HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/24/2023 AFTER THE FACT RECORD DRAWING, pc 1 MASON COUNTY PUBLIC HEALTH
ARCEL V..— : "iCATION
Owner Name Al4aW5 At Assessor Parcel# 3zo?tI - So -Dy,c.o.(
Mailing Address PO 3381 O/M Specialist Name 39b11r(-44/ &it T7C-
City. State, Zip t it id 4 1$52e installer Name
Site Address /7I f i722 5 4006" ad Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
. ;I:NSTALLATION CHECKLIST l
System Type um"III Pretreatment Type i
l:
Drainfield Ln. Ft. 45 Drainfield Sq. Ft. 136 Drainfield depth 1-i! 1
>5 ft. from foundation? - - -
T-�� - - ❑ NIA �YES ❑ NO I
>50 ft. from wells? - at' '1 w - ❑
>50 ft. from surface water? - - ❑ i
WCleanout between building and tank? - - ❑ N ❑
,V Tank baffles present? - -- - - -- - - - - - - - - - ❑ ' ❑
a24" access risers over each compartment'- ❑ iU
W Effluent filter installed?- -. - . J El
tin I
Septic tank size 1247o gal Manufacturcr L0'1 (-46•4 Cal:PM
C D-box water level and speed levelers used? - -- - - -- - - --• --- - - • VW/A ❑ YES ❑ NO 1
00 Manifold/D-box accessible from surface? - - - - - ;, ❑ E j
1? Check valves installed? _ ._ _ -. .- _ _ _ - ❑ ❑ I
oQ " S� r
2 Transport Line Size 2 Schedule;C:ass 'T
I
-Y
Bedrooms installed; (ifknown)} 2 r 13 ❑4 -_s 5 ❑5 ❑Commercial/Other x
•
>10 ft. from foundation?- - - El NM 1ZYES ❑ NO i
>100 ft, from wEiis? ❑ G
>100 ft. from surface water? - -- - j ❑
a >10 ft.from potable water lines? - - - - - - - ❑ ' ❑
ewee� > 5 ft. from property lines and easements?- - - - - - - I! ❑
lL > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑
Observation pots present? - 0
Cl Graveless chambers or X Clean gravel used? (cheer,one)
Proper cover installed over drainfleid? - - - - ❑ X ❑
Pump tank setbacks cor.sistsnt with septic tank? . - --~- - - -- --- - - i.-1 N/A YES ❑ NO
ZPump tank size_550 gal Man,;facturer ON C�..tJ 12.r
4 24" access riser(s) and accessible from surface?- - - - -• ❑ ❑
W 2 Alarm or Control Pane! Installed? - - - - - fl L_'
Control Panel equipped with Timer/ETM/Counter- ❑ .__:
-• Pump installed in Bucket or X On Bicck or 0 Other D°1145 � .T tV •
2 Pump Make/Model =loats ar ❑ Transducer
0_ Tank draw down inirnin Pump caoacilY 3^ ~ Squirt :-eight ft .
Pump on time Pump off time Daily flow set at gpc:
-- - -' Updated2.290)tG
3-21)21' - 50 0(4(5_3
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel #32. 24 •-50 — QV
RECORD DRAWING
0 Drainfteld&manifold
orientation&layout
w/dimensions for
re-location.
El Trenchibed
dimensions and
critical distances
within layout
❑ Septic/pump tam
Location w/dimen-
sions for re-location
EI Location of buildings
existingiproposed
Observation ports,
dean-out locations,
&manifoldstd-boxes
Q Location of wells,
surface water.roads,
&waterlines.
El Reserve area(s)
❑ North Arrow
If needed drawing may be attached on a separate page No. Pages Attached /
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED OlM SPECIALIST
t certify that the information contained in this document is accurate to my knowledge. The drawing and information
h en obtei rough common locating practices. 2,3
y vi
Signature of Designer or Approved CM Specialist Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may cr may not include a county inspection. This information is to only
document an existing OSS location and components.
ki iSlike‘-2641 4(z�rIz 3
9
Si nature of Env�ro�' en(a!Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE JpdauC znenu,s
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