HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 12/19/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name MUELLER, DAVID D& LORI A Assessor Parcel# 123215100010
Mailing Address 231 NE RIVERHILL LANE O/M Specialist Name Franklin Clark
City, State, Zip BELFAIR WA 985289645 Installer Name Unknown
231 NE RIVERHILL LANE Designer Name Unknown
Site Address BFLFAIR WA 98 789645 g
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type Gravity Pretreatment Type N/A
Drainfield Ln. Ft. rtwaO Drainfield Sq. Ft. Unk n Drainfield depth Unknown
>5 ft. from foundation? - - - - - ❑ NIA YES ❑ No
>50 ft. from wells? - r - f_, - - - - - ❑ In ❑
Y• >50 ft.from surface water? - - t - - ❑ ❑
FQ- Cleanout between building and tank' - q_c,- ❑ 11 CI
✓ Tank baffles present? - - ❑ M ❑
a24" access risers over each compact ent?-- - - - - - - -- ❑ CI IN
W Effluent filter installed?- By - ❑ U ❑
CO Unknown
Septic tank size 1200 gal Manufacturer
O D-box water level and speed levelers used? - - ❑ NIA 111 YES ❑ NO
J
oO Manifold/D-box accessible from surface?- - ❑ 11 CI
m Z Check valves installed? - - • ❑ ❑
0Q 2 Transport Line Size 4" Schedule/Class 3034
Bedrooms installed (if known) MI 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A IIII YES ❑ NO
0 >100 ft. from wells?- - CI U CI
w >100 ft. from surface water? - - CICI11
u. >10 ft. from potable water lines?- - ❑ III ❑
Z > 5 ft. from property lines and easements?- - ❑ U ❑
Q
re > 30 ft. from downgradient curtain/foundation drains? CIII CI
o II
ports present? - ❑ ❑
❑ Graveless chambers or • Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ® ❑
Pump tank setbacks consistant with septic tank? - - IN NIA ❑ YES ❑ NO
• Pump tank size N/A gal Manufacturer N/A
Z
< 24" access riser(s) and accessible from surface?- - ii ❑
F- Alarm or Control Panel Installed? - - 11 ID CI
a E Control Panel equipped with Timer/ETM/Counter- -
II CI ❑
0
a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other N/A
a• Pump Make/Model N/A ID Floats or ❑ Transducer
Q.
a Tank draw down N/A in/min Pump capacity N/A gpm Squirt Height N/A ft
Pump on time N/A Pump off time N/A Daily flow set at N/A gpd
Upcated 229/20'.6
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 123215100010
RECORD DRAWING
Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
El Trench/bed
dimensions and
critical distances
within layout
El Septic/pump tank
Location w/dimen-
sions for re-location
■ Location of buildings
existing/proposed See Attached
® Observation ports,
clean-out locations,
&manifolds/d-boxes
1.1 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 obtained through common locating practices.
3J11204 L' , C (Franklin Clark) 12DEC2025
Signature of Design r o 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.
(41\Q/I.A1(66Y17) 17j1,61
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 2/29/2016
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