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HomeMy WebLinkAboutSWG2024-00225 - SWG As-Built - 8/4/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION xjo--3 Permit Number SWG 2024-00225 Parcel # 32021-58-04062 1 1 (--- g Applicant Name Em ire Hom 1 p es Construction LLC Subdivision (Name/Div/Block/Lot) 1 N la Applicant Address PO Box 241 Shorecrest Beach Estates#1 BLK: 4 LOT: 62 1 `'`' C=3 ry City. State. Zip Kelso, WA, 98626 Installer Name Mason County Excavating 401 (4 Site Address 80 E Kingston Way, Shelton Designer Name Arrow Septic Designs, Inc: r7----,:.=7 INSTALLATION CHECKLIST it Full System installation ❑ Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - E N/A 0 YES E NO >50 ft. from wells? - - ❑ Ei ❑ >50 ft. from surface water? - ❑ ❑ Z - Cleanout between building and tank? - - ❑ ❑ U Tank baffles present? - - ❑ ■❑ ❑ a24"access risers over each compartment?- - ❑ ® El W Effluent filter installed?- ❑ ❑ u) - Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES • NO O Manifold/D-box accessible from surface?- - ❑ El ❑ m— Check valves installed? - ❑ El ID- pQ 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 p 0 R 6 C ... ;ercial/other >10 ft. from foundation?- Ir� ��� . 0 YES NO 0 >100 ft. from wells?- _ _ ❑ —) >100 ft. from surface water'? - ��� -4 -- 0 '' 0 wE ❑ Lia-. >10 ft. from potable water lines?- MASON COUNTY ENVIR0NMEti yCal-, E ❑ Z Q > 5 ft. from property lines and easements?- ,EBW_ ❑ a 0 ce > 30 ft. from downgradient curtain/foundation drains? ❑ • ❑ c) Drainfield level and observation ports present - - ❑ © ❑ In Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ El ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A Q YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Z grx 24" access riser(s) and accessible from surface?- - ❑ 1. ❑ a Alarm or Control Panel Installed? - - ❑ © ❑ 2 Control Panel equipped with Timer/ETM/Counter- - ❑ © ❑ _a Pump installed in ❑ Bucket or • On Block or ❑ Other a Pump Make/Model Zoeller N152 � El Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 2.5 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd .,\.area 8/2/(2018 Parcel 1 3 20 2 I - 5S- O 4O cn2 Mason County OSS Installation Report pg. 2 ABANDONMENT RECORD Were existing septic components abandoned as pay of his project? - n YES ii No I If yes, please describe: _ i Were all components pumped out and properly abandoned per WAC246-2?2A-G300? - ❑ YES i 1 NO RECORD DRAWING pep This is a permanent record and must be accurate and descriptive enough tc re-locate in the need of maintenance activities and future development. Typical.Record p D.3wnngs contain: D2infield 8 manifold orientation&layout.SeptiJo:mp tank location.North arrow.reserve dreinfieit.exsrr.g and proposed bL;e.ings,location of wells,waterlines. f wells.oosena:on ports.Ceanovs,and other maintenance access points, lncomp;ete Record Drawings.ray create additonai delays in final installation approval and related permits. 1 5-e_ to PPROVEAu, 0 4 2025 . „ i h:, i MASON COUNTY ENt IRONMENTAL,,, Ja , it I Record Drawing Attached d 4 CERTIFICATION OF INSTALLATION I INSTALLER DESIGNER/ENGINEER ! 1 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'APPRCVED'by I 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 a/i 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 attaphed Record Drawing is accurate. form,and attached Record, wing is accurate. Signature of Installer f,ate, '. '' ,,1 ; •ry C Printed Name of Signee Y� t` MASON COUNTY PUBLIC HEALTH ` ,�r' '� i The undersigned approves this Installation Report and !.QPAULA 5J;‘'Y' JOHN80N \t 1 Record Drawing on behalf of Mason County Public ���% S�IC� !S)=ti IGN��t'" I Health: e� snit_ "SSS.J4" I e ' ' ---'7'. A i/A2!" %— y,-.) 1 - &s --Ls--- i Signatur> or ofifilii-enta!!-lea Specialist Care (stamp, signature and date) I THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON Ti-E MASON COUNTY WEB SITE i,pca:ec 82'23'5 �i �3.5' Pr; wear f D. LO I ,J? —.--ire„cY1,e.S C 5I 0 . c. W i es ex-„4Z_ Lo v L.• o 1 y,,c;thbe{`5 4444. TT 7A5_,ou,,if 5 feL T - 7 -:,.-; . . -2„-q--1\_,--c--...r.e, i , / -, t;Y..P BCE Y.\NGSIZN \t.ik` . Al‘ , fralk74.°/7,..ftites. � O 1 Z < �a PAULAJOYJOHNSON �� © 1-S . .� JE�i15 SfGNK�( _fib mi Ezv! s��TiT ,..E" sc. So 3`k . l o `& I i ` R ` J O Key• Qo«t 0 Audio-Visual Alarm i 0Cleanout I ( Zo ?A-�K!NI I I 0 NuWater BNR-500 ATU Tank II ! O 4 1,000 Gallon Pump Chamber 4` Wa%-QY O Valve Control Box KtNCISToN \rPry— 4 PAPRovPto - � � Aa�n�oA,c , UG 0 4 "l177 ii 9EAlp., _ 7._