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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built AFTER THE FACT RECORD DRAWING, pg MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION 9 Assessor Parcel # 2�30 - 7 - 7 7a Owner Name S/���o� Z/iti �� S�/�6- •c,G � j Mailing Address Z/4 £. /o'eLAiv T - O/M Specialist Name 1� City, State, Zip -- 7-/ �7-6a/, 11i9 9 s Installer Name e-,on Go Azi Site Address 2 Y 3 e- AE-z-f9/viy AV, Designer Name G))/---e5 £/S7ro . Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type (..,R4viT� Pretreatment Type ,, Drainfield Ln. Ft. �Q Drainfield Sq. Ft. z4-ft2 Drainfield depth $)� ❑ NIA YES ❑ NO >5 ft.from foundation? - ❑/ 0 >50 ft.from wells? 0 / 0 Y >50 ft.from surface water? - ❑ E z H Cleanout between building and tank? - 0 [V 0 ❑ 0 U Tank baffles present? Pe�a�s�r� [2'"a- 24"access risers over each compartment? �eu"s+:D Efr W Effluent filter installed?- Septic tank size !PD0 gal Manufacturer ,� YES O D-box water level and speed levelers used? - ❑ N/A ❑ E❑ 0 O 0J ❑� 0 R+tanifoldlD-box accessible from surface?- - / 0 0 u. fd2 Check valves installed? - L� (73Q �1 Schedule/Class— y0 2 Transport Line Size Bedrooms installed (if known) ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- -- � N/A ❑'YEs 0 NO - � 0 >100 ft.from wells?- 0 W >100 ft.from surface water? 0 0 it >10 ft.from potable water lines? CIz > 5 ft.from property lines and easements?- '- 0 ©� GI > 30 ft.from downgradient curtain/foundation drains? - - 0 E1,- 0 • Observation ports present? - - ❑ El Graveless chambers or Clean gravel used? (check one) ' 0 Proper cover installed over drainfield?- - 0 L� Pump tank setbacks consistent with septic tank?- /A El YES • Pumtan k`SizE--- LU/ _Jal Manufacturer __. -_----"`- , Z 0 Q 24"access riser(s)and access' ace?- .---"'-"- T ❑ f-a. Alarm or Control Panel Installed? - " ❑ El CI 2 Control Panel equipped with TimerS,F M1Counter- a Pump installed in ❑ Bu et or ❑ On Block or 0 Other a Pump Make/Mote- 0 Floats or cer a • Tank draw down in/min Pump capacity gpm Squirt Height Pump on time__ Pump off time Daily flow set at gpd Updated 2/29/2016 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 3 ..a 30-' 7 70 RECORD DRAWING ❑ Drainfield&manifold orientation&layout wldimensions for re-location. ❑ Trench/bed dimensions and critical distances within layout ❑ Septic/pump tank Location w/dirren- sions for re-location ❑ Location of buildings existing/proposed ❑ Observation ports, clean-out locations, &manifoldsid-boxes ❑ Location of wells, • surface water,roads, &waterlines. ❑ Reserve area(s) ❑ North Arrow If needed drawing may be attached on a separate page No.Pages Attached CERTIFICATION OF INSTALLATION DESIGNER!APPROVED O/M SPECIALIST I certify that the information contained in this document is accurate to my knowledge. The drawing and information has been o tamed t ugh common locating practices. /o — 2 P 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. °R4ma0\0 10/28/25 Signature of Environmental Health Specialist Date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE onset°n?na`7m" • _ _ 9 • w W I B� $tF, nci d C _ ,- . m a � Fi0V ia ` gi64k Z7tm � \Ji ` Men�l `p '( Ii � T7 s th St `,1 a N 4 D q„ N...frc, `• 4th St a �.... 0 w , pda p a �J B ; .fd m n < k. V' (� z 2nd st 2ne.g4 m�m B St CD - t W p � a O co n 10� ost O c I 0 • CI a OStee°`- ?'sas �(.�WA � � Qt a D Z • (` so strt. �aa. �' h 0 I� t` t w ail 6 �0 n Boundary. St m : '�_ fZt I \ b `Vn� m 3 tl F1 z • i % \ � ‘N • z fl ° 1 m III a Z A c� �1\Q a v ii \/o'cr... .k- NI tu �� ,� t � aC I r�� fi 1� � �t��A �� o , ii oI fib -- h ;' 4 h i z �� I_ J L .J� I,‘ / f A V n i''' ( L.. i '4) rt, u,': • _._�_ IAA —y f�9.gW g,_______ Ns. o� oo ��• MIoo Z tit i r c ei v, co ha g 11 I a o c� Z 3 0 • • y 1' r Ti • O Z r.. '\ rr: u: >I to ifi , .: . wr._ tot 0 :7r.•:._ ;t•• y J' 1 N O IO �� Ni. - �? \ t Z O 1 O m • � � � ' rn It m \-.Ns \ 73 C K