HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 12/30/2025 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name CAMBRIA REMILLARD Assessor Parcel # 320291300340
Mailing Address 470 SE ARCADIA RD O/M Specialist Name N/A
City, State, Zip SHELTON, WA 98584 Installer Name UNKNOWN
Site Address 470 SE ARCADIA RD Designer Name ADAM HUNTER
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. 134 Drainfield Sq. Ft. 402 Drainfield depth 18
>5 ft. from foundation? - - ❑ N/A ❑✓ YES ❑ NO
>50 ft. from wells? - - ❑ 0 ❑
Y >50 ft. from surface water? - - ❑ 0 ❑
Z
H Cleanout between building and tank? - - ❑ 0 ❑
U Tank baffles present? - - ❑ 0 ❑
a24" access risers over each compartment?- - ❑ 0 ❑
W Effluent filter installed?- - E ❑ ❑
cn
Septic tank size 1000 gal Manufacturer LOCAL
�o D-box water level and speed levelers used? - - ❑ N/A 0 YES ❑ NO
�O Manifold/D-box accessible from surface?- - ❑ 0 Cl
mZ Check valves installed? - - 0 El ❑
p Q
2 Transport Line Size 4 Schedule/Class PVC
Bedrooms installed (if known) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
0 >100 ft. from wells? - - CI ❑
W >100 ft. from surface water? - - CI 0 El
u.. >10 ft. from potable water lines?- - ❑ 0 El
Z > 5 ft. from property lines and easements?- - ❑ ✓❑ ❑
ec > 30 ft. from downgradient curtain/foundation drains? - - El ❑ El
0
Observation ports present? - - El 0 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - El 0 ❑
Pump tank setbacks consistant with septic tank? - - El N/A ❑✓ YES ❑ NO
`-L Pump tank size 50 gal Manufacturer LOCAL
< 24" access riser(s) and accessible from surface?- - ❑ 0 ❑
I—
a. Alarm or Control Panel Installed? - - ❑ 0 CI
2 Control Panel equipped with Timer/ ETM /Counter- - 0 ❑ ❑
n
a Pump installed in 0 Bucket or ❑ On Block or ❑ Other
2 Pump Make/Model GRINDER ElFloats or ❑ Transducer
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
Updated 2129/20'6
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 320291300340
RECORD DRAWING
• Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
O Trench/bed
dimensions and
critical distances
within layout
Q✓ Septic/pump tank
Location w/dimen-
sions for re-location
• Location of buildings
existing/proposed
2 Observation ports,
clean-out locations,
&manifolds/d-boxes
❑✓ Location of wells,
surface water, roads,
&waterlines.
• Reserve area(s)
O North Arrow
If needed drawing may be attached on a separate page No. Pages Attached 1
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 obtaine. rough common locating practices.
12/30/25
Signature of Design-r 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.
N''f\,{1 1Z /77 o)zc
Signature of Environmental Health pecialist 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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