HomeMy WebLinkAboutAFTER THE FACT RECORD DRAWING - SWG As-Built - 5/20/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCELA IDENTIFICATION
Owner Name \-- �e (j,�Vf,,L( _ Assessor Parcel # ' \t- � �� 7Q
Mailing Address 31 QQ (- 1 fl op/M Specialist Name�`O,t.&C- .E'-t�CO.�C
City, State, Zip TA . t �C1 i Installer Name V`&.\�< 0V\
Site Address Zq U . t A C --R Designer Name QL‘k.d
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type C .kR V\( Pretreatment Type a
Drainfield Ln. Ft. /ZO - -/ Drainfield Sq. Ft. 3(00 Drainfield depth /p /r
>5 ft. from foundation? - - ❑ N/A OYES ❑ NO
>50 ft. from wells? - - El X ❑
Z >50 ft. from surface water? - - ❑ Cgf ❑
H Cleanout between building and tank? - - ❑ 0 ❑
o Tank baffles present? - - ❑ cl ❑
d24" access risers over each compartment?- - �' ❑ [�'
W Effluent filter installed?- - F.: 0 4
in
Septic tank size \ n gal Manufacturer (1i` ` QU r\
CID-box water level and speed levelers used? - - ❑ N/A ❑ YES R:i NO
QO Manifold/D-box accessible from surface?- - ❑ [i] ►�
mE Check valves installed? - /� - ❑ 0
6E4E Transport Line Size ` 7 Schedule/Class
Bedrooms installed (if known) ❑ 2 V3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A iErYES ❑ NO
O >100 ft. from wells?- - ❑ (r ❑
W >100 ft. from surface water? - - ❑ 171 ❑
>10 ft. from potable water lines? ❑ �f ❑
Z > 5 ft. from property lines and easements?- - ❑ I�J ❑
Q > 30 ft. from downgradient curtain/foundation drains? - - ❑ I' ❑
Observation ports present? — ❑ ❑ ( `fr
❑ Graveless chambers or Clean ravel used? heck one)
Proper cover installed over drainfield?- - ❑ ❑
Pump tank setbacks consistant with septic tank? - - At(N/A ❑ YES Dap ti4 '..3
• Pump tank size gal Manufacturer
Lis
< 24"access riser(s) and accessible from surface?- - ❑ ❑
aAlarm or Control Panel Installed? - - ❑ ❑ 0
co b
2 Control Panel equipped with Timer/ ETM/Counter- - ❑ ❑ q i4
n
/Z Pump installed in ❑ Bucket or ❑ On Block or ❑ Other i
a
E Pump Make/Model ❑ Floats or ElTransducer I r 7
dTank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 2/29/2016
71(7.
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 62-0i c-23— 00
RECORD DRAWING
Drainfield&manifold �t0�� _ Cl
orientation&layout 1
.4 1 ;/5.01- 4
w/dimensions for
re-location. .
1 -+-iic.._3b 2 4/
El Trench/bed ,y I ®-6-- ale_
r 11
dimensions and I `�
critical distances ! i o\N tj i
within layout 1. e 1 4 .
El Septic/pump tank � A4 4
Location w/dimen- __A `e • ` (, ce�`
sions for re-location S 1 `�N O /
t ~Location of buildings '
existing/proposed r /
❑ Observation ports, 1 q ,
sz,.... . 10000,a( 7 C. 017.
clean-out locations, a�� ., 7N ral sep - e.--Ta"k.44.
&manifolds/d-boxes Q.
❑ Location of wells, /r $t�R
surface water, roads, VCA
r �1 ill �'ret�t-
-\''''''
&waterlines. ,, ;Q*M,d t /
_,\
Reserve area(s) /2)" x
North Arrow _ vi `
ILD \ �t j
, k LN N'1 ;
, ::.
\ -0 \ T
. 6
IA
‘ .--:(17.---- ---v}leAl
If needed drawing may be attached on a separate page No. Pages Attached 0
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
I certify th,L mation_cotlttined in this document is accurate to my knowledge. The drawing and information
h_ ea rough•common locating practices.
s...0"--' Signature of Designer or Approved O/M 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.
SGotnn _512al7_-5
Signature of Environmental Health Spec' ' t Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 2/29/2016