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HomeMy WebLinkAboutSWG2023-00458 - SWG As-Built - 9/10/2024 Mason County OSS Installation Report pg. 1 MASON COUNTY PU LIC HE H APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00458 Parcel # 32016-53-04008 R ��p Applicant Name Empire Home Construction LLC Subdivision (Name/Div/Block/Lot) ��'Fp Applicant Address PO Box 241 SHORECREST TERRACE 4TH ADD BLK:4 LOT: 8 City, State, Zip Kelso, WA 98628 Installer Name Mason County Excavating Inc. Site Address 91 E Greenwood Ln Shelton,WA Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s) Only ❑ Dr infieltl Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type Nu Water BNR-500 >5 ft from foundation? -------- - - - -- - ---- -- - -- ---- ❑ NIA MN YES ❑ NO >50ft. from wells? - --- ----- - --- - -- - - -- - - - - -- - -- ❑ Cl Z >50ft. from surface wateR --- - -- ----- -- - - - -- - El-- -- ❑ © FClilanout between building andtank? --- - - - ---- - -- ------ ❑ ❑ p Tank baffles present? - ------ --- ---- -- - - - -- -- - -- - ❑ ❑ f- El access risers over each compartment?- - - - - ---- ---- - -- ❑ CIL W Effluent filter installed?- - ----- - ---- ---- - -- -- ❑ ❑ H gNiL-Svo Septic tank capacity (working) NUWater bal Manufacturer Hagerman O D-box water level and speed levelers used? -- --- - --- ------ El WA ❑ YES No 0J 0 ManifoldID-box accessible from surface?--- -- -------- --- - ❑ ® ❑ o?Z Check valves installed? -- - - ¢ - - - ----- - ❑ ® ❑ OQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 113 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- - -- - -- -- - - - -- - - - - ---- -- . ❑ NIA ® YES No >100 ft. from wells?---- ------ --- --- - ------ --- --- ❑ ® ❑ W >100 ft.from surface wateR ----- - ---- -- --------- -- ❑ ® ❑ LL >10ft. from potable water lines?-- ---- ----- --------- -- ❑ ® ❑ z >5ft. from property lines and easements?- --- - -- -- - ---- - - El I] ❑ a ❑ ® ❑ C >30Rfrom tlowngredient curtain/foundation drains?- - -- - - - - - - 0 Grainfield level and observation ports presen[ -- - --- -- - - - --- ❑ ® ❑ K Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- -- ---- - - ----- --- ❑ ® ❑ Pump tank setbacks consistent with septic tank?- -- ---- ------ ❑ wA ® YES NO hd Pump tank capacity Mood) 1000 aal Manufacturer Hagerman 24" access riser(s)and accessible from Surtam?---- -- ---- --- ❑ ® ❑ ~Q Alarm or Control Panel Installed? -- ----- - ---- -- El ® ❑ D_ ___-__ - ❑ � Control Panel equipped with Timer/ETM/Counter-- - - - -- - -- - El 7 a Pump installed in ❑ Bucket or ® On Block or ❑ Other a- Pump Make/Model Zoaller N152 Floats or ❑ Transducer - 9L Tank draw down 2.5 in/min Pumpcapacity 48 bpm Squirt Height' ft a Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd VOCaIR OrIt/[p19 Mason County OSS Installation Report pg. 2 Pendell* 32016 -53-OH60$ ABANDONMENT RECORD Were "lung woo components abanooned as part of Nis project? -—------------ ❑ Yes NO If yes, plasm deaniDe', Were all componerta pumped out and propeny abandoned per WAC246272A-M? --"'--- ❑YES ❑ NO RECORD DRAWING mb.,pMm,nml rKwe.na m.n a.emunu,ne aoenpure mwaa m e PPAF In a nee or m.muP&, „.P vi—d Nbn a,r,leWm TyPOI RewC p,uPpeaauin: bryMMaa mnaua we,P,M al,ryj SepaVpump l4..Ipueon.Nw .r.xm dMIMMa.,vwq ma Pap PUoms.loueon olxMN.r lna. FaA apYWkn Wne.aunwro.,na can murrten.Me,vau venu. InumpRu F.ruR onrs6e Pu wrc ads laMrysin"I inWlNen eWrnaleM MCYa pumas. ® Record Drawing Attached CERTIFICATION OF 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"APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been c4amc0approved by both the designer shown here have been cleamd(approved by both and Meson County Public Health and meet ell 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 )orm and attePhed Record Drawing is accuate. norm and attached Record Drawing is accurate. 