HomeMy WebLinkAboutSWG2024-00147 - SWG As-Built - 6/25/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2024-00147 Parcel # 32021-58-03011
Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot)
Applicant Address P.O. Box 241 SHORECREST BEACH ESTATES#1 BLK: 3 LOT: 11
City, State, Zip Kelso,WA 98626 Installer Name Mason County Excavating
Site Address 200 E Lynwood Dr, 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
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft.from wells? - ❑ 1] ❑
>50 ft.from surface water? - i f�'- 5 V ❑ 0 ❑
Z
HCleanout between building and tank? - - ❑ I
U Tank baffles present? - ' 1 11 - JUN 1_IZ Z5 _ ❑ • ❑
a24" access risers over each compartment?- - - - ❑ I ❑
W Effluent filter installed?- By - - - - - - - mil I ❑
Hagerman
Septic tank capacity (working) 1,250 gal Manufacturer Ha 9
o D-box water level and speed levelers used? - - ❑ N/A [] YES 0 NO
oO Manifold/D-box accessible from surface?- -
❑ a ❑
mz Check valves installed? - - ❑ I ❑
a E Transport Line Size 2 inch Schedule/Class 40
Bedrooms installed (check one) ❑ 2 [2 3 014 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ NIA [U YES ❑ NO
O >100 ft. from wells?- - ❑ I ❑
W >100 ft. from surface water? - - ❑ • ❑
Er. >10 ft. from potable water lines?- - ❑ ❑■ ❑
� > 5 ft. from property lines and easements?- - ❑ ❑� ❑
Q
re > 30 ft. from downgradient curtain/foundation drains? - - ❑ ® ❑
p
Drainfield level and observation ports present ❑ Mil 0
® Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ 0 ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ® YES ❑ NO
• Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman
z - El El
• 24" access riser(s) and accessible from surface?
~
n. Alarm or Control Panel Installed? - - ❑ U] El
E Control Panel equipped with Timer/ETM /Counter- -
❑ 0 El
a Pump installed in ❑ Bucket or 0 On Block or ❑ Other
2 Pump Make/Model Zoeller N152 1:1 Floats or ❑ Transducer
a.
a Tank draw down 2.25 in/min Pump capacity 50 gpm Squirt Height 4 ft
Pump on time 1.8 min Pump off time 6 hours Daily flow set at 360 gpd
Updated S12 /20t8
Mason County OSS Installation Report pg. 2
Parcel r 52-0 2.t—58r0 301 I
ABANDONMENT RECORD
- AYES :I Na
Were existing septic comps abandoned as part of this P "r„ject? �e���t�\
If yes, please describe: 4� , `� YES i] NO
Were al!components pumped out anal crop . y abandoned per WAC24E-272A-0300? -
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to relocate in the reed of maintenance activities and future development Typical Record
Draw ngs contain: Drairreld&manifold orientation&layout.Septicipump tank location.Nord:arrow,reserve crsir.`.eld.exsur.g and pro posefinal bushingsn approval and dalocafion of wells,wateni res,s.
wells.observation ports,cleanouts,and other maintenance access pats. Incomplete Record Drawings may create addi5onal delays
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Record Drawing Attached 1
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 cleared/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
and Mason County Codes. State and Mason. County Codes
I further certify that all information contained on this 1 further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
Sii,gnature of Installer Dare A''''1
y..\.4_ . T. ..qk
Printed Name of Signee .7PAIN 0 1,04 .c,H ',
MASON COUNTY PUBLIC HEALTH � k. .--.010 ',a .f
Tne undersigned approves this InstaIIe ,on Report anal 0 \ stooans
1
Record Drawing on behalf of Mas�iq�County P � � y JOHNsoN '
Health �U�CO0N Y`S "{' e .P.AuLA.JOY
t1�s sE i�NE '��
i(
11/0 OS
Signatu of Environmental Health Specialist Dkdq 'fcoy,,.,f/ (stamp, signature and date)
r THIS FORM MAY BE SCANNED AND AVAILABLE FOR Rump,/VIEW ON THE MASON COUNTY WE3 SITE upeatee 82t20t8
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