HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/12/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Nana l FQre'f SJ u A 4 i39IpN Assessor Parcel R '12 33/ 'd 5 0114
Mailing Address 92-5 S/w 31C 0/M Specialist Name
City, State, Zip FZ:OfkaL W4t' W4 Installer Name dAk,k.ivvrc
Site Address /�2-0 N Mffi�AIMJX-_ Designer Name IzEdNwn
Please complete this checklist to the best ofyoarknowledge. If items are unknown leave blank
INSTALLATION CHECKLIST
System Type 6RAV r-y PretreatmertType 0(&Ar)
Drainfiekl Ln. Ft. 90 Drainfied Sq.Ft. Drainfiekf depth �.y ,•
>5R from foundation? --------------------------- ❑WA am �so
>50ft.from wells? -____________________________ ❑ ❑
2 >5oft.from surface water? -______________________- ❑ ❑
HCleanout between building and talc? ------------------- ❑ ❑ ®'
U Tank baffles present? -- ------------------------- ❑ ❑
24'access risers over each compartment?---------------- 13 ❑ ,�
WN Effluent fifter installed?--------------------------- ❑ ❑ �'
Septic tank size �J �JD oat Manufacturer f/Ajh-pow✓ ?
0 D-boxwaterlevelandspeedlevelersused? --------------- ❑aA OYES ❑ NO
BOLL Manrfold/Dbox accessible from surface?---- ❑ ❑ ❑
m oZ Check valves Installed? -__ ___ _ _____ _
-- __. ❑ ❑ ❑
Transport Line Sae ScheduletClass
Bedrooms installed(if known) 02 ❑3 ❑4 ❑5 05 ❑Commerciau0ther
>10ft.from foundation?-------------------------- ❑ NnA EjYES No
>100 ft.from wells?----------------------------- ❑ ❑
>100 ft.from surface water?------------------------ -
❑ ❑
ti >10ft.tore Potable water lines?--------------------- ❑ El
ZZ >5 ft.from properly lines and Easements?---------------- ❑ ❑
a' >30ft.from dowagradient cunauJfoundatkm drain?---------- ❑ ❑
O Observation ports present? -------------- ❑ ❑ "El-
[] Graveless chambers or I� Clean gravel used? (chwk drN>) n,.0
Proper cover installed over draiinfieleld?------------------- ❑
Pump tank setbacks consistant with septic tank?------------- ❑ WA ❑ YEs ❑ NO
Y Pump tank size sat Manufaduer
Q24-access riser(s)and accessible from _ ---__. ❑ ❑ ❑
ILAlarm or Control Parcel Installed? --- -- [/L - ❑ ❑ ❑
Control Panel equipped with Timer/ / ---/_�-------- ❑ ❑ ❑
IL Pump installed in El Bucket or On or ❑ Other
EL Pump Make/Model ❑Floats or ❑Transducer
a
Tank draw down inknin Pump Capacity Opm Squirt Height R
Pump on time Puny off time Daily Now set at apd
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AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel B Y Z� Svoo ( y'6
RECORD DRAWING
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CERTIFICATION OF 9iSTALLATION
DESIGNERI APPROVED DNA SPECIALIST
I cer*that the Inrormabon contained in this document is accurate to my knowledge. The drawing and information
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O�OS 26QL1
rcrApprmved Gl ,V@dom Date
MASON COUNTY PUBLIC HEALTH
Thom waft"the lad record drawing,which may or may not include a county inspection. This mlormalm is to only
document an existing OSS location and components.
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