HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 1/12/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name .fioWT- 4 PO S To L- Assessor Parcel# no Z( - y 4 - 000 t V
Mailing Address O/M Specialist Name lZ.o�.4, FIVSI-
City, State, Zip Installer Name V 0 l'NooyV
Site Address Designer Name UN KA)OWV
Please complete this checklist to the lest ofyourknowledge. If items are unknown leave blank
INSTALLATION CHECKLIST
System Type 6RA✓LT-11 Pmtrea6nent Type No N.=
Drainfeld Ln. FL 7$ Drainfield Sq.FL Drainfield depth /
>5 ft.from foundation? ----------- 7�2�
{� wA ( YES ❑ No
>50 ft.from wells? ------------->50 ft.from surface watm? ---------r Cleamaut between building and talc? --- _ JATT i _ _ ❑
tj Tank baffles present? ------------ --------------- ❑ ❑
a24'access dsers over each cowoot erl? By— -._M ❑
W Effluent filler installed?--------- _ �uT________ ❑ ❑ IS
TA Septic tank size D 5 Z11111Manufacturer t/i KNarjA
o D-box water level and speed levelers used? --------------- ❑NG ❑TES NO
00 Manifold/D-box accessible from surface?------ _ ❑ ❑ ❑
aOZ Check valves installed? ---------------
Transport Line Size
Bedrooms installed(if known) ❑2 133 ❑4 ❑S ❑6 ❑CommerciaROthef
>10ft.from foundation?-------------------------- ❑ NrA [jj YES No
G >100 ft. from wells?----------------------------- ❑ ❑
-t >1001thomsurfacewatell------------------------- ❑ B ❑
W
LL >10ft.from potable water lines?---------------------- ❑ ® ❑
Q2 > 5ft.from property lines and easements?---------------- ❑ 12 ❑
C >30ft.from downgradienl curtaiMoundation drama?---------- ❑ ❑ 91
Observation pots present? ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (Chak arm)
Proper cover installed over drainfield?---- --------------- ❑ 10 ❑
Pump tank setbacks consistent with septic Wlr?------------- ❑ 1NA ❑ YES ❑ No
Y Pump tank size Oso moludacNNaf
Q24-access dser(s)and accessible from surface?------------- ❑ ❑ ❑
IL Alarm or Control Panel Installed?-------- - ❑ ❑ ❑
Control Panel equipped with Timer/ETM/Co ,_ ❑ ❑ ❑
__ ___
4 Pump installed in ❑ Bucket or ❑ On r ❑ 011sr
a Pump Make/Model ❑Floats or ❑ Transducer
Tank draw dawn in/min Pump capacity
IL
wm Squirt Height R
Pump on time Pump off time Daily flaw set at apd
wa..ew.mm
AFTER THE FACT RECORD DRAWING, pg2 Assessor Parcel If 32C2I — CoDt0
RECORD DRAWING
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If needed drawing may he attached on a separate page Na PagetAf chW
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED DIM SPECIALIST
1 carti(y that the information confairled in this document is accurate to my knowledge. The drawing and information
has=common locating practices.
Dea9—"ofApprovad 0/M SpedahaI Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may or may not include a county inspection. This inlonmation is to only
document an existing OSS location and components
Sgnah"of Envkomrrental Health Speaalist Date
THIS FORM MAY BE SCANNED AND AVAHAB.E FOR PUBLIC VIEW ON THE MASON C 100EB SITE ai zosooro