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Home My WebLink Aboutswg2022-00173 - SWG Application - 4/2/2025 _. 311 341-70; Mason County OSS Installation Report pp. i MASON COUNTY PUBLIC HEALTH -APPLICANT/PERMIT INFORMATION Permit Number SWG 7Dfl- Oot73 Par�In 3a�.a4-�s- qoZI Applicant Name Earl Tdhfny 3 , Subdivision(NamelDiv/BlOCklL Appilcant Address P..d Sox ,7755 1?d•City,state,Zip - 48 Z8 Installer NameStleAddress Z N& Designer Name AN6 INSTALLATION CHECK IST 'WFuesysteminsha can ❑HnkWordy ❑Drelndew Only ❑Repair ❑O�ch�/er System Type Pressw�e, pren 6salmentType�,_ >5It.from foundaffon? --------------------------.- ❑wA fires ❑ No .50ft.from well? ----------------------------- ❑ ® ❑ T >50ft.from surface water7 ------------------------- ❑ E ❑ HClearout between building and tank? ------------------ . ❑ ® ❑ U Tank baffles presmrt7 --------------------------- ❑ In ❑ 6 24'access users over each compartment?---------------- ❑ ® ❑ 1.11 N EMuent filter installed--------------------------- ❑ ® ❑ Sepal tank size ra.OG, del ManufacWrr 0 D-box water level and speed levelers used? -------x------ ❑as. ❑Y AffNO Ou ManiholrYD-box accessible from surface?.---------------. n ❑ mi Check valves installed? --------------------------- ❑ ❑ �i TransportL esize l.o' SMad"Class 40 Bedrooms installed(check") W 2 3 ❑4 ❑5 ❑B ❑Commercial/Other >70ft from foundation?--------------------------- ❑WA JE Es No G >700 ft from Wells?----------------------------- ❑ ® ❑ >700 it from surface water?------------------------ ❑ ® ❑ LL >10 R from potable water lines?---------------------- ❑ ® ❑ `2` >5 ft from property lines and ease�---------------- ❑ ® ❑ R' >30n.fromdowMmdientcudainRoundaffmckl ?---------- ❑ ® ❑ Drair"d level and observation ports present-------------- ❑ ® ❑ ® Graveless chambers or ❑ dean gavel used? (cheek she) Proper cover Installed Mar draiMeld?------------------ - ❑ ® ❑ Pump tank setbacks Wn9istelawdth septic task?------------- ❑ NIA ❑ vas ❑ No X Pumptankske ( doo at Menufacbmer / Mar✓• 5 24'access riser(.)and accaesio m e lefroufen?------------- ❑ 0 ❑ CL AlarmorC:ontrolPanelInstalled? --------------------- ❑ M ❑ 7 Control Panel epcPpad wMh Timer l ETM l Counter----------- ❑ ❑ IL Pump installed in ❑ Bucket Or ® On Block as ❑ Other _ IL Pump Artake"Ddel I wd.4d Bats a ❑Transducer y Tank draw dawn a a IiVmin Planp capatl--1A.4S .�Pm Squid Height 40 ft j Pump on time I-S w. Pump off time 46H. Daly flow set ei A4D_Apd 7 k-d 0116=009£ edS We eno;S o!dwfio LZ£L•SZSL+aW Mason County OSS Installation Report pg.2 pmobj# 38?29 -75-y'6110 ABANDONMENT RECORD Were enlstlng sepac companenta abandoned as part m mis WI..17 ._____________ - [j ws ® xo If yes,please deeedba !W,m ak cmpproms pumpedoutand properly abandoned Per WAC246472ArMOU?-------- ❑ m t� RECORD DRAWING 11x.b a%mmmY�rerun aw nun w,acuue.m euen.a...w.se n is1..M.�•A.n.w Mm.1n�.naw rWaw.vna M.na.NaBAne lam lama dY.Mp.moss.e(Yn'0E a rinMbb aikryxm 6 uau-'.9.y4Jp.'mplMbmtiel xOR,M:mv,iefenaba.�trld,eti.C:y vEPRe9¢E haaWR bPanurlll.YxMame. •aL,WelrRon0a4.LemuLLYe una.eanuvmaeovos eW W.MvnpYie nvntl JnMySmNm.tf NQJ n'W a0anbmY inWYen B(pwear.0:e60pNLL $tt Air-ActIFD ERmrd Drerring Aiached 1 CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that l installed the system in wowdanse with I antl that the system has been installed In aeenr- the septic design stamped APPROVEO•by Mason dance whe the seeds design are mad APPROVED°by County Public Health and Nat any deviations shown Masan County Public Health and that any der4aiiCAS here have been meared'approved by bath the designer shown bare have been cleared/appieved byboth and Mason County Public Health end meet as Slaw myself and Mason County Public Health end meat all end Mason County Codes. Sbte and ldason County Codes I further cerh'fy V)pf ag Information contained on this 1 further car ily that au Information contained on this form and attac Recortl Drawing is accurate. fo m antl adacher/ cord Orava'ng h accurate. 9 r4-Z-6 — 5lanarwaminaeser ash F . PrmtMNMre S'gnee � , ,.qY ��N I MASON COUNTY PUBLIC HEALTH malamYaxmeau The undersigned approves this Ins Report gpd Record Drawing on behalf of Mason 0 lic'Yp9 P`o• H-'iat Health: �d'l O YFy✓iq 1p1,S O 1 Synofm ffEnveoranardathealfhSPEW& OEte NT4l IMP &1,v0/Id0W i nfla fGRN. YBE SGWNEC MICAWVLI LF FOR l PLHtlC AY7HEMA$Q,y�'p�r7Y�$S11f `_-- Zd 086CLZbOW 8dS pus enolS 0!dw610 2:Ct5Z 6t J-N 1 E'AKc 1'DDDIbS RECORD DRAWING fcbknonueM hr✓!sl .t�aad. ,F�u`�-7t-�olro T� MA0161015 .. RECEIVED IW p�®VF 44SONCpNN PR�?10a f FNpjRaN D�q MENTq�b� 1 P Resent- . � IE ry_�tr ANLNONYOWEH OENIIE I