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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 2/26/2024r ' AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Owner Name DAVID JOVANOVICH Assessor Parcel# 51908-50-00112 Mailing Address 60 W BLAKELY O/M Specialist Name 4 &Le _//L7.1-{�j 'n� City, State, Zip ELMA, WA. 98541 Installer Name ft) a 0 w..) Site Address SAME Designer Name A)./ ✓Lcyui 4-c I Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type GRAVITY Pretreatment Type Drainfield Ln. Ft. 10'X30' Drainfield Sq. Ft. 300SF Drainfield depth 18" >5 ft. from foundation? - - 0 N/A gJ YES 0 NO >50 ft.from wells? - - 0 0 0 Z . >50 ft. from surface water? - - 0 4 ❑ H Cleanout between building and tank? - - 0 0 ✓ Tank baffles present? - - ❑ tgl 0 a 24"access risers over each compartment?- - ❑ 0 2.1 `W Effluent filter installed?. - ❑ 0 ZI Septic tank size l b 00 gal Manufacturer Na- 4-Nr.W,i 0 D-box water level and speed levelers used? - - Of N/A 0 YES ❑ NO ow O Manifold/D-box accessible from surface?- - 0 0 El coE Check valves installed? - 0 0 OQ 2 Transport Line Size Schedule/Class Bedrooms installed (if known) XI 2 ❑3 ❑4 ❑5 ❑6 OCommercial/Other >10 ft.from foundation?- - ❑ N/A $YES ❑ NO O >100 ft.from wells?- J 0 0 W >100 ft. from surface water? - - IDX 0 u` >10 ft.from potable water lines?- - ❑ 2g ❑ QZ > 5 ft.from property lines and easements?- -gip-`r't - 0 Igi 0 Q > 30 ft. from downgradient curtain/foundation drains? -- --..V - ❑ ❑ Observation ports present? - - 0 0 .t1 0 Graveless chambers or fJ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 0 Pump tank setbacks consistant with septic tank? - - 0 N/A 0 YES [g NO • Pump tank size gal Manufacturer Q24"access riser(s) and accessible from surface?- - 0 0 0 aAlarm or Control Panel Installed? - - 0 0 0 • Control Panel equipped with Timer/ETM/Counter- - 0 0 0 IL Pump installed in ❑ Bucket or 0 On Block or 0 Other d Pump Make/Model ❑ Floats or 0 Transducer ` J 2 a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 2/29/2018 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 51908-50-00112 RECORD DRAWING N' Drainfield&manifold orientation&layout w/dimensions for re-location. 5] Trench/bed j f �0 dimensions and ;t�'/t�� kv)4 1 A `' 6 critical distances within layout 0 Septic/pump tank Location w/dimen- sions for re-location IA Location of buildings existing/proposed 0 Observation ports, clean-out locations, NAj &manifoldsld-boxes rtsz Location of wells, p � cti surface water,roads, e,31 1 ^t!Y I ''� t'4'�4 &waterlines. 116 Reserve area(s) 5:0f e•rr a ra_i',e:cicJ I 1174/ aGG..•ed N. North Arrow 17 51)#uJ4ki dw ClhQ„Jq. Zele) `ri f f e'W, i.voS he ij 11 IA o ,v G'leo f I Ala/ J'vi I. • If needed drawing may be attached on a separate page No. Pages Attached 1 CERTIFICATION OF INSTALLATION DESIGNER/APPROVED O/M SPECIALIST /certify that the information contained in this document is accurate to my knowledge. The drawing and information has been o ed throppgh common locating practices. ..,..) a .; ,,1 -,„_1--/ __ Signature of De er 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. I,� Signature of Environmental Health Specialist Date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2n9rz016 rnp 0nig \01/4, ova G.l l.,uite. 14,14 L ie'r�A/�►.� Dpi ov 12, /a itgu �q �p © PF. pa<1 .e rev tn. 0 Ito. (bey. (� 5-4114e baaIJe.i1 C-9 cieJarJ0, • - Or ,e4. le ) .. i Sa 5 418 r\ %.4 CINDY E.WAITE4' LICENSED DESIGNEE 6. VV ExP,HES 05,10i 69' 4 �a w B1 l y (Jk.. v, , ya 4 913