HomeMy WebLinkAboutAFTER THE FACT AS-BUILT - SWG As-Built - 3/25/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name ( AV� L%5%0k Assessor Parcel # 422yo53ooa to
Mailing Address Po 56,et tol4 O/M Specialist Name
City, State,Zip Wauv.. XA -gA;45 Installer Name
Site Address Designer Name
Please complete this checklist to the best ofyour knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type Gyawd4 Pretreatment Type
Drainfield Ln. Ft. Drainfield Sq. Ft. l!j� Drainfield depth
>5 ft.from foundation? --- - - - --- - --------- --- - - -- Lg NIA ❑YES NO
>50 ft.from wells? --- - - ---- - ----- 7}��}� 1lII - - ❑
Z >50 ft.from surface water? - - - - -- - --- D �-t5 al- ❑
Q Cleanout between building and tank? ---- ❑ ElF INAR 21014_
U Tank baffles present7 - --- - - - - - - --- ----- ❑ ❑
Fa 24'access risers over each wmparbnentT• g-- --- - - ----- -- ❑ ❑
W Effluent filter installed?- --- - - --- - --- y�—�` ❑ ❑
rn
Septic tank size LUo a gal Manufacturer NIA
O O-box water level and speed levelers used? ---- - ---- - ---- - ❑ NIA ❑YES Lx�,No
0t0 Manifold/0-box accessible from surface?- - - - - --- - -- -- - - - - ❑ ❑
CaZ Check valves installed? - - --- - - - - - - ---- - --- - - - --- - [v� ❑ El
GQ
S Transport Line Size A' ve. ) Schedule/Class 40
Bedrooms installed(if known) 1l ❑2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?- - - ----- - ---- - -- -- ----- - - - lyN/A ❑ YES ❑ NO
G >100 ft.from wells?- - - - -- - - --- - - ---- - ❑ ❑
W >100 ft.from surface water? - ----- - - - -- - - -- - - - --- - -- ❑ El
M >10ft.from potable water lines?- ----- - --- - - --- - - ----- ❑ ❑
QZ >5 ft. from property lines and easements?- - --- - - -- - ----- - ❑ ❑
OC 130 ft-from downgradient curtainlfoundation drains?- -- - ---- - - ❑ El
Observation ports present? - -- ---- ----- - - El ❑ I�
El1 Graveless chambers or l�J Clean gravel used? (check one)
Proper cover installed over drainfield?- - - -- - -- - - - ---- - - -- ❑ ❑
mp tank setbacks consistant 'h septic tank? - - -- r- - -- - - ❑ NIA Y
ES
ump tank gal an adurer
24"acce ner(s)and Seal le from su ?- - -- - - --- - -- ❑Alarm r C trol Pan Install d? - - - -Co rolP net equi ed wit imer/E /Count r- - - - -- - - -pin tailed ❑ Bu et or On Blo or Othe
Pump odel ❑ Floats r aTank draw down irvmin Pu pacity pm Squid htPump on time Pump off time Daily flo
�w..erramie
"I� V. v 1 a .r / PARCEL NO. _ 4'
THURSTON-MASON HEALTH DISTRICT. • DATE IB�ASIS FOR FEE AA/pUM REgTL
DIVISION OF ENVIRONMENTAL HEALTH - U� - - On^
329 WEST FOURTH ITO W.K0 P.O.WXM (,1 b,(
PHONE 153-0013 PHONE*24 101
OLYMFIA,WA 98501 SHELTON,WA 98594
OWNER / 1 L r
fl L L' G FRe
DIRECTIONS TO SITE:
y� O® TOTAL
FEES
M AGE
CONTRAOOR E.f R
lEATi L
ADDRESSOR i
LOCATION •R• .RoolPf
ME OF PLAT e rY- No
T SOIL TYPE ✓f C f 6/ _�
TOWNS P RANGE SEC.
+ L.9 DEEM TO WATER TABLE FT.
WATER
SOURCE ❑PUBLIC PRIVATE PERC.TESTS: INCHES PER HOUR
TYPE OF (
BUILDING ANOA.W4 &A* BASEMENT 5� 2- By DATE
HOOF 0BEDROOMS 3 BHSF 2 DGASPeOSAEi SEPTIC tANK ISI GAL. pe�NpryY-GAL
SPACE RESERVED FOR C /�� �J�I��'^'ppp p.
REPIACEMENTS DSTRIBUTION FIEUD c0 FT DISTRIBUTION TILE TOTAL �1.,[0� O FEET
.' NORTH-SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA -7 Ly Q Sp FEET
QUANTITY OF
APPROVED STONE ' 0 CC�U. YD. SAND—CU. YD.
'
f�I�rJ� FILL REQUIRED�0 7`— CU.YDS.
THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT
THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE.
TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO
TOP Of TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH
OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO
LOW TO MEET THESE ELEVATIONS,A SEWAGE ELECTOR MAYBE
REQUIRED.
ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES:
BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD
�7 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES
AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET
At OF ANY WELL FR R SH WATER LAKE OR STREAM;I OO FEET FROM
4 Y.
NOTE: FOOTING DRAINAGE, DOWNSPOUTS, WATER$OFTENER AND ANY
OiHEP SCHA WATER NOT E SEPTIC 15 SEWAGE SHILL NOT RE E DISPOSAL
TOOK DISCHARGED INTO THESEPTIC TANK SYSTEMDRTHE SEWAGED UST AREASE/ yq CONNECTED
ALL SEWAGE.THESE INCILIDTICTAN NG SINK AND LAUNDRY Wg51E, MUST BF
CONNERED TO THE SEPTIC TANK
2 QD FfeS $j�2GS, CV FINAL INSPECTION REQUIRED BEFORE BACKFILLING
OFFICE USEONLY x TO RE EACKFILLED
DATE APPLICANT MUSI CALL FOR INSPECTIONS LISTED BELOW ANEA INSR[CTION 1b.
A V ❑ O NgpPROVED i" STRAW
BY, , E� STONE
OVER TILE
aJ J. SEWAGE APPROVED ❑ p PROVEDQ
6 7 BY � - _ /l / @r� STONE
1 WMEE ❑ APPROVED ❑NOT BY UNDER TILE
PROVED
CROSS SECTION OF TRENCH
Printed from Mason County DMS
r AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
❑ Dreinfield&manifold
onentatbn&layout
w/dimensions for
reJocatlon.
❑ Tre hlbed
dimensions and
cft.1 distances
within layout
❑ Sepdcipump tank
Location w/dimen-
slons tor re-IocaGOn
❑ Location of buildings
exhdnelgoposetl
❑ Observation ports.
deanun locatore,
&m nruldds/d-boxes
❑ Location of wells.
.,dace water,roso.,
&waterlines.
❑ 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
1 certify that the information contained in this document is accurate to my knowledge. The drawn..end/-f . lien
has been obtained through common locating practices. ( � —( liri 1�'w
- z4 p Sdber�
Signature of Designer orApprovetl0/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.
Signature of Environme tal Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
RECORD DRAWING continued
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