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HomeMy WebLinkAboutSWG2022-00480 - SWG As-Built - 8/14/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2022-00480 Parcel# 32105-51-00007 Applicant Name Paul 8 Dada Fiedler Subdivision (Name/Div/Block/Lot) Applicant Address 5930 NE 65th Ct HIGHLAND PARK#1 LOT:7 City, State, Zip Vancouver,WA 98661 Installer Name Joe Fassio Excavating Site Address 210 E Arellem Rd, Union WA Designer Name Mow Septic Designs Inc. INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other 50o Precrash System Type Shallow Pressure 14 - eatment Type NuWater BNR-500 >5 ft.from foundation? �, � 1 E]NIA0- YES ❑ NO >50 ft. from wells? - y ,' ❑ II Z >50 ft. from surface water? in-I - ❑ II FCleanout between building and tank? - - - ® ❑ U Tank baffles present? - - - ❑ ® 0 C 24"access risers over each compartment. - 0 II 0 W Effluent filter installed?- 'Y - 0 0 MI Septic tank capacity(working) `Fluwater pal Manufacturer Hagerman CID-box water level and speed levelers used? ❑ N/A 0 YES ® NO p0 Manifold/D-box accessible from surface?- - 0 Q 0 O= Check valves installed? - 0. Frukin 0 ® ❑ Oa 2 Transport Line Size 2" Schedule/Class 40 Bedrooms installed(check one) ❑ 2 ❑3 ®4 0 5 ❑6 0 Commercial/Other >10 ft.from foundation?- ❑ NIA ® YES ❑ NO O >100 ft. from wells?- - ❑ a 0 W >100 ft from surface water? 0 ® ❑ E >10 ft. from potable water lines? 0 ® 0 Z > 5 ft. from property lines and easements? 0 I 0 4t 2 > 30 ft.from downgradient curtain/foundation drains?- - - - - ❑ 0 ❑ O Drainfield level and observation ports present - ❑ MI ❑ Q Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield? 0 MI 0 Pump tank setbacks consistent with septic tank?- ❑ NIA ® YES 0 NO Y Pump tank capacity(flood) 1,00 gal Manufacturer Hagerman Q24' access riser(s)and accessible from surface? 0 y��`'y_ 0 1.— Alarm or Control Panel Installed? ---$C�,A= Sic y tiyouae- ❑ t,IWtt1,A • 2 Control Panel equipped with Timer/ETM /Counter ❑ '�(ArA"p,y'T' ! ❑ 7 vIQ 1,Y1J _a Pump installed in ® Bucket or 0 On Block or ❑ Other �1 In 6• Pump Make/Model Zoeller N152 © Floats or 0 Transducer d Tank draw down 2 in/min Pump capacity 44 gpm Squirt Height 5 ft Pump on time 2.7 min Pump off time 6 hr Daily flow set at 480 gpd L,ca.a_„m,s Mason County OSS Installation Report pg. 2 Parcel# 32 .oa- St- 8poo1 ABANDONMENT RECORD YES ® NO Were existing septic components abandoned as part of this project? If yes, please describe: 0 NO Were all components pumped out and properly abandoned per WAC246-272A-0300? ❑ YEa RECORD DRAWING This u a pamunent record and must be accurate and descriptive enough to re-Meats in the need of maintenance activities and Ndn development Typical RewN Drawings Pram Drvrhtld6manifold anen®on&layout.Sctc'Wnm n^klo¢eon.North arrow.resen20.anfidd.a mng and proposed buildings,lomdon of wells,v ed and weds.observation pats.dances.and other mabw ass ss points. Incomplete Read Drawings may mate additional celays in final ,sSYsSan approval Ss A 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. Sig ree of installerr Date clog �T'''a Printed Name of Si nee . {�P MASON COUNTY PUBLIC HEALTH • The undersigned approves this Installation Report and A if �` Record Drawingon behalf of Mason CountyPublic D 3` PRtu o new Health: I i ite c,..._mi•t),Czi(;IiMR'- imabs.i&�G SB-LS Signature of Environmental ealth Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE dpolse az:nmd _— £a5+ Pt(CIieW1 kd A' St ..a, I _ it . / p Zp 40 bo 80 210E (1n Q /�M• Ro! i3zro -CI- / NI wail l P Pr op eased 38R I I && St+.+Se I p p.J t CS) 3' x Slit! ri CI o 'er 4 )-4/40 9 i 1 -9 IN i \nbe}ween / / APPROVED Alai \ -� MASON CCLM1T' El,ITC M14EyTALHEALTH . \ \ \\ wet: N. \ \ eke 2 . Cieana he � t•_U do / ^, 500 Galion Pre TraTrashtaxi( (Th Nuwa e- BNR-500 ATu Ta<-< . _00 Gal'oz BianP Chsn* Dear cS 1}I Valve Con_oi Sox N e FhA0 OIN CN III��� .+/O< 01 1t l Ubr Isissh iXMNC4 J`J/::✓ 8