers used? -------------- - NIA ❑YES ❑ NO Manifold/D-box accessible from surface?-- - - ❑ ® ❑ -------- -----Check valves Installed? -------------------------- ❑ ® ❑ E Transport Line Size 1" Schedule/Class 40 Bedrooms Installed(check one) ❑2 ❑3 Q 4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?---------- ---------------- ❑ NIA YES ❑ N0 >100ft.fromwells?----------------------------- ❑ LI ❑ >100ft.fromsurfacewater? ----------------------- - ❑ >10ft.from potable water lines?--------------------- - ❑ ® ❑ >5 ft.from property lines and easements. ❑ ® ❑ >30 ft from downgradient curtaintfoundation drains?---------- O . ® ❑ Drainfield level and observation ports present ------------- ❑ ® ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover Installed over drainfield?------------------- ❑ ® ❑ Pump tank setbacks consistent with septic tank?------------ - 0 N!A ® YES ❑ NO Pump tank capacity.(flood) 1250 gal Manufacturer INFILTRATOR 24"access riser(s)and accessible from surface?-------------Alarm or Control Panel Installed? - ------------------- - ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter------------ ❑ L■J ❑ Pump Installed In ❑ Bucket or ® On Block or ❑ Other Pump Make/Model AY MCDONALD#22050E2AJ ® Floats or• ❑ Transducer a• Tank draw down OSCAR: NA In/mIn Pump capacity 30 apm Squirt Height NA ft Pump on time 22 SECONDS Pump off time 3 MIN 38 SEC Daily flow set at 480 gpd undated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 320357590052 ABANDONMENT:RECQ9 Were existing septic components abandoned as part of this project? --------------- ❑ YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -------- ❑ YES ❑ No RECORD:DRAWING.: This is a permanent record and must be accurate and descriptive enough to ro-locate In the need of maintenance activities and future development Typical Record Drawings contain: Drainfield&manifold orientation&layout Septiclpump tank location.Noith anew.reserve drainrteld.existing and proposed buildings,location of wells,waterlines, wells,observation pods,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays In final installation approval and related permits. ❑ Record Drawing Attached CERTIFICATION:OF INSTALLATION_`: INSTALLER DESIGNER/ENGINEER 1 certify that I 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 attac R ord Drawing is accurate, form and attached Record Drawing is accurate. 3/31/2026 Signature of installer Date BRANDON THOMPSON r. : : �. .� Printed Name of Signee MASON COUNTY PUBLIC HEALTH lan ';C i° The undersigned approves this Installation Report '-I .�.`• 5100412 '•�i Record Drawing on behalf of Mason County Public " ADAM.1.HUNTER Health: ��d, Signature of Environmental Health peciallst Date 4 -. t4(sfamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABL O LIC VIEW ON THE MASON COUNTY WEB SITE Updated 8(2112018 q1 tiF�lTy SCALE-1"=40'-0" 337.09' 20' ry I I I O O✓/p�tiig9cq� U /J 0 9 I°y I F4�Ty oarog/�s "v o«aauvxren y 'i•I'uiCfivr,:J ' wl O 3. 4 3 WI �I 7 KI PRESSURE TEST COMPLETED BY INSTALLER W I + SQUIRT HT: N/A OSCAR DRAWDOWN: N/A OSCAR TIMER SETTINGS- ON: 22 SEC 0 I OFF: 3 MIN 33 SEC O I 03 1200GAL SEPTI TANK JIM HUNTER&ASSOC. O4 PROPOL UMP K CONTRACTOR P.O.BOX 162,OLY,WA 98507 BAYS//ORE 05 PROPOS D DRIV I 753-1226 © I -1 JHANDASSOCIATES@HOTMAIL.COM INSTALL DATE-9/13/26 EXISTING LL I RECORD DRAWING SITE ADDRESS I LEGAL 33 3' SE ASHLEY RD OSCAR II H4O SUPPLY!RETURN LINE FINAL DATE- 0117/25 10 HEADWORKS(SEE DETAIL PG.2) TPtf 320367590062 SITE B SWG2023-00031