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HomeMy WebLinkAboutSWG2025-00239-ASBUILT - SWG As-Built - 7/25/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00239 Parcel # 31902-75-90033 Applicant Name Dewhill Homes Subdivision (Name/Div/Block/Lot) Applicant Address 1830E Brockdale Rd TR C-3 OF SURVEY 4/46 TR 1 OF SP#583 AF#365991 City, State, Zip Shelton, WA 98584 Installer Name B-Line Construction, Inc Site Address 93 SE Dusty Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ■❑ Other 1,200 gal 2-comp pre-trash tank System Type Shallow Pressure Pretreatment Type NuWater BNR-500 ❑ N/A j YES ❑ NO ? - - - - - - - - - - �VE ->50 ft. from wells. � ❑ � ❑ Z >50ft. fromsurfacewater? - - - - - - - - - - - - - - - - ❑ UI ❑ Cleanout between building and tank? JUL Za�0j6- - _ -_ ❑ 0 ❑ Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - ❑ F ❑ 24"access risers over each compart '` - ❑ U ❑ W_ Effluent filter installed?- - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ Septic tank capacity (working) NuWater 500 gal Manufacturer Sound Placement a D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A [] YES Q NO o0 Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑ UI ❑ OdCheck valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ U ❑ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 UI 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A Q YES ❑ NO >100ft. fromwells?-- - - - - - - - - - - - - - - - - - - - - - - - -- - - ❑ F ❑ W >10oft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ M >10ft. frompotablewaterlines?- - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ Z > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - ❑ 0 ❑ a t > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ I ❑ ❑ Graveless chambers or © Clean gravel used? (check one) Proper cover installed over drainfield? -- - - - - - -- - - - - - - - - - Li UI El Pump tank setbacks consistent with septic tank? - - -- - - - -- - - - - ❑ N/A W YES ❑ NO Pump tank capacity (flood) 1,250 gal Manufacturer Sound Placement 24" access riser(s) and accessible from surface?-- - - - - - - - - - - - ❑ W ❑ Alarm or Control Panel installed? - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ Control Panel equipped with Timer/ETM/Counter - - - - - - - - - - - Pump installed in Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty 280 ■❑ Floats or ❑ Transducer a.- Tank draw down 1.3 in/min Pump capacity 33 gpm Squirt Height 2.5 ft Pump on time 1 minute Pump off time 3 hours Daily flow set at 270 gpd Updated 812 112 01 8 0 Mason County OSS Installation Report pg. 2 Parcel# 3t0'215 '9ccJ ABANDONMENT RECORD 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 re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports.deanouts,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 DESIGNERI 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 al(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 /further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. OS- 28 --2,to Sign./u of Installer -_ Date }) l 4.//af )otnC� � Printed Nam of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public y* PAULA JOY JOHNSON Health: iG� $1r�1��S1r`oNv� Signature of Environmental alth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 1. 'I)1•r � Y�I 1l�,1 I i +lte� , � / •/ � J O / \ I . l•�1 gat �• N ' ' ��� � �! r� Ffl LL1 1U1 Sl t P11 �j o•-- - •1 r..W.... h) 'M 2) �:tl t\X11 "Y r __ - ______ Kayla Milam From: DO NOT REPLY <noreply@masoncountywa.9ov> Sent: Friday, May 8, 2026 10:44 AM To: Environmentalhealth Subject: OSS Inspection request for Nancy Dewey-SWG2025-00239 Submittal request for: Nancy Dewey Site Address:93 SE DUSTY LANE,SHELTON WA 98584 Permit Number:SWG2025-00239 Parcel Number: 319027590033 Installer Narne: B-LINE CONSTRUCTION INC Installer Phone Number: 360-489-9169 , fY Ii 9AY o 820261111 Installer Email Address: office@b-lineconstruction.com Designer Name: PAULA JOHNSON Designer Email Address: PAULAJ@HCTC.COM Inspection Request Date: 2026-05-08 Inspection Type: Other Comment\ Notes: DF Only- Please call Taylor 360-489-9169 Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. If no contact is made by the health department within the three business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. f. • MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00239 ADDRESS: 93 SE Dusty Ln PARCEL: 319027590033 DATE: 5/12/2026 HOUSE TO DRAINFIELD DRAINFIELD TO HOUSE