HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 7/11/2022 AFTER THE FACT RECORD DRAWING, pg1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
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Mailing Address ^�/ LI 0�^-' �~ / (]/K8 Specialist Nonn
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(�ity. 8�o\e. Zip �' 44 �w"' �«�~�' Installer Name
Site�d�ron� �� '- ^� ' ��� ����� �� �eo|gnerNmnne /'�4 ��~6���~�
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
. INSTALLATION CHECKLIST
System Type ���u��=x "�� Pmheo1mentType
^�
Drnin0o|d Ln. F1. ��� * � Drain�n|� Sq. FL � ��«» � D,o|n5o|d �pp(
'5#. from foundation? ' ' F-1w/x EIYES wn
>50ft. from wells? ' - - - -- - - - 1:1 X
>5D ft. from surface water?' ' 1771 �l
-- -- --
-- C|canout between building and tank? '
Tank baffles present? ' Fl
24^ access risers over each compartment? F-1 171
UJ Effluent filter installed?' 1771 EJ
wn Septic tank size -750 gal Manufacturer --ol I Y -- --
D'box water level and speed levelers used? ' ' X^^ vss 'o
kAmnifo|d/D'box accessible from surface?'
Check valves installed? '
64 ��''
2 Transport Line Size ^ . Schedule/Class
Bedrooms installed (if known) F712 17713 [ ]4 5 F75 FjCommemia|/Other
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^1O ft. homfoundmUnn? ' F] wm ves ��'wo
^1UUft. fronu wells?' ' El 1771
`1UO �. from su��o�wa�er? ' � ' 0 Fl
>10 ft. from potable water lines?'
' 5ft. from property lines and easements?'
> 30 ft. from downgradiont curtain/foundation drains?' - - El
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Observation ports present? ' ' El Fl
F� 8rmve|onoohambern or 'O^Clean gravel used? (check one)
Proper cover installed over dro�nUa|d?'
Pump tank setbacks consiotontwith septic tank? - NIA vsa NO
Pump tank size gal k8aoutooLuer
-- 24^ access rioer(u) and accessible from surface?'
'- Alarm or Control Panel Installed? ' - - - - - - - - - - - - - - - - - - - '
Control Panel equipped with Timer/ ET/N /Counter- El
a- Pump|nn�a||odin �l Buoboi or �� On Block or �l Other
-- --
CL
Pump Make/Model El Floats or El Transducer
CL~^ Tank draw down in/min Pump capacity gpm Squid Height h
PumpunUme Pump off time Daily flow set ot gpd
upd"*^xoynom
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AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 2.2 2 2 f (Do c'S
RECORD DRAWING
Drainfleld&manifold
orientation&layout
yr/dimensions for
re-location.
El Trench/bed
dimensions and
critical distances
within layout
0 Septic/pump tank
Location wldimen-
sions for re-location
El Location of buildings
existing/proposed
Li Observation ports,
clean-out locations,
&manifolds/d-boxes
El Location of wells,
surface water,roads,
&waterlines.
El Reserve area(s)
El North Arrow
02PLI3&AI()
eZce.
(21 •
•
If needed drawing may be attached on a separate page No. Pages Attached I
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED 0/M SPECIALIST
/certify that the information contained in this document is accurate to my knowledge. The drawing and information
ha en obtai rough common locating practices.
(.7 cf izo
Signature of Designer or Approved 0/M Specialist Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may or may not include a county inspection. This information is to only
document an existing OSS location and components.
\ZI-fe,t/y .FCt00 (
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2/29)2018
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