HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
1 p \PARCEL IDENTIFICATION
Owner Name A�ssessor Parcel#
Mailing Address 7 l= t LJL < �WM Specialist Name
City, State, Zip ,roc„�c y?ems WA Installer Name
Site Address 27+51 Wl v.-.n LiLfic e- DesignerName
Please complete this checklist to the best of yourknowledge. If items are unknown leave blank.
(� INSTALLATION CHECKLIST
System Type !',...,.., �o dlaJ.��/ Pretreatment Type
Drainfeld Ln. F_t.7 Drainfield Sq. Ft. Z Z Drain
feld depth
>5 ft.from foundation? �1 NIA YES ❑ NO
>50 ft.from wells? ------ -- - - ---- - g'-��-B yy ❑
Z >50 ft.from surface water? - - - --- - - - -- - - - is El
F Cleanout between building and tank? - -- -- ❑
U Tank baffles present? - --- - - -- - -- - - - --- - -- - P9 ❑
d24"access risers over each compartment?-- 8y-- - -- P9 ❑n(
W Effluent filter installed?---- - - - -- ----- - - - -- ---- - - -- ❑ ❑ FJ
N �66t]
Septic tank size. gal Manufacturer
O D-box water level and speed levelers used? ❑ NIA [A YES ❑ No
p0 Manifold/D-box accessible from surface?- - --- - -- - - --- - --- ❑ P] ❑
mZ Check valves installed? --- - -- --- - - - - - - - - --- ------ ❑ El¢ M
f Transport Line Size ( Ht Schedule/Class
Bedrooms installed (if known) ❑2 El ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft,from foundation?- - - - - - - --- - ❑ NIA MYES ❑ NO
>100 ft. from wells? - --- - --- - -------- ❑ ❑ [A
W >100 ft. from surface water? ElN1 El
u. >10ft. from potable water lines?--- -- ----- --- - ---- - --- - ❑ 51 ❑
QZ >5 ft. from property lines and easements?- -- - - ❑ ❑ R'J
> 30 ft.from downgradient curtain/foundation drains?- - --- - - - - - ❑ ❑ m
Observation ports present? ❑ ❑ ❑
❑ Graveless chambers or W Clean gravel used? (check one)
Proper cover Installed over drainfeld?--- -- -- - -- - ---- --- - ❑ ❑
Pump tank setbacks consistent with septic tank?- ❑ NIA Yes ❑ No
te Pump tank size I66 aal Manufacturer
Z 24"access riser(s)and accessible from surface?----- -- ---- - - ❑ ❑
I
IL (la—rg Control Panel Installed? ---- - - - ----- --- - - - - - - ❑ W ❑
f on rol Panel equipped with Timer/ETM/Counter- - - - - - -- - -- ❑ ❑
7
d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑ Transducer
E
=) Tank draw down in/min Pump capacity apm Squirt Height ft
IL
Pump on time Pump off time Daily flow set al gpd
�
Or
PN�^e cn+s 0� ew-a�
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcelp 2223.��SZ—Oebp�
RECORD DRAWING
❑ Drenfeld&manifold
orientation&layout
wldimensions for
re-location.
❑ Trenchlbed
dimensions and
critical distances
within layout
❑ Septintrump tank
Location wldin,
sions form location
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations.
&manifoldsid-boxes
❑ Location of wells,
surface water,roads,
&waterlines.
❑ Reserve arrests)
❑ North Arrow
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 been obtained through common locating practices.
Signature of Designer orApproved DIM 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.
rC 12 Sl�lj
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAI LABLE FOR PU BLIC VIEW ON TH E MASON COO sl WEB SITE unaemea arzsrzaia
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