HomeMy WebLinkAboutSWG2024-00280 - SWG As-Built - 9/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2024-280 Parcel# 22132-11-90313
Applicant Name Dale Arnold Subdivision (Name/Div/Block/Lot)
Applicant Address 260 E.Willow Blue Lane
City, State,Zip Shelton,Wa 98584 Installer Name B&C Building Solutions
Site Address 30 E.Pinetree Point Designer Name Bob Paysse
INSTALLATION CHECKLIST
I Full System Installation 0 Tank(s)Only 0 Drainfield Onl Repair ❑Other
System Type pressure _mil ent Type N/A
>5 ft.from foundation? - _te,-S%-\11"
_ • ❑ A YES ElNO
>50 ft.from wells? - ti
II 0
Y >50 ft.from surface water? - t'
Z % - --
lQ_ Cleanout between building and tank? - r _�v6 1 - U ❑
tJ Tank baffles present? - ❑
Ill 0
a 24"access risers over each compartment - ❑ 111 0
111
Effluent filter installed?- -Si-
Septic tank capacity(working) 1500 0 • 0
gal Manufacturer Evergreen Precast
n D-box water level and speed levelers used? --- ----
- IN N/A 0 YES 0 NO
gO Manifold/D-box accessible from surface?- 0 III 0
GQ Check valves installed? 0 III CI
X Transport Line Size 2" Schedule/Class 40
Bedrooms installed(check one) 0 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?• - - El N/A III YES ❑ NO
0 >100 ft.from wells?- - ❑ ! 0
W >100 ft.from surface water?- 0 ill ID
it Z >10 ft.from potable water lines?. - 0 Mi 0
z >5 ft.from property lines and easements?- - CI MI
>30 ft.from downgradient curtain/foundation drains?- ❑ NI 0
ca
Drainfield level and observation ports present -
❑ Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfield?- . ❑ ® 0
Pump tank setbacks consistent with septic tank?- ❑ N/A ® YES ❑ NO
ZPump tank capacity(flood) 1500 gal Manufacturer Evergreen Precast
< 24"access riser(s)and accessible from surface?- 0 U 0
I—
a.
Alarm or Control Panel Installed? - ❑ ® 0
Control Panel equipped with Timer/ETM/Counter• ❑ ® ❑
d Pump installed in ® Bucket or 0 On Block or ❑ Other
--
a.
Pump Make/Model Liberty 280
� ❑ Floats or ®Transducer
a. Tank draw down 1.3 in/min Pump capacity_ 40 gpm Squirt Height 8 ft
et.
Pump on time 1.5 minutes Pump off time 4 hrs Daily flow set at 360 gpd
Updated&21n018
4
I
Mason County OSS Installation Report pg. 2 parcel# 22132-11-90313
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? • - 0 YES ® NO
If yes, please describe:
Were all component pumped out and properly abandoned per WAC246-272A-0300? 0 YES El NO
RECORD DRAWING
This V a permanent record and must be accurate and descriptive enough to re4oasts In the need at maintenance activities and future development Typical Record
Drawings contain. Orannfield&manifold orientation&layout,Septclpurnp lank location,North aloe.reserve drainfield,
existing and proposed t„nldings.location of wets,wotar+nes,
Wals,observation ports,deanoutc,and other maintenance ataxic points. YtcanWale Record Drawings may create additional delays,n final instal,tic,approval and related permits.
II Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I 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 moot 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 1 further certify that all information contained on this
form,andand attached Record Drawing Is accurate. form and attached Record Drawing is accurate.
l
Signature of Installer Date i.
CC�YL� �J�S #�`� ik
Printed Name r;
Signee A
le, k
r►MASON COUNTY PUBLIC HEALTH ir '''
The undersigned approves this Installation Report and �•• ,'
Record Drawing on behalf of Mason County Public 1lQ, sae �°N'MYttut
Health: ,.! . '.:' `
EXPIRES
can ElVe7X
Signature of Environmen Health Specialist Date (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Uvdaleett2trtote
, _
- -
1._____
1
PINE TREF COVE
I
I
1
I ( I
PRIMARY h
RESERVE AREA I p MAINTAIN 101+
AS PER DESIGN I "' II i I _ 1
FROM WATERLINE
TO SEPTIC LINES &
COMPONENTS
DOWNSLOPE I °kiVEWPs.`
50'ATTN. ZONE u
NO CUTS OR SOIL I
EXCAVATION/
COMPACTION
I ��
jzz,
I SEPTIC TANK
I PUMP TANK
APPROX. FUTURE
HOME LOCATION 1 A PPRO V
— 1`( ED x
I SEP 12 Z015 m
MASON COUNTY ENyIRONMFNTAI NEALTN8
1 RET --I
1
r
I 1(14
1 .•'bfi .r r,iAT
I I
1 .
L _ RECXMID DRAWINTG
PIONEER DIGGING, INC. Lit;t0,k1EIZ: DALE ARNOLD f27 {h�LLI: If_;I Ih`l.f'_
PARL[L=:2?132ll�0313 27+III. -1 till
SEPTIC DESIGNS Atx)REF.S: 30E PINE TREE PT Kk."10I,627 R,ti.'I:-0 32
30$3 I%VON BEN SON RD GRA PE\IDA.\%4 9$510 L 'K;NE.it: R OBERT H.PAYSSE °'"""r`"�•1--- "'-r...." ate`.~..."1CO"'"•'"Oin.
nw»a�aavre.rem �craecoiwr*or. oraa.nrtvrw.a.�enti
c*Tk.E 360 42o ISO P\ 300 12-•2353 SHE.!T: ASBtm.T SCAT P=90 r1"'orc c.oc..cw xm.cn.c tiowea ro uw.410
snnc coisaworrs