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HomeMy WebLinkAboutSWG2025-00378/ASBUILT - SWG As-Built - 9/4/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2025-00378 Parcel# 32232-52-09015 Applicant Name Empire Home Construction Subdivision (Name/Div/Block/Lot) Applicant Address P.O. Box 241 UNION-GRAYS HARBOR&UCRR ADD BLK: 9 City, State, Zip Kelso,WA 98626 Installer Name Mason County Excavating Site Address 191 E Alderney St Union Designer Name Arrow Septic Designs Inc INSTALLATION CHECKLIST © Full System Installation ❑Tank(s)Only ❑ Drainfleid Only ❑ Repair ❑Other System Type Shallow Pre tment Type NuWater BNR-500 >5 ft.from foundation? -- ------- mi ❑ N/A YES ❑ No >50 ft.from wells? - - - - - --- -- - - ----------- ❑ U ❑ z >50 ft.from surface water? -- - -- - - - --------- --WI' ❑ U ❑ F Cleanout between building and tank? - ❑ U U Tank baffles present? - - ---- --- - By - ❑ ❑ o~. 24"access risers over each compartm . -en -- - --- -- --�- - - ❑ Q ❑ W Effluent fiilter installed?-- - - - - - - - -- - - ---- - - - ❑ ❑ Septic tank capacity (working) NUWater S00 QS t Manufacturer Hagerman C D-box water level and speedlevelers used? ------ --- - - ---- ❑ N/A EYES NO DO Manifold/D-box accessible from surface?- -- - - - -- - -- -- ---- ❑ Q ❑ Ooz Check valves installed? - - - - ----- - ---- --- ------- -- ❑ ® ❑ oa 5 Transport Line Size 2 inch Schedule/Class 40 Bedrooms installed (check one) ❑ 2 ®3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?-- ----Be�N� ------- -- ❑ WA DYES NO >100 ft.from wells?------------- --- - - ----------- ❑ ® ❑ w >100ft.fromsurfacewater?- ------- ----- ------ ----- ❑ ® ❑ LL >10ft.frompotablewaterlines?----------------- - ---- ❑ ® ❑ ? > 5ft.from property lines and easements?---- ------------ ❑ p ❑ a X > 30 ft.from downgradient curtain/foundation drains?--- --- ---- ❑ ® ❑ Drainfield level and observation ports present - - -- - - ---- -- - - O UI ❑ ® Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfleld?--- - --- ---- ------- - ❑ ® ❑ Pump tank setbacks consistent with septic tank? ---- ❑ WA YES ❑ NO `L Pump tank capacity(flood) 1.000 gal Manufacturer Hagerman . 24-access dser(s)and accassible from surface?- ---- ❑ I] ❑ Alarm or Control Panel Installed? -- ----- -- - - -- - - - ----- ❑ *1 ❑ M Control Panel equipped with Timer/ETM/Counter-- - -- - -- - - - ❑ 0 ❑ a Pump installed in O Bucket or Q On Block or ❑ Other Pump Make/Model Zoeller N152 I Floats or ❑ Transducer Tank draw down 2.25 in/min Pump capacity 43 gpm Squirt Height 10 ft Pump on time 2 min Pump off time 6 hrs Daily flow set at 360 ypd Mason County OSS Installation Report pg. 2 Parcel x 322 32-5 2— 09 D ABANDONMENT RECORD Were existing septic components abandoned as part of this project? ---- ---- ------- ❑ YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? -- 0 YES ❑ NO RECORD DRAWING This is a permanent record and must M accurate and descriptive enough to re-locate in the need of maintenance actiJRma and Nun development. TMoa Reood prawip9 mnteln'. Orwn1dd&manloid Mmlidcn&layout SeptiWump®nklooEcn,NOM enw:,rests darns,e,a n9 and proposed buildings.baton of weds,vicetallnes. weds,cLmrvetan pats,tleanaM anti other meunnann aaeac MPm. Intcmplete Rmvd Dravinda may au¢aG4densl tlelryainfindmsol.one rm+l and Sated pmtls. � K Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that/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 clearedrapproved by both the designer shown here have been clearedlapproved 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 l further certify that all information contained on this l further certify that all information contained on this form and arts tied Record Drawing is accurate. form and attached Record Drawing is accurate. D �/� Signat of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and NJ Record Drawing on behalf of Mason County Public P Ste <D Health: Q.. PAULA JOY JOHN50N.'a Nt 1�Uvfvl�(7 e. \ "1 410 -tl-Z-6 - Signature ofEnvironm tal Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE U@at. ealacle • 1C0 ' �aA�Aw cy e5 vfAZA-V 0% 'O" 41o . 21XSb ® ypPE 3 S I QORCri / � �.' OS Audio-Visusl A1aSm W ,✓ 3 �1w 5K / O Cleanest 100 vx*K'Y / NuWater BNR-500 ATU T yP,�U EWI 4 1,000 Gallon Pump C4az 5 Valve Control Box / PtirUb X (4)3' X50 ` gt JAP4 D,r. -rkENc+tEs W rrtl o�,�,,gipp i� ytx 4s pSCf-R E ALE U ST• • z� -� APPROVED ASTj-fl�s SEP 04 2026 x?IRS Nor Co se-1- hi MASON COUNTY ENVIRONMENTALHEALT! RET tctl E N¢'", GiT V t t v_yFr q�c%Z � .d••w�m�� **`Note to installer** f Sleeve waterline when within 10' 5100]09 of septic transport line.Maintain PAULA Jo nor HHsofS 10' minimum between water SE Ep•' line and septic tanks/drainfield. L am DO NOT REPLY <noreply@masoncountywa.gov> Friday, August 21, 2026 8:42 AM Environmental health OSS Inspection request for Empire Home Construction - SW Submittal request for: Empire Home Construe Site Address: 191 E Alderney St, Union Permit Number: SWG2025-00378 Parcel Number: 32232-52-09015 n Installer Name: Mason County Excavating %�' Installer Phone Number: 360-490-3144 /fir f=' Installer Email Address: masoncountyexcavating@yahoo.com r Designer Name:Arrow Septic Designs Designer Email Address: paulaj@hctc.com Inspection Request Date: 2026-08-24 Inspection Type: Full System Comment\ Notes: y ou for submitting Your final install request.The install should be complete and ready to inspect Thank Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather Request modated by con be accomtacting onsite staff. Installer is responsible for obtaining Septic Designer/Engc,i.gineer in approval prior to backfill of system components. If non contact is made by therm, health deDrawl da s of notice,the installer maY�OVef. Mason County Asbuilt Form, Record Drawi business Y be subm • °� •gar;. t���' a. i�� 6r� 4 x .r..4 �7.X�= ��✓mss. .