HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/22/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
owner Name �s Ctl� Assessor Parcel# SM4 - lev.e)-o� 1o44 4
Mailing Address t'N &Y InZSG O/M Specialist Name SoiAIA& V M!i p
City, State, Zip r�MOrG AG- 9207-4o Installer Name rrAA/n�
Site Address 9.00 F Gcx.nk�f G.1.b)- �. Designer Name t r�S..l
Please complete this checklist to the best ofyourknowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type &p,-�brVrhK Pretreatment Type
Drainfield Ln. R. l7(J Drainfield Sq. Ft, ZZAO Orainfield depth
>5 ft.from foundation? ------ --- ----- El WA YES ❑ No
>50 ft.from wells? ----- --- ----Ean3uA
❑ ❑
Z >50 ft.from surface water? -- ---- - - ❑ ❑
F Cleanout between building and tank? - ❑ �( ❑
U Tank baffles present? - -- -- -- -- - ❑ PC ❑
t- 24'access risers over each compartmefu Effluent filter installed?-- -- -- - -- - Q ❑Septic tank size �G� aal cre<e
0 D-box water level and speed levelers used? -- ---- - -- -- - - -- NIA ❑YES ❑ No
J10
DO Manifold/0-box accessible from surface?-- --- - -- - - --- - --- ❑ ❑ ❑
n?Z Check valves installed? --- -- - -- --- - - - -- ❑ ❑ ❑
0
Transport Line Size Schedule/Class
Bedrooms iretailed(if known) M 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other I /,
>10 ft.from foundation?--- ----- ----- --- -- --- -- - -- ❑ WA A❑,rvES � � NO
>100 ft.from wells?------------------- -- - -- --- -- ❑ t31 ❑
W >100 ft.from surface water?- -- - -------- -- - --------- ❑ ❑
LL >10ft.from potable water lines?- - - ------------------- ❑ ❑
QZ > 5ft. from property linesand easements?----- ----- -- ----
❑ Q� ❑
C > 30 ft.from downgradient curtain/foundation drains?--- -- ----- ❑ ❑
Observation ports present? ❑ ❑
❑ Greveless chambers or Ar Clean gravel used? (check one)
Proper cover installed over dreinfield?---- ----------- - - -- ❑ ❑
Pump tank Setbacks consistent with septic tank?---- - --- ----- lK WA ❑ ves ❑ No
Y Pump tank size aal Manufacturer
Q24"access risers)and accessible from surface?------------- ❑ ❑ Ely Alarm or Control Panel Installed? --- ----- -------- ----- ❑ ❑ El
jControl Panel equipped with Timer/ETM/Counter- -- - - --- --- ❑ ❑ ❑
IL Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
1 Pump Make/Model ❑ Floats or ❑Transducer
5
a
Tank draw down in/min Pump capacity apm Squirt Height ft
Pump on time Pump off time Daily flow set at apd
w�marmrzore
AFTER THE FACT RECORD DRAWING, pg2 AssessorParce1p3ZtoLA— 0-000qy
RECORD DRAWING
❑ Dminfield&manifold o �� Cota{Se
orientation a layout OP OnaA RrSerJe km
w/dimensions for
relocation. _
❑ enubetl dim
dimensiona and
withi.I ,dis
tances
within layout �.f/r��
❑ Sepbdpump tank
Location w/dimen- 11
sions for re-location
❑ Location of buildings ,S
msting/proposed I 1 M
❑ Observation Pons,
d an-outlocations, 4*—�—_ D
&manifolds/d-boxes �E 0A.
[�
❑ Location of wells,
surface water,made,
&walemnes.
❑ Reaerve area(s) I t r �O i
❑ North Arrow
. lo
If needed drawing may be attached on a separate page No. Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
I certify that the information contained in this document is accurate to my knowledge. The drawing and information
has be ractices.
S 1/114
M
natcieofDesigner or Appmved"Specalist Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may ormay not include a county inspection. This infomlation is to only
document an existing OSS location and components.
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE u�°e1e° 3016