HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 3/28/2018 I
AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
��"" PARCEL IDENTIFICATION
Owner Name al 14.✓. Assessor Parcel# 32-02-I —58'-O26 I ( _
Mailing Address `t' �? N vJ 2' 'AVE O/M Specialist Name C `/
City, State, ZipY etc C w'L rW'� 9 a��5 Installer Name c u�
� �r 6� _
QQ �
Site Address & E 3400-n Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type Pretreatment Type
Drainfield Ln. Ft. COO I Drainfield Sq. Ft. 18a Drainfield depth
>5 ft. from foundation? - - ❑ N/A 81 YES ❑ NO
>50 ft.from wells? - - ar e ❑
Z >50 ft.from surface water? - - ❑ e ❑
H Cleanout between building and tank? - - ❑ 0 NI
U Tank baffles present? - - 0 0
d 24"access risers over each compartment?- - ❑ 0 tg
N Effluent filter installed?- - 0 0
Septic tank size 1000 2 C gal" Manufacturer ON Q-a....)
0 D-box water level and speed levelers used? - - 'N/A ❑YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ ❑ 0
cilZ Check valves installed? - - 0 0 0
0 «
2 Transport Line Size Schedule/Class 04 0•0-...)
Bedrooms installed (if known) '2 ❑3 ❑4 ❑5 ❑6 ❑CommerciaUOther
R
>10 ft.from foundation?- - N/A (Es ❑ NO
CI >100 ft.from wells?- 0
W >100 ft. from surface water? - - ❑ 0
it Z >10 ft. from potable water lines?- - 0 0
>5 ft. from property lines and easements?- - 0 ❑
12 >30 ft. from downgradient curtain/foundation drains?- ❑
CI
Observation ports present? - - ❑ ❑ P.
❑ Graveless chambers or xp Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 Int 0
Pump tank setbacks consistant with septic tank?VEICZ—urer
- N/A ❑ YES ❑ NO
ZPump tank size gal ct
Q 24"access riser(s) and accessible from sue?„kR A�-' g- - ❑ 0 0
a Alarm or Control Panel Installed? - 11u�' - 0
0
0
• Control Panel equipped with Timer/ETM/ t•er- ''.- ❑ 0 0
Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a' Pump Make/Model ❑ 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 qpd
Printed From Mason County DMS Updated 2/292016
Printed from Mason County DMS
44.
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
❑ Drainfield&manifold
orientation layout5E'1J ^l 1�
wldimenslonsns for
J
re-location.
❑ Trench/bed 604 "ra �--0c \
dimensions and CA ••��
critical distances COR
within layout �,f ,� , �5� b w
❑ Septic/pumptank ►�L• �
. t.
Location wldimen-
sions for re-location lti 1:3r-'/L
• Location or buildingsoG/existing/proposed ��dr4 rat_ 2-21 &v.v.r1S Ctr C6 07,
0 Observation ports, rer ? `Y%—
clean-out locations,
&manifolds/d-boxes
❑ Location of wells, t4.4 1) 440544'5 '/FLA4Sele4 �� V 5E--rD
surface water,roads,
&waterlines. 14AVTA 1 1 ' ( 5 7b G O Q 1—#4+713721rES
❑ Reserve area(s)
❑ North Arrow
If needed drawing may be attached on a separate page No. Pages Attached
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
has b obtained h common locating practices.
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 not include a county inspection. This information is to only
document an existing OSS location and components.
(A 3 �- -- I o F re__corc t
Sign::of Environmental Health Specialist Date 1(�(,,Lf p
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2/2912016
Printed From Mason County DMS
Printed from Mason County DMS
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Printed From Mason County
Printed from Mason County DMS -.