HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 8/24/2023 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 ,'Geve
Drainfield Ln. Ft. 92 Drainfield Sq. Ft. 276 Drainfield depth
'
>5 ft. from foundation? - -��� N/A El YES NO
>50 ft.from wells? - i __ \ ❑- , ❑
Z >50 ft. from surface water? - �Z� gf ❑
HCleanout between building and tank? -- --; --P6-`- - -• ❑
U Tank baffles present? - - - - -`t. - 4 ❑
a24" access risers over each compartment?- - ii ❑
Cl)W Effluent filter installed?- : - - ❑ ❑
Septic tank size s/50 gal Manufacturer a"Jc4 t hJelw✓
o D-box water level and speed levelers used? - - p N/A ❑YES X NO
QOJ ElEl0
Manifold/D-box accessible from surface?- • - - -
QQ Check valves installed? - - E] ❑
E Transport Line Size �� Schedule/Class
Bedrooms installed (if known) J2 Cl 3 04 ❑5 06 ❑Commercial/Other
>10 ft.from foundation?- - ❑ N/A YES ❑ NO
O >100 ft. from wells?- - El [Si Cl
W >100 ft. from surface water? - - ❑ El R
•ti >10 ft.from potable water lines?- - - - ❑ Si
Z > 5 ft. from property lines and easements?- - ❑ • El
cc > 30 ft. from downgradient curtain/foundation drains? - - Z. ❑ El
Observation ports present? - - ❑ El E
El Graveless chambers or a Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ Zr. ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES X NO
`-L Pump tank size gal Manufacturer
< 24"access riser(s) and accessible from surface?- - - El El El
l— Alarm or Control Panel Installed? - - - - ❑ El 0
• Control Panel equipped with Timer/ETM /Counter- - El El ❑
n- Pump installed in ❑ Bucket or ❑ On Block or El Other
n'• Pump Make/Model El Floats or ❑Transducer
d Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
,Updated 2n92016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
gTrench/bed
dimensions and
critical distances
within layout
,® Septic/pump tank
Location wldimen •
-
sions for re-location
Er Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations,"t,
&manitoldsld-boxes
❑ Location of wells, // /
surface water,roads,$i' ki Ok-ct tiu r e/J cr..) �CO�[�, /
&waterlines. iI
0 p
Reserve area(s) L` Cam a• &J G(7/ Zal UL/
tog North Arrow T't'f.plc.. /9
�e c 4J e j
If needed drawing may be attached on a separate page No. Pages Attach of l'--^ti 9'�
Air
CERTIFICATION OF INSTALLATION , '?.o.t `�•
DESIGNER/APPROVED O/M SPECIALIST a C •Y E •IT
EA '
LICENSED DESIGN
I certify that the information contained in this document is accurate to my knowledge.`y,:‘,`
has be btained rough common locating practices. EXPIRES os:,o,
(414t
Si natuesignerrA roved O/M Specialist bate
9 9 PP P
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.
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upaaleu 2/152016
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