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HomeMy WebLinkAboutSWG2024-00183 - SWG As-Built - 1/27/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00183 Parcel# 22017-51-00066 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 TIMBERLAKE#9 TR 66 City, State, Zip Kelso, WA, 98626 Installer Name Mason County Excavating Site Address 140 E Elk Place, Shelton Designer Name Arrow Septic Designs, Inc. INSTALLATION CHECKLIST O Full System Installation O Tank(s)Only ❑ Drainfield Only O Repair O Other System Type Shallow Pressure Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - ❑ N/A ■❑ YES ❑ NO >50 ft.from wells? - - ❑ ■❑ O Z >50 ft. from surface water? - - ❑ 0 ❑ H Cleanout between building and tank'? ❑ 0 ❑ V ' Tank baffles present? - - O ED O 24"access risers over each compartment?- - O ❑j O a. W Effluent filter installed?- - O O 0 Septic tank capacity(working) NuWater b00 gal Manufacturer Hagerman 0 D-box water level and speed levelers used? - - O N/A ❑ YES ❑■ O_ 0' Manifold/D-box accessible from surface?- - El -❑ �� OLL OQ Check valves installed? - - -&fit- PL-14'"-fl - 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) O 2 '• 3 ❑4 O 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - O N/A ❑■ YES O No © >100 ft. from wells? fit ❑ ❑■ ❑ W >100 ft. from surface water?- - - - - - - _' ❑ 0 ❑ C' '7 LT. >10 ft. from potable water lines?- - - - I A ❑ ❑■ > 5 ft. from property lines and ease ?- -}K 2-2 2" ' ❑ 0 O CC > 30 ft. from downgradient curtain/f n is i R{}Q.IPAFNIAI.HEAL: ❑ 0 O Drainfield level and observation port e t — - 1 tr 'n? O Graveless chambers or O Clean gravel used? (check one) Proper cover installed over drainfield?- - O © O Pump tank setbacks consistent with septic tank?- O N/A 0 YES O NO • Pump tank capacity (flood) 1,000 qal Manufacturer Hagerman Z .< 24"access riser(s)and accessible from surface?- - O © O tL Alarm or Control Panel Installed? - - O 0 O E Control Panel equipped with Timer/ETM/Counter- O 0 O C- Pump installed in ❑ Bucket or 0 On Block or O Other a'• Pump Make/Model Zoeller N152 ■❑ Floats or O Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 8 ft Pump on time 1.8 min Pump off time 6 hr. Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 12011 — S( — 000 (0 Co ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - O YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - O YES O NO 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 Drawings contain: Drainfield&manifold orientation&layout.Septic/pump tank location,North arrow,reserve drainfield,ebsting and proposed buildings,location of wells,waterlines, wells,observation ports,deanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. )-e-&_ AAtt-OV\Lk • Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that l 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 i further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. 1 -5- 2p Signature of Installer Date Printed Name of Signee7•k MASON COUNTY PUBLIC HEALTH • -` The undersigned approves this Installation Report and :,� ) Record Drawing on behalf of Mason County Public 6 �' PAULA JOY J49 OHNSON . i He h: L'imrsu:s�IES'I'G ark•• % (Ai (mIN1 l'2?-.2.a' -` I-Zo -Zc., Sign t f 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 821/2018 • ,• 2 0 8k•7 1 o �p -Lo 0 4c '".� 1 ` \ \ A5-bid if \ \ \ 1 \ ' LMPiRE \0M. C NisTRunch Ppc;Et 2.1D11-51- t OM to Co 2-'la 1 PL 0 . 5i.7e• 5(0' \ \ - \ \ \ \ i1 !$i 1 3 SR H.o us E i .‘„,+....) i (--i5' 59 s. [if Z ) ►�°, / sr o .0 / 37' C2) 3'x 33 .5 'Frima�r r• / - drop'f i�ld "'rt- 6AR,S ty i O �J �, w t'I'•1n 2� LF Y2S-eYV e, • ---- .K),(-As,i4c4"\ ( .... i (a 5.55' yi = E EL A(i'L .:_____ Audio-visual Alarm OCleanout O NuWater BNR-500 ATU Tank 4 � O 1,000 Gallon Pump Chamber T •ot • ,'r{ O5 alve Control Box . * .. ‘I'2'4 PPRO VT 5100349 ••cpl 1�� PAULA JOY JOHNSON ••y� JAN 2 7 l't�k$D O r l(N IVI ' MASON COON 2020 exP+ ii TV ENVIRO (- Z.o-7.00 ,.!t Fo 1�MENTAL HEAL