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HomeMy WebLinkAboutSWG2024-00398 - SWG As-Built - 10/30/2025 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00398 Parcel # 22017-50-00041 Applicant Name Empire Home Construction LLC Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 TIMBERLAKE#2 LOT:41 City, State, Zip Kelso, WA, 98626 Installer Name Mason County Excavating Site Address 401 E Annas Way, Shelton Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST IN Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type OSCAR = treatment Type NuWater BNR-500 Y >5 ft. from foundation? � � - ❑ N/A El YES ❑ NO >50 ft.from wells? - J G� �,- ❑ El ❑ Z >50 ft. from surface water? - - - - - - ?- - -a \ ❑ ❑ ❑ Q Cleanout between building and tank? - - `-` % \ ❑ El El 0 Tank baffles present? - -9C —,>-- ❑ 1- 24" access risers over each compartment - - - - - - ❑ CI ❑ d ❑ ❑ El W Effluent filter installed?- - � - N Septic tank capacity (working) NuWater 0 g Hagermanal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A El YES 0 NO oO Manifold/D-box accessible from surface?- - - `-42L4 '� 0: CI- - - - - ❑ c9 Z Check valves installed? - - ❑ ❑ 0 oQ 1" Schedule/Class 40 2 Transport Line Size Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 El 6 ❑CommerciallOther >10 ft.from foundation?- - ❑ N/A 0 YES El NO 0 >100 ft. from wells?- - ❑ II ❑ W >100 ft. from surface water?- - El El ti >10 ft.from potable water lines?- - ❑ El ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q ec > 30 ft. from downgradient curtain/foundation drains?- - ❑ A CI O Drainfield level and observation ports present - - ❑ 0 ❑ 0 Gravciccc chamhcic- er ❑ Gic gravcF dcce (chock one) Proper cover installed over drainfield?- - El CI Cl Pump tank setbacks consistent with septic tank? - - ❑ N/A Q YES ❑ NO • Pump tank capacity (flood) 1,000 qal Manufacturer Hagerman < 24" access riser(s) and accessible from surface?- - ❑ 1- 0. Alarm or Control Panel Installed? - - ❑ El ❑ ❑ E Control Panel equipped with Timer/ ETM /Counter- - El D a- Pump installed in ❑ Bucket or ❑ On Block or © Other On bottom of tank a• Pump Make/Model AY McDonald E-30 ❑U Floats or ❑ Transducer a. a Tank draw down -- in/min Pump capacity 9.20 gpm Squirt Height -- ft Pump on time 22 sec Pump off time 3 hr-44 sec Daily flow set at 360 gpd Updated 8/2 2018 V Mason County OSS Installation Report pg. 2 Parcel# Z1-0 11--SV- O.°oq,k ABANDONMENT RECORD • II YES D NO Were existing septic components abandoned as part of this project? - �� If yes, please descri•be:• Z El� CArk �� \ (i^ v`5� NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - ® YES 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 Record gs.location of Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location.North avow,reserve drainfield,easting and proposed buildings approval and rdawatenumts• ae wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may ate additional delays in final Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with 1 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 I further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. 10—Z\ —ZS' i+ Signature of Installer Date ✓ f r\'‘_ j.,,,,,; -4 Printed Name of Signee ter o1 WA 'l� MASON COUNTY PUBLIC HEALTH '1!2� ; 1ti The undersigned approves this Installation Report and '' slouse5 .��. Record Drawing on behalf of Mason County Public .-+"?` PAUTA JOY JOHNSOr.. • Or Health: LialkiS tSUESir+Lttt R11-40dour s �a� �� ?+r�is y\p� !o(�0t2-c t o -Zs-z Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated a2t2ote 4?roke.c-} Fr"w+aYy t FieY�e - �v,� .tehla� A LP*ESt Rs t2 F _hr.:R- 9- f y iDi Pri nn c;“ 5 13.5 I ?eio 95.5'O — 7 eseffUe. if, 13.E e) L _115 5, — -- J 3 ° �a' © rr(() 5' TYW Lc\ _ _!� - , \S sjr) --� p R\Q EwR- `y I \ L 27, ID 3R IIIPprg.,\LINIc \ v i4._-- J tjC�� : = C D t� -7-0 3t-, Ol Audio-Visual Alarm �5-b i O Cleanout �?#�I R'e. H-e)KS `'' s' Sys, 1CI.N 0 NuWater BNR-500 Pretreatment Tank �E. : ZZC t-1-S J ✓CJ- C)- 1 0 1,000 Gallon Single Compartment ��Y pump Chamber/Clarifier Tank 1211. A- nngs ,5 A . t S- r 0 OSCAR Mound Drainfield 0 2 EXiS 1ng jrI,Z 4,\10- �-f m,z� Asolki R®\/EIS .�fi -1--.1=s deGomm iss;ohEct 014 MASON COUNTY ENVIRONMEN .4 ,, ;,o. ,D PAULA JOY J1.1Nso,.•!'! RET otri4sr_otEsfci�; a •