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HomeMy WebLinkAboutSWG2025-00176 - SWG As-Built - 5/27/2026 o T Mason County ®SS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APUANTLPERMfl1NFORMATiO.N .. Permit Number SWG 2025-00176 Parcel# 31902-75-90021 Applicant Name Dewhill Homes Subdivision (Name/Div/Block/Lot) Applicant Address 1830 E Brockdale Rd City, State, Zip Shelton, WA 98584 Installer Name B-Line Construction Site Address 91 SE Dusty Ln, Shelton,WA Designer Name Arrow Septic Designs, Inc Ii STALLATI N2C ECI LIST 2-COf .. Full System Installation ❑Tank(s)Only ❑ Drainfield Only ;❑ Repair Other 1,200 gallon pre-trash tank System Type Shallow P ent Type NuWater BNR-500 >5ft. from foundation? ------- - ----L6n - - - ❑ NIA [YES LINO >50ft.fromwells? -- - - - - - - - - - - - �y 1O26 ❑ ❑ Z >50ft.fromsurfacewater? -- - - - - - - - - - - - -- - - - - - ❑ ❑ Cleanout between building and tank? - - --- - - - - - - - ❑ 0 ❑ < Tankbafflespresent? - - - --- - -- - - - - - -- ❑ [ I ❑ 24" access risers over each compartment?-- -- --- -- - -- ---- ❑ EI ❑ lU ` Effluent filter installed?---- -- ❑ II ❑ t93 Septic tank capacity (working) NuWater 500 gal Manufacturer Sound Placement t3 D-box water level and speed levelers used? ------ ------- -- ❑ N/A ❑YES 0 NO o Manifold/D-box accessible from surface?- -- - - - -- --- --- - -- ❑ II ❑ Check valves installed? - - -- - °`-' - ❑ ❑ ❑ :.:.,�. Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation? - - - - - - -- - - - - - - - - -- - ---- - ❑ N/A AYES LINO >100ft.fromwells2-- ---- - - - -- ------ - -- - ------ -- ❑ ❑B ❑ >100 ft. from surface water?-- - --- - - --- ------ - - --- -- ❑ 0 ❑ >10ft.frompotablewaterlines?- - - - -- - ---- - -- - - - - -- - - ❑ III ❑ -�- > 5 ft from property lines and easements?- - -- - - - - -- - - - - - - ❑ II ❑ > 30 ft from downgradient curtain/foundation drains?- - - - - - - - - - ❑ I1 ❑ Drainfield level and observation ports present - - -- - - - - - --- -- ❑ ® ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - ----- - - --- - - -- ❑ Q ❑ ry Pump tank setbacks consistent with s ptic tank? - ❑ N/A ❑Q YES ❑ NO (�1�{'j�Flaodl�--- - ---- - Pump tank capacity(flood) 1,200 'gal Manufacturer Sound Placement ,.y 24"access riser(s)and accessible from surface?--- ----- - - - - - ❑ ® ❑ fZ Alarm or Control Panel Installed? - --- - - - - - - -- - -- - - - - -- ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - -- -- ❑ ® ❑ Pump installed in Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty 253 0 Floats or ❑ Transducer Tank draw down 1.4 in/min Pump capacity 31.25 gpm Squirt Height 3 ft Pump on time 64 sec Pump off time 3 hr Daily flow set at 270 gpd Updated 8/21/2018 r � Mason County OSS Installation Report pg. 2 Parcel# 31 9 02- Z5- 9 ooL Were existing septic p tic components p nts abandoned as part of this project? -- ----- - ----- - - 0 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 ecord and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septicipump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports.cteanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIF1CATIOtOF 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"APPROVE©"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. 5-7- Z(0 Sign u of installer Date Printed Nam of Signee 7 '�, -s3•VQ•ABri , i��, MASON COUNTY PUBLIC HEALTH Y 41� The undersigned approves this lnstallatier` eporF and Record rawing on behalf of Mason County Pub i3 sro 349 PAULA JOY JOHNSON1 ' Heal `J �'L'���t���a 17�.����:�' N/Z qs0 t �& s.Lo t Signature of Environmental Health Specialist (stamp, signature and date) THIS FORM MAY BE SCANNED AND A�IA{L BLE PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 �gCTy H1lV3N 1b1N3WNOal a 3 LNfloO NOSvW NQSN OP or vl i. 9ZOZ t Z AdW Nvsrv�or nor v-in•dd � \•'gyp .' 3AOU I -? `"0 _TaQL+2t � Q=-?mss uo -D oo '1 C r A7 Y1SCtQ -s - S {� •y:,3 , itt81A o^LILY �/• �8 Q�j rf./ -..5 C . 3S I . ri ( .. osx c ) ___ Ii • I s - ( { \�1