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HomeMy WebLinkAboutSWG2023-00415 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00415 Parcel # 32021-58-04009 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 241 SHORECREST BEACH ESTATES#1 BLK: 4 LOT: 9 City. State, Zip Kelso, WA 98626 Installer Name Mason County Excavating Site Address 210 E Hillcrest Dr, Shelton, WA Designer Name Arrow Septic Designs 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? - -- ❑ NIA ❑■ YES D NO >50 ft. from wells? - - - - t?- �$9 }. -r;tt\- ❑ ® ❑ z >50 ft. from surface water? - � ' ''�,`� Q Cleanout between building and tank? -'1„)', ❑ . ❑ o Tank baffles present? - � _ �U� 2 i'J \, ❑ ❑■ ❑ d24"access risers over each compartme.t=.- - - - • - --- - - I ❑ 00 W Effluent filter installed?- ---==`.s-! ❑ 0 ■❑ cn Septic tank capacity (working) NuWat gal Manufacturer Hagerman a D-box water level and speed levelers used? - - ❑ NiA ❑ YES ❑■ NO �O Manifold/D-box accessible from surface?- - ❑ ® ❑ u. 00 Z Check valves installed? - - ❑ NI ❑ 6 Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) 0 2 ❑■ 3 0 4 ❑ 5 ❑ 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A . YES ❑ NO 0 >100 ft. from wells?- - ❑ ❑■ 0 t >100 ft. from surface water? - - ❑ ❑■ ❑ LL. >10 ft. from potable water lines?- - ❑ ❑■ ❑ Z > 5 ft. from property lines and easements?- - ❑ ❑■ ❑ Q Ix > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - ❑ X E a Drainfield level and observation ports present - - ❑ 0 ❑ • Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑■ ❑ Pump tank setbacks consistent with septic tank?- - ❑ N/A Q YES ❑ NO Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman < 24' access riser(s) and accessible from surface?- - ❑ © ❑ ~ a Alarm or Control Panel Installed? - - ❑ II ❑ n Control Panel equipped with Timer/ ETM /Counter- - ❑ ® ❑ a Pump installed in ❑ Bucket or 0 On Block or ❑ Other a• Pump Make/Model Zoeller N152 ❑■ Floats or ❑ Transducer d Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 6 ft Pump on time 1.8 minutes Pump off time 6 hours Daily flow set at 360 gpd z:etl8_._,.'8 Mason County OSS Installation Report pg. 2 Parcel# 32�21 - SO- D 09' ABANDONMENT RECORD Were existing septic components abandoned as pan of this project? - - 0 YES No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES D NO 1 RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Retort Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tanit location.North arrow.reserve drainfield,exsting and proposed buildings,location of wells,waterlines, wells,observation ports.Cleanouts,and other maintenance access points. Incomplete Record Drawings may ceate additional delays in final installation approval and related permits. is 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- 1 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer G Jate - I pi 1w ..?f Printed Name of Signee /l.�` o. ..a ,t), r MASON COUNTY PUBLIC HEALTH ,ta `h • �, ' The undersigned approves this Installation Report and r‘' " N .=-r�,l�.' s i c.34; :�'f• Record Drawing on behalf of Mason County Public :: P.AULA JOY JOHy, i •;+5i Health: .?3_1_01111- S7 Signature of Environment I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 8212018 • �, 1L � J • II 1 , le 7sgsire. ,1 & t co 6‘ — — — — — r '1-1t0 V\E - "7‹:). Z . -A 'CP- ;41' S i ci- 1 1. { i;.5' (5) -5' 2(40 ' PRIK n D•F• --i e_ .rso-W- J_E �4J E �-rri SG ALE ;„_ -O, '� . A w eN L.o, ,d/� o +o mo 30 40 1 cA�c, L*.S2OZt-58-0acooa ,�F'�0y�?S { 10 e ?3:\1.10P-E 2N "rq4H�ll H K� AN.O Audio-Visual Alarm �.... ity[1o� O2 Cleanout ,�,. , v O • ,-,.3 NuWater BNR-500 ATU Tank ...' 510.348 PAULA JOY JOHNSON •O 1,000 Gallon Pump Chamber 'L'tC S *Mg NSA!"EXP S 1 ' 0 Valve Control Box 'CI-2,s