HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 1/6/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name 21'/11 4W1 I/bl POLAP Assessor Parcel # 2Z1 3u ' If 3 'oocxno
Mailing Address O/M Specialist Name -32M
City, State,Zip
Installer Name
7b23 F 5-SW am Designer Name ?3
Site Address
Please complete this checklist to the best of your knowledge. if items are unknown leave blank.
INSTALLATION CHECKLIST
System Type 'T1 Pretreatment Type N
I
Drainfield Ln. Ft. Drainfield So. Ft. 3� ,�Drainfieltl depth 2>5 ft.from foundation? --- ----- ---N�---- ....... JtWA ❑r�YES ❑ NO
>50ft, from wells? - -- ------------------------- - ❑ ml ❑
Z >50ft.from surface water? -------------- --------- - ❑ ❑
F Cleenout between building and tank? ------------------- ❑ 4
U Tank baffles present? - - -- - --- ----- - --- --------- - ❑ t��r ❑
1- 24"access risers over each compartment?- - -------------- ❑ yr
Q.
W Effluent filter installed?-- ------- ----- -- - ------- -- - ❑ ❑
y UNJ COUGfO(1•i
Septic tank size Manufacturer ,,
a D-box water level and speed levelers used? -- ------------- [I WA ❑YES KNO
QO Manifold/D-box accessible from surface?---- - ------ ----- - ❑ ❑
In= Check valves installed? - ------- - --- - -------- ❑ ❑
oa 4° Schedula/Cless 814<-k
f Transport Line Size
Bedrooms installed(if known) 2 1:3
13,-,704 ❑5 ❑6 ,y❑I Commercial/Other
>10 ft.from foundation? --- - -- - -hb'- fftj- ------ L] WA AYES No
O >700 ft.from wells?- ------- ----- --------------- - ❑ [Jq ❑
W >100 ft,from surface water? -- -- -- ------- ----------
❑ El
Z >10ft.from potable water lines?- ----- ------ ---------- ❑ ❑
QZ >5ft.from property lines and easements?-- -- ------------ ❑
C >30 ft,from downgradient curtain/foundation drains?--------- - Q( ❑ Q
Observation ports present? s,,/ - -- ---- ------ - ❑ ❑ �(
❑ Greveless chambers or I ! Clean gravel used? (check one)
Proper cover installed over drainfeld?- --- -- --- ---- - ----- ❑ CJ ❑
Pump tank setbacks consistent with septic tank?--- ---------- DI NA ❑ YES ❑ NO
`1 Pump tank size gal Manufacturer
Z 24'amass riser(s)and accessible from surface?- ------------ ❑ ❑ ❑
N
d Alarm or Control Panel lnstalletl? - --- -- -- ----------- ' ❑ ❑
2 Control Panel equipped with Timer I ETM I Counter----------- ❑ ❑ ❑
7
C Pump installed in ❑ Bucket or ❑ On Bock or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer
a
Tank draw down In/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at apd
Up .]ll6A+0
AFTER THE FACT RECORD DRAWING, pg 2
Assessor Parcel# 1 ~� 13�
RECORD DRAWING
Dramfield a manifold
ohimialion&layout
widwansione for
ra-location.
El Ton-albed
dimensions and
criNcal distances
within layout
❑ Septicipump tank
Location wolionen- "\
sionsrot re-1oC9tin
Tj .option of buildings
exisdngtproposetl
Obsar tdosods,
aen-outloc
Cdons,
&manrfoldsltl-boxes U A14
1
Location Of wells,
airlines
i water,roads..waretl roads. `Y
a lnes. \ �
Reserve steals)
Nodh Arrow
If needed drawing may be attached on a separate page No.Pages Attached `
CERTIFICATION OF NSTAUAMN
DESIGNER!APPROVED DIM SPECIALIST
I certify that the information contained in this document is accurate to my knowledge. The drawing and information
has b obtains ought common locating practice))
//b
Signature of Desgli81'ar'Appmved 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.
��-XrD ,m—�✓t6n�1 6 (7/5-
Signature of of En omomentel HAMM Specialist I Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE
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SAINford septic Repa/rrLLC
301E Wallace Kneeland Blvd STEa224-332 1W079023M
Shelton, WA 98584
PROPERTYINFORMATION
Locellan:7623 E STATE ROUTE 3
Shelton
Tab ID:221304300AI)
aw T• JERRY E S MARGIE E HAYDEN ET AL
7621 E STATE ROUTE 3 Us®
SNEUON.WA 88684 GENERAL SYSTEM TYPE:Conwntlonal (Non Prep surl2ed)
ON ID:221304300000
County Area:Oakland Bay MRA
Nad
ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT
r,napected:01VV2025 - Inspection Type:ROUTINE - Conniption SbNa:No comctlons needed an
Company: Work Petlmmed By' Sue mIMd014)"0255yl
Bamtprtl.ptic Repair LLB Thaddeus Bamford Thaddeus Bamford
COMMENTS 6 GENERAL INSPECTION NOTES
No Deflclencles Noted
Inspacbtl Aram rwtla wit omen for aner the lace as emu
GENERAL SITE 6 SYSTEM CONDITIONS
The General Site and Slatem Corbitloos wwre: __. _ . OY Inspeow
OWoponenta accassibl for sfeh, '_,_ YES
All requiredo senfielparr ed(If no-sp 'Iommed loop t nem• nnow): _ _ r[s
Soda[rN•Muent rrom en camponeni linduenp mourW aeepaoel: _ _. --_._
_ No
Component eppwr to be w0brtl M_ro..1 beds _ _ ___
YES
Ira erencr chment(sa =mMmperdooswdacas) _ _ NO _
All riser foe sacure,fastened upon Oepenurd _..
YES
Eletlhra ira needed wh.S en se in2.d_Rhll.l c. _ NIA
S
In ctea mm name pwrmde In fblcMtlNM: YES
we on a.. _ M^�^_n_i _ _
Root inWabn on any component. If YES aescdae In mmnMM: NO
ThNlnB presume oL. a. ll YES doibec.ard, nla: NO
TM1a noimNNrucY vacant w uses irp enny,eeeeesmenl W tlb6enMW wx rcI pwlWe. N/A
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
TM1b Wm enl we, xer lmapW
Daps in .conoltian:
D-Bps outlet set m allow adisill di eatriou irn:
TM1ia wm ant wam FN,ImpMM
Cwn nent a ers to W"hoporing as Intended YES
Pondm resenp llVES ellin consnio,ts: No
DninReb wee vawumM,flushed orM1 din etletli II YES.•e a inert NO
Thu cam entwea: Futly YES
A,m u level wnMn n ace Nol Iimlts II NO ea a menu: YES
Allre uirea oaMes in ace NiA.No baffles re udae� YES
Ccm annentl SWIM amumulaton Indep.if deal
eNrent t aloe muleYon inrlm,If Whir
Putn I recpmmerWed
mar+ro*mdwverrtu+uwenwonoe n+e.+T+vww*enmmr.+/.w.nmrrumurrursvwv+rs wbu•M+er+m.
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