HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built AFTER THE FACT RECORD DRAWING.pg 1 MASON COUNTY PUBLIC HEALTH
�� PARCEL IDENTIFICATION
Owner Na'"ejur"r 111E Assessor Parcel#
Mailing Address Per DIM Speciaksl Name
CM state, Zip Va Installer Name 17�.
Site Address �� £ N ' •a Cesigner Name
Pleasecomplete this checi to the best efynurknowledge. Itilems en unkild"kare blank.
INSTALLATION CHECKLIST
System Type . w Pretreatment Type
Dranfieltl Ln.F r t ��_ Otalnhtld Sq. FL 306o DrainfieN depth
>51t hom(ourMaiar? -- --------------------. ' Nla .OYES ❑.0
w 150h.from ells? .----------------------------- ❑ %9 ❑
WC
Y >50ft from sudace water? --------------------- -- ❑ q ❑
Q Cloanow between building and lank? ------------------- El
❑ yh�SQlj ❑
UTank wite.present? --------------------------. ❑
d 24-accessrisers over each companmenl?---------------. ❑ ❑
W ENuent bier mstayed?--------- ------------------ ❑ ❑
m 12dO dal Mxlubcuel, t?3 Krity'��i
Septic lank size uu
0 D two water level and speed levelers used? -------- w ❑YES ❑ ao
DO Milutoldul"ot accessible tram Surface?---------------- Q ❑
m= ------------------- --- ❑ ❑ ❑
COegk valves dlSWlled? ----
ea: Selrd"'Class
� TrampM Line Sze
Bedrooms kpteged(itImmen) 142 ❑tl ❑a ❑5 06 ❑Comenercavother
>10 h.from foundabon?----------------------------- ----- XM ❑YES ❑ no
0 >100&from wells?----------------------------- ❑ ❑ ❑
>I00h flgmsurfacewalK?------------------------ ❑ ❑ Liy- >loft.from potablewatertlnes?---------------------- ❑ ❑ ❑
$Z >5e fiom'mped,final and easernenls?---------------- ❑ ❑ ❑
d >00 h from downgratkenl curtainRourdfaeon drakes?•--------• ❑ ❑ ❑
Oburveuon ports present? .-----------_. ❑ ❑ ❑
❑ Graveless chambers of ❑ Clean gravel Used? (drat one)
Pmper cover viStaled over drairdole?. ------------------ ❑ ❑ ❑
pump rant setbacks consisUm wan seppc tardy?------------- �ww ❑ YES ❑ ao
Y Pumptanksize gal MarWaduar
6
21.10Ce55 riser(s)an0 accessible from Surface?------------- ❑ Q
6 AWrm or Conbol Panel Installed?-- --- ""''- ❑ ❑ ❑
f Control Panel equipped with Tuner l ETM I Doumer----------- ❑ ❑ ❑
!l Pump installed in ❑ Bucket a ❑ On Block or ❑ Other
a Pump Make/Modet ❑Floats or ❑Tramducer
b Tank tlraw down iNmin Pump capacity gput Squirt tteigM e
Pumponbme Pump gO time Daily flow set at qpd
I
Printed from Mason Cour)=y DMS
Printed IT ra Ma"n,,Cowrtv EMS
1736 SR Mile Hill Drfve �v
BP7LCTRA Laboruorlea- Port Orchard,WA 9M
www.apectre-lab.com
.-aa..m.w.a�... (360)443-7845
COLIFORM BACTERIA ANALYSIS FORM
nwBaaaa(aea rpdeNd Carob ��
31 9 is y1 ° a&aa
tee se ea -L.
Z�Cru yy/bfo•t!
Type of Walrgratin(deia pit/=en)
DOe,WA ❑&owB aQlp
OpWA.aG WB9,aWma PmlM wuwaa,F.a.aseaa7lpt5t
Da - - _ _ —
titelenNean
are Ptea 6,-ya7-S1711 Cea Pleee
noun F..Plaie
rearora 1Raaa.,alarad d&mpaaea5
SaWLE MFONATM --
araaaeleaktYlnrek 'NC.
gc.dt rose +Mpt.,.myy� saedatraawammmroa Coliform Distribution System
79ZJenyen a
y,, Sampling Procedure
TmalSeeala(mpapbwtu) Step Oae Step Four
113 RmftDWa,am Sampa aaseaeeWaMe.aa.an.) AvoidpoorsamplesheSSUChas There maybe some liquid or
takd,a,en,vp ❑ No❑ 0 ..... Bin swivel fanem,hot and cold mixing powder in the sample bottle to
Qtlna.Raa"Tda_ Fro_ taneets(ndthasinglelever),lakyor remove chlorine.Do not rinse it
Vaae&aedvytai.YtmaaWr, spraying faucets,drinking out
agpaa 6aaN5WeRdaSnWa __ founteins,inin,,Wsmks,frost-free Step Fuse
I a untaupdpymdnsmaty daa hosebgrounTlev-el oeetshelow oraau To avid consummation while
���J -- -� -� gomdleseL taking the sample,hold the bottle
❑TN" ukaond:v.� Ro'-' Step Two neuthebottom with onshand and
O , Nxie Rgduat Tom_F% Removesayattachmemsfromthe hold the top of the ap with the
Sees,including senators,screaa5, other.Now unscrew thervp.
4.ue.naaammrowreame washers,hoxsandweterlBNrs.If
D ❑ ,,,❑ L11J y P DONOTsettheoapdown,touch
Eat �Fep4ew.oM Re.e n. oachoosetoduin(eetihesam la
5.0snaeoAsMa�o* Sar.E aitepriorto ample collection,be anypartafthecepthatteuchasthe
sureto flushthoroughlyto ramose bottleorlatanything touch the rim
LAB EON Y all disinfectant oftbebottleorinsidetheespJ
UUnaalOW"Tdd Ca&am Rsraend 6eaH Step Six
Ema OEtaeataea Boldthebotdounderthe stream of
RPttaea.&saiso-Raeutad: ,u:. water.bearefulnottolatthebottla
Csaasamaal>ss tmp) 0T 13 machtheampletap.Fillthebottle
totheindicatedf liline,donota:low
Boom amid Raearrou CdaemUlmal.EW_IlOpa, w � it to overflow.RBIDate the bottle
Faaltm&m nSBu rPc Wt --...
�Sj fvmthewatarBowandsecurethe
uonmrrr cr,eaTsmasd.a c Stop Three
cap.
-162o-QI MAR Tmnuuthembiwencronlyand Stet Seven
leti[rmwithastearivstreamfw Completethelab&lip.Roteanything
Wn0Co0` 0e1YipT1AiB at last five minute.Before namua!aboat$esamplecoRectioa.
woo�L 2491 collecting the sample,tum the
°YNtljeoMAR 1 Q 2�� FlHR 1 Q '(�� waterdowatoa.hinsaeamand Stet Eight
letthewaterrunforoneminute, Searethelabslipto thebottlewith
1 oox iatu.ow if they system is chlorinated, rabberband.Dehverthe sample to
oo1 memunthe(ceechlerineandnote Centric Anslytial Labs as soon as
trace ,,.rr,rr,.r.r.rr.mmomrne themeesnrementonthelebslip. possible.
aararar. ....r.arta.nr.
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Printed From Mason County DMS
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