HomeMy WebLinkAboutSWG2023-00483 - SWG As-Built - 7/25/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2023-00483 Parcel# 32016-53-03036
Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot)
Applicant Address PG Box 241 Shorecrest Terrace 4th Add/Blk 3/Lot 36
City. State, Zip Kelso WA 98626 Installer Name Mason County Excavating
Site Address 170 E Greenwood Ln, Shelton Designer Name Arrow Septic D"kins,Inc
INSTALLATION CHECKLIST
® Full System Installation ❑Tankts)Only ❑ Drenfield Only ❑Repair ❑Other
System Type Gravity Bed Pretreatment Type
>5 ft.from foundation? ----- ---- - -- ❑NrA ® YES NO
>50ft.from wells? ._ _ ___ __ _ _ __ __ _ _____ _ _______ - ❑ ® ❑
Y >50ft.from surface water? -- ---- -- --- - ------ - -- - -- ❑ ❑
Z ? -__ ___ _ __________ _ - ❑
Cleanout between building and tank. ❑
U Tank baffles present? -- - ---- - - -- --- - - ------ -- --- ❑ ® ❑
F 24'access risers over each compartment?---- --- -- -- ---- - ❑ ® ❑
n ❑
w Effluent fitter installed?----- --- --- - - --- -- - - ----' - - ❑
N
Septic tank capacity(working) 1,200 at Manufacturer Hagerman
O D-box water level and speed levelers used? ---- - - --- -- -- -- ❑ NIA ■ YES ❑ NO
oLL —
Manifold/D-box accessible from surface?-- ----- ----- --- -- El ® ❑
iyq Check valves installed? - - - - -- - - - --- - -- - ----- -- ❑ El
0q
Se Transport Line Size 4' Schedule/Class 3034
Bedrooms installed(check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10ft.from foundation?----- - --- - - - -- - - ---- - -- -- - El WA NYES ❑ NO
1100ft.from wells?-- ------- ------- - ---------- - - ❑ ® ❑
W >100 ft from surface water?- -- -- - -- --- -- ----- - --- -- ❑ ® ❑
FL soft.from potable water lines?- -- --- - ---- --- -- - --- - ❑ ■ ❑
Z >5ft. from property lines and easements?-- -- ---- ------ - ❑ ® ❑
X > 30 ft.from tlowngredient curtamttoundation drains?----- --- - - ❑ ® ❑
0
Dreinfield level and observation ports present - - -- - - - - - -- - - - ❑ ® ❑
❑ Graveless chambers or M Clean gravel used? (check one)
Proper cover installed over dreinfield?- - - - - - - --- - - --- -- -- ❑ ® ❑
tank setbacks consistent with septic tank?------ - --- - -- ❑ wA ❑ Yea NO
1C Pump tank ca flood) gal Manufacturer
24'access nserls)and ac efrom aurfece?---- - - ----- -- 0 �
a
Alamr or Control Panel Installed? --- - - - - - ---- ---- ❑ ❑ ❑
Control Panel equipped with Timer/ETM/Coun - -- - - - - ❑ ❑ ❑
n. Pump installed in ❑ Bucket or ock or ❑
o_ Pump Make/Model
❑ Floe ❑ Transducer
0
Tank draw iMmin Pump capacity gpm Squirt Height ft
mp on time Pump off time Daily fbw set at
wean m,aore
Mason County OSS Installation Report pg. 2
=arcelm 3Q-o16 -43-03o31e
ABANDONMENTRECORD
- _______ yes IS NO
Were existing septic components abandoned as part of this Project?
If yes, please describe: Lj
ND
Were all components pumped out and property abandoned per WAC248-272A-0300? - - ❑ rE$
RECORD DRAWING
mu u a wrm«.m.iNeN W muu a..cuma.M d•-HG.<n-,h.r --N tine n.,or m•inNn<w<.<—.ne Nan awelnW^<nl !Ypml a<wm.
rvmn.�..•...N<m.nnae....ano«a enc<.<a puimmgs,imum,r.w<H.w«<n�n<:.
oe.i.iv.nnaa. rn.innaaam«am«um.uaaayw�.secwwmnn.iorevo< s:mgv<aa aeomna aawsin anal in«aueo<.wmw..e M.w roan^+.
w•,ee..n..<n cos.,a..n<uu.«w am«m.'nwww.m...w� inramoi«<a«oa o..»,n
1PROVE
JU�2 5 2024
�asoNcouNTv NviRONm�� i
jow
. Record Drawing Attachea
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certity that I installed the system in accordance with I certify that the system has been installed in awor-
the septic design stamped'APPROVED'by Mason dance vAh 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 clearadiappmved by both the designer shown here have been cleared(appmved by both
and Mason County Public Health and meet all State mysetland Mason County Public Health and meet all
and Mason County Codes. Stale and Mason County Codes
I further certNy that all information contained on this I further certiry that all information contained on this
form and arts ad Record Drawing is accurate. form and attached Record Drawing is accurate.
-I
Signet of Installer \ / Date
{k uy\ VIYK— }.
Prmh%:I Name of Siynee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and AJOYJ
Record Draing on behelr of Meson County Public �., .0,02191ON.He SSSIS)d•
S' Health Sp asa'st Date istamp,signature and date)
THIS FORM WYSE SCn NEDANDAVMI N 9 FOR PUBUCVIEWONTHE MASON COUNTYWEBSITE uw•<^��eo+e
p�proxmate SGALE 1 Z0
A R�c�Ss oho
As — Eu;l
EMNZEVAOMEGONSC WION
Skec*310te•55-090310
' / 1�o EGremux�od Ln.
�55 rk
F�
A="fes-r HOLE
axr1.� 'lg„
Cy
1 298`r aiox Z7 pAM $RND,
i
oo X Es 10 x45' QYiN Qr
�I . 9ravit ) draiv\\ l
bea w�'�'h io'x45
a 3't YeServe, Vow.
o �
Zo
a-►'
3aR
M0.nu f acturad }tome
z8
AgPPROVE
JUL 2 5 2024
WMASON COUNTY ENVIRONMENiAI H h
JBW \
Q ( sno ' E G,REEWwoOV LN-
-k�. e ��*�
C.QUl�.e.rc j � � = PAl1lA JOY DD JOMNSON '.
t
7—t5—Uf