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HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 6/1/2026 AFTER THE FACT RECORD DRAWING, pg 1[ MASON COUNTY PUBLIC HEALTH PARCEL If©I {CTI I ATIOT+1 , Owner Name Assessor Parcel# __J 6 G °kc Mailing Address \ O/M Specialist Name City, State, Zip Installer Name Site Address Designer Name Please complete this checklist to the best of your knowledge. If items are unknown leave blank. System Type Pretreatment Type Drainfield Ln. Ft. �� Drainfield Sq. Ft. Drainfield depth • >5 ft.from foundation? ----- --- - - ❑ NIA YES ❑ NO •'>50ft.fromwells? -- --- ---- -- --- ------- ❑ ❑ • >50 ft.from surface water? - - - - - -- - ��t- i; 76- - ❑ ❑ �' �l ? ; Cleanout between building and tank? - ------ - -- -- ❑❑ Tank baffles present? - -- - - - - - - ---—_=-. - ❑ `� ❑ • 24"access risers over each compartment ---- -- - ❑ ❑ LtsEffluentfilterinstalled?-- - - ----- - ------ - - -------- •- ❑ ❑ Septic tank size gal Manufacturer ______ _ • D-box water level and speed levelers used? --- ----------- - NIA ❑YES ❑ NO o Manifold/D-box accessible from surface?--- ------ ------- - ❑ ❑ Check valves installed? - -- --- ❑ ❑ I \\ - - - - - - - - - - - - -- - - - Transport Line Size \\ Schedule/Class Bedrooms installed (if known) ❑ 2 t4 3 ❑4 ❑5 ❑6 ❑Commercial/Other • >10ft.fromfoundation?--- - - - - - - -- --- -- -- - - - - - - -- ❑ NIA YES ❑ NO >100ft.fromwells? - ---------- ----- -- -------- -- ❑ ❑ >100 ft.from surface water? ---- ---------- -- ----- -- - >10ft.frompotablewaterlines?- -- ------- ----- ----- - - ❑ ❑ >Sit.fromproperty Vines anti easements?- - ----- - - - - - - - - ❑ ❑ • :;->30 ft.from downgradient curtain/foundation drains? - - - - -- - - - O ❑ • Observation ports present? -- --- -- -- - --- ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Propercoverinstalledoverdrainfield?---- --------- - -- - -- ❑ ❑ ti .Pump tank setbacks consistant with septic tank?------------ - ❑ N/A YES ❑ NO Pump tank size gal Manufacturer ___rC 24"access riser(s)and accessible from surface?--- ---- - - ---- O O • Alarm or Control Panel Installed? --------- -- ----- ----•- ❑ ❑ Control Panel equipped with Timer I ETM I Counter- -- - - - - - - - -2 ❑ ❑ 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 2/29/2016 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# �°l` ,'� .l ' f 7: Sk 1$ 1.,,` �.. yft k:Y '� .(fi• f +R*i.. i.. t" 5 S ❑ Drainfield&manifold orientation&layout w/dimensions for re-location. ❑ Trenchibed dimensions and critical distances G within layout ❑ Septic/pump tank \3'Cc ('\1i� Location w/dimen- sions for re location • 4 ❑ Location of buildings tir : ��r existing/proposed ❑ clean-out locations, � � '-" — �` &manifo►dsld-boxes \ ' Y .. .. " y O`er ❑ Location of wells, f '4 surface water,roads, &waterlines. ❑ Reserve area(s) ❑ North Arrow g 5100214 , . O Dale L.Tahja ,ter LICENSED DESIGNER a dCd if needed drawing may be attached on a separate page No.Pages Attached DESIGNER/APPROVED O/M SPECIALIST I certify that the information contained in this document is accurate to my knowledge. The drawing and information s been obtain thro common locating practices. Signature of Designer or Approved 0 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 l � Y L ' N 0 0 o:1 O �•y J�,�„ � f,... ��,//' - ��'��.w,...,,,,�,,,,� � X11 V1`� '�.� 3 S El