1 Signature ofmatafter Date !�1, Y"•t.t�O.Y� �.11"L c "`i�f Printed Name of Signee MASON COUNTY PUBLIC HEALTH ', t The undersigned approves this Installation Repon and Record Drawing on behalf or Mason County Public rPAULA JOY JonxeoN r. Health: go A 10/?iY 9-S—Z'f SlgneUam Of Enwmnmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANDAVAIIABLE FOR PUBLIC VIEW ON THE MASON COUNTY WES SITE uWnu v^a^" - Mason County OSS Installation Report pg. 1 MASON COUNAD APPLICANTI PERMIT INFORMATION Permit Number SWG 2023-00458 Parcel# 32016-53-04008Applicant Name Empire Home Construction LLC Subdivision (Name/Div/Block/Applicant Address PO Box 241 SHORECRESTTERRACE4TH City, State, Zip Kelso, WA 98628 Installer Name Mason County Excavating Inc. Site Address 91 E Greenwood Ln Shelton,WA Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft from foundation? - -- ----- - - -------- -- - ------ ❑ wA ®YES NO >50 ft. from wells? - - - - - - - - -- ------ ----- - - -- -- -- ❑ ® ❑ 14 >50ft. from surface water? -- - - - - ---- - - ---- -- - - - - - - ❑ ❑ rCleari between building and tank? - - -- - - ---- - - - - - ---- ❑ ® ❑ t) Tank baffles present? - -- - - - - -- - -- - - - - - - - - - - - - - - - ❑ ® ❑ H 24"access risers over each compartment?- - - - --- - - - -- - -- - ❑ © ❑ Q. Effluent filter installed?- - - --aN - -- - - - - - - - - - - - ❑ ❑ ❑� Septic tank capacity (working) NUWatef gal Manufacturer Hagerman o D-box water level and speed levelers used? -- - - - - - - - - - - -- - ❑ NIA ❑YES NO QJ O Manifold/0-box accessible from surface?- - -- - - --- - - - - - -- - Check valves installed? - - - - -off- - - -- -- - - - ❑ ® ❑ �2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 6 CIS ❑Commemial/Other >10ft. from foundation?-- - -- --- -- - -- -- - - - - - -- - - - - ❑ NIA ® YES NO C >100 ft. from wells?- -- - ------ --- - - -- -------- - - - . ❑ N ❑ w >100 ft, from surface water? . - - - - - - - -- - --- -- --- - - - - ❑ IN El LL >10ft. from potable water fines?- -- - -- ----- - - ------ - - - ❑ ❑ QZ > 5ft. from property lines and easements?- - --- - - - ----- - - ❑ ® ❑ C >30 4. from downgradient curtain/foundation drains?- - - - - - - - - - ❑ It ❑ Drainfield level and observation ports present - - - -- -- -- - - - - - ❑ ® ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?----- -- -- --- -- -- -- - ❑ ® ❑ Pump tank setbacks consistent with septic tank?--- - -- - - - - - - ❑ NIA Q YES ❑ NO Y Pump tank capacity (flood) 1000 at Manufacturer Hagerman Q 24-access riser(s) and accessiole from surface?- - - - ---- - ---- ❑ ❑ aAlarm or Control Panel Installed? --- -- - -- - - - ❑ ® ❑ jControl Panel equipped with Timer/ETM/Counter - - - - - -- - - - ❑ K ❑ d Pump installed in ❑ Bucket or 0 On Block or ❑ Omer IL Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 7' ft Pump on time 1.8 min Pump oft 8me 6 hr Daily flow set at 380 gpd VMtl!]b3f1p18 S�ecIED b.44"CERl.xN6 - E to' OF AM UEENA� LN- ,5w�p-cSc co MPDN ENT o O 0 ,O •O ;O 40 �b•5 1 i — � �t�~2��3o° 9sl+voats — — {0 Cc vu0mG k6vl. Yroots lG 15' *r j-23" J` +r(Jdts -to (4)3'x5V Q+'imRv dralh fi(d -trtr4 s ill �o Jtk¢ r5. ® 5'aQ Ur;,VV. 20o r_� �L % Ale, AppRo\j Ol Audio-Visual Alarm 10 SIR -&14 ltN z clesnout ncRCNMEH� HEA © NuWater BNR-500 ATU Tank MASON COUNry EN�c� ' 8 1,000 Gallon Pump Chamber G 5 Valve Control Box ebJo PAUU JOY JONNlfpJ .� 1 9- s2{