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HomeMy WebLinkAboutSWG2023-00372 - SWG As-Built - 9/27/2024 r � Mason County OSS Installation Report pg. 1 MASON COUNTY PUB EALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2023-00372 Parcel # 22017-50-00045 s Applicant Name Empire Home Construction LLC Subdivision (Name/DivBlock/Lot) RFC ¢1p Applicant Address PO Box 241 TIMBER LAKE#2 LOT:45 F City, State, Zip Kelso WA 96626 Installer Name Mason Cvinty Excavating Site Address 560 E Lakeshore Dr E, Shelton 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? - - - - - - - - - - - - -- - ---- ------ ❑ NA ® YES ❑ No >50ft.from wells? - -- - - - -- ------ ----- ---- - - - - -- ❑ © ❑ Y >50ft.from surface water? -- - --- -- - -- ------ - - --- - ❑ ❑ Z Q Cleanout between building and tank? ---- -- -- ------ ----- ❑ ❑ U Tank ball les present? - - - -- - - - - - - --- ---- - -- - ----- ❑ ® El 1- 24"access risers over each compartment?----- --- - -- --- -- ❑ ® ❑ a M W Effluent filter installed?----- -- - - - --- - -- - - - ❑ ❑ Septic tank capacity(working)__BNB-500 gal Manufacturer Hagerman O D-box water level and speed levelers used? -- -- -- - - — - - - - - ❑ NIA ❑ YES ® No O Manifold/D-box accessible from surface?-- - --- -- -- - -- - -- - ❑ ® ❑ QZ4 Check valves installed? --- -- - -- - - - - - - - -- - -- - -- -- - ❑ ❑ O Transport Line Size 2' Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other 110ft,from foundation?- - - - - - - - -- - - - - - - - - -- - -- -- - ❑ NIA YES NO >100 ft, from wells?-- -- - - - - - ---- - -- - - -- - - - ----- - ❑ ® ❑ w >100 ft. from surface water?- - - - - - - -- - - ------ - - - - - - - ❑ . ❑ M >10ft.from potable water lines?- - - - - - - - -- -- - -- - - - - -- ❑ ■ ❑ >5 ft.from property lines and easements?- - - - - - -- ❑ ® ❑ K >30ft. from downgradient curtaintoundation drams?- -- - - - - - - - ❑ ® ❑ Drainfield level and observation ports present ---- -- - ❑ ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- -- - ---- - ------ - - ❑ ❑ Pump tank setbacks consistent with septic tank?-- ---- - - --- -- ❑ NIA ® YES ❑ No Y Pump tank capacity (flood) 1,000 at Manufacturer Hagerman ¢ 24"access risags)and accessible from sudaca?- - - --- - - - -- -- ❑ E ❑ a Alarm or Control Panel Installed? - -- --- - - - - - ❑ ❑ Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - ❑ ® ❑ a Pump installed in ❑ Bucket or ® On Block or ❑ Other a Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer :3 Tank draw down 4 in/min Pump capacity 76 opm Squirt Height 2 ft a Pump on time L2 min Pump oft time 6 hr Daily flow set at 360 opd Jp1M M�20'.B i 1 Mason County OSS Installation Report pg. 2 Parcel# ZZD11 -�- OOO`kj ABANDONMENT RECORD WCR existing septic Wmppnent9 abanooneC as pan of this pmlect7 ---- --- -- ------ ❑ YES ■ NO If yes, please describe: Were all components pumped out and propelly abandoned per WAC24E-272A-03001 "- --- - - ❑ YES ❑ NO RECORD DRAWING <ma me mu..u.iP&.ne d-P%r,--1'm rt.lwu m m.n..a of m..rc.n.nu.omm..ma man Gaaopmmt rlp<al 9.we •�•'� M punned,.1.11 P`R—N.WEW.1.1,-cl w.n,w.unne:. nmw9q.Wren^DNMtlaamMAda m.nJYattdl.Yuf..sep4.+vLT4 wYbuoan..OM tt.'u F nnm m.lYaon aR�'a eM:tlaW Gann. w.a..m.m.mn pau,a..nwe..nc war muma.�awu pa�u. InwnGlpa RecPO Onw.a mry a..u.aeroovl CYy. ■ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certhy that I installed the system in accordance with i cently 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 c/eareo/apprDved by both the designer Shown here have been cleared/epproved by both and Mason County Public Health and meet all State myself and Mason County Public ti alBl and meet al/ and Mason County Codes. State and Mason County Codes /further certl/y,that all information contained on this I further certify that all information contained on this form and atta?had Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Data V" f Printed Name of Signs. 11 ./ MASON COUNTY PUBLIC HEALTH y f. Tha Ono...igned iuplove.true Installation Report no ' pAULA JOY JDHNBON': Record Drawing on behalf of Mason County Public Uld IGN Heal( ' own q k7/Zy Signature ofcnNronme tel Health Specialist Date (stamp, signature and date) THIS FORM MAY 89 SCANNED AND AVAILABLE FOR PUBLIC VIEW ON 7HE MASON COUNTY Was SITE uxnn Pt'AL'.e / . ZZ O �1C-LppiJl.h JOY JO'N9aN. O R 9 p\(bJt t` 3 B1Z I �. ero'I-¢cF t'r�ma,y + I Z-1 X48J �}eSQW�' areas �- ev ' . Jeln ic!etra"�'L- � D s5� (2) I primate( D.F '�`�d�� R5 ` W',;h ReserJe abNe __ � L_akes�:o•-s Dr. c '�— a.,d �x..lo� f: , - 2o' r—s--3 H4G O 16 zo +Jp qc AQ_h Jtl Q Audio-Visual Alarm O2 Cleanout tjCn r' = Lc.KESY.er�- Tr- E. © Nu Water BNR-500 ATU Tank 4 V%e- L-]c�. ' •^sr `ly„ � 4 1.000 Gallon Pump Chamber �u /ce l L2{ i7-SC-n 5 wr Cm. l.r� -sip Q 5 valve Control Hox APPROVED SEP 27 2024 MASON COUNTY ENVIRONMENTAL HEALTH RET