HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 7/18/2024 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner NameMlC[lelle Dea..n Assessor Parcel# 22W4- 11' ObO-I�
Mailing Address%)9 5*" Ava S. Untt *3a5 O/M Specialist Name
City, State,Zip £drgonds WA 0190212 Installer Name
Site Address 3d 1 - Slre&LD6signer Name
Please complete this checklist to the hest of yourknowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST System Type Pretreatment Type t�n -�i l0``
Drainfleld Ln. Ft. f�_ Dreinfield Sq. Ft. ..� V� Dminfield depth
>5R from foundation? ---------------------------- ❑N/A NYES ❑ No
>50 ft.from wells? ------- ---------------------- ❑ ® ❑
Z >50 IL from surface water? --- - - - - --------------- -- ❑ ❑
FCleanout between building and tank? -------------------- ❑ IN
V Tank baffles present? - - - - - - ---- ---- ------------- ❑ ® ❑
a24"access users over each compartment?------ ------ - --- ❑ ❑
y Effluent fiker installed?---- - ----- - ---- - - - ---- -- --- ❑ ❑
Septic tank size VnD gal Manufacturer
G D-box water level and speed levelers used? - - ------- ------ ❑ WA QIJ YES ❑ NO
J ❑
OLL Manifold/D-box accessible from sunface?- ----------- -----
El
Check valves installed? - - - ---- ------ ------- ------ [� ❑ El
f Transport Line Size -t Schedule/Class
Bedrooms installed(if known) ❑2 ❑3 04 ❑5 ❑6 ❑Commercial/Other
>10 tG from foundation?--------------- ------- ---- ❑ WA 09YES NO
>100 ft.from wells?------------------------------ ❑ ❑
W >100 ft.from surface water? - - - ---- -------------- --- El ® El
IL >10ft.from potable water lines?- ----- ------------- --- ❑ ❑
ZZ >5ft.from property lines and easements?-- - ------ ----- -- ❑
4' >30 ft.from downgradient curtain/foundation drains?---------- ❑ ❑
Observation ports present? - - - --- - ------- El El
❑ �p Graveless chambers or 't' Clean gravel used? (check one)
Proper cover installed over drainfield?-------------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------ - WA ❑ YES ❑ No
Y Pump tank size gal Manufacturer
Q24"access riser(s)and accessible from surface?------------ - ❑ ❑ ❑
aAlarm or Control Panel Installed? --- - ----------------- ❑ ❑ ❑
Control Panel equipped with Timer/ETM/Counter----- ---- - - ❑ ❑ ❑
7
o_ Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a Pump Make/Model ❑ Floats or ❑ Transducer
2
=) Tank draw down in/min Pump capacity gpm Squirt Height ft
a
Pump on time Pump oft time Daily flow set at gpd
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AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel #
RECORD DRAWING
❑ Drainfield&manifold
onentation&layout
w/dlmenslcvs for
re-location.
❑ Tumnatbed
dimensions and
onhi l distances
within layout -I
❑ Sept,upump tank 5-�-�- In,1+u G�2. Ct
Location w/dimen-
sions for re-location OVAV J I h GJ
❑ Location of buildings
existing/proposed
❑ Observation ports,
dean-out lmadons,
&manifoldeld-boxes
❑ Location of wells,
surface water,roads,
&waterlines.
❑ Reserve areas)
❑ 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 ined g common locating practices.
-1/1
Signat of Designer or proved 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 cialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNWWEB SITE uraewe vzaan+s
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22004 - U - 00070
JUL 0 3 2024
SUU 3
600
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