HomeMy WebLinkAboutAFTER THE FACT RECORD DRAWING - SWG As-Built - 4/26/2026 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name .ice l S�1osl� �+ .art�i Assessor Parcel# /2..9 3� -��F� ÔO
Mailing Address P&. a 7— O/M Specialist Name
City,State, Zip 0° ' - / l4 fl
%'nstaller Name _ no�-/ kx��,d a
Site Address -2 1/ A) E . I,// Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type e�'rs'er'u Di Pretreatment Type
Drainfield Ln. Ft. O (62 Drainfi - Drainfield depth / - ,
>5 ft.from foundation? --------_ _ N/A j.YES ❑ NO
>50ft.fromwells? ----- --------' ---H
--- ------- _ ❑
>50 ft.from surface water? ------- _.APR 2 7 2QLp_- u ❑
Cleanout between building and tank? -- --- . ❑
v Tank baffles present? - ------ . _ -_- ❑
24"access risers over each compartment?------------------- ❑ JJ ❑
l Effluent filter installed?-- ________ - ❑ ❑ ❑
Septic tank size /SO'o gal Manufacturer ry ..#-
D-box water level and speed levelers used? --------------- NIA ❑YES ❑ NO
�O Manifold/D-box accessible from surface?--- ----------- - -- ❑ ❑
G� Check valves installed? --------------- --------- -. ❑ ❑
2 Transport Line Size " Schedule/Class £o
Bedrooms Installed(if known) ❑2 []3 ❑4 ❑5 ❑6 RConlmerciallQther
>10ft.fromfoundation?----------- --------------. ❑ N/A YES ❑ No
>100 ft.from wells?------------ -- ------------ --- ❑ ❑
>100 ft. from surface water?- -- -- -- - ---------------_ ❑ ❑
Z >10 ft.from potable waterlines?----- - -------------- -. ❑ ❑
>5 ft.from property lines and easements?- ---- ---- ------_ ❑ g ❑
>30 ft.from downgradient curtain/foundation drains?------ - -- - f1 ❑ ❑
Observation ports present? ❑ ❑
❑ Graveless chambers or J Clean gravel used? (check one)
Proper cover installed over drainfield?------------------- ❑ 91 ❑
Pump tank setbacks consistent with septic tank?--------- ---_ ❑ N/A YES ❑ NO
Pump tank size /O e'oe gal Manufacturer
24"access riser(s)and accessible from surface?----------- - - ❑ ❑
Alarm or Control Panel Installed? -- -- ------ --- ---- - - ❑ ❑
Control Panel equipped with Timer/ETM/Counter------- ---- ❑ ❑
ti Pump installed in ❑ Bucket or Z On Block or ❑ Other
Pump Make/Model . Floats or ❑Transducer
d Tank draw down in/min Pump capacity apm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 2/29/2016
"4V t S f/ �iJ raj
i i
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
wldimensions for
re-location.
❑ Trenchibad
dimensions and
critical distances
within layout
❑ Septic/pump tank
Location w/dimen-
sions for re-location
❑ Location of buildings
existing/proposed
❑ Observation ports,
clean-out locations,
&manifolds/d-boxes
❑ Location of wells,
surface water,roads, _;,
&waterlines. J
❑ Reserve area(s)
❑ North Arrow
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION OF INSTALLA
DESIGNER/APPROVED O/M SPECIALIST
/certify that the information contained in this document is accurate to OçWjd he drawing and information
has been,obtained through corpmon locating practices.
Signature of Desig er orApproved O/M Specialist Date ' 5' a
per CI,I�Y L WAITE .,
MASON COUNTY PUBLIC HEALTH .. ; ____
This is an after the fact record drawing, which may or may not include a county irec isp tion. 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 Updaled 21292018'
211 NE Sand I-till Rd,,Pelfai�[,WA 98528, USA, Belfair-Tahuya Township, Parcel Id: 1233044Q0000
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GIS Legend
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??!1G p 211 NE Sand Hill Rd, Belfair,WA 98528, USA, Belfair-Tahuya ownship, Parcel Id: 123304400000
.. _ 1 Office
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�� 2 Storage units
3 1500 gallon septic tank
/1 4 1000 allon pump tank
fl 5 Transport line
6 IVa1ve box !
7 Primary drainfield I _
8 Proposed reserve drainfield
9 lWaterline
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