HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/14/2026 r
AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL.IDENTIFICATION
Owner Name 1`Z,p\ 5e A&1rk 2( 'k\ Assessor Parcel# L42 0 g"' S—OO0 tO
Mailing Address ZIliMD U Specialist Name
City, State, Zip Qp 6o,, Q. Q$' Installer Name
Site Address t oS "� -e. Designer Name SG.Mei . N C,&lc
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
tt INSTALLATION CHECKLIST
System Type ,"COJ/J Tl. Pretreatment Type
Drainfield Ln. Ft. 50 Drainfield Sq. Ft. I :O Drainfield depth I Z 3&
>5 ft. from foundation? -. ------ -� I -- ❑ WA YES ❑ NO
>50ft. fromwells? --- ------- ❑ i' ❑
Z , >50 ft.from surface water? ----- --APR Z-20 -- - - ❑ kr ❑
H. Cleanout between building and tank? - ------------ -- ❑ ❑
O1 Tank baffles present? -- --- -- - ❑ ❑
Fr 24"access risers over each compart ---- ----- ® ❑ ❑
-W Effluent filter installed?-- - -- --------- - ------- - ---_ �' ❑ ❑
Septic tank size 7S0 gal Manufacturer C'mcpfke
D-box water level and speed levelers used? --- - -- - -------- f 'NIA ❑YES ❑ NO
Manifold/D-box accessible from surface?- --- ------- ------ [� ❑ ❑
-M- Check valves installed? -- -- -- -- -- - - - --- ----- - --- ❑ ❑
-
N Transport Line Size Schedule/Class
Bedrooms installed (if know I or'2 " ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10ft.fromfoundation?-- - - -- -- - - ---- - --- ---- -- -- ❑ NIA DYES [g NO
0 , >100ft. fromwells?---- ----------- -- - ----------- ❑ ❑
J- >100ft. fromsurfacewater? ----- - - - - - - - ---------- - - ❑ ❑
LL-- >10ft.frompotablewaterlines?----------- - - --------- ❑ [g ❑
Z > 5 ft.from property lines and easements?-- - - - ------- -- -- ❑ ❑
> 30 ft. from downgradient curtain/foundation drains?---- -- ---- - ❑ ❑
Observation ports present?
❑ Graveless chambers or X• gravel used? (check one)
Proper cover installed overdrainfield?--- --- ------------- ❑ ❑
Pump tank setbacks consistant with septic tank?---- --------- NIA ❑ YES ❑ NO
Pump tank size gal Manufacturer
a . 24"access riser(s)and accessible from surface?---- --------- ❑ ❑ ❑
.a Alarm or Control Panel Installed? - - ---- - ----- -- ---- --- ❑ ❑ ❑
Control Panel equipped with Timer/ETM/'Counter- --- - ------ ❑ ❑ ❑
• f? ' Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
Pump Make/Model ❑ Floats or ❑ Transducer
Tank draw down in/min Pump capacity gpm Squirt Height ft
- Pump on time Pump off time Daily flow set at gpd
Updated 2/2912016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#Li z l ' t 3TOX!Dt0
RECORD DRAWING
Drainfield&manifold -
orientation&layout
A
w/dimensions for I t �,I
re-location. �0 ,(C�' /1•
Trench/bed �91�
dimensions and
critical distances
within layout oOl
Septic/pump tank t
Location w/dimen- ¢� 1 ®`
lions for re-location
1 �
Location of buildings l $; 30
existing/proposed
❑ Observation ports, r o
clean-out locations, —,
&manifolds/d-boxes
Location of wells, 3�D
surface water,roads,
&waterlines.
Reserve area(s) 4w'.(
N,G'ta �a� l ,.� `
North Arrow J U.
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION�0F 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.obtainedju errfocating practices.
ature 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.
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated 2129)2016