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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/17/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH - `. PARCEL IDENTIFICATION Owner Name IAd T) n. % Assessor Parcel# Mailing Address &*30 (( CZ A o�}�} �� DIM Specialist Name City, State, Zip 2�9ON,�� 9m.J5N Installer Name �Site Address Designer Name Il� Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type fb�✓�I� Pretreatment Type Drainfield Ln. Ft Drainfield Sq. Ft. -7-4.0 Drainfield depth `Z--ILA >5ft. from foundation? --------------- -- - - - - -- - - -- ❑NIA ❑ NO >50ft.from wells? ------------------- -- - - -- -- -- ❑ ❑ Z >50 ft.from surface wateR -------------------- -- - - ❑ ❑ Cleanout between building and tank't --------------- - --- ❑ ,❑,/ ❑ O Tank baffles present? - - - - - - - - - --------- -- -- - - - -- ❑ L7 ❑ IL 24"access risers over each compartment?----------- -- --- El ❑N ,© Effluent filter installed?--- ---- ----------- --- ------ ❑ u Septic tank size m gal Manufacturer ��'A�`�Okn' o D-box water level and speed levelers used? - - - - -- --- ------ LrJ ^WA ❑ves ❑ No �O Manifold/D-box accessible from surface?-- - - - - -- - -- ------ —/ ❑ Q- Check valves installed? -- - - -- -- - - - - - - - ----- ----- - G LS ❑ ❑ 2 Transport Line Size /✓/� Schedule/Class Bedrooms installed (if known) 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other >10 ft.from foundation?---------- ----------- --- ❑ NIA .L•7/v/Es ❑ NO 0 >100ft from wells?- -- -------------------------- ❑ ❑ W >100 ft from surface water? ------------------------ ❑ I�,���,,// ❑ LL >10 ft.from potable water lines?---------------------- ❑ LyJ ❑ Z > 5ft. from property lines and easements?----- ----------- ❑ L—�/ ❑ C >30 ft from downgradient curtain/foundation drains?---------- ❑ L7 ❑ / O Observabon ports present? - - - ----------- ❑ ❑ F ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?--- --- -------- ----' ❑ ❑ Pump tank setbacks consistant with septic tank?------------- WA ❑ YES ❑ NO td Pump tank size gal Manufacturer Q24" access riser(s)and accessible from surface?--- - --------- ❑ ❑ ❑ aAlarm or Control Panel Installed? -------- ------------ ❑ ❑ ❑ Control Panel equipped with Tmer I ETM/Counter------ ----- ❑ ❑ ❑ IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other tL Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily Bow set at gpd uraa..a u =16 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#7ZCo 7—y3— O�OZO RECORD DRAWING Drainfiekl&manifold -� (p� o-4.e 1t8 orientation&layout wldimensions for re-location. } / �TrenchPoetl dimensions and critical distam'ES I �i l9ithin layout j} eptidpump tank `N• `O Location wldimen- ^^!! ions for re-location lam" Location of buildings (1, existing/proposed G�`oSe N aL Observation ports, clean-out locations, I8/—� N 1&manrfoldsidboxes u Location of wells, surface water,roads, \�)n .0 waterlines. \v HIV `► ° Re ervearea(s) JU / ND&S n`FA�'�vI}� North Arrow C r .� yVA,(' m 4A Ifneeded drawing may he attached on a separate page No.Pages Attached CERTIFICATION OF INSTALLATION DESIGNER/APPROVED DIM SPECIALIST I certify that the information contained in this document is accurate to my knowledge. The drawing and information ha en obtained th mnmrt locating practices ignature of Designer 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 Signature of Environmental Ifealth Specialist Date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE u"kas 'pearl's