HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/24/2023 (2) TER THE FACT RECORD DRAWING, pg MASON COUNTY PUBLIC HEALTH
CaN ,� PARCEL IDENTIFICATION
��G , t O wner i -me J A'Nc at)►X— '�-_ Assessor Parcel# 3to2 21
10.x.-Ni• if'' ;", • Address PO Zoe( 33't�1 OIM Specialist Name-Zr'rn "--11 SGQ
City, State, Zip l�c� e. +�V4 4$5213 Installer Name
Site Address 1/39 Se 14D 1k 5er Designer Name
Please complete this checklist`o the best of your knowledge, If items are unknown leave blank.
INSTAL l_ATION C 1ST 1
System Type z
�''�"' _ pretreatment Type �/A' __ 1
1 1
Drainfield Ln. Ft. « Drainfield Sq. Ft. 4� _! Dra!nfield depth f — Z I
>5 ft. from foundation? IQ 0-04 - •NrA ❑YES ❑ NO
>50 ft.from wens? - -Cttl ki 1- - ❑ X ❑
>50 ft. from surface water? ❑ ❑
Cleanout between building and tank? -- - - - - - - - - - . - - - -- m fl ❑ i
U Tank baffles present? u
F- 24' access risers over each compartment?- ❑' 0 1�� t
a.
ILI Effluent filter installed?- - ice., ❑ Jd►�
(!) I
j Septic tank size MOO gal Manufacturer L .*t.,
0 D-box water level and speed teveiers used? - -. M.Nik ❑YES ❑ NO i
OO Manifold/D-box accessible from surface?- ❑ 0 1
m2 Check valves installed? - -- - - - - ❑ ❑ 1
a m Transport Line Size T� Scheduie/Class 2 1
Bedrooms installed (if known) ❑2 [ f 3 ❑4 0 5 06 ❑Commercial/Other 1
>10 ft.from foundation?- -- - ki NIA ❑ YES ❑ NO $
C >100 ft,from wells?- - - ❑ K 0
W >100 ft. from surface water? - - ❑ X ❑ I
if. >10 ft. from potable water lines?- - 7 ❑
Z > 5 ft. from property lines and easements?- -
-
> 30 ft. from downgradient curtain/foundation drains? - - ❑ • i❑
fl
Observation ports present? - - ❑ 0 I rt
Gravetess chambers or 4 Clean gravel used? (check one) 1
Proper cover installed over grainfield?- - ❑ le 0 b
Pump tank setbacks consistent with septic tank? - -- - V NIA ❑ YEs ❑ NO
Y Pump tank size cal Manufacturer f
Z 24" access riser(s)and acces ' e from surface?- -- - •• - - - - ' 0 0 l
~ Alarm or Control Panel installed? - - - - - - - ❑ ❑ ❑ 1
Li..
2 Control Panel equipped with Timer I ETM I Cot.. , - - - - -- - - - - 0 ❑ 0
=
13. Pump installed in ❑ Bucket or 011 On Lk or : Other 1
Pump PJtakeifv'.odei ✓ i Float or ❑ Transducer i
0. Tank draw down in/min Pumc capacity _ __gpm Squirt :-teignt ft $
Pump on time Pump off time Daily flow set at gpd '
Y Updated 2.2912376
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parc&# 3202 2 I—octeeC,
RECORD DRAWING
O Draintlald&manifold
orientation&layout
wldlmensions for
re-location.
El Trenchloed
dimensions and
critical distances
within layout
Q Septictpump tank
Location wldimen-
sions(or re-location
❑ Location of builcings
existing/proposed
0 Observation ports,
clean-cut locations,
&rnar:ifolds/d-boxes
❑ Location of wails,
surface water,roads,
&waterlines.
❑ Reserve area;sj
❑ North Arrow
•
If needed drawing may be attached on a separate page No.Pages Attache. 1
. IT—
CERTIFICATION OF INSTALLATION ,
pEp
DESIGNER]APPROVED O/M SPECIALIST 4I
i certify that the information contained in this document is accurate to my knowledge. The drawing and information
has been obtain through common locating practices. 4!
4 Ivi J 2,3
• Signature of Designer or Approved O/M Specialist Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may or may no!include a county inspection. This information is to only
t document an existing OSS location and components.
i
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE.FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2n9/2016
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BAMFORD SEPTIC REPAIR,LLC 1--- j 1 1- I 1 1 ---f- 1 -;-
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301 E WALLACE KNEELAND BLVD i"--1----4,---1---. t --t
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STE 224-332 --I---r---. .+._.t_i___1.±,._.1._..._.........,_i. .
-- ------ -„„ . SHELTON,WA 98584-2985 i( _ 11
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