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HomeMy WebLinkAboutSWG2025-00380 - SWG As-Built - 7/16/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00380 Parcel# 22123-22-50020 Applicant Name JBF Developers, LLC Subdivision (Name/Div/Block/Lot) Applicant Address 2916 NW Bucklin Hill Rd#162 City, State, Zip Silverdale, WA 98383 Installer Name Shumaker Construction Site Address 270 E April Ave, Grapeview Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type >5 ft. from foundation? - - - - - - - -- - - ❑>50 N/A Q YES ❑ NO ft. fromwells? - - - - - - - - - - (� - � - - ❑ ❑ Z >50ft.fromsurfacewater? - - - - - 1�- - - - - - - - - - - - - _ El II ❑ Cleanout between building and tank?i*� - -- - - - -------- - El -�Z-- - - ❑ El Tankbafflespresent? - - - - - - - - - - - - - - - - - - - - - ❑ ❑■ ❑ 24" access risers over each compart + ?! - - -- - - - ---- - El Q ❑ W Effluent filter installed?- - - - - - - - -- - - - - - - - - - - - - - - - - - El ❑■ ❑ co Septic tank capacity(working) 1,200 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - - - - - - - - - - - --- El N/A ❑ YES ❑I NO Q0Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - El Q ❑ mZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑ QQ M Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) El 2 R 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ❑■ YES ❑ NO >100ft. fromwells?- - --- - - - - - -- - - - - - - - - - - -- - -- - - ❑ UI El W >100ft. fromsurfacewater? - - - - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑ M >10ft. frompotablewaterlines?- - - - - - - - - - - -- - - - - - - - - - El 0 ❑ > 5ft. frompropertylinesandeasements?- - - - - - - - - - - - - - - - El IN El W > 30 ft. from downgradient curtain/foundation drains?- - - - - - - - - - El ® ❑ Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ II El ❑ Graveless chambers or Q Clean gravel used? (check one) Proper cover installed over drainfield?- -- - - - - - - - - - - - - - - - - ❑ ■❑ El Pump tank setbacks consistent with septic tank?-- --- - - - - - - -- El N/A Q YES ❑ NO Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman H6 24" access riser(s) and accessible from surface?-- - -- - - - - - - - - ❑ © El • 1 Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - El © ❑ • Control Panel equipped with Timer!ETM/Counter- - - - - - - - - - - ❑ I ❑ G.- Pump installed in Q Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty 280 Q Floats or ❑ Transducer d Tank draw down 2 in/min Pump capacity 46 gpm Squirt Height 5 ft Pump on time 1.9 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8121/2018 Mason County OSS Installation Report pg. 2 Parcel# 22 ZJ'ZZ-'SOoZo 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: Grainfield&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. c&cL Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that/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 I further certify that all information contained on this 1 further certify that all information contained on this kSignature and act ed-Re Drawing is accurate, form and attached Record Drawing is accurate. —(-2( of Installer Date ' \ S Printed Name of Signee ti H MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report an Recor rawing on behalf of M County Blc li '> r( tocan9 � � � PAULA JOY JOHNSON• l He the NCOU"ryF 2.9?O t. IC�tSE 1�LSs�NEa.. 7 —lc�-2� nature of Environment l Health Specialist Da d i 11/ (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 821/2018 is c 0 1'a �O U ! 2Z(23-z2. 5o2b _27o E Pr P K I tr pN� 4- I - Q I �F��P� _�KPrPf��t�u�1 vJ�► �95 � ._. n ..� h k e Cl) OAudio••Visual Alarm . ' PROVEQ Q o o Cleanout /i1.o`. s• t� 1200 Gallon Septic'Tank�y 2-Comparlmcnt:with JUL2 9 2026 , ,1 IafUucx�t:l lller MASON COUNTY ENVIRONMENTAL HEALTH , 1.200 Gallon Pump Chamber ::� ti�. DJA ( °` 5 Valve Control Box Cra�3 t 1c4 ' C7RI Ma D.F• / 1 . • c � �I Rhonda Thom son Frorr" DO NOT REPLY < se"t" Saturda noreply@masoncount wa. To: Y July 4, 2026 2:51 PM Y gov> subject: Environmentalhealth OSS Inspection request for JBF Builders LLC -2025 00380 1�. Submittal request for:JBF Builders LLC Site Address: 270 E April Ave Permit Number: 2025 00380 Parcel Number: 22123-22-50020 Installer Name: shumaker Construction Installer Phone Number: 360 509 1222 Installer Email Address:atshumaker@msn.com Designer Name: paula Johnson Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-07-06 Inspection Type: Full System Comment\ Notes: 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. 1 MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00380 ADDRESS: 270 E April Ave PARCEL: 221232250020 DATE: 7/6/2026 FM�P r _ r rz HOUSE TO DRAINFIELD t - DRAINFIELD TO HOUSE