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HomeMy WebLinkAboutSWG2023-00345 - SWG As-Built - 3/12/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2023-00345 Parcel# 32104-58-00065 Applicant Name Nathan Peterson Subdivision (Name/Div/Block/Lot) Applicant Address 5215 Minard Rd W ALDERBROOK G&Y#9 TR 65 City, State, Zip Bremerton,WA 98312 Installer Name Mason County Excavating Site Address 120 E Susan Ln, Union Designer Name Arrow Septic Designs Inc. INSTALLATION CHECKLIST Full System Installation ❑Tank(s)Only my ❑ Repair ❑ Other System Type Subsurface D ' -7P vestment Type NuWater BNR-500 >5 ft.from foundation? --- --- - - - --- - - -- p - - - ❑ NIA ® YES ❑ NO >50 ft.from wells? -- -- - - - - -- - - - - -- — - - - ❑ x El Z >50 ft.from surface water? -- - -- - - - --- — ❑ III El C=j go F Cleanout between building and tank? - ---- - ❑ H ❑ O Tank baffles present? -- - - -- - - --- - -- - �—• �- - -- - ❑ N ❑ a 24"access risers over each compartment?--- -�` ❑ 0 ❑ W Effluent filter installed?----- - -- - - - - -- - C --- - ❑ ❑ 0 N Septic tank capacity(working) NUWate gal Manufacturer Hagerman 0 D-box water level and speed levelers used? -- ----- - --- ---- ❑ NIA ❑ Yes ® No J 00 Manifold/D-box accessible from surface?-- .��=� - - -- ❑ ® ❑ OQ Check valves installed? - -- --- -- - - - ❑ ® ❑ 2 Transport Line Size i" Schedule/Class 40 Bedrooms installed (check one) ❑ 2 4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?--S�� � C ❑ NIA ❑ YES 0 No 0 >100 ft, from wells?---- --- - - --- - - -- -V///rrr IN ❑ W >100 ft.from surface water?- - - - - - - --MAR --- -- ® ❑ ii 110ft.from potable water lines?----- - 7-- Z P 'u4SVE -- © ❑ C > 5 ft.from property lines and easements- ---- - - - - 0 kVjP9NW ® ❑ > 30 ft. from downgradient curtain/foundation drains?AR �17AL HE 0 ® ❑ Drainfield level and observation ports present - - --- - - ❑ ❑ Proper cover installed over drainfleld?--- - - - ---- -- --- -- - - ❑ 0 ❑ Pump tank setbacks consistent with septic tank?-- ---- - --- - -- ❑ NIA ® YES ❑ No N4 Pump tank capacity(flood) 1,000 gal Manufacturer Hagerman Q 24"access Ni and accessible from surface?--- --- --- ---- ❑ El0~. Alarm or Control Panel Installed? -- - -- - - - - - - ❑ ® ❑ Control Panel equipped with Timer/ETM/Counter- - - - - -- -- - - ❑ ® ❑ a Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank a Pump Make/Model Sta Rite 28 gpm ® Floats or� ❑ Transducer a Tank draw down 2.25"In 10 in/min Pump capacity 4.3 gpro Squirt Height ft Pump on time 7 min Pump off time 1.84 hr. Daily flow set at 360 gpd UP'Ialetl Bl(12010 Mason County OSS Installation Report pg. 2 Parcel n 3 7 t z)4— 58 — Oeo COS ABANDONMENTRECORD Were existing septic components abandoned as part of this project4 - - - - - - - - - - --- - - ❑ YES ® NO It yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? '-- --- - ' ❑ YES ❑ NO RECORD DRAWING 11ib b.pemuvn racaiC me mvn Ce,ewrte and a.s POva mwgh w n.l w In the nm of malrN nmo 9Mv w end N m EevdaMwt Typo l Ro=e omannae ana�: oiamwd amandaa memaupn a IgxN.sepevpmm unx 1paunn.rvwm.aw.�vene malnnaa,emdnp as PPpowd wddo-as,leaden xwdls,vre�en�ws. wells,duervadan Pwu,tlwngrte,eM elho mainmum aww poN1 Inwmpleu RamN Ceauifga nuY amM eetl2.�ul dYrya In Nul'meWlNm epPmva and Ma1W pumas. APpR ® V � ® MAR [0 i MASON COUNTY JBNpN'MENTAIHEALTH 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 clearedrapproved by both the designer shown here have been clearedlapprovad by both and Mason County Public Health and meet all State myseltand Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further cef*that all information contained on this I further certify that all information contained cn this form and atta tl Recroro'Drawing is accurate. form and attached Record Draawing is accurate. � — t - 21-25 � Signal of Installer Date F ,10.Y yltrV— Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and AUTA 'O as P JOY JOHNSON Recn swing on behaH of Mason County Public Sgn furs o Env mnmental Health Speaelud Date (stamp, signature and date) THIS FORM MAY BE SCANNED ANO AVALLJIBLa FOR PUBLIC VIEW ON THE MABON COUNTY WEB SITE uWawaarstrsme wI PwnzER p SCALE 0 a ,0 1a 30 10 NLIE ?ETE ZnN -+�ot K�� Yeszce��31104-5R-000foS ® o o _l �-0 E SuSAN LN. ------ 6 04 Cl z5' c� dd Nth 15 15'x 45 ' DsilP PAOLA JOY JOHNS ON PxPinPs o QOo SF Drip reSrrvr 3- t2-z5' I I S\ope per Geo-ice rcper+. v- @� SPr zo 148 01 z® O Audio-Visual Alarm O cleancut a P P R ® V E O3 500 Gallon Pre Trash Tank MAR Z 0 2o15 0 NuWater BNR-500 Pretreatment Tank MASON COUNTY ENVIRONMENTAL HEALTH OS 1,000 Gallon Pump Chamber JB W 0Subsurface Drip System lleadworks