HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/24/2023 t.
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AFTER THE FACT RECORD DRAWING, pg ; MASON COUNTY PUBLIC HEALTH
_, , ARCEi IDENTIFICATION
Owner Name 3/h1�' 5 A'D� Assessor Parcel# yz,02.7- So -oei esd
Mailing Address a7 ' 3381 OM Specialist Name 391 I 5f17C.
City. State, Zip 1t-F le`d* 152g Installer Name
Site Address /7! !?22 4'4E gd Designer Name
Please complete this checklist:o the best of your knowledge. If items are unknown leave blank.
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;NSTALLATtO CHECKLIST
System Type CaAliii1V ?re`reat'rent Type i
Drainfield Ln. Ft. `IG Drainfield Sq. Ft. 136 Drainfield depth t-2.2 t
>5 ft. from foundation? - C` -h _ - i j N/A 6 YES ❑ NO 3
' >50ft.from wells?• . '1 - - - - - ❑ ❑ i
>50 ft.from surface water? - Eln [3
Cleanout between building and tank? - ] iE ❑
o Tank baffles present? - - - - E
A-- 24' access risers over each compartment? . -. . - - LJ J ,
III Effluent filter installed?- ❑
1
Septic tank size 12GI° gal Manufacture LOCAA, e-64020
12) D-box water level and speed levelers used? - -- - -- - - -- --- - - - VNIA ❑YES ❑ NO 1
�O Manifold/D-box accessible from surface?- - - -- -- - ••• -• -- •- -- -- - - - - --- ❑
m*2 Check valves ins ailed? __ __. .- _ _ _ i-`� ••'' ❑
0 Q 1I �l I
2 Transport Line Size 2 Schedule Class 54'1 D i
P Bedrooms installed (if known) A 2 7113 ❑4 [3 6 ❑5 ❑CommercialiOther
I >10 ft.from.cu-dation?- -- - ❑ NMN '?Es ❑ NO
1 CI >100 ft, from wells`?- - Li>100 ft. from surface water? ❑ ❑
4 i ;Z >10 ft.from potable wafer fines?• - - - - - ❑ ❑
> 5 ft, from property lines and easements? - _ _ _ ❑ ❑
4 > 30 ft. from dcwngradient curtain/foundation drains? 0
E5 Observation pots present? - - ❑ 01 Cr-
.
0 Graveless chambe-s or X Clean gravel used? (check one)
i Proper cover installed over drainfe!d - - - - - - 0 JX fl
Purr:p taw setbacks ccnsistant with septic tank? - - ---- - - - • i_J NIA--_iY<YES ❑ Ni1
1 :>i Pump tank size gal Man<sfacturer -ONk -
sr24' access risers) and accessible from surface?- - - - -• - -_ _ - _ _ . Fre ❑'
a. Alarm ,r Control Panel installed?
❑ " y1
Centro! :Panel equipped with Timer!ETM !Counter ❑ ❑ !
P�;n?installed in 0 Bucket or cOr. Blec�c or ❑ Other DD1 115 I tt
Pump Make/Model ji='oat_: r Transducer
ft Tank draw down--_ ____inim in Pump capacity __ _—gp • Height- ;t
5
I Pump on time---`_- Pump off time Daily flow set at opo
AidiralidliMM
Updsied 229,,J'i.
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257^ '' O'/OQ3
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 3202. ' 0 '440c=1J
RECORD DRAWING
O Draintield&manifold
orientation&layout
widimensions fa
re-location.
• Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tan(
Location wtdimen-
sions for re-location
❑ Location of builcings
existing/proposed
❑ Observation ports,
dean-out locations,
&manifotdsld-boxes
O Location of wells,
surface water,roads,
&waterlines.
❑ Reserve areas;
❑ North Arrow
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If needed drawing may be attached on a separate page No. Pages Attached 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
h en obtairOrough common locating practices.l
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Signature of Designer or Approved DIM Specialist Date
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 Updated2/29liots
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, SHEtTWA 88584296
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