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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/24/2023 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION 405-cp 4- `..).-4 k_icc,H'c. Assessor Parcel # (� 1 g��.` Li `D��t� Owner Name -�-��� illy �j v-�,� Mailing Address 51t`-D `NE R.l•Jou✓ c 4- .0 LJO/M Specialist Name City, State, Zip 04'{N)csL - , ) ciy 513 Installer Name Site Address (2}11 0. 1A--k---9:101(1- e.o Designer Name ti Lill A/ t..,-'a . Li `5''r)J Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type (.4 fe041-y Pretreatment Type Drainfield Ln. Ft. /(00 1 Drainfield Sq. Ft. Drainfield depth >5 ft.from foundation? - •- ❑ N/A ► YES ❑ NO >50 ft. from wells? - ❑ Y >50 ft. from surface water? - - Elg 0 Z ' HCleanout between building and tank? CIU Tank baffles present? ❑,/' ❑ a24" access risers over each compartment?- - LJ CI W Effluent filter installed?- ❑ ❑ to Septic tank size /,to) gal Manufacturer 0 D-box water level and speed levelers used? - - 27N/A ElYES ❑ NO —10 Manifold/D-box accessible from surface?- - ❑ ❑ [��" mZ Check valves installed? - ❑ 6 Q " Schedule/Class 2 Transport Line Size Bedrooms installed (if known) ❑ 2 El 3 ❑4 El 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A 24iES ❑ NO >100 ft.from wells?- - ❑ Fe ❑ W >100 ft.from surface water? - CIti, >10 ft. from potable water lines?- - ❑ i� ❑ Z > 5 ft.from property lines and easements?- CIce > 30 ft.from downgradient curtain/foundation drains? - ❑cl Observation ports present? - - ❑ El ❑ Graveless chambers or ❑ Clean gravel used? (check one) ❑ Proper cover installed over drainfield?- - ❑ 12(Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES El NO Pump tank size gal Manufacturer ` Z Q 24" access riser(s)and accessible from surface?- - ❑ ❑ ~ Alarm or Control Panel Installed? - - CI CI ❑ a 2 Control Panel equipped with Timer/ETM/ Counter- ❑ CI ❑ D a- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other_ a Pump Make/Model CI Floats or CI Transducer E a ft Tank draw down in/min Pump capacity gpm Squirt Height Pump on time Pump off time Daily flow set at gpd Updated 2/29'2016 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# RECORD DRAWING n n lr El Drainfield&manifold �,, rOrr orientation&layout IC( / ' t.n+ w/dimensions for 1 , re-location. k � Trench/bed ,` / f / y 1C. dimensions and critical distances L.. within layout Ii eptic/pump tank 13Location w/dimen- 2 si ns for re-location le Location of buildings ( r -�_Wo t --��� .. existing/proposed -7 7 . dObservation ports, 0- t clean-out locations, ir- /7' - 10 �r- -29 &manifolds/d boxes Awl—-. __ y5' v 121 Location of wells, D ii 1 z�� 5surface water,roads, &waterlines. !r' '1 El Reserve area(s) ft, Er<lorth Arrow cT J........--"J 7,-. Cr\-.22 1 N 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 has been ob d th�ugh mmon locating practices. - j ' - e/ ,b • 3 Signature of Designer or Approve d O/M 4iPecialist 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. 1 f- L,t, (---c— \k-ti\Ulk Signature of Environmental H Ith Specialist Date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2/20/2016 S :' ' 2 r° qv Ebb C7 " 4 " l 1 ►-. 8 i • r arV4'4 . ,ea+a 6 't y t b 9p y�c{j S 47 N '--_ PTil .:-.1 . cm, p, , 4 • 8.i3 oai A U) n5I' b $Q2 4 ' b N ► >+11b b ° .• it iii 4 0 r, i a - b " 8o hi o1 8 A OLD1 i __w fi -.- — ---s "r Ooa00 tO x C g c 0 t , i 1 4 .e. 0 4e,e- R ---- \-" 5i" PI Nl 0 1 4114 �� • 4,c, cr. alp II I Liii !I 'p�fi `Ifit�e ryx x b 8 C '''\,,,,..„ co I gb td4 6b.gN rv�b �6b rii 2 . '7m .,N O G• $,,, 8 I d 1 � 88 1 6.88 8 c 1 I IR5 kI to xii s mil mi. n u rir _ - IIi >> o° Ci CPI i itN PCN h x '� 111111111111111 Ig � � b m m 14 A . 1 g ►iiiiiiiiiiiiill g I Y o° '� x a G v Po, _ ..tea .�-n±�: g+. —i41 i�t.11 I faobt3 K $ t ; 121; t-,m ,14. IN. �' I - 8 O i ;11 1 ill ill r a 47 n 4 a/4 s atrrsr► At is ► , 181 R pi ;i1 gun a m o ii! liI le; 2 a al4 4 SS Law s�� hii li ti ' © • 0 O • • 4i 1 Q ,�, Qf b C► co> C�> 'nf _1 5i : � 1 x 1:,, ,k, . i 0.i�: Pm r to n e,- R' 14w .• , - li k.,.i.,. 0 sI I V" ' i". -'744.1 U N II 3y S � • V op� om 4m �7 +�` O ` s V] A,`..._.. ma ALSO 06-64 AP.NO. 1888678