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HomeMy WebLinkAboutSWG2024-00182 - SWG As-Built - 8/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC Hett LT__ APPLICANT/ PERMIT INFORMATION .. .- g Permit Number SwG 2024-00182 Parcel # 32021-58-04059 rC r`: 61 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) i w Applicant Address PO Box 241 Shorecrest Beach Estates#1, Blk 4, Lot 59 �� c4 City, State, Zip Kelso, WA 98626 Installer Name Mason County Excavating 1 Site Address 201 E Lynwood Dr, Shelton Designer Name Arrow Septic Designs, Inc i C�J 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? - - ❑ N/A ❑■ YES ❑ NO >50 ft. from wells? - - ❑ 0 ❑ >50 ft. from surface water? - ❑ ❑ Z H Cleanout between building and tank? - - ❑ UI ❑ U Tank baffles present? - - ❑ ❑■ ❑ a24" access risers over each compartment?- - ❑ 0 ❑ W Effluent filter installed?- - ❑ ❑ ❑■ N 8NR- Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES El NO �J O Manifold/D-box accessible from surface?- - ❑ 0 ❑ a?— Check valves installed? - ❑ ❑■ ❑ oQ E Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ ■ iii-iff- 6 ❑Commercial/Other >10 ft. from foundation? la N/A Q YES ❑ NO >100 ft. from wells?- ❑ ❑ W >100 ft. from surface water? AUG-� 4 1(12T�j_ - � 0 ❑ u. >10 ft. from potable water lines?- - -5 MkS90i CQUa�Y-ENVi '❑ 0 ❑ z ReNZENTAL i-EALT Q > ft. from property lines and easements?- �� - ❑ 0 ❑ re > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ o Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ II ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ci YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z < 24" access riser(s) and accessible from surface?- - ❑ • ❑ H Alarm or Control Panel Installed? ❑ 0 ❑ a -? Control Panel equipped with Timer/ETM/Counter- - ❑ 0 ❑ Cl- Pump installed in ❑ Bucket or 0 On Block or ❑ Other Pumpa. Make/Model Zoeller N152 ❑■ Floats or El Transducer Tank draw down 2.5 in/min Pumpcapacity 48 Height p y gpm Squirt Hei ht 6 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd Updated S/2 i/2018 Mason County OSS Installation Report pg. 2 ?arcel a 2- - - 4 ABANDONMENT RECORD r Were existing septic components abandoned as part of this project? - - YES ® NO If yes, please describe: i Were all components pumped out and properly abandoned per WAC246-272A-G300? - r YES ❑ NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the reed of maintenance activities and future development. Typical Record Drawings contain: Drainlie:d&manifold orenation&layout.Sep:c'pu,^p tank location.North arrow.reserve cra,rteid.exstr.g and proposed buildings,location o`wells.waterlines, weds,observation ports,deanouta,and other maintenance access poirts. Incomplete Record Drawings may create additional eetays in 5ral installation approval and related permits. --ES-- .5. \9•civ-Q-KA 04 tPPROVE \ENVIR Al �: AUG MASON COUNTY ONM2025ENTAL HE Jaw ALTh J 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 and Mason County Codes. State and Mason. County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. 1 - \S-2.-S Signature of Installer Date p ',ter; V r', Printed Name of Signee � o • MASON COUNTY PUBLIC HEALTH r ~� , i��h ., � � NO s The undersigned approves this Installation Report and t ti' Record Drawing on behalf of Mason County Public �`?.' sto.aaa ': • Yam: Health: 4, .?AULA JOY JOHNSON ';� LtC Sl:ti�;iGN�t" 7- Z3-z�s- Sign u. 1(A)t,(_,vel nvironmental Heal h Specialist Date , �o (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upcatec 92:2C18 I (45 ,ALe' , -- , r ;a 4O `? 21 r 4 r S-bu.11 t 21(31 . v. -1-- 0 ..)--j 2,C i_-_- . ik--, A4e..;,...,,c- ci__br-... >C ! _ c0 coo 3 ?C SO ' f--NY‘ • 4,s 1 •-\.- 0.c. kJ' { — _ 1 -� Ze o r 1--_F g,-- -c•r - -6 O St. eve, ----T./ /' / / / S _l � /� �la�� / uI � / / / • / r / / A / PPROVEt- / ��. .. / / , vi V" AUG 0 4 2025 4'A'.u,> c5 • MASON COUNTY ENVIRONMENTAL HEALT� r _ , f JBW !����J r \NI o.AA r--. o Kep: 44. 4 OAudio-Visual Alarm of rFO Cle anout :w 7'4, s itis3NuWater BNR-500 ATU Tank �4: siooaas y45 PAULA JOY JOHNSON .;� N O4 1,000 Gallon Pump Chamber izuL t�U�-)8zoNt`1 OValve Control Box Z - 23-Z S