HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/12/2026 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name Assessor Parcel # 2 22I O 5
Mailing Address ; :° "` O/M Specialist Name i4s —
City, State, Zip r . r _,Ate ► ?Ilnstaller Name
Site Address Sr43c Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type, . Pressure Pretreatment Type
Drainfield Ln. Ft.,S ..' L*. FT- Drainfield Sq .Ft. O ` Drainfield depth.
>5 ft.from foundation? - ❑ N/A []'Yes ❑ NO
>50ft.fromwells? - - - - - - - - -- - __ - :. ---- ❑ ��/ ❑
>50ft.fromsurfacewater? --- --- ---- - - - ❑ L''J
El
Cleanout between building and tank? - - - - ❑ ❑
V Tank baffles present? --. --- -- - -- --.__ _ . _ - - _ - ❑
24" access risers over each compartment?.-, ❑ ❑
W Effluent filter installed? -- - - - ❑ ❑
Septic tank size, gal Manufacturer
G. D-box water level and eed levelers used? - - - - - - - - - - N/A ❑ €S ❑ NO
DO Manifold/D-box accessible from surface?-- --.-..------------- -- ❑/ ❑
mZ Check valves installed? - ❑ ❑
Transport Line Size `lii Schedule/Class
Bedrooms installed (if known) ❑ 2 ®3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation? -
N/A ES NO
>100 ft.from wells? �_ _ ,
J >1:00 ft.from surface water? -.— - ❑ LEI ❑
u. >10 ft.from potable water lines? -
Z > 5 ft.from property lines and easements? ❑ [r ❑
> 30 ft.from downgradient curtain/foundation drains? - - - - - - - - - ❑ ❑ ❑
Observation ports present? ❑ ❑
Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - - - - - - - - - - - - - - - - -- ❑ ❑
Pump tank setbacks consistant with septic tank?- - - - ---- ❑ N/A E 'YES ❑ NO
Pump tank size al Manufacturer
Z
< 24"access riser(s)and ccessible from surface?-'--------------- ❑ ❑
Alarm or Control Panel Installed?
Control Panel equipped with Timer/ETM /Counter- - - - - - - - - - -
Pump installed in ❑ Bucket or ❑ On Block or d Other
Pump Make/Model 1 »`tO Floats or ❑ Transducer
a . Tank draw down • ` _ in/min Pump capacity „gpm Squirt Height. ..ft
Pump on time, Pump off time urn .
Daily flow set at gpd
Updated 2/29/2016
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
wldimensions for
re-location. ac4a
" te(
❑ Trench/bed Vl�""
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.
❑ Reserve area(s)
❑ North Arrow
If needed drawing may be attached on a separate page No. Pages Attached.
CERTIFICATION OF INSTALLATION
. ...... ..
DESIGNEI / PRUNED I.M.SPECIAL
l ce the info atron :ortta rted n:fhis do ament is accurate to my knowledge. The drawing and information
as be 0jta1n throng c mmort o r ettees
t
Sig attire of Designer or Approved O/M'S elo isf 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 0SS location and components.
6/3/26
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
This is the 3bd drainfield for
5220 NE Northshore Rd
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