HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 8/3/2021 JUL3 0 Z U'l l
AFTER THE FACT RECORD DRAWING, pg 1 MA§9N COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name - .ZI/'/'-fee_. kC%G, Assessor Parcel# -4 z2(2- .S rt!i a<2-
Mailing Address /`/02_ G-t/C /497Z5 O/M Specialist Name
City, State, Zip �`��y /v`�"2J/
y .�.`�Si. ., r=tea• Qpe,,/ Installer Name
Site Address I en 19 F "J Cceel< Designer Name
Please complete this checklist to the best of your knowledge. if items are unknown leave blank.
INSTALLATION CHECKLIST
System Type •.`] 4-.A,"^ Pretreatment Type
Drainfield Ln. Ft. Cb 0 . Drainfield Sq. Ft. 2.., 0 Drainfield depth
>5 ft. from foundation? - - 0 N/A it YES ❑ NO
>50 ft.from wells? - - - . ❑ 0 ❑
Z . >50 ft. from surface water? - 0
< Cleanout between building and tank? - - 0 0 0
V Tank baffles present? - _ _ - 0 0 0
a24"access risers over each compartment?- - 0 rn 0
LU Effluent filter installed?- y❑cn
71
Septic tank size f u O u gal Manufacturer iv u1 /'„,a
o D-box water level and speed levelers used? - 0 N/A ID YES ❑ NO
OO Manifold/D-box accessible from surface?- - 0 0 0
OQ Check valves installed? - ❑ 0
0
2 Transport Line Size Y Schedule/Class
Bedrooms installed(if known) TA 2 0 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation? - - ❑ N/A 21 YES ❑ NO
CI >100 ft. from wells?- p46r� 6.15 - 0 g ❑
W >100 ft. from surface water? - El &�- ' 0
W >10 ft.from potable water lines?- - 0 0 D
Zer— >5 ft.from property lines and easements?
> 30 ft. from downgradient curtain/foundation drains? - - .-TZ ❑ 0
Observation ports present? -
0 Graveless chambers or ❑ Clean gravel used? (check one) 0
0
Proper cover installed over drainfield?- - ❑ g 0
Pump tank setbacks consistent with septic tank? - - 0 N/A ❑ YES jZi NO
Y Pump tank size gal Manufacturer
Z
< 24"access riser(s) and accessible from surface?- - 0 0 0
a. Alarm or Control Panel Installed? - - 0 0 0
Control Panel equipped with Timer/ETM/Counter- - 0 ❑ 0
O. Pump installed in 0 Bucket or 0 On Block or ❑ Other
* E Pump Make/Model
j 0 Floats or ❑ Transducer
d Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 2/29/2016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# '-l.22/2 -So I/O f2.
RECORD DRAWING
❑ Drainfeld&manifold
orientation&layout
w/dimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
Location w/dimen-
sions for re-location
El Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations,
&manifolds/d-boxes
❑ Location of wells,
surface water,roads,
&waterlines.
❑ Reserve area(s)
❑ North Arrow
If needed drawing may be attached on a separate page No. Pages Attached 4
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/NI SPECIALIST
I certify that the information contained in this document is accurate to my knowledge. The drawing and information
has been obtained throw common locating practices.
t°a-2;4 7 zq 7i
Signature of�esi ner or ApprovedSpecialistl 9 g OM 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.
I fti\s),Iervv.44/ t?) 3L
Signature of Environrrntal Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated2r29/20to
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