Loading...
HomeMy WebLinkAboutSWG2024-00340 - SWG As-Built - 11/7/2025 f Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00340 Parcel# 32021-56-02040 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 241 SHORECREST TERRACE 3RD ADD BLK: 2 LOT:40 City, State, Zip Kelso,WA 98626 Installer Name Mason County Excavating Site Address 780 E Wood Ln, Shelton,WA Designer Name Arrow Septic Designs INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ OtherNuWater BNR-500 System Type Shallow Pressure Pr- -atment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ No >50from wells? - S� - ❑ I 0 ft. I 0 >50 ft. from surface water? - -n ' - ❑ Zbuildingtank? - -- - I � Cleanout between and P1, v--� 0 ❑ 0 Tank baffles present? - ' ' ' 0 ❑ a24" access risers over each compartment?- �y - ' ❑ 0 ❑ W Effluent filter installed?- ❑ ❑ ❑ cn Hagerman Septic tank capacity (working) NuWater BNR gal Manufacturer ❑ D-box water level and speed levelers used? - - ❑ N/A ❑ YES ® NO 00 Manifold/ID-box accessible from surface?- 0 II 0 CE) Check valves installed? - - ❑ 0 0 ❑Q 2 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 0 3 ❑4 ❑ 5 ❑ 6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A Li YES 0 NO CI >100 ft. from wells?- - ❑ I ❑ W >100 ft. from surface water? - - ❑ ® ❑ ti >10 ft. from potable water lines?- - ❑ 0 ❑ Z > 5 ft. from property lines and easements?- - El Xi El £ > 30 ft. from downgradient curtain/foundation drains?- - ❑ © ❑ Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ © 0 Pump tank setbacks consistent with septic tank?- - ❑ N/A Q YES ❑ NO `-L Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman < 24" ar-rpss riser(s) and accessible from surface?- - El NJ El a. Alarm or Control Panel Installed? - ❑ 0 2 Control Panel equipped with Timer/ETM/Counter- - 0 II ❑ m EL Pump installed in ❑ Bucket or 0 On Block or ❑ Other 2 Pump Make/Model Zoeller N152 ® Floats or ❑ Transducer a Tank draw down 2 in/min Pump capacity 38 gpm Squirt Height 7 ft Pump on time 2.3 minutes Pump off time 6 hours Daily flow set at 360 qpd Upd:ec E212C 18 3202.t - 5(9-' 02DA-0 Mason County OSS Installation Report pg. 2 Parcel# ABANDONMENT RECORD 0 YES .tlNO Were existing septic components abandoned as par, of this project? - If yes, please describe: El YES ID NO Were all components pumped out and properly abandoned per WAC246-272A-0300? RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and btu development ecation wT call Recort amines. erve drainfieid. sting and Draw trigs contain. Dra afield&man fold orientation&layout.Septic/pump 50 Inco mplete on.North arrow.e Record Drawings may create addmonal delayproposed in final nstalla`on approval and related permits. wets.observation ports.deanars,and other maintenance access Po * 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 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 l further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. — ' t1/ o4 / L5 r, Signature of Installer Date Printed Name of Signee �otr r f� d .s ?� I ti I. MASON COUNTY PUBLIC HEALTH „ ~ ��h Tho undersigned approvers this Installation Report and `f� ?: + .�� Record Drawing on behalf of Mason County Public r sta 34a • ULA JOY JOHNSON �' is Health: gsg1-1 .:::. �h tGNEft'___'fit ( I 17�S rmo $ sir,fir• Signature of Environ ental Health Specialist Date (stamp, signature and date) • THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE up""e2120+5 SCALE O' p do zo 30 40 OUP ��� ,, e . -10' 6Nw eE OME Nc c iob til - , ' L 3�ot\-5t0-02o40 -lo C Woof LAN E ______ \,,,j\c.,...) Dg kvtt�A4 p1 a Y. 4 r G 3� ‘ 33- 1 z 13 Z 13 2-3 t. - c?A *. O 4 o 0 LC1 tA COI\Um �a Gt fired Ci- ? Lit m 0 }EOM y _:. - _,..) ...--- ....--- .....------ ...„---- ____-- , .....---- . 44)10#111111 \4001111 ..„----- ____- L PG l Set-S1 Key C4% - 1 X So' -r2 E,c,t(- S JJ 0 Audio-Visual Alarm @, ' Q . C." w tom'. tR ESQ2.k.)F 0 Cleanout '5 o 0 -t- eeLCO C 20 0 LF) 0 NuWater BNR-500 ATU Tank �� 01,000 Gallon Pump Chamber a ... . ,.. kr3 y- . - S:i,‘,\.OV\ v f /11A, NP. 0Valve Control Box 4,.e 1' A 5'0034G PAULA.YJYJo4NSCN.';.L ISr:}7y:-el�r�Et {' Il—S-2-s