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HomeMy WebLinkAboutSWG2024-00148 - SWG Application / As-Built - 7/6/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2024-00148 Parcel# 32021-53-04035 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 Shorecrest Add Replat/ BLK:4/LOT 35 City, State, Zip Kelso, WA 98626 Installer Name Mason County Excavating Site Address 210 E Bridger Ln, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST ® Full System Installation ❑Tank(s)On ❑ Drainfield Only ❑ Repair ❑Other System Type Shallow Pr r .ir Pretreatment Type NuWater BNR-500 >5 ft. from foundation? - - - - - - - - - ❑ NIA ❑ YES ❑■ No >50ft. fromwells? - - - - - - - - - - -JU - ❑ 0 ❑ Z >50 ft.from surface water? - - - - - - - -�2026- -- ❑ Li ❑ Cleanout between building and tan .By- - -- LI - - ❑ 0 ❑ Tankbafflespresent? - - - - - - - - - - — - - - - - - - - " ❑ Li ❑ 24" access risers over each compartment?- - - - - -- - - - - - ❑ Li ❑ LL W Effluent filter installed?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑ W N 5414_ Septic tank capacity (working) NuWater 500 gal Manufacturer Hagerman ❑ D-box water level and speed levelers used? - - - - - - - - - - - - - - - ❑ NIA ❑ YES Li No �J O Manifold/D-box accessible from surface?- - - - - - -- - - - - - - - - - ❑ Li ❑ mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - O Li ❑ ca 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ■❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft. fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA AYES O N ❑ >100ft. fromwells?-- d _ - �, - - - - ❑ Li >100ft.fromsurfacewat - -' - - - - ❑ Li O W LL >10ft.frompotablewate ? - - - �r ... - - - - - - - ❑ Li ❑ ? > 5 ft. from property lines y• asen112"tits. - - - - - - - - - - " ❑ 0 ❑ W > 30 ft.from downgradient curt irdf4uhdalton dreihs?----- - - - - - - ❑ ® ❑ Drainfield level and observation ports present =.- - - - - - - - - - - - - ❑ © ❑ W Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- - - - - - - - - - - - - - - - - ❑ ■❑ ❑ Pump tank setbacks consistent with septic tank?-- -- - - - - - - - ❑ NIA Q YES ❑ NO Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman q24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ® ❑ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - ❑ UI ❑ Control Panel equipped with Timer/ETM/Counter- - - - - - - - - - ❑ II ❑ - 0- Pump installed in ❑ Bucket or Li On Block or ❑ Other Pump Make/Model Zoeller N152 0 Floats or ❑ Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 12 ft Pump on time 1.8 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8/21/2018 w Mason County OSS Installation Report pg. 2 Parcel# 3 2-OZ_- S 3 - o Ifo 3S ABANDONMENT RECORD Were existing septic components abandoned as part of :his project? - -- - -- - - - - - - - - - ❑ YES ® NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? ---- -- - - ❑ YES ❑ 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: Draintield&manifold orientation&layout.Septic/pump tank location,North anew,reserve drairfield,exsting and proposed buildings,location of wets,waterlines, wells,observation ports,deanoL s,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. See- - -mac JUL 0 MASON � ���� COUNTY ENVIROAJ It Tgi 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 /further certify that all information contained on this form and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. -2`l- 2�0 Signat A of installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report andx Record Drawing on behalf of Mason County Public PAULA JOY JOHNSON Health: l'ICEf5I±h� St.or, Signature ofrn ron ental Hea#h Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upcated WS:/2018 ________________________ 5 - - c A — - o' o3S V , l 2� 2i o St4i.� t tiN Stems - 1 : 2.0 cK ` o 1° 30 c.E a • .t` O O � o S.�- '3o 5 � o f Nrt ko . ems' 3�i-I J L( 9 L M S I S L 4'o - " SL Lv-1 I / t � C rl n� O1 Audio-Visu21 Alarm OCleanout 3 N'Water 3X12-500 ATL`Tank O1 000 Gallon Pimp C1amber C V2ve Co-ro Box APPROVEr .0 JUL 06 6 2O2n y 510049 "�1e, 1, 4 PAULA JOY JOfiNSON �] MASON COUNTY ENVIRONMEN'' JBW �� Z11 i ? / i I : in i / // I/J I . J - 1 Y �� fly .P�°•. • ' • • iA i - 2- ' / - Ka' Ia Milam From: Sent: DO NOT REPLY <noreply@masoncountywa.gov> To: Friday, June 26, 2026 12:20 PM Subject: Environmentalhealth OSS Inspection request for Empire Home Construction - SWG2024-00148 Submittal request for: Empire Home Construction Site Address: 210 E Bridger Ln, Shelton Permit Number: SWG2024-00148 Parcel Number: 32021-53-04035 l/f r z6 �' Installer Name: Mason County Excavating By Installer Phone Number: 360-490-3144 Installer Email Address: masoncountyexcavating@yahoo.com Designer Name: Arrow Septic Designs Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-06-29 Inspection Type: Full System Comment\ Notes: Install will be ready on Monday morning, please text or call Allan at 360-490-3144 if you do the inspection before the 3-day window. Thanks. Thank you for submitting your final install request. The install should be complete and ready to inspect on the 'Inspection Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather situations may be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. If no contact is made by the health department within the three business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval.