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HomeMy WebLinkAboutSWG2025-00156-ASBUILT - SWG Application / As-Built - 7/7/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00156 Parcel# 32021-54-01001 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address PO Box 241 Shorecrest Terrace 1st Add/BIk 1/Lot 1 City, State, Zip Kelso, WA 98626 Installer Name Mason County Excavating Site Address 2371 E Crestview Dr, Shelton Designer Name Arrow Septic Designs, Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfield Only El Repair ❑ Other System Type Shallow Pressure Trench Pretreatment Type NuWater BNR-500 >5 ft. from foundation? -- - - - - - - --.fri'� y El N/A Q YES ❑ NO >50ft.fromwells? - - - - - - - - - - - - ��� d _� _ ❑ ❑ El >50 ft.from surface water? - -- - - - - -jdt -o-7- � ❑ EU El Z Cleanout between building and tank? - -- - - -- -- -- -- - o Tankbafflespresent? - - - - - - - - - -B - ❑ EU ❑ - ❑ EU El 24° access risers over each compartment ❑ w Effluent filter installed?- - - - - - - - - - - _- - - - - - - - - - - - ❑ ❑ ❑■ rn Bk� Hagerman Septic tank capacity (working) NuWater 500 gal Manufacturer G1 D-box water level and speed levelers used? - - - - - - - - - - - -- - - ❑ N/A ❑ YES NO �J O Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - - ❑ UI El OOZ Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ 0 ❑ 04 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 UI 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.fromfoundation?- - - - - - - - - - - - - - - - - - - - - - - - - - ❑ N/A OYES ❑ NO ❑ >100ft. fromwells?-- - -h ^�- * '� - - - - -- - ❑ M El >100ft. fromsurfacew ? - - - - - - - " El It El W >10ft.frompotablew nes.--- F--- - - -- - - - - ❑ ❑ Z > 5 ft. from property Ii d ea5� e - - ' ❑ UI ❑ W > 30 ft. from downgraOiOMO"IMMOUhldatid ,tit ins? - - - - - - - ❑ II ❑ Drainfield level and observation ports,j $3t - - - - - - - - - - - - - - ❑ EU ❑ W 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 Y Pump tank capacity (flood) 1,000 gal Manufacturer Hagerman Q24" access riser(s) and accessible from surface?-- - - - - - - - - - -- ❑ U Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - El © El a� Control Panel equipped with Timer/ETM/Counter-- - - - - - - - - - El p ❑ 0- Pump installed in ❑ Bucket or ® On Block or ❑ Other Pump Make/Model Zoeller N152 Floats or El Transducer a Tank draw down 2.5 in/min Pump capacity 48 gpm Squirt Height 5 ft Pump on time 1.9 min Pump off time 6 hr Daily flow set at 360 gpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# 322 - - O' o o ABANDONMENT RECORD Were existing septic components abandoned as par of his protect? - --- -- - - - - - - - - ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-2?2A-0300? ---- --- - ❑ YES NO RECORD DRAWING This is a per anent record and must be accurate and descriptive enough to re-locate in the need of maintenance activi':,es and future development `picdi Rector Drawings contain: Drahfieid&rrtaneofd or entedt&isycut.SepdoJp nnp tank lc:atop,North arrow,reserve dtinfield,existing and proposed buitdings.location of webs,waterlines, wells,observation ports,cieanou ,and other maintenance access xirts. Incomplete Record Drawings:.ay eate addltorJJ delays in firal it is lation approval and related permits. ttAi 1� u JUL 0 B r.02 MASON COUNTY ENVIRONMENTAL HEAL T r ® Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER /certify that 1 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 /further certify that all information contained on this I further certify that all information contained on this and atta ed Record Drawing is accurate. form and attached Record Drawing is accurate. Signari of Installer Date c\\ x Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and r �• Record Drawing on behalf of Mason County Public PAULA JOY3JOHNSON, �\ y.. Hea L'l�flSfib�? St� IE�Q 7 1-7 -Z(v Sig a e f nvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC ViEW ON THE MASON COUNTY WEB SITE Updated&2 /20'8 l ' ! fr1 �1`he t�� +fit'5 cc ts�nT��l CID O tJ C */ / / / / / / so cl di / / ] h11 - , I ti :&; 12 '* I co d!r r-i ci 1 H I r Ol Audio- Visual Alarm Cleanout - O3 NuWater BNR-500 ATU Tank Chamber• O4 1,000 Gallon Pump `lv ;- O Valve Control Box ECIlk ry�2�, MPSON SOU�jI Eti v of�ABH �1 • 5100349 PAULA JOY JOHNSON 1`tS �fii0 z • • . MASON COUNTY Public Health & Human Services FINAL INSPECTION: SWG2025-00156 ADDRESS: 2371 E Crestview Dr PARCEL: 320215401001 DATE: 07/02/2026 Th _ LJ HOUSE TO DRAINFIELD jfr II�f t i DRAINFIELD TO HOUSE (ayla Milamt �t =rom: DO NOT REPLY <noreply@masoncountywa.gov> Sent: Monday, June 29, 2026 1:45 PM To: Environmentalhealth Subject: OSS Inspection request for Empire Home Construction - SWG2025-00156 Submittal request for: Empire Home Construction Site Address: 2371 E Crestview Dr, Shelton _ Permit Number: SWG202S-00156 JUN Z 9 2026 J Parcel Number: 32021-54-01001 IL By Installer Name: Mason County Excavating 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: 2026-07-01 Inspection Type: Full System comment\Notes: Please call or text Allan at 360-490-3144 if inspected before end of 3-day inspection window. Thanks. kyou for submitting your final install request.The install should be complete and ready to inspect on the 'Inspection Than Y uest Date' and remain uncovered for three bite staff. Installer is responsible d for obtaining Septic Designer/Engineer installationy Req contacting onsite accommodated by components. If no contact is made by the health department within the three approval prior to notice,l of system days of the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation emus businesst Yroyal. be submitted for final installation app 1