HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built +• r
AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name N4 t . M Shalt, S 6k4rk Assessor Parcel# /Z$ oo
Mailing Address / �s• O/M Specialist Name
City,State,Zip /`� Wfe I-ler/r'er ii ' nstailer Name rio9 G7I ad
Site Address 2 !1 A) F c /t.Jl r Designer Name
Please complete this checklist to the best of your knowledge. Ifitems are unknown leave blank.
INSTALLATION CHECKLIST
System Type_ f is I s Pretreatment Type
Drainfield Ln.Ft. /U /..2 Drainfi Drainfleld depth Y9- fay 'A0d , s� 1
>5 ft.from foundation? --=--- --- - NIA .YES ❑ Na
>50 ft.from wells? -- mac. ❑
>60ft.from surface water? ------- __i. . a 1--
Cleanout between building and tank? - •- -.--- ---. ❑
V Tank baffles present? ------------By--- ❑
W24"access risers over each compartment ❑ ❑
Effluent.fiiterInstalled?.----------------- ------ ❑ ❑ ❑
Septic tank size ISO1r gat Manufacturer ty.a./
0 D-box water level and speed levelers used? --------------- .❑NIA ❑YES 0 NO
a00 Manifold/D-box accessible from surface?----------------- ❑ ❑
Check valves installed? --------- ---------------- ❑ ❑
Transport Line Size . " Schedule/Class . c4€earl 1O
Bedrooms installed if known) 3( ❑2 ❑ 04 ❑b ❑6 Commercial/Other
>10 ft.from foundation?-------------------------- 0 N/A EYES 0 NO
>100ft.fromwells?----------------------------- 0 ❑
W >100 ft.from surface water?------------------------ ❑ ❑
ti >10 ft.from potable waterlines?------------- ----- --- ❑ ❑
>5 ft.from property lines and easements?---------------- 0 ❑
>30 ft.from downgradient curtain/foundation drains?------- - ------- - -- ❑ ❑
Observation ports present? ------------ --- ❑ ❑
❑ Graveless chambers or Z) Clean gravel used? (check one)
Proper cover installed over drainfield?------ ------------- ❑ ❑
Pump tank setbacks consistent with septic tank?------------- 0 NIA ;8 YES ❑ NO
hd Pump lank size 1O Ot? gal Manufacturer 1"c
R24"access riser(s)and accessible from surface?------------- ❑ ❑
Q, Alarm or Control Panel Installed? ------------------ --- ❑ ❑
Control Panel equipped with Timer/ETM I Counter----------- ❑ 0
C. Pump installed in ❑ Bucket or 0 On Stock or ❑ Other
, Pump.Make/Model , Floats or 0 Transducer
a. Tank draw°down ______ in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
2n0/z616
1 �p l
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AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING.
❑ Dralnttetd&manifold
odentatlon•&layout
w/dlmenslons for
re-location.
❑ Trenctubed
dfrnenslons and
critical distances
within layout
❑ Septiclpump lank
Locationw/dlmen-
slons for redocallon
❑ Location of buildings
existing
/proposed
O Observation ports,
clean-out locations,
&manifolds/d•boxes
•❑ Location ofwefls;
surface water,roads,
&waterlines.
❑ Reserve area(s)
❑. North Arrow
If needed drawing may be attached on a separate page No,
Pages Attached
I _ _
CERTIFICATION OF INSTALLA
DESIGNER/APPROVEb.O,M SPECIALIST
l certify that the information contained in this document is accurate to & dV he drawing and Information
has been talned through co mon locating practices.
Signature of Deslg erorApproved OIM-Specialist` Date
p� C+'rnv L WAITE .,
MASON COUNTY PUBLIC HEALTH , ..� « _
This is an after the fact record drawing, which may 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 UpdIod2nsrzole
Y I
211 NE Sand i-ffil Rd,S` N.i WA 98528,USA,Belfair-Tahuy Township, Parcel Id: 123304400000
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211 NE Sand Hill Rd, Beifair,WA 98528, USA, Belfair-Tahuyajownship,, Parcel Id: 123304400000
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2 Storage units
3.� 1500 gallon septic tank
4 ;1000 allon pump tank
5 ;Transport line
6 Valve box
7 P Primary drainfield
8 Proposed reserve drainfield
9 Waterline i -
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