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HomeMy WebLinkAboutSWG2020-00466 - SWG As-Built - 12/22/2023 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2020-00466 Parcel# 42307-50-00104 Applicant Name Brett Nydegger Subdivision (Name/Div/Block/Lot) Applicant Address 3052 42nd Ave W LAKE CUSHMAN#2 TR 104 City, State, Zip Seattle,WA 98199 Installer Name Joe Fassio Excavating Site Address 140 N Potlatch Dr N, Hoodsport Designer Name Brian Sund Original Designer INSTALLATION CHECKLIST 0 Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair 0 Other System Type Gravity Bed Pretreatment Type >5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO >50 ft. from wells? - - II ❑ Y >50 ft. from surface water? - 0 11 0 Z 1-- • Cleanout between building and tank? - - ❑ ❑� ❑ V Tank baffles present? - - ❑ CO ❑ a24" access risers over each compartment?- - ❑ U ❑ W Effluent filter installed?- - ❑ UI ❑ co Septic tank capacity (working) 1,060 gal Manufacturer Infiltrator 0 D-box water level and speed levelers used? - - ❑ NiA © YES ❑ NO p0 Manifold/D-box accessible from surface?- - - ❑ In ❑ co-2 Check valves installed? - - I ❑ ❑ thQ 2 Transport Line Size 4 inch Schedule/Class 3034 Bedrooms installed (check one) ❑■ 2 0 3 ❑4 ❑ 5 ❑ 6 0 Commercial/Cther >10 ft. from foundation?- - ❑ N/A 1.1YES ❑ NO O >100 ft. from wells?- - 0 0 �^}� W >100 ft. from surface water? - ❑■ 0 -�, ' f a: >10 ft. from potable water lines?- - ❑ ❑ Yn5 z > 5 ft. from property lines and easements?- - ❑ IN ❑ Q . ❑ ❑ � > 30 ft.from downgradient curtain/foundation drains?- - • Drainfield level and observation ports present - ❑ IR ❑ ❑ Graveless chambers or 0 Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ® ❑ tank setbacks consistent with septic tank? ❑ N/A ❑ YES o • Pump tank c (flood) gal Manufacturer Z 24" access riser(s) and a ible from surface?- ❑ ❑ ❑ Q " F- a Alarm or Control Panel Installed? - ❑ ❑ 2 Control Panel equipped with Timer/ETM /Cou -- - - ❑ ❑ ❑ a Pump installed in ❑ Bucket or ock or ❑ a ::d :eIM0d0 loTransducer in/min Pump capacity gpm Squirt Height ft mp on time Pump off time Daily flow set at d ---pcated 821 2318 I Mason County OSS Installation Report pg. 2 Parcel# 4 2�0 1— 50-UO k oL ABANDONMENT RECORD 0 YES 14 NO Were existing septic components abandoned as part of this project? If yes, please describe: YES NO Were all components pumped out and properly abandoned per WAC246-272A-0300? - RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and to n�s'e�on of weds, r Record lines, D,-avings contain: Dran`ield&manifold etien on&layout.SepacrpuTp ink locaOo:t.North arrow,reserve dairf eld.exsting and proposed wells,observation ports,clearoute,and Omer maintenance access points. Incomplete Record Drawings may ceate additional delays in final hsfaUeton approval and related permits. 11. 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 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 I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. w 71 � � \\/Z /2 3 Sirs of Installer ate "tt tb P0 e. PC SSro �' Printed Name of Signee �r� �� riz of y"Hi • \F1.. MASON COUNTY PUBLIC HEALTH tom' .. .j.—• v�tij.� The undersigned approves this Installation Report and ���� �U Record Drawing on behalf of Mason County Public ;� tcoa '.,,,�. N-- PAULA JOY JOHNSON .'7 Health: r•L'1•C, ,c UESIGNEa 'Ja l 2—Lt-Za Signature of Environmen I Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updd1eO 821r2J18 'I81 ,, Taralb.‘ 111":..IIIIMailet 0 1,2 CA:o\ \ / , �� .� el \✓ ���� 11 APPROVED Ri-\�*19° l DEC 2 2 2023 e��e�L\ MASON COUNTY ENVIRONMENTAL HEALTH -.5 5 f` RET W0iZx,4' w� ,A\oN`- Q 0, Kew: ` 0Cleanout -/ 0 1,200 Gallon Septic Tank 2-Compartment with Effluent Filter 5 CA,,_ : t = 2 O 03 D-Box with speed-levelers i and cover to surface AS f3.Ut LT- 'BREIT N yDEGGER IC 'PmceL 423o-I 5o oolc74 4.. %?:14 o N ?o-r� H t�16.,,, ,,A.„'3. hATc DR !� � - Iii.ps,. ,, \Aoc17s?oKT) v� A q 6548 if '., -" j . � PAULA JOY JOHNSON ••Y� FxPtxes�Tl;i [Z..- -23