HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 7/1/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name 7-14 a- --x-om.rlsm,,j Assessor Parcel # 3TI54/ 34o/zo
Mailing Address 7-0 £. m1VK«rJ gp O/M Specialist Name GKIAWSM c wsr¢ucnod
City, State, Zip sNfc-rn,1 -uq 9s$"gL/ Installer Name �N^w wrr
Site Address sr r- 45 a6e�C- Designer Name SKI'J'If2 mNs1'wn-w..i
Please complete this checklist to the best of your knowledge, if items are unknown feave blank.
INSTALLATION CHECKLIST
System Type c->2rwrr/ Pretreatment Type dL4
Drainfield Ln. FL r Zd Fz" Dralnfleld Sq. Ft, z(Sd`Er Dminfield depth /Z
>5 ft. from foundation? . - - - - -- - - - - - -- - - -- - - - - - - - - - ❑ N/A ETYYEs NO
>50 ft. from wells? .- - - - - -- - - -- - - - - - ❑ O/ ❑
Z >50 ft,from surface water? - - - -- - - -- - - - --- - - - --- - -- ❑ ❑
FCleanout between building and tank? -- -- -- - - - - - - - -- - - - - ❑ ❑
U Tank baffles present? . - - - -- - - - - - - - - - - -- -- - - - - - - -- ❑ d ❑
a24" access risers over each compartment?- -- -- - - - - - - - - - -- ❑ ❑ d
LU N Effluent filter Installed?- - -- -- --- - - - -- - -- - -- - - - - - - - ❑ ❑
01
Septic tank size 11-00 gal Manufacturer co✓czf' T
g0 D-box water level and speed levelers used? -- - - - - - - - - - - -- . [INiA [-YES ❑ No
00 MU. anifold/D-box accessible from surface?- - -- - - - - - - - - - --- ❑ ❑
OQ Check valves Installed? - -- --- - - -- ---- - -- - - - -- - - - . 9' El El
f Transport Line Size Schedule/Class 36 3`I
Bedrooms installed (if known) ❑2 3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10k. from foundation? -- - - - - - - - - - - - - -- - - - - - -- - -- ❑ NIA 16'YEa ❑ NO
>100 ft. from wells?- - - - - - --- - - -- -- - - - -- - - - - - -- - - ❑ �0./' El
W >too ft, from surface water? - - --- -- - - - - - - --- -- - - - - - . Ej LJ ❑
u. >10ft. from potable water lines?- -- - - - - - - - - - - - - - - - - - -- ❑ d ❑
_ > 5 ft. from property lines and easements?- - - - - - - - - -- - - - -- EI El
> 30 ft. from downgradient curtain/foundation drains?- - - - - - -- - - ❑ IJ ❑,�/
Observation ports present? - -- - - - - - - - - - - - El ElL7
❑ Graveless chambers or Ef Clean gravel used? (check one)
Proper cover installed over drainfield?--- - -- - - - - - - -- - - - - . ❑ ❑
Pump tank setbacks consistent with septic tank? --- -- - E.`NIA ❑ YES ❑ NO
ZPump tank size gal Manufacturer
H 24"access riser(s)and accessible from surface?-- - - - - - - - - - -- E( ❑ ❑
d Alarm or Control Panel Installed? -- - - - - - - -- - - --- -- - - — ❑ ❑ ❑
7 Control Panel equipped with Timer f ETM/Counter- - -- --- --- - ❑ ❑ ❑
0- Pump Installed in ❑ Bucket or ❑ On Block or ❑ Other
IL
Pump Make/Model ❑ Floats or ❑ Transducer
Tank draw down In/min Pump capacity ll p aci p ty_ apm Squirt Height ft
Pump on time pump off time Daily flow set at gpd
Up W]l 2o'e
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
u Dreinfield&manifold
orientation&layoul
w/dimensions for
re-Iocetlon.
E�'Trench/bed
dimensions and
critical distances
wlihln layout
Eff'saptldpump tank
Localion Wdlmen-
sluns for re-locadon
E�T'Localbn of buildings
,_./adding/proposed
u Observation pats, 'll'
clean-out locetlons,
,—,/&manlfoldsrd-boxes
u Looatlon of wells,
surface water,roads,
&waterline&
[T Reserve steals)
North Arrow
If needed drawing may be 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
has been obtained thrgfNgh common locating practices.
Signature of Designerol-Approved 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.
Signature of Environmental Health Specialist Onto
THIS FORM MAY BE SCANNED ANDAVAILABLE FOR PUBLICVIFWON THE MASON COUNTYWEB SITE ul.m nnenole
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