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HomeMy WebLinkAboutSWG2024-00046 - SWG As-Built - 6/6/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00046 Parcel # 22017-50-00038 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 Timberlake Div 2, Lot 38 City, State, Zip Kelso, WA 98626 Installer Name Mason County Excavating Site Address 601 E Lakeshore Dr E, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST U Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure • -treatment Type NuWater BNR-500 >5 ft. from foundation? ❑ WA YES ❑ NO >50 ft. from wells? s-t- � Si - ❑ 0 ❑ z >50 ft. from surface water? 'it1j ❑ HCleanout between building and tank? - 0`l_- - - - - - - ❑ I ❑ U Tank baffles present? - - - - - ❑ 0 ❑ a 24" access risers over each compartm t - - - - - - E I ❑ W Effluent filter installed?- - ❑ ❑ 0 N t3i4-- Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ] YES 0 NO J Dix 0 O Manifold/D-box accessible from surface? n- - ❑ 0 OOZ Check valves installed? o`er F �4 ❑ • ❑ 0< 40 2 Transport Line Size 2" Schedule/Class Bedrooms installed (check one) ❑ 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 0 YES ❑ NO CI >100 ft. from wells?- - ❑ 0 ❑ W >100 ft. from surface water? - - ❑ 0 ❑ E >10 ft. from potable water lines?- - ❑ CI ❑ z > 5 ft. from property lines and easements? - ❑ 0 ❑ a cc ❑ ME ❑ > 30 ft. from downgradient curtain/foundation drains?- - o Drainfield level and observation ports present - - ❑ ® ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistent with septic tank? - - ❑ NIA 0 YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman z - ❑ ❑ Q 24' access riser(s)and accessible from surface?- - - H Alarm or Control Panel Installed? - - ❑ I. ❑ n. 2 Control Panel equipped with Timer!ETM /Counter- - ❑ 0 ❑ m - Pump installed in ❑ Bucket or 0 On Block or ❑ Other EPump Make/Model Zoeller N152 0 Floats or ❑ Transducer a Tank draw down 2.25 in/min Pump capacity 43 gpm Squirt Height 6 ft Pump on time 2 min Pump off time 6 hr Daily flow set at 360 gpd edated s212O 8 O -1 - SO- i! 38 Mason County OSS Installation Report pg. 2 Garce(r 22 ABANDONMENT RECORD - 7 YES ii NO Were existing septic components abandoned as part of:his project. I`yes, please describe: ({ YES NO Were all components pumped out and properly abandoned per WAC2e6_272A-0300? RECORD DRAWING This is a p Pti 9 future degs.eloplocation ntwells,wa a:ices. permanent record and muse be accurate and descriptive enough to re-locate in the reed of maintenance activities and tun:re development Typical Record Drawings contain: Drain`eld 8 manifold onerabon 8 layout.Sepdcfp'urno tank lo:zton.Norte.arrow.reserve drain`.eid.exl ng and proposed na Incomplete Record Drawings may create add!tiena!delays in final insteation approval and related dermas. wells,xservz5or,ports,deanas,and ether maintenance access coo.• . IncomPl t '� V /�� 5*\-cw-A-K, u t.7` • im 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 cieared/approved by both the designer shown here have been cleared/approved by both • and Mason County Public Health and meet all State myself and Mason County Public Health and meet all W and Mason County Codes. State and Mason County Codes 1 further certify that all information contained on this I further certify that all information contained on this • form and atta,phed Record Drawing is accurate. form and attached Record Drawing is accurate. • n } Signature of Installer Date f..., 4 Printed Name of Signee � g MASON COUNTY PUBLIC HEALTH „��. . ‘i.)The undersigned approves this installation Report and I' •� ,; '- ..• Record Drawing on behalf of Mason County Public 5100349 '• l'), '^�' PAULA JOY JOHNSON �n Health: 11C8 U �t I;ti' + C°( 61Rb- Signature of Environmental ,ealth Specialist Date (stamp, signature and date) • TH,S FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY VJEB SITE .:pca:ec 82,2C 5 'ri J-- cE 5 " r � e t ti K•�' SEA e,\ d "^"\, �Nf'b . . \ • \ 584 iSIA,14-5'P N . ,, :y A p p \- Fi ° © o JuN 0 6 6/ ® ' O �!ASO;Y COON ?025 9 ryE' , " ,1 REr NLi I . ' \ \ i '-.\--d s p O Audio Visual Alarm cyyts- 0 Cleanout Eo i 1 03 NuWater BNR-500 ATU Tan i ��' •. 2S 104 1,000 Gallon Pump Chamber 1 v.. O Valve Control Box 14 N../ (3) . \ \I I I-E° i. G3 \ 5 I A, \ \ \ v - r scLi-re- .. ire ,„..5..„ „,,,,, L Ti to 1 \ arl • 10.4.0i7A. . %.• 510034 •. '•�j\ Lo' PAUTA JOY JOHNSON '?.\/1 EVRE3 /95� • 5-22-as