HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 12/12/2023 442
AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUB HEAL'TW
PARCEL IDENTIFICATION R�CF�FO y220
Owner Name -fir' c:! S L-I‘k a(/rl Assessor Parcel# L,Z Z / Z- 5 / a c/uo6
Mailing Address /9C /-40X b a O/M Specialist Name 'Dole/ O(( 6
City, State, ZipEz S7-R c'.I D O✓' c(7D e.7lnstaller Name f?� 41 /�'S`�
S'
Site Address Z_Y 2 `T L/ /U i/t 'f Y/C / Designer Name ()Ai KNc w+-'
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKUST
System Type (o fe 4✓I 4-vv_ Pretreatment Type /v o A-)
Drainheld I n.Ft. -(DO ;/ Drainfield Sq.Ft. Drainfteld depth oRy 4"
>5 ft.from foundation? - - ❑NIA El-YES ❑ No
>50 ft.from wells? - - 0 - 0
Z >50 ft.from surface water? - - ❑ ® ❑
H Cleanout between building and tank? - - 0 Er-- ❑
o Tank baffles present? - - ❑ a ❑
a24'access risers over each compartment?- - 0 0
(W Effluent filter installed?- _ El 131 CI
Septic tank size (Z.c.C., gal Manufacturer 1-1 pt 66 2 Vk't&N
O D-box water level and speed levelers used? - •- WA ❑YES ❑ No
k8 Manifold/D-box accessible from surface?- - 0 0 0-
Ea,Ow
Z Check valves installed? - - E. 0 ❑
QQ 11 '' �
z Transport Line Size `? Schedule/Classj q'3 0
Bedrooms installed(if known) ' 2 ❑3 ❑4 ❑5 ❑6 ❑CommerciaUOther
>10 ft. from foundation?- - ❑ NIA [YES ❑ NO
9 >100 ft. from welts?- - CICIW >100 ft.from surface water? - - 0 CI •
Z >10 ft.from potable water lines?- - ❑ 1:21- ❑ co ...... o
3 >5 ft.from property lines and easements?- - 0 ( - ❑ 1 am rg
>30 ft from downgradient curtain/foundation drains?- - ❑ c,.
Observation - ❑ _. Ig ports present? !!!"""�"" ��J1
❑ Graveless chambers or ' Clean gravel used? (check one) I Cl
Proper cover installed over drainfield?- - CI ❑i -
(41
Pump tank setbacks consistent with septic tank?- - 0 WA ❑ YES cf NO I 'U
Pump tank size gal Manufacturer
Q 24'access riser(s)and accessible fr su ce?- A
❑ ❑
aAlarm or Control Panel Insta ? - ,-.)( ❑ ❑
Control Panel equipped with Timer/ ounter-- 0 0
a Pump installed in 0 Bucket Other
fl Pump Make/Model ❑ Floats or� 0 Transducer
a. Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Day flow set at gpd
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AFTER THE FACT RECORD DRAWING �ZZ � z ' S ( U� `�
pg 2 Assessor Parcel#
RECORD DRAWING
17f-Cirainfteld&manifold
orientation&layout
vddirnersions for
re-location.
NON`
❑ Tr J
dime and
distances
/Within layout
Septiclpump tank
Location widimen-
sions for re-location
Location of buildings
existing/proposed
Observation ports,
clean-out locations,
&manifokis/d-boxes
Location dwells,
surface water,roads,
&waterlines.
0 Reserve area(s)
Eti North Arrow
P� tVv)1 f
If needed drawing may be attached on a separate page No.Pages Attached -2--
i
CERTIFICATION OF INSTALLATION
DESIGNER!APPROVED O/M SPECIALIST
I certify that the informal' contained in this document is accurate to my knowledge. The drawing and information
has been t common locating practices.
Signature Approved QM 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.
�)1t tZ 3
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCAMIED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE upa eee 21292016
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RECORD DRAWING (continued)
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