HomeMy WebLinkAboutAFTER THE FACT UPDATED 4-1-2026 - SWG As-Built - 4/1/2026 { \ Qp -1 / ' J2
I ' O2
AFTER THE FACT RECORD DRAWING, p9 9 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name U � ���'+� • blo Q- Assessor Parcel#
Mailing Address 5( Prr-e-IJem O!M Specialist Narne
City, State,Zip L)N 14N� / Installer Name
Site-Address !� 1i1" Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type- �`'' � � Pretreatment Type �/
1 r Drainfeld S Ft. Drainfield depth 1-Z
Drainfield Ln. Ft. 2f 4
>6 ft.from foundation? - - - ----- - /1124257 - --------- SNIA YES [j NO
>50 ft.from wells? - -- - -- --- - -- - - -- - - - --- --- - - -- ❑ ❑
>50 ft.from surface water? - ---- ------- --- ---- -- - -- ❑ ❑
Cleanout between building and tank? ---- -------- -- - - -- - ❑
Tank baffles present? - - -- --- - - -- - --- - - - ----- - - - - ❑ ❑
243 access risers over each compartment?---------- --- -- ❑ ❑
W Efftuentfilterinstalled?- - - -- -- ---- - ------ - - - -- -- - -
0) ❑ ❑
tt ,J®
Septic tank size � gal Manufacturer FE? ! (_A"'
to D-box water level and speed levelers used? NiA ❑YES ❑ NO
p9ManifoldlD-box accessible from surface? \V"--------- - -------_-_ _ - - ❑ ❑
LIZ Check valves installed? -- ----- - `-�� - -- -- -- / ❑ ❑
®�t d [7N/rGda��l
Transport Line Size - Schedule/Class
Bedrooms installed (if known) 2 3 ❑4 ❑5 ❑6 ❑CommercialiOther
>10 ft.from foundation?------- - -- - -- - WA ❑ YES [] NO
>100 ft. from wells?----- - --- ---- - - ---------- - - - - ❑ .lI ❑
J >100 ft.from surface water? - - - -- --- - - -- -- - ------ - - - ❑ ❑
ii >10 ft.from potable water lines? ------ ------- ---- - - -- 0 ❑
2 >5 ft. from property lines and easements?- -- - - - - - -- - -- --- ❑ ❑
>30 ft. from downgradient curtainlfoundation drains?- - -- - - - - - - -9 ❑ ❑
0 Observation ports present? --- ---- -- - - - - - 0 ❑
O Graveless chambers or , Clean gravel used? (check one)
Proper cover installed over drainfield?---- -- -- - ------ - --- ❑ ❑
Pump tank setbacks consistent with septic tank? -- --------- - - NUA ❑ YES ❑ No
YPump tank size Mal Manufacturer 24"access riser(s)and accessible from surface?-- ---- - -- --- - ❑ ❑ ❑
t— ----- -- -- - - -- - ❑ ❑ ❑
� Alarm or Control Panel Installed? -- --- - -M Control Panel equipped with Timer!ETM I Counter - - --- - - - - - ❑ ❑ ❑
- Pump installed in ❑ Bucket or ❑
On Block or ❑ Other
E' Pump Make/Model ❑Floats or ❑Transducer
Tank draw down inlmin Pump capacity gpm Squirt Height
a" Daily flow set at^ Mpd
Pump on time Pump off time
upeatatl?113Ro16
Printed From Mason County OMS
Printed from Mason County DMS
c- CIA//
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#3 Z"-'a'
RECORD DRAWING
Q Draindc d&inagifotd
orientation&layout
re-I.widimnsIensfor p �l
ocatlbn.bn.
[] rrenc)itbed
dimensions and
• crliI al distances
within layout r�• 0 Septic/pump tank G
Location wldimen- C)
sions for re-location
o Location of buildings
existingiproposed
0 observation ports,
clean-out locations,
&manifold id-boxes
Q Location of welts,
surface water,roads,
&waterlines.
