HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name KATHY GREIFF Assessor Parcel# 22209 33 90280
Mailing Address 7191 N E NORTHS SHORE RD O/M Specialist Name
City, State, Zip BELFAIR,WA. 98528 Installer Name
Site Address SAME Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type GRAVITY Pretreatment Type / Give
Drainfield Ln. Ft. 92 Drainfield Sq. Ft. 276 Drainfield depth
>5 ft. from foundation? - - ❑ N/A g(YES ❑ NO
>50 ft.from wells? - - ❑ ® ❑
Z >50 ft.from surface water? - - ❑ X ❑
HCleanout between building and tank? - - ❑ El
U Tank baffles present? • - ❑ Ril ❑ p
a24"access risers over each compartment?- ❑ ❑ 1
coW Effluent filter installed?- ❑ ❑
�/
Septic tank size ( x� gal Manufacturer Yvv� �Nvw✓ r,
>
I N
0 D-box water level and speed levelers used? • - p N/A ❑ YES L No No
au_O Manifold/D-box accessible from surface? - - - -- _ _ - ❑ ❑ 2 w
03 Q Check valves installed? - - ❑ ❑
Trans ort Line Size " 1
P Schedule/Class
Bedrooms installed(if known) [42 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A X YES 0 NO
❑ >100 ft. from wells?- - ❑ ❑
—1 >100 ft. from surface water? ❑ ❑ kJ
W
•
LL >10 ft. from potable water lines?- ❑ S ElZ > 5 ft. from property lines and easements?- CIX ❑
12 > 30 ft.from downgradient curtain/foundation drains? - . X ❑ ❑
Observation ports present? - - ❑ ❑ gl
❑ Graveless chambers or Az Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank? - - El N/A ❑ YES X NO
Y Pump tank size gal Manufacturer
Z
< 24"access riser(s) and accessible from surface?- - ❑ ❑ ❑
dAlarm or Control Panel Installed? - - ❑ ❑ ❑
E Control Panel equipped with Timer/ETM /Counter ❑ ❑ ❑
m
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a.
2 Pump Make/Model
❑ Floats or ❑ Transducer
ri Tank draw down in/min Pumpcap
acity acit P Y gpm Squirt Height ft
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
Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
Trench/bed
dimensions and
critical distances
within layout
,® Septidpump tank
Location w/dimen-
sions for re-location
NI Location of buildings
existing/proposed
❑ Observation ports, NAd/
clean-out locations, ' !
&manifoldsld-boxes
❑ Location of wells, /
surface water,roads,�l s( 2 IN//e/ (,J aJ ,j'Cayce 1
&waterlines. f/
Reserve area(s) Cam a, &N q 7/
eg North Arrow T.c.t.pie I ( "7
�P c Gc4 ej
If needed drawing may be attached on a separate page No. Pages Attach -;%— Csti v'
CERTIFICATION OF INSTALLATION v, ° -
DESIGNER!APPROVED 0/NISPECIALIST 0 c v E Air
LICENSED DESIGN
I certify that the information contained in this document is accurate to my knowledge.
has beCbtained rough common locating practices. EXPIRES 05/101
Signature of is i n ror Approved O/M Specialist bate g e esg e
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.
K/ 0 Al k/-/
Signature of Envirorental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updatetl 2r20f2016
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