HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 12/15/2023 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Z
Owner Name R vob�V\ ONPIVX-c) Assessor Parcel # Zi\\10- 0 - a‘D
Mailing Address 23632 NE,S-1,-•�--'ce- 3 O/M Specialist Name v'., °-
City. State. Zip
`�e-LCc-"', Wpr q gS2-8 Installer Name R�-v. '''"-er ?
Site Address (g 4\ -E GCYtit61.1., Designer Name \O(ACC. ;G\AY`S0Y\_ -OKA-
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Please complete this checklist to the best of your knowledge. If items are unknown leave blank.,e0.4.0.k.
..11 INSTALLATION CHECKLIST
System Type PftSSU,YG Fj�-la Pretreatment Type N I A
Drainfield Ln. Ft. 50 ' X°V Drainfield Sq. Ft.
AC50 Drainfield depth l�
>5 ft. from foundation? - - - - - -Y\-0- -"-417-.N.`,'�'- - II N/A ❑ YES 0 NO
>50 ft. from wells? - ❑ IN ❑
>50 ft f o u water? - - ❑ I N ❑
II�� b i ee�� 4 ❑
Q CIeh25ut between building and tank? - - t�A �5� �
F ® ❑
U Tank baffles present? - - } 0
F- 24" access risers oiier-eadh compartment?- - ❑ in ❑
a IN ❑
W Effluent filter installed? ❑
cn
Septic tank size \,o�.O0 gal Manufacturer
❑ D-box water level and speed levelers used? - - 5 N/A ❑ YES ❑ NO
DO Manifold/D-box accessible from surface? dal\VctIv�s - ❑ � 0
mZ Check valves installed? - V"' �`i^e`1� ❑ IN ❑
❑a Schedule/Class 40
2 Transport Line Size
2 �3 04 ❑ 5 ❑6 Commercial/Other
Bedrooms installed (if known) El
>10 ft. from foundation?- - - -► -a- u` - - ® N/A ❑ YES ❑ NO
❑ 5 ❑
>100 ft. from wells? ❑ ® ❑
W >100 ft. from surface water? ❑ ❑
LL, >10 ft.from potable water lines?- 0III 0
z > 5 ft. from property lines and easements?- - ❑
II Q 0
Q > 30 ft. from downgradient curtain/foundation drains? IN 0 1111 ❑
Observation ports present?
❑ Graveless chambers or II Clean gravel used? (check one) 0
Proper cover installed over drainfield?- - ❑
II Pump tank setbacks consistant with septic tank? - - ❑ N/A
li YES ❑ NO
Pump tank size I I 042° } gal Manufacturer C1Oncx.e.,-t-e ❑
z - ❑ MI
Q 24" access riser(s) and accessible from surface? ❑ MI ❑
~ Alarm or Control Panel Installed?
E Control Panel equipped with Timer I ETM I Counter-
a- Pump installed in ❑ Bucket or 5 On Block or ❑ Other
a Pump Make/Model Lib eX ` v) S L50 ❑ Floats or 0 ,
Transducer
�� m Squirt Height " ft
Q. Tank draw down t -15 in/min Pump capacity gP
n- 1 , 9� gpd
Pump on time �. MtV\u�GS Pump off time CD 1"l 0�AY5 Daily flow set at 3k
,;��ateC 2:29.2C16
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 2..1—\\kP"30
RECORD DRAWING
Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
E. Trench/bed
dimensions and
critical distances
within layout
'® Septic/pump tank
Location w/dimen-
sions for re-location
2 Location of buildings
existing/proposed (�
®' Observation ports.
clean-out locations, PQ
&manifolds/d-boxes
2. Location of wells.
surface water,roads.
&waterlines.
IR Reserve area(s)
North Arrow
If needed drawing maye.54.attached on a separate page No. Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/ Oal4 P SPECIALIST
I certify th anf tl rtitained in this document is accurate to my knowledge. The drawing and information
has bee r aine gl ' lion locating practices.
6 ^U 9
)L-1 a- Z3
Sign - - _ .Specialist Date
EXPIRES 0 %7 5/
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.
1114
Signature of Environmental Healt Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upaae.225120'S
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