Loading...
HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/17/2024 (2) AFTER THE FACT RECORD DRAWING, fig 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Owner Name Assessor Parcel# Mailing Address O/M Specialist Name City, State,Zip Installer Name Site Address 0.ce Designer Name Please complete this checklist to the best ofyourknowledge. Ifftems are unknown leave blank. INSTALLATION CHECKLIST System Type �Y Pretreatment Type Drainfiela Ln.Ft. �_ -Yi -. Dreinfield Sq. Ft. �� Dreinfeltl dep��th///Z z�-I >5ft.tram foundation? --------------------------- ❑NIA LprES ❑ NO >50 ft.from wells? -------- ------------------ --- ❑ rg ❑ Z >50ft.tram surface water? -- --- ------------------ - ElNd ❑ r Cleanout between building and tank? ---------------- - -- ❑ b" ❑ U Tank baffles present? ----- - -- ------------------ - ❑ 6 24'access deers over each compartment?---------------- ❑ ❑ NEftluentffter installed?----- - -- - -- -- -- -------- El ❑ Septic tank size Z-OT sal Manufacturer Z. f Dar/1 t] D-box water level and speed levelers used? ------ ❑ WA ❑vas ❑ No 0J 0 Manifold/)-box accessible from surface?------ ----- --- --- ❑ ❑ ❑ Check valves installed? --- -------------- 0.( �� ❑ ❑ 2 Transport Line Size SchedulelClass Bedrooms installed(if known) ❑2 ❑4 ❑5 ❑6 ❑Commercial/Other >10ft.from foundation?-------------------------- ❑ Nu IVYEs ❑ NO >100 ft.from wells?----------------------------- ❑ W ❑ W >100ft.from sudacewater?-----------------------. ❑ b- ❑ LL >10ft.from potable water lines?-- ------ -------------- ❑ (�' ❑ 2 >5 ft.from property lines and easements?- ---- Q ❑ �' ❑ C >30 ft.from downgredient curtain/foundation drain?---------- ❑ ❑ C Observation ports present? - - ❑ ❑ ❑ ❑ Gmveless chambers or Nr Clean gravel used? (check one) Proper cover installed over drainfeld?------------------- ❑ ❑ Pump tank setbacks consistent with septic tank?--------- ---- 'Q1uA ❑ YES ❑ NO 2 Pump tank size net Manufacturer F24"access riser(s)and accessible tram surface?------------- ❑ ❑ ❑ y Alarm or Control Panel Installed? --------------------- ❑ ❑ ❑ 7 Control Panel equipped with Timer I ETM/Counter----------- ❑ ❑ ❑ C Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a Pump Make/Model ❑ Floats or ❑ Transducer f Tank draw down in/min Pump capacity apm Squirt Height ft a Pump on eme Pump off time Daily flow set at gpd �zai.a vnrzo,s i AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# `-7 - 'AS-©Q62C RECORD DRAWING Dramfield&manifold orientation&layout w/dimensions for re-lorabon. tLl TmnclVbed dimensions and critical distances ,y.., "hln layout Septirlpumptenk Location w/dimen- on9for L of bOCalift Location ro xd buildiigs k—, bs4rplpropo O (� Observation awls, tleannul locations, &manbtoWsld-b�orps, Location of wells, surfers water,roads, &waterlines. Reserve areas) Nwih Anaw ! If needed drawing may be attached on a Separate page No. Pages Attached 1 CERTIFICATION OF INSTALLATION DESIGNER/APPROVED DIM SPECIALIST I certify that the info containedmant is accurate to my knowledge- The drawing and information has b g Comm ng practices. of Designer crAppromd DIM Specialist Date MASON COUNTY PUBLIC HEALTH This is an after the fact record drawing, which mayor may not include a county inspection. This information is to only document an existing OSS location and components. �*�en Signature of EnWmnmentat Hea#h S 'alisl Date THIS FORM MAYBE SCANNEDANDAVFILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE U°°�i0 0t8 ti v Sj xaj g a M — ° V � 3 � p h a H o �+ y d 3 �� � m rj