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HomeMy WebLinkAboutSWG2024-00234 - SWG Application / Design - 3/22/2026 —Iwn APR 002026 Mason County OSS Installation Report ffa/1 AP ON COUNTY PUBLIC HEALTH APPLICAf 171RMIT NFORMATION Permit Number SWG 2025-00234 Parcel # 32030-51-03005 Applicant Name Victor Nicolas Subdivision (Name/Div/Block/Lot) Applicant Address 2133 Montana Blvd City, State, Zip Shelton WA 98584 Installer Name House Brothers Site Address 2133 Montana Blvd Designer Name Jim Hunter INSTALLATION'CHECKLIST O Full System Installation ❑Tank(s)Only ❑ Drainfield Only IN Repair ❑Other System Type Pretreatment Type >5 ft,from foundation? ------- - ❑ NIA ®YES ❑ NO >50ft.fromwells? ------- - - - -- - -- -- --- ❑ Z >50 ft.from surface water? - -- ----411j -MAR-? -2026 - ❑ ® ❑ HCleanout between building and tank?--- ❑ 0 ❑ V Tank baffles present? - -- - -- -- Sy- -- _ - - - - ❑ LII ❑ a24"access risers over each.compartmen - - -- - - - ❑ ® ❑ �W Effluent filter Installed?--- -------- -- ----- -- ---- --- .- ❑ III ❑ • Septic tank capacity(working) BNR 500 gal Manufacturer Sound Placement • D-box water level and speed levelers used? --- --- ---- ---- - N/A ❑ YES ❑ NO 0 O Manifold/D-box accessible from surface?-- --- -- - - -- ---- - - ❑ ❑ •Oz Check valves Installed? - - - -- - - - - -- - - - ----- ----- -- ❑ ❑ Transport Line Size 2" Schedule/Class Schedule 40 Bedrooms installed(check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- -- - - - - --- - -- - -- -- - - --- -- ❑ NIA :®YES ❑ NO >100ft.fromwells? - -- -- - -- ----- --- --- - -- - --- -- ❑ 0 ❑ >100ft.-from surface water? - - - - --- -- - - - ------- --- - - ❑ © ❑ W u >10 ft.from potable water lines?------- --•-. --- - --- --- - - ❑ ® ❑ e?e� > 5 ft.from property lines and easements?- - -- - --- -- - --- -- ❑ ® ❑ f]C > 30 ft.from downgradient curtain/foundation drains?--- - - -- --- -- --- - ❑ ® ❑ Drainfield level and observation ports present -- - - --- ❑ •® ❑ ❑ Graveless chambers or 11 Clean gravel used? (check one) Proper cover installed over drainfield?--- --- -- -------- --- -- ❑ ® ❑ Pump tank setbacks consistent with septic Tank?.---------- --- - ❑ N/A ® YES ❑ No '1 Pump tank capacity(flood). 1250 gal Manufacturer HB Precast 24"access riser(s)and.accessible from surface?- --- ---- - -- -- ❑ ® ❑ Alarm or Control Panel Installed? ----- - --- -- --- - - -- - - - ❑ II ❑ Control Panel equipped with Timer!ETM I Counter- -- - - - --- - - ❑ II ❑ Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Liberty 290 ® Floats or ❑Transducer Tank draw down in/min Pump capacity 5O gpm Squirt Height ft LL Pump on time 1,5 M',1 Pump off time 1 ho c Daily flow set at 36 C7 gpd Updated 8/2112018 Mason County 0SS Installation Report pg. 2 Parcel# 32030-51-03005 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ---- --- - -- --- -- © YES NO If yes, please describe:abandoned old tank Were all components pumped out and properly abandoned per WAC246-272A-0300? -- ------ JE YES O NO • RECORD DRAWING This Is a permanent record and must be accurate and descriptive enough to relocate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfiald,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts.and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. s_ %Record Drawing Attached CERTIFICATION OF INSTALLATION' INSTALLER DESIGNER!ENGINEER I 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 l further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record awing is accurate. Sig ture of Installer è.late , y f 2 - 'd05 Printed Name of Signee MASON COUNTY PUBLIC HEALTH yw� 51O273 j The undersigned approves this Installation Report and ', 1Al4O A Ftt NTFR Record Drawing on behalf of Mason Cou g3pubib Lir, t'1SFt)Df51C►t4ER Health: Signature of Environmental Health Specialist Date �✓�O �6' (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR P VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 1' / f 0211/1/L ':" __ ____ // tj 1 �ld �1 / I ,.•.f t; l�-�$� (17�+/L..r G� "��lGlFp�� � o ��1 f f� � _ 4 "4SO4 0 , o y4•• ALP �L .,.. ._--.=,_t,.8:,.�-,�..._..�_•�.�-�_�- �..,......�,..._�.�.��_ -.__.. _._..� O� 57273 s.1�+ .__,__ _�....__.. ,._...,. _�. m_ .._,.-.__.____..,_�.....,._T....._......_ _..,.-. .-.... .. ,,_.._.__..._..-__....._. ..___, •--_-.,r-,.. )AMES R.FSMT','R °r LICENSED DfStGfNER ' JIM H U"N-rER 8c ASSOC. CON rRacroR EXPIRES: 0;/22/— OOu5ECST�-1G12,5 (� P.C. BOX 12 OLY,WA 98507 753-IZZ6 YN5TALL BATH fl 2u-Th rrE RECORD DRAWING S A�nRE_SSJLEGAL I +-r 2133 MoNTAMP, SLVi.3 OWNER - V c.co? y«N�.IC�Ac.- S F2TTNL DAT!E 'ZrJ TPR '�✓ZO3 CJ IU� -' SE-R C52oZ-i.O2,7•j