HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/24/2023 AFTER THE FACT RECORD DRAWING, pg MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name DA''t l'A'U -Nj V Assessor Parcel# 32-02-Q' 2I ` D�
Mailing Address PO 3bX 33f3P1 O/M Specialist Name 5/1•7Wua SCpnc oc-+4'r1
City, State, Zip -b ;IA °le6.26 installer Name
Site Address l7 31 se iibuieirah Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
. INSTAL► ATION CHECKLIST i
System Type atutv iry — Pretreatment Type /b''
1 1 a 1
Drainfield Ln. Ft. l� Drainfield Sq. Ft. g Drainfield depth I ` 2
>5 ft. from foundation? - t1Q ��1 - 1NJA ❑YES 0 NO
>50 ft. from wells? . ail y Kfir%2, - ❑ ❑
>50 ft. from surface water? - -- - - - - - ❑ X 0
hCleanout between building and tank? - -- - -• - - - ; ❑ I
o Tank baffles present? - -• - .- - - 0IX ❑
r-: 24" access risers over each compartment?- - ❑ ❑ i
a.
LW Effluent filter installed?- CI X
Septic tank size 1209 gal Manufacturer 1 kt-. C.t t. T "
i
n D-box water level and speed levelers used? • -- Z.NlA ❑YES [] NO
oO Manifold/D-box accessible from surface? - 7 ❑
n?z Check valves installed? - -. - - _ - , ❑ ❑
0< ttLL`, — —2-`s3 1
Transport Line Size T Schedule/Class
Bedrooms installed (if known) �,/3 l
❑ 2 l� ❑4 ❑ 5 �j 6 ❑}Commercial/Other l
�,,, i
>1C ft. from foundation?- •- Q NJA ❑ Y_s [] No f
0 >100 ft, from wells?- ❑ ( ❑ g
W >100 ft. from surface water? - - - - •- - ❑ El
i. >10 ft. from potable water lines?- - ❑
— > 5 ft. from property lines and easements?- - ❑ El
DE > 30 ft. from downgradient curtain/foundation drains?- - ❑ ❑
n
Observation ports present? - - L 1 1 �' t
❑ Graveless chambers or ki Clean gravel used? (check one) J
Proper cover installed over drainfield?- - ❑ ❑
i
Pump tank setbacks consistent with septic tank? - - W NIA ❑ YES ❑ NO
i
Pump tank size dal Manufacturer i
Q24"access riser(s) and acces ' e from surface?• /r ❑ ❑ I
t-0. Alarm or Control Panel installed? - - -
Control Panel equipped with Timer/ETM/Col.. - - - ❑ ] ❑ f
t1 Pump installed in ❑ Bucket or ❑ On x or —' Other
- 1
2 Pump Make/Model . ' E Floats or ❑ Transducer
0_ Tank draw down in/min Pump capacity gpm Squirt Height ft t
Pump on time Pump off time Daily flow set at gpd ':
Updated 2.29431G
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 32-02 —2 `d7
RECORD DRAWING
❑ DraInfield&manifold
orientation&layout
w/dimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
Location wldimen-
sions for re-location
❑ Location of builcings
existinglproposed
❑ Observation ports,
clean-cut locations,
&manifotdsld-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 Attache,. I
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 obtai through common locating practices.
Li VI 1 23
• Signature of Designer or Approved DIM Specialist Dale •
•
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.
`/t
Signature of Environmental Health Specialist Gate
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 2/1340t6
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BAMFORD SEPTIC REPAIR, LLC I_ �j- _ _....-.=._I---- r- I-- -.. __ --_t_
301 E WALLACE KNEELAND BLVD • i i , i I , ,.-1-- -- .. - i
STE 224-332 . -- . 1 _..-,-_.. --1-_.1.----� - -- -+j- +-
SHELTON,WA 98584-2985 It . ... I rt ' ,