HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 11/13/2024 AFTER THE FACT RECORD DRAPAR MASON COUNTY PUBLIC HEALTH
PARCEL
Assessor Parcel# 1i' Ott- 'S— Qp0'3z'
Owner Name
Mailing Address 1*50 tJ OIM Specialist Name
City, State, Zip
rlr;,;` Ljip, ggsf-I Installer Name
tY'DW ti8¢S.
Site Address S"--'""°" _ Designer Name
Please c,,Plet,this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
r
Pretreatment Type CT Drainfield depthFt. I� Dreinfteld Sq. Ft. u°_______________ __ ____ ___ ❑ NIA BYES
NO
foundation? --- ❑m webs? -__ _ __ _ _ ____________ _ _ _ _ _ ___.m surface water? -____ _ ___ _ _ _ _ _ _ ________- ❑ ❑El
li_ t behveen building and tank. ❑ ❑
Tank bathes present? -- - --- - - - - - - - - - --- - -- - --- ®. ❑
24'access risers over each compartment?-- - ----- - ----- - - ❑
Effluent filter installed?----
�- - ❑ ry❑_ ^ ^�
Septictanksize 1 [200 gal �L�Manufacttunrelr13 ln.r F�XiS+t W"may
Z s' rb¢Y"•�"-- WA ❑YES q9 NO
D-box water level and speed levelers used? - - ❑
Gg Manrfold/D-box accessible from surtace?--- ❑ ❑ la
QZ Check valves installed? --- ---r - - ---- --- 3 34 ! ,7 W� F}DkS�
Transport Line Size
ISchedule/Class O 2?�0
Bedrooms installed(if known) ❑2 '03 ❑4 ❑5 ❑6 ❑CommerciaVOther
>10 ft.from foundation?-___ _ _ _ _____ _ ___ _ _ ___ __ __ - ❑ WA Ryes ❑ No
>100 ft,from wells?-___ _ ________ ____ ___ ________. ❑ Er ❑
❑ El ❑
w >too ft,from surface water?-- - --- ------------ ----- ❑ ❑
u. >10ft.from potable water lines?- - - - -- ------------ -
- - - - -- ------------ --- -
Z > 5 ft,from property lines and easements?- ---- -- ❑ ❑
Q
K >30 ft.from tlowngratlient curtain/foundation drains?-- --- --- - - ❑ 19 ❑
O Observation ports present? ---- - ❑ ❑
❑ Graveless chambers or 'Clean gravel used?. (check one) El
cover installed over drainfield?--- - - - -- - --- --- ---- ❑
tank setbacks consistent with septic tank?-- ---- -- - ---- WA YES NO
Y Pump tank siz at Manufacturer
QCI
24"ecceaa rioer(s)end ec le from aurfec.?-------
dAlarm or Control Panel Installed? - -- -- --- - --" - -- - ❑ ❑ ❑
Control Panel equipped with Timer/ETM/Coun - . . . . .
- - - - - ❑ ❑ ❑
O- Pump installed in ❑ Bucket or ock or
a Pump Make/Model ❑ Flo r ❑Transducer
a Tank dew in/min Pump capacity gpm Squirt Heigh
ft
mp on time Pump oft time Deity flow set at
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Assessor Parcel#
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FMAHE FACT RECORD DRAWING,RECORD DRAWING
eld 8 manifold
ith&WYOY
eruions for
a4on.
mibns and
I dirtan_
layoutitlDump tankbri,wltlirMn-
afinr _Fltlon of WiminO.tinypmWsedenJatlon pods,nout!.Radon.anrfoldslbbates
wram
&watertirm.
Raewve area(.)
Natth Arrow -
If needed drawing may be attachea cn a separate page No Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED DIM SPECIALIST
I Certify that the tormabOn contained In this document is accurate to my knowled y d lnronnabon
has been obtai through common locating practices. '
Signature Of Designeror AppmvedOMSpecialist T Date s{- PAU"JOY JOHNSONshARUAII
'.
MASON COUNTY PUBLIC HEALTH t This is an attar the rect record drawing, which may or may not include a county inspection. This intormation is to my
dOcdment an existing OSS locatldn and components.
--'1 11/13/2024
R T i son
Signature of Environmental Health Specialist Date
THIS FORM MAY SE SCANNED AND AVAILABLE FOR PUBLIC V',EWON THE MASON COUNTY WEB SITE °WPe=vesame
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EH Setbacks
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C.)No founoa)ionlodnmelw D...2n n 30fl.ticwng2tlient of
Dalnr�eWlFtaurva area
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