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HomeMy WebLinkAboutSWG2023-00343 - SWG As-Built - 3/19/2025 Mason County OSS installation LI MASON COUNTY PUBLIC HEALTH CANT/PERMIT INFORMATION Parcel# 22018-53-00060 Permit Number SWG 2023-00343 Subdivision (Name/Div/Block/1-00 me Applicant Name Empire Ho Construction -LC TIMBERLAKE#5 LOT:60 Applicant Address P 0 Box 241 Zip Kelso WA 98626 Installer Name Mason County Excavatinc City, State, P Site Address Tim 2420 E benake W Or Designer Name Arrow Septic DesignsInc. INSTALLATION CHECKLIST Grainfield Only Li Repiur ❑Others Pressure Full System Installation ❑TankPr Only ❑ Pretreatment Type NuWater BNR-500 System Type re Bed ❑ NIA ® VEs ❑ NO >5 tt,from foundation? - - --- ❑ ® ❑ >50 ft.from wells? - - ❑ ® ❑ 2 >50 ft.from surface water? -- -- " ' - -- ❑ HCleanout between building and tank? --- - - --------- - 7ankbafflespresent? - - - -- -- - - -- - - - - - --- - - -- -- - - ❑ U ?.__ _ _ __ ___ _ _ ___ . ❑ ❑ a24"access risers over each cemparfment W Effluent fitter installed?- - - - - - - - - - - $11k�- ❑ ❑ Hagerman Septic tank capacity(working) NUWater 500 gal Manufacturer ❑ No NIA ❑ YES 0 D-box water level and speed levelers used? ---- ❑ ❑ J �O ManrfolND-box accessible from surface?-- - -----'-'__ ❑ $pp _"` _ ___ _ _ . 2 Check valves installed? -- - -P -�µ' �' - ❑ 04 Schedule/Class 40 a Transport Line Size 2^2" q 5 6 ❑Commercial/Other Bedrooms installed (check one) ❑ 2 ®3 ❑ ❑ ❑ ❑ NIA ® YES ❑ NO >10 ft,from foundation?-- - - - - - - - ---------- ❑ © ❑ >100 ft,from wells?- --- -- - - - """-- _- _ - ❑ Q ❑ W >100 ft.from surface water? - - - - -" '_____ __ El LL >tO ft.from potable water lines?- ----- - ❑❑ Q ❑ >5 ft.from property lines and easements?- --- -- - --- ------ ❑ 6 O > 30It.from downgradient curtain/foundation drains?- --- - --- -- ❑ ® ❑ Draintteld 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 gal Manufacturer Hagerman Q24-addeae nand)and accecalmc from aMace9-- - -----_-_ - 13 ® ❑ ~ Alarm or Control Panel Installed? - - - --- - - - - - ' - '-- ❑ ❑ a ❑ a Control Panel equipped with Timer!ETM/Counter-- - -- - - - - - - Il Pump installed in ❑ Bucket or ■ On Block or Other a. Pump Make/filodel Zoeller N152 ® Floats or ❑ Transducer a 76 gpm Squirt Height 7 tt Tank draw down 4 inimin Pump capacity a 8 hr Pump on time 1.2 min Daily flow set at 360 gpd Pump off time Mason County OSS Installation Report pg. Z Parcel# 22O18- 53- 0 ICAO 60 ABANDONMENT RECORD Were exiaang septic components abandoned as part of this proles[ 7 _ _____ _ ___ YES ■ NO 1f Yes, please describe'. _ NO Were all components pumped out and property abandoned per WAC246-272A-03001 ___ _-_ - YES RECORD DRAWING _ i1N 4 a pa .r.MLN aM muN W KOYM antl aaawsuw anOuaM1 b rNWb in Na nab.!mainnnaMa iGYvitlR NL dui Cin95,IOaM1M o'YYs wx2caNn<s. DmxnOa cancan: DninfiW 6lvniftla MaMNm 64WM1 SroOW+^P uM leuvan.NrvT nrmv.nsene 9artIANe.anbN9 eM POGO ,rela,Mrnvwm Vu4.en^cw.°^e°>'✓"'ii^�^aa��O°iMs. Ircample40.�C DnwinOe rt4Y�n aEERentl EeIM in M1nal inf411avd�appmW a��Ma4-0GaM1^M1° ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that 1 installed the system in accordance with l 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 clearadapproved by both the designer shown here have been clearedtapproved 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 /further certify that all information contained on this form and attephed Record Drawing is accurate. form and attached Record Drawing is accurate. Signal"of Installer Date I'�� f.GYM �vrIL Printed Name of Signee MASON COUNTY PUBLIC HE LTN The undersigned approves this installation Report and AJOY Record Drawing on behallo/Mason County Public Health: am sl(ct Signature of Envimnme tal HealID Specialist Date (stamp, signature and date) THIS FORM MAY BE SCA,INEO AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VMS SITE owa4eamrsO�a a9 _ APPROVED MAR 18 2025 LLL ar MASON COUNTY ENVIRONMENTAL HEALTH 242o E 7iN 6rrla'r a rsfi r RET $Cal[: ! "= 20' e a 2tl 3a ft c N a Z7' x48' I �JQr MN 2ZS' �Cx45 Kc cEAvE i *SLkEVF tc i ' DQRinFSE D yJtrvAlN t0' I j 44 ! tex45 a ;:r,=.•=.a il`--� 56P'C11� Wa'CE 0.- $5• SAM- OAudio-Visual Alarm O2 Cleanout QNuWater 13NR-500 ATU Tank d 1,000 Gallon Pump Chamber 5 Valve Control Box G PAUtA J10 1 JOHNS ON;