HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/3/2023 0- AL:•ii;:.rie -LI L.1 0 L.0 2t,g:---5 .-, 0 0 2,-- -.,
�' K — 2023
AFTER THE PACT RECORD DRA�`VIN ; pg MASON COUNTY PUBLIC HEALTH
G?PARtCEL 3190-T, (CATION
s Lee - Assessor Parcel# 22202- 5cf-O2ooq
Owner Name C� � - r--------Mailing Address (2( fa I�c�on 120 O/M Specialist Narnafk eW 1/4w / .
City, State, Zip �.1�.1�A 85� E nh?a �rdi�E N TA L
Site Address (Of IA' WTI W Des e R.1
Please complete this checklist_ to the vest of your knowledge. If items are unknown leave blank.
.��, INSTALLATION CHECKL,ST —_
System Type gam,•/f� -_ Pretreatment Type---�5
Drainfield Ln. Ft. 4741 Drainfizld Sq. r t. �42 _ Drainfield depth Z
>5 ft. from foundation? 0 NIA YES 0 NO
>50 ft. from wells? • ❑ ❑
. >50 ft. from surface water? - - ❑ �j El
Q Cleanout between building and:ank? - ElElr-
Tank baffles present? - - - ❑ ❑
24" access risers over each compartment?- - - - ❑ 1g
tLI Effluent filter installed?- -. • ❑ U
c
Septic tank size J coo gat Manufacturer Le •L etN Caere
D-box water level and speed levelers used? '4N!A ❑YES ❑ NO
O Manifold/D-box accessible from surface?- - ❑ ❑ Ej
O u.
m'2 ElCheck valves installed? - ` ❑ ❑
2 Transport Line Size 7 . Schedule/C:ass ���✓ C 1/C
i Bedrooms installed (if known) 2 ❑3 C a El 5 ❑6 ❑CommerciallOther
>10 ft. from foundation?- - 0 NIA 'YES [] NO
c >1CO ft, from wells? - 0 X ❑
u.1 >100 ft. from surface water? • ❑ g
0
LL >10 ft.from potable water lines?- ❑ ❑
eeZ > 5 ft. from property lines and easements?- - ❑ ❑
oe > 30 ft. from downgradient curtain/foundation drains? - ❑
Observation ports present? - - - -- - - ❑ ❑
❑ Graveless chambers or Ne Clean grave used? (check one;
Proper cover installed over drainfield?- ❑ g ❑
Pump tank setbacks consistent with septic tank? N/A ❑ YES ❑ NO
`.d Pump tank size qa! Manufacturer
d24" access riser(s) and accessible from surface?- -- - - - - El ❑ ❑
O.
Alarm or Control Panel Installed? - - ❑ 0 0
M Control Panel equipped with Tamer;ETM i Counter- •- - - - ❑ ❑ ❑
r- Pump installed in ❑ Bucket or 0 On Block or ❑ Other
Pump Make/Model, r Floats or ❑ Transducer
2.
Tank draw down __inlmin Pump capacity _gprn Squirt Height ft
Pump on time Pump off time- Daily flow set at gpd i
Updated 212/2016
•
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#22aD25`1-"02o09
RECORD DRAWING
O Drainfield&manifold
orientation&layout
wldimenslons for
re-location.
❑ Trenchtbed
dimensions and
critical distances
within layout
• Septiclpump tank
Location w/dimen-
sions for re-location
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-cut locations,
&manifotdsld-boxes
• Location of wells,
surface water,roads,
&waterlines.
❑ Reserve area(s)
❑ North Arrow
Zefr56 SEC Z 7-1
If needed drawing may be attached on a separate page No. Pages Attached .
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
I certify that the information contained in this document is accurate to my knowledge. The drawing and information
h been ob ed through common locating practices.
/a 1241ZZ
Signature of Designer or Approved DIM 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.
(4(-3 1
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2/290016
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{ 301 E'WALLAC KNEELAND BLVD
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STEi224-332 _. _
I —(--— SHELTON,WA 98584-2985;_.
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