HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 12/12/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name / jY Ci va.i\sk.vir� r' Assessor Parcel # Z2.014 -5. -00104
Mailing Address /41502 ` Zvi6 .1 1 Y W1 O/M Specialist Name `V )/ACTONA4._
City, State, Zip (5.1) Aktriofi 4Installer Name il,McIROAV\
Site Address -2O Sk-rQ J Ig Designer Name "7aYWa Y\AC NCO:, '
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type �A1/, -iY Pretreatment Type
Drainfield Ln. Ft. 96 4 /- Drainfield Sq. Ft. Z88 A-/— Drainfield depth Z
1-1
>5 ft. from foundation? - - - ❑ NIA Al YES ❑ NO
>50 ft. from wells? - - ❑ ,( ❑
Z >50 ft. from surface water? - - - - - 1a - ❑ gr ❑
HCleanout between building and tank? - r,C£-Q - �'� 0 ❑ ❑
U Tank baffles present? - 1/� ❑ g ❑
d ❑
24" access risers over each compartme ?- - - - - - - - ❑ k
W Effluent filter installed?- Si- . El
N
Septic tank size -750 gal Manufacturer W+ ttiit\ it��c_tele_
9 D-box water level and speed levelers used? - - tgi NIA ❑ YES El NO
oO Manifold/D-box accessible from surface?- - g CI CI
m- Check valves installed? - - CI CI
oQ �l�� �c
2 Transport Line Sizeq Schedule/Class
Bedrooms installed (if known) X 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A 'YES ❑ NO
O >100 ft. from wells?- - ❑ tif ❑
W1>100 ft. from surface water? - - ❑ ❑
LL >10 ft. from potable water lines?- - ❑ ❑
Z > 5 ft. from property lines and easements?- - ❑ CI
oe > 30 ft. from downgradient curtain/foundation drains?- - fEi ❑ ❑
• Observation ports present? - kr ❑ Ii
❑ Graveless chambers or Elea gravel used? (check one)
Proper cover installed over drainfield?- - ❑ fki ❑
Pump tank setbacks consistant with septic tank?- NIA ❑ YES ❑ NO
• Pum size gal Manufacturer
Q24" access riser(s ccessible from surface?- ❑ ❑ ❑
H
a Alarm or Control Panel Installe . ICI CI
2 Control Panel equipped with Timer/ETM%CbU ❑ ❑ ❑
m
a Pump installed in El Bucket or ❑ On Block or ❑
a.
D Pump Make/Model CIFloats --o Transducer
R
a. Tank draw down in/min Pump capacity gpm Squirt Height ........., --
Pump on time Pump off time Daily flow set at gpd
Updated 2292016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# ZZ.CA\D`,j3j
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
wldimensions for
re-location.
❑ Trench/bed
dimensions and
critical distances
within layout
❑ Septic/pump tank
Location w/dimen-
sions for re-location
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations, CeP'
&::: 1 :Te5
\surface water,roads,
&waterlines.
❑ Reserve area(s) r�
❑ North Arrow
If needed drawing may be attached on a separate page No. Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
9 I certify that the information-contained in this document is accurate to my knowledge. The drawing and information
has bee atned througti,coMmon locating practices.
/e
ure of Des ner 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.
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 229/2016
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