HomeMy WebLinkAboutSWG2023-00423 - SWG As-Built - 4/9/2024 Mason County OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SwG 2023-00423 Parcel# 22233-51-00046
Applicant Name Timothy Thaden
Subdivision(Name/oiv/Block/Lot)
Applicant Address 90 E.Old Ranch Rd.
City, State, Zip Allyn we 96524 installer Name Arrow Excavation
Site Address 4940 Mason Lake Dr.VV. Designer Name Bob Paysse
INSTALLATION CHECKLIST
❑Full System Instellaaon Tanks)Onty ❑Dreinfeld only 13 Repairr.
Pretreatmentoth
ent Type❑
System Type
>5 ft.from foundation? -------------------------- -
13❑wA �YEs ❑❑No
>50 ft,from wells? --------------- ------------- - ® ❑
Y >50ft.from surface wateR - - ---- - - -- - -------- -----
_ ❑ ® ❑
Z
FCleanout between building and tank? ---------- ❑ ■ ❑
t7 Tank baffles present? ---- - ------ -- - ---
---- ❑
1 24'access clears over each compartment? .
fW Effluent filter installed?----- --- ------- -----"---- - ❑ ❑
Heggerman
Septic tank capacity(working) 1500 del Manufacturer
O D•box water level and speed levelers used? ----- -- ®NIA ❑
YES ❑ NO
Js-r ❑ Cl
OLL Manifoldalves installed?
accessible from--- - - -- --- --_-- - ❑ ❑
M= Check valves Installad7 - - --- - - -
Q Schedule/Cta"
Transport Line Size --
3 4 ❑ 5 ❑6 ❑Commercial/Other
Bedrooms installed(check one) ❑ ❑ ----- ------- ® NIA YES ❑ NO
2
>10 ft.from foundation? � ❑ ❑
>100 R from wells?- - -------- - --------------- - --------- --
❑ ❑
J >100 fL from surface water?------
------ ❑ ❑
W >10fL from Potable water lines?-- - - --- `-"---- ® ❑ ❑
Za >5 ft.from property lines and easements?----- --`- ❑ El1' 130 it.from downgredient curtain/foundation drain?-------- -- ❑ ❑
Dainfield level and observation parts present --------
❑ Gravelass chambers or ❑ Clean gravel used?-(check one) ❑ ❑
Proper cover installed over drainfield?---------
WA ® YES ❑ NO
Fpump
k setbacks consistent with aePtic tank?----------'-- ❑ Haooerman
1500 oat Manufacturer O
nk capacity(flood) ❑
ss Rser(s)and accessible from surface?--_-=i=_-__- : ❑ ® ❑Control Panel Installed? ----------anel equipped wNh Timer/ETM/Counter•--- ------'stalled in ® Bucket or ❑ On Block or Other
Floats or ❑Transducer
ake/Model Little
Giant(solids) ft
INmin Pump capacity go
Squirt Height
Tank draw down Daily flow set at gpd
Pump on 5me Pump off 0re wa.�smrp,.
Mason County OSS Installation Report pg. 2
Parezl# 22233-51-00046
ABANDONMENT RECORD
O YES ❑ NO
Were existing septic components abandoned as part of this project? ------
If yes, please describe'. - ® YES ❑ NO
Were all ocmponents pumped out and properly abandoned per WAC24B-272A-0300? - -- ----
RECORD DRAWING
Thin N.wrmenem racers and muu on-c 1.•na d—IPrne enough W m4o=m In he need er mule eNaYw aedtlruh,�w m=n W.�1 wars
"go".—in: D"'Yed Aman'roid Wemetlon&Yyea aesed" mPrent kcatlan.NOM envx,MaM tlninAaM,sought,en PrdWw
—11,oho.nnenn none,Wn_h..M ueer mfvbnenwewss points. Inwnpbre Remrd Dmrnpa may Male eddM.nW dWY.In nral IIssues,ggIu0V aM Mer•d pe^'We,
Record Drawing Attached
CERTIFICATION OF INSTALLATION
rINSTALLER DESIGNER/ENGINEER
y that I installed the system in accordance with I certify that the system has been installed in accor-
ptic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED'byy Public Health and that any deviations shown Mason County Public Health and that any deviationsave been cleared/approved 6y both the designer shown here have been clearad/approved by bothason County Pu61ic Health and meet all State mysel/and Meson County Public Health and meet allason 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 attach of Record D 1 v 91s e1qaffate form and attached Record DMwing is accurate.
v t
nature oflasfaller ate
John Gilliand e;
FP,ktad Name of Signee
N COUNTY PUBLIC HEALTH 1\7
en.e:Tp ...e
ntlersigned approves this Installation Report antl - -rd Drawing on behalfof Mason County Publich: � ���r9 I LLA st re nviranmenI 1 Health Specfalisf Defe
(stamp, signature and date)
018
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SRE Opdelb galn
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SOLIDS HANDLING
PUMP BASIN (500 GAL)
MASON
LAKE `
APPROX. EDGE
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CUSTOMER: 1IMOT14YTHADEN
PIONEER DIGGING, INC PAP cEL t 2m3-5w0096
.A[7DREE4 4940E MASON LK DR W
SEPIC k3 E�AfFAK1X-.WBUh4GtruNRD3D, GKAPSA'EW.NA yN590 DE9GNER: OBERT K PAYE
FAt IEET ASBW.T SCALE P=30