HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name AIn+r5 -OEt-L. .Assessor Parcel#
Mailing Address 311 bE 1C4W4ZLfru(2 Q OlM Specialist Name W Sic' IX
City, State, Zip I VJA `W04 Installer Name - AyVf G� )
Site Address 3i(PS C. !PrCk4SU"J6 Piz Designer Name Je"aJ4-lali
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type P.eireatment Type IJ A-
r
Drainfield Ln. Ft. ZGr7 Dralnfield So. Ft._ O� _ Drairfield depth 1-2
>5 ft. from foundation? ----------- ------ ---- -- - -- ❑wA !!ppp{{{Yes NO
>60ft.from wells? ------- ----- - -- ----- - - -- - - - - - ❑ ❑
>50ft.from surface water? - -------------- - -- - - - - -- ❑ ❑
Fa- Cleanoutbetvacenbuildingandtank? -------------- - -- - - ❑ � ❑
V Tank beffies present? -- - - - - - -.-- ---- - - - -- - - - - - - -. ❑ ❑
1- 24'access risers over each compartment?--- - ❑ X ❑
WEffluentfilter installed?- - - - -- - - --- - --- -- - - -- - - - - ❑ ❑
N
Septic tank size flee gal Manufacturer-
o D-bow:water level and speed levelers used? -- -- - - - DKNIA ❑YES ❑ NO
0J
0 Manifold/D-box accessible from surface?-- - ------ -- -- - - - - ❑ ❑ ❑ i
t?Ik Ik
0Q Check valves installed? -- -- -- ----- -- ---- - ; - - - - ❑ ❑ Ela e
Transport Line Size 2 schadule/Class- LtD
g Bel.come installed (if known) ❑2 1<3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation? - - --- --- - - - -- -- - --- -- - - - - - ❑ NtA wee ❑ NO f
L., >100 ti,from wells?---- - - - - - - --- - - -- ---
..- ..- - - -- - ❑ ttt3
W >100 ft.from surface water? . _------ .. - - - - -- - -- -- - - - . ❑ ❑
M �10@.from potable waterlines?----- - - --- ---- ---- - - - - ❑ ❑ p
Z >5ft.from property lines and easements?-- -- -- - -------- ri ❑
>30 ft.from downorad!ent curtain:tlo!mdation drains? - ---- - - -- - _ $( ❑
❑ Oraveless chambers or 4 Clean gravel used? ighzck one`
Proper cover instafisd over drainflaid?----- ---- ----- -- - -- ❑ A ❑
Pump tank setbacks crnsistant with septic taak?--------- - - -- 1-1 Nu Yes NO
Y Pump tank size 320 at Manufacture_.Ly W-eyfYtOAQ�t I� aE
g2A"access rlsar�s)and accessible from surface?--------- - - -- ❑ �( ❑
Alan or Control Panel Installed? - --- --- -- - - -- -- - - - ❑ ❑
Control Panel equipped with Timer!ETM/Counter-- - -- - - - - - ❑ ❑
a Pump inffia!Ied!a i-; 2:!che,. or ❑ On Block or ❑ Other •�sr -r -
Pump Make/Model YZ Ficats or ❑Transducer i
a
Tank draw down ___inlmin Pump capacity_,__gpm W� Squirt Height ft !7i
Pump on time ll O'Np Pump o8ti� e g Dam ily flow set at y� Ipd j
1palt^:RiRoln
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#21p�e}� —doloo,9
RECORD DRAWING
❑ Dralneeld&manifold
.notation&layout
wldimanblons for
reioagon.
❑ Trenchroed
dimensions and
on c distances
vathin layout
❑ Seplidpump lank
laatkm widii
sons,for re-lualbn
❑ Location of buildings
exisfing/proposed
❑ Obauvation pods,
deartoul loatbns,
&noodfoldsld-boxes
❑ Lncegonofwalls,
Wdel'eM r.roads.
&wated nes.
❑ Five.eras($)
❑ North Arrow
Sep 2 JS ,
If needed drawing may be attached on a separate page No.PagesAaeohed
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
h been ob of through common locating practices.
21rb1z3
Signature of Designer crApproved 0/M Specialist Date
MASON COUNTY PUBLIC HEALTH
This is an afferthe fact record drawing, which may or may not include a county inspection. This intimation is to only
document an existing OSS location and components.
Signature ofEnwronmentat Health Speuafist Date
THIS FORM MAY BE SCANNEDANDAVAIIABLE FOR PUBLIC VIEW ON THE 1 ASON COUNTY WEB SITE
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SITE PLAP
lLEG OES Rlp lI i 4DER BEACH JWME T TR=-d
'BAMFORD SEPTIC REPAIR,LLC SITE dD�re:ss� aloe e PICKER!NG RD
301 E WALLACE KNEELAND BLVD y s.eLTw.uesuTou
STE 224-332
SHELTON,WA 9OU-2985 ^ f
Sanford septic Sepa/rxLLC
301 E. Wallace kneeland Blvd STEa224-332 13e01902344
Shelton. WA 96564
PROPERTYINFORMATION
Location:3968 E PICKERING RD
Shelton
Tax 10:220045000003
seem JAMESSBELLETAL
84TH ST SW Utah
I.AKEWOOD,WA
08499 GENERAL SYSTEM TYPE:Conventional (Non-Pressurized)
ON ID:220045000003
County Area:Case Inlet
ON-SITIE WASTEINATER TREATMENT SYSTEM INSPECTION REPORT
;peeled:02`1042023 - Inspection Type:ROUTINE- Correction Status:No corroc0ons needed
pany Work powered By: SuemldOd0VI.Y20236y] a
lBamford.seplic Repan,LLC Thaddeus Bamford Thaddeus Bamford 11I1
COMMENTS 8 GENERAL INSPECTION NOTES
No Deficiencies Noted
hei ected for Aher the Fad AS-BUILT. Located!lines 0 drain field.
NO ohsowd problems.
GENERAL SITE 8 SYSTEM CONDITIONS
The General Site and System Conditions were: Fully Imbedded
Components ecdelrf for
ed(iservice' YES
All required secedeperlormetl(il no specify omitted inspection hems In notes): YES
Surfacing ellluenl from any empon nd(including mound seepage): NO
Components appear to he Esential-do visual leaks. YES
Improper¢nUOaCM1meM(BVWVIR9(mpGmiWe eudafEa) NO
All riser has securely hastened upon departure: YES
I-Areal repairs needed If YES describe In comments: NO
l t many c.mp.cddts If YES tl b coin 1 NO
thing problems observed IFYIESdedonseaddedurnin, NO
The Mueeldruclure was seems or used infiniquidi assessment of the drelMeltl was not possible. NO
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
nna tun,pm,om was: Fuge pynOed
Effluent bvN within operational limits(it No eaplatn in COmmenta) YES
M required leaOles in place(NIA=No Saflles dequiredl: YES
Compartment l Scum pnchas.11olharspedfy):
Compartment1 Sludgeondraccumulation(chess.IIther euesed
Compartment 2 Sound eccumulal tfo(I(inche.If otherr speci 1.
Compartment 2 Sludge ecwmulalion(inches If other specily).
Pumping recommended NO
Mmute0Wnr:ant ConsWcbe Martel'.Gravel
Th'16c7lnp. enlcods: FlayImluden
Laleralllnes flu shed: NO
Average squirt height(if pedormad)(feel,Ifother specify).
Ponding prasenty If YES explain in comments: NO
This component was Fully Inspecsa]
Conlmis lundimning: TES
Tested gallons per minute flow I it
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