Reserve area(s) 1
0. North Arrow
,n DYE \ Z_ rtc ' --S
n loc
s6- Z
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION.OF INSTALLATION
DESIGNER/APPROVED OlM SPECIALIST
.1 certify that the information contained in this document is accurate to my knowledge. The drawing and information
has been obi ' d through common locating practices.
ii/ /&i
Signature of I rieieMpproved.0/M,Specialist Date
MASON COUNTY PUBLIC HEALTH
This is an.after the fact record:dtaw kig, which may or may not include a county inspection. This information is to only
document an existing OSS location and components. U � —1 Ii
if
Signature of Environmental H alth Specialist Date
THIS.FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upda'td=0016
Printed From Mason County DMS
Printed from Mason County DMS
LL1 HJ I HJ . L
.i__--! _ - - ---- - -- -- -- - { � I __..�
LLLJ 1.F i
-i -
TT
ti : 1 TII► IIINLI II1bE fi
f i I
i'tr :!.
I 4I4I1III IZ 1I
IL I
Hi± HIrHIh
LtILItW �' - I - -
L ± LJ
! i I i it 1 . L _ .__ .-_I , 1 __
!I I -
- J .LIJJLH$ H ±± tLL
J .J_LLJ_ _L L. L. LL ; t iH--H H- HI- -
Hi:Hitp: :±ii HT ::H L HEHEI
H P HTHJILJ[I II rIHIJIlIb 1111 1] I1ILLI
I : II1I bH
DAMFOR SEPTIC R PA1 ,L C
: � 30i�.E� AL�:A. lS1�EELl�N�LVD Ii
'•-- _ -�_f._ _. ___i_-_) _ .___1___ ____;.__— _ __ __-•_-- _ -� _—� ___ _ l SH �TbN,i I I 1 I
P'"nted fr rn 111@�son ounyDf4S1j ( I I I I ! !
Hare*ird septic Repa®r,LSC
301 E. Wallace Kneeland Blvd STE#224-332 13607902364
Shelton, WA 98584
PROPERTY INFORMATION
Location:290 E 5TH ST
Union
Tax ID:322325051041
riot is Patrick N&Linda S Dubos
51 E ARELLEM RD Use:
UNION,WA
98593 GENERAL SYSTEM TYPE:Conventional (Non-Pressurized)
ON ID:322325051041
County Area: Lower Hood Canal Watershed
rite
fete na'C
llva
Inspected:09/23/2021 - Inspection Type:PROPERTY SALE Correction Status:No corrections needed
Company: Work Performed By. Submitted 10/05/2021 by:
Bamford septic Repair.LLC Thaddeus Bamford Thaddeus Bamford
COMMENTS&GENERAL INSPECTION NOTES
No Deficiencies Noted
Used camera and locator to locate drain field lines. Used mini excavator to verify lamer leg. Approximate 200 of drainfield
GENERAL SITE&SYSTEM CONDITIONS
The General Site and System Conditions Were: Fully Inspected
Components accessible for service, YES
All required service performed(if no-specify omitted inspection items in notes): YES
Surfacing effluent from any component(including mound seepage): NO
Components appear to be watertight-no visual leaks: YES
Improper encroachment(strucwreslimpervious surfaces) ^_ N NI riser lids securely fastened upon departure: YES Electrical repairs needed. If YcS describe in comments: _N/A
Root intr Sion on any components. If YES describe in comments: NO
Settling problems observed. It YES describe In comments: NO
The hcuse/slructure was vacant or used Infrequently,assessment of the drainfield was not possible. YES
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
This component was: Fvtly laspocted
Pending prbsent7 If YES explain in comments: NO
Drainfleld wasvacuumed,flushed or hydro-jetted?(If YES,explain in comments) NO
Did the drainfield pass a hydraLdic test?(NA.If not completed) N/A
Partially Inspected
This component was:
Effluent level within operational limits(if NO explain in comments): YES
All required baffles in place(N/A=No baffles required): YES
Compartment I Scum accumulation(Inches,if other specify):
Compartment 1 Sludge accumulation(Inches,if other specify): NO
Pumping recommended:
ri o atos CCoat,,P:alaer,ie:s ra The OnSda Sew'n(jn s-sio n at!n,,tom o or ViiJ,to nn Hay a list lost t a guasvmtce a1 optaba:l or ruiWS pnl(atmetice
Prin a rtl : 0�� R � n �- -ou ' Rio rep at�n+tv.on(inerme.com Pa(fe 1 of
Printed from Mason County DIAS