HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/10/2023 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name 7 /446 C,,C/�yitrlibV5. Assessor Parcel# 7e7-'4 7/�� W
Mailing Address S.3 7 752 /t/'c,0,.4 rc, O/M Specialist Name r� ' / vS , • .A.(;
71
City, State,Zip Sit-e/4- GA 9e Sec( Installer Name 6/1)a/Lrr?W 4
Site Address / )' ireA0.0 /'69(t Designer Name `.fi/i(,l/dwn
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type 6.A7464j Pretreatment Type AI-We, 79'"E'c-nrl
Drainfleld Ln. Ft. f' Drainfield Sq. Ft. lLZ-U Drainfield thy,
7 �P
>5 ft.from foundation? - - ❑NIA yfYES ❑ NO
>50 ft.from wells? - {�i�_-,}VIE El Mr ❑
Z
>50 ft.from surface water? - u !_ ll ❑ ❑
Fa- Cleanout between building and tank? --- I - e-4-2023-- ❑ 0
igi
0 Tank baffles present? - ❑ ❑ TAN
a24"access risers over each corn.- - lay- - 0 0 fa-
ILJ
rW Effluent filter installed?. - • ❑ 0 V*
Septic tank size //U 1) gal Manufacturer G -f".1S.7.0r\-e--
O D-box water level and speed levelers used? - - ❑ WA ❑YES t=No
oO LL Manifold/D-box accessible from surface?- - 0 0 .5
ig-
dz Check valves installed? - , / - t❑ El
Transport Line Size `T Schedule/Class S�G�[ e c l l� f�N'S✓f/.
� v3 a
Bedrooms installed(if known) ❑2 3 ❑4 ❑5 ❑6 ❑CommerciallOther
>10 ft.from foundation?- - ❑ WA AYES ❑ No
0 >100 ft. from wells?- - 0 rgi— 0
W >100 ft. from surface water? - - 0 El
•
ti >10 ft.from potable water lines?- - 0 ❑
Z >5 ft.from property lines and easements?- - ❑ yam- ❑
>30 ft_from downgradient curtain/foundation drains?- - ❑ 0 0
0 Observation ports present? - - 0 ❑ 0
❑ Graveless chambers or Clean gravel used? (check one) /T/N'7 I`
Proper cover installed over drainfieki?-
Pump tank setbacks consistant with septic tank?- - ❑ WA ❑ YES ❑ NO
zPump tank size gal Manufacturer
Q 24'access riser(s)and accessible from surface?- - ❑ 0 ❑
aAlarm or Control Panel Installed? - ----_
❑ ElControl Panel equipped with Timer/ ounter---
❑ ❑ ❑
a- Pump installed in et or 0 On B k'' or ] Other
Pump Mak 1
Ea' ID Floats or El Transducer
D. Tan raw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
Updated 2092016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 3Z0 2,-1 56 C 5CC:
RECORD DRAWING .
Draintield&manifold J
'orientation&layout
wldimensions for
re location. 0,:e
Trenchlbed
dimensions and __.. - ---.-critical distances i
1within layout All
ati
rogi Septic/pump tank V 0
Location w/dimen-
sions for relocation
a.
pil Location of buildings h
existing/proposed 1
❑ observation ports, "
dean-out locations,&
&manifoldsfd-boxes
/��s G►
l►: Location of wells,
surface water,roads,&vrate i 4 ( 20 10
dines. -I
El Reserve area(s) imp 4.---
r. /D1
i� North ArrowF
3p~ �11TO 3ci. /` _�—
' �7 I So I Ott 1O(tgo,�'
I
i
�,n� oGK w�i1
Ip p CA- / X/00
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
1 certify inf Lion contained in this document is accurate to my knowledge. The drawing and information
has common locating practices.
/`-� 050/ Z. _
Signa or Approved AMI Spedalst Dais
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?----IN-Ark Ito \7,-5
Signature of Environmental Health ' list Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE tiPdaled 22ote