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HomeMy WebLinkAboutSWG2023-00417 - SWG As-Built - 8/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION do 0 Permit Number SWG 2023-00417 Parcel # 32021-58-04008 -< ,____ g Applicant Name Empire Home Construction LLC Subdivision (Name/Div/Block/Lot) C PP P "�- Applicant Address PO Box 241 Shorecrest Beach Estates#1 BLK: 4 LOT: 8 �.. b City. State, Zip Kelso, WA, 98626 Installer Name Mason County Excavating A Site Address 220 E Hillcrest Dr, Shelton, WA Designer Name Arrow Septic Designs, Inc. iWi I 1 r INSTALLATION CHECKLIST • Full System Installation ❑ Tank(s) Only ❑ Drainfield Only ❑ Repair ❑ Other System Type Subsurface Drip Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A g YES ❑ NO >50 ft. from wells? - ., - El � ❑ >50 ft.from surface water? - - P -H- - !,...k";. 0 ❑ `� ,. . HCleanout between building and tank? - - - - - ill 0 ❑ U Tank baffles present? - - -AU& O-4-2025 ■ ,_:. [I ❑ a 24" access risers over each compartment?-fb}A-SON-COUNTY ENVIRONMENTA ,A D-- UI ❑ w Effluent filter installed?- JB-I- - - El El Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman `0 D-box water level and speed levelers used? - - ❑ N/A El YES El NO ACS )<O Manifold/D-box accessible from su acc?- -- r - - - - ❑ El ❑ 032 Check valves installed? - - - - - ❑ 0 ❑ ❑Q 2 Transport Line Size 1" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A g YES ❑ NO CI >100 ft. from wells?- - ❑ © ❑ -1 >100 ft. from surface water? - - ❑ II ❑ w Li >10 ft. from potable water lines?- - ❑ ■❑ ❑ z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q CL > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ • Drainfield level and observation ports present - - ❑ I ❑ ❑ Craveless chambers or ❑ Clcan gravcl uacd? (check onc) Proper cover installed over drainfield?- - ❑ • ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ■❑ YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24' access riser(s) and accessible from surface?- - ❑ . ❑ t— o_ Alarm or Control Panel Installed? - - ❑ © ❑ 2 Control Panel equipped with Timer/ ETM/Counter- - ❑ © ❑ n d Pump installed in ❑ Bucket or ❑ On Block or I. Other On bottom of tank o'• Pump Make/Model Sta-Rite Step 20 1/2 hp 115 V 0 Floats or ❑ Transducer a Tank draw down 1.75/10 in/min Pump capacity 3.3 gpm Squirt Height -- ft Pump on time 9 min Pump off time 1.84 hr. Daily flow set at 360 gpd ;.l:ec.S 2.,a g. 2 Parcel 32-021- � - o�koo$ Parcel r Mason County OSS Installation ReABANDONMENT RECORD r" YES ■ NO abandoned as Dar. or:his proect? - - - - - - - - - - - - - - - '— We.e existing septic components ` If yes, piease describe: - - - - i_! YES %I NO ` Were a!i pcmpc"ens pumped out and properly abandoned per bV:.C24�272A-0300? ' - -- ; RECORD DRAWING _ descriptive enough to re-locate in the need of maintenance actvities and bui..,re s.loCaton otweypicawa'e•c^es, This is a permanent record and must be accurate and eptfptank location.North arrow.reserve cra:`•eid.�erestny and propos d b u r gs approval ..eia.led e. e s. �ens.os contain:ports, clean &ma,andfto orientation i 3 layout.Se ss poi rnp wens.obsenraten posts.Ceanou�,and other maintenance access ports. Incomplete Record Drawings may cease ad�enz.''e:ays in"nal.------ PV '\161 C\rNC2j\ i Z ...../ t AppPOVE i 1 AUG 0 4 2025 MASON COUNTY ENVIRONMENTAL HEALTH 6 JBW ; 0 R ill Record Drawing Attached a 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 1 the septic design stamped'APPROVED°by Mason dance with the septic design stamped'APPROVED"by i 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 short here have been cleared/approved by both and Mason County Public Health and meet all State mystlf and Mason County Public Health and meet ail i and Mason County Codes. Stag and Mason County Codes I 1 further certify that all information contained on this I furt+ter certify that all information contained on this form and attaphed Record Drawing is accurate, form and attached Record Drawing is accurate.7-ct-is- A Signature of Installer mate 1 , ,,.. ‘,aY\ 1%k‘,‘r.4_, ,, Printed Name of Signee , .. � �J,ftiO l i 1 MASON COUNTY PUBLIC HEALTH t�� 51'. .7 • The undersigned approves this Installation Report any /r� PAULA JOY JOHNSON Li Record Drawing on behalf of Mason County Public -e- I.IC $EI51). GRER Y 3 Health: [/ 'P (4-Y:�S `1 -Z3-ZS Signa'fure�f vironmentalHealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON rriE MASON COUNTY WBB S;TE ,;peat"a2:2C:8 ` WA�f ER \(_._______ (o5 S. 5 _ — E.. 5 ...... _ _ 2.4 ' , 32 5,-.-b- Z`l I )< B in i v tnYL0 Cie. ill HI PtILCZI(9 \(s.5' 1... .� 0 $ ; ------ 210 0 At u. CtC lured 9. \>:. :Ciiii .... ar ! SG ALE ' -0__' 4a p0 ,A. th:� ;o �0 30 4. 9 RC eL S2.0Zt'5 8-C"C^cc 3 MPsoN c°�N�y J8W •2.Z0 \uzAes'; A7� Key_ may' \54 O Audio-Visual Alarm �Air �y,. J4 o O2 Cleanout �� e, tr � O3 NuWater BNR-500 Pretreatment Tank .,.�� '.V� Chamber ' ' St0034S Cf‘ O4 1,000 Gallon Pump '�` PAULA JOY JOFINFON•��` 5 Subsurface Drip System Headworks c� iC A ri i N tQ" 7- Z3-2S