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MASON COUNTY PUBLIC HEALTH AFTER THE FACT RECORD DRAWING ASBUILT
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Owner's Name �JP�f U\tom N 4\0f?D Assessor's Parcel# 32\3 { — Z�—UCGD�J
(Twelve-Digit Number)
Owner's Address 2\I U) u D7t ----t D6 F Cam` Site Address Z 11 nD l3�t4(oE LAJ
City, State,Zip f�*ia_TOti ��\ "\�S�`� Designer's Name
1. TYPE OF SYSTEM
2. SEPTIC TANK NO YES T�
>5 ft. From foundation?............................................................. ❑
>50 ft from wells? ................................................................... ❑
>50 ft surface water? ................................................................ ❑
Building stubout to septic tank: cleanout if not 1-2%? ............ ❑
Risers installed for access?........................................................ ❑
Tank size: gal.
3. DRAINFIELD
>10 ft from foundation?........................................... ❑
> 5 ft from property lines and easement lines? ......................... ❑
> 100 ft from wells?............................................................ ❑
> 100 ft from surface water? .............................................. ❑
>10 ft from potable water lines?............................................. ❑ rj)
Clean-outs and observation ports resent?......................... ❑
4. PUMP/PUMP CHAMBER ❑
This attached record drawing was created by Mason County Public Health using information obtained from available records
and a site inspection. All locations are approximate.
i 2 22 20\5
Environmental Health Specialist Date
Revised May 2013\
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This site map was created by MCPH by coordinating measurements and information from several sources.including the Mason County GIS and a field
review. All locations are approximate.
Record Drawing
OO Cft �v� Parcel: 3 Z 13 -21- OW00
Public Health Owner: �1��rJ — 1{OSS
Date: 1 LI Z2 I ZO.1 S
Always working for a safer healthier Mason County Page: 2 of Z