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HomeMy WebLinkAboutSWG2023-00416 - SWG As-Built - 8/23/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00416 Parcel # 32021-55-02010 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 SHORECREST TERRACE 2ND ADD BILK: 2 LOT: 10 City, State., Zip Kelso WA 98628 Installer Name Mason County Excavating Site Address 90 E Ashwood Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST Q Full System Installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A ® YES ❑ No >50ft. from wells? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ 2 >50ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - ❑ Q ❑ H Cleanout between building and tank? - - - - - - - - - - - - - - - - - - - ❑ ® ❑ U Tank baffles present? - - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ® ❑ IL 24' access risers over each compartment?- _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ❑ ® ❑ W Effluent filter installed?- - - - - - - - ❑ ❑ rn 3p _sso Septic tank capacity (working) NuWater gal Manufacturer Hagerman �0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A ❑ YES ® NO DO Manifold/D-box accessible from surface?- -. x- -,-�- - ❑ © ❑❑ ® ❑ GQCheck valves installed? - - - -� - t - — - \QQ - f Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ® 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. from foundation?- - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . ❑ NIA ® YES NO >100 ft. from wells?- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ® ❑ ty >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - - - 5: >10ft. from potable water lines?- - - - - - - - - - - - - - - - - - - - - - ❑ ® ElQ > 5 ft. from property lines and easements?- - - - - - - - - - - - - - - - ® ❑ OW > 30 ft. from downgredient curtain/foundation drains? - - - - - - - - - . ❑ ❑ Drainfield level and observation ports present - - - - - - - - - - - - - . ❑ ❑ W Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfieW- - - - - - - - - - - - - - - - - - - ❑ ® ❑ Pump tank setbacks consistent with septic tank? - - - - - - - - - - - - - El WA X yes ❑ No Y Pump tank capacity (flood) 1,200 gal Manufacturer Hagerman F24"access nser(s)and accessible from suface?- - - - - - - - _ _ - ❑ ® ❑ a Alarm or Control Panel Installed? - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ❑ K ❑ jControl Panel equipped with Timer/ ETM/Counter- - - - - - - - - - - ❑ R Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Motlel Zoeller N152 ® Floats or ❑ Transducer Tank draw down 3 in/min Pump capacity a p acit p y 66 gpm Squirt Height 6 ft Pump on time 1.35 min Pump off time 6 hr Daily flow set at 360 gpd 111.1 11 tl1-1r10 e Mason County OSS Installation Report pg. 2 Parcelit SZ02A - 55— OZAlO ABANDONMENTRECORD ® Were existing septic components abandbnec as part of this project - --- - - - - - - - -- - - YES NO❑ If yes, please describe: Were all components pumped out and property abandoned per WAC246-272A-03007 I--- --- ' ❑ YES NO RECORD DRAWING mu..Y^^NYIt m.'ON aM mull M.CWM.IW a.urlVaa s.Wsn m TIOCW{n N.neltl ar m.Nbllinc..ttl'/itio.4 NWn a«NopmMt 11 1 aOmN of Y ii'vxax: n1.IM6k nINnRW'MCMlM1 a IryWI sw4Wumo IYM bUOGn.npT Neu.rtYrve C2iMItlO,.nOfi4 ena NOwX.dibNYs.lxJ4m W v.Yi,xMMn. �.w..aaw.v.n Faa.anaa,.m anr�wwman.nre.wu Ida. lrcamol.0 aevN oownc.mcr aura wmuonN creep in nw'm.waim woA.a ma iwue vm.n.. ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I terry that I installed the system in accordance with I certlty that the system has been installed in accof- the septic design stamped'APPROVED'by Mason dance with the septic design stamped'APPROVEX by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been clearedlapproved by both the designer shown here have been clearedhepproved 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 l further candy that all information contained on this I further certify that all information contained on this form and atta sd Record Drawing is accurate. form and attached Record Drawing is accurate. r g Za-zk Signatum oflnstaller Date Pf'.1AY1 ZYK- Pdnteof Name of Signee !- MASON COUNTY PUBLIC HEALTH The undersigned approves this installation Report and Record Drawing on behalf o1 Mason County Public N sto "a .r 'qr PAUTA.IOY�oNNsoN•',. Health:rye,, ��� /t /� L C R�/� I VCR' ' Mr 6 ' �/.���j,(.t un p t p nature of Envimnman a/Health S oelist tDataW \ D a u J2�Sig M (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ero•me ors,rzo.e .Ra S tys.',�-- x rj l � 5 �100 sq.�t �inS#rtr}� Cct��ofF o° 0 Ye 58rVv ti' i t�L �c�rrpl#3 DZt�5 027i� q0 ft�hwad INE la I �qqp 4 X ' 7'.I �- � 56 yo• \ t OAutho-Visual Alarm J1, SLo. 3 1 O2 Cleanout Z*, fiyiz2 © NuWater BNR-500 ATU Tank \ s. n 1,200 Gallon Pump Chamber $ _ s Valve Control Box U9Gdci�kX X IS, Ci� T,o XZ-Si C�-) 3x35�` CZ)3' X40 , (I) �Xy5 = 200LF— //Qr� w•'+�+'y D•F. Tre„J,.� � S' C-G- w-� 11''� -F-t dY�P T e:Sc+YJG APPROVED r. r,. AUG 2 3 2024 . MASON COUNTY ENVIRONMENTAL HEALTH T o tt'y RET PAfILAJOY JOiNSON 1 9 I--7 Q - 1µ