HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 2/1/2024 (2) AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION .
Owner Name /4/14 r , i)'er"4,t'S assessor Parcel# 7oo 7 - l 3 -c c,oc:Mailing Address 5/2:- 5`'; ' c(-'_ v�A - / O/M Specialist Name /?�,�/ £�r l
City. State. Zip J L (L �1- io'S `r Installer Name 'Ai 164/ebt,.,
Site Address b C L 3-ILA sp<-qv,< v c.i Designer Name c!A/ XNcw.1
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type C,kA-v, U- Pretreatment Type �'U /" -�--
Drainfield Ln. Ft. ( ,2.C' Drainfield Sq.Ft. Drainfield depth 2 ''i
>5 ft.from foundation? - - ❑ NIA .1 YES ❑ NO
>50 ft.from wells? - �,- -- - ❑ ► ❑
>50 ft.from surface water? - I I L E I L__1�`_ _nil l❑ ❑
Z jj
F Cleanout between building and tank? --- 1 I -FEB-�T?r --1 `1'❑ 0 eg
V Tank baffles present? - i i -L. / ❑ 501' 0
a 24-access risers over each compartment?- - El '_ El
tW Effluent filter installed?. By------__._=:i❑ ❑ X
Septic tank size /70C) gal Manufacturer RA-Ks i)'A-'
O D-box water level and speed levelers used? - - ❑ NIA ❑YEs ❑ NO
DOManifold/D-box accessible from surface?-- -- - 0 El El
m Z Check valves installed? - - 0 ❑ ❑
0
m Transport Line Size Schedule/Class
Bedrooms installed(if known) ❑2 ❑3 ❑4 ❑5 ❑6 ommercialWOther
>10 ft.from foundation?- - 0 N/A ' YES 0 NO
a >100 ft.from wells?- - 0 El
W >100 ft.from surface water? - - ❑ El •
ti >10 ft.from potable water lines?- - ❑ 21- ❑
QZ >5 ft.from property lines and easements?. - 0 a ❑
d >30 ft.from downgradient curtain/foundation drains?- - ❑ ,IF)- ❑
o
Observation ports present? - - ❑ 0 g-
❑ Graveless chambers or (.Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank?- - ❑ NIA ❑ YEs ❑ No
zPump tank size gal Manufacturer
Q 24-access riser(s)and accessib ; from su ?- - 0 0 ❑
i
1- Alarm or Control Panel Install-, - - ❑ ❑ ❑
j Control Panel equipped with T. -II• Counter- - - 0 El
B- Pump installed in ❑ Bucket r ❑ On Block or ❑ Other
a-• 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 Daily flow set at gpd
Updated v:srmle
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AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# • �'�7 / C UL 00
RECORD DRAWING
ip Drair�ld&manirolde
orlenta isti n a layout y°
re-location.
widimensions ra 2�1 l�
323 Trench/bed. t t �a
amensons and r
cfltical distances I /
witinlayout0 .
` �� 1
tank t f
I , o . _
widimen- \ ,,
skins for re-localion v /
Loca on of buildings /
eodalkifyixoposed9
�a
,D� '❑ obseroai on ports, _dean-oul locations. e� _
0
maniolsi -0boxes j
,t'
L Location ohveBs, . .
a a water,roads,
& /
waterlines.
es. `\
Reserve area(s) ' -
pit North Arrow
N..
If needed drawing may be attached on a separate page No.Pages Attached
(13
CERTIFICATION OF INSTALLATION
DESIGNER!APPROVED OM SPECIALIST
I ' that the information contained in this document is accurate to my knowledge. The drawing and information
has through common locating practices.
0,J0 20
Designer or Approved Q%4 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 uva*aa ots