HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 5/29/2026 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION ) '
Owner Name �5 I'a.�,- `4 ( `"l
i 4s Assessor Parcel # ZQ 5
Mailing Address Zt Cl - (�C�'O O t�ict�t� Z)�• O/M Specialist Name I��"��Q ' , ►` '
City, State, Zip 2� Utz � �$ Installer Name
Site Address fo & M 'J€ Designer Name __
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type ( f'(b. J l _ — Pretreatment Type
l} , �f
Drainfield Ln. Ft. t"'f0 Drainfield Sq. Ft. Z� Drainfield depth ZEE
>5 ft. from foundation? - - - - - 9}£{ ❑ NIA YES ❑ No
- - - - - F+r
---- --- ---- - ❑ ❑
>50ft. fromwells?
>50ft. from surface water? - - - - - -3 j -MAY 4- -ll &- - -- [1b1 [1Z i :1
Cleanout between building and tank? =-- - - -- --- --- -- - ❑
Tank baffles present? - - -- - - El ❑
24"access risers over each compartment?---= =-- - --------- - - - - ._2
W Effluent filter installed?- - - - - - - - - - - -- -- -- ------ - - -- ❑
U, Septic tank size 0 gal Manufacturer
0 D-box water level and speed levelers used? - - - - - - - - - - - - - - - NIA ❑ YES ❑ NO
00 Manifold/D-box accessible from surface? - - - - - - - - - - - - - - - (� ❑ ❑
C9 Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - -- - - ❑ ❑
ft
E Transport Line Size Schedule/Class
Bedrooms installed (if known) ❑ 2 ❑3 04 ❑ 5 ❑6 ❑Commercial/Other, .se�
>10ft. fromfoundation? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NIA OYES ❑ NO
>100ft. fromwells? - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - El ❑
W >100ft. fromsurfacewater? - - - - - - - - - - - - - - -- - - - - - - - - - El ❑
M >I0 ft. from potable water lines?- - - - - - - -- - - - - - - - - - - - - - - ❑ ❑
QZ > 5 ft. from property linesand easements?- - - - - - - - - - - - - - - - El f4 ❑
> 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - (� ❑ El
Observation ports present? ❑ ❑
❑ Graveless chambers or ( .Glean gravel used? (check one)
Proper cover installed over drainfield? - - - - - - - -- -- - - - - - - - El ❑
Pump tank setbacks consistant with septic tank?- - - - - - - - - - - - - ❑ YES ❑ NO
Pump tank size gal Manufacturer
Z
24" access riser(s) and accessible from surface?- - - - - - - - - - - - - ❑ ❑ El
Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - - - - El ❑ ❑
Control Panel equipped with Timer/ ETM I Counter- - - - - - - - - - - ❑ ❑ ❑
O- Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
a' Pump Make/Model El Floats or El Transducer
as Tank draw down _inlmin Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 2/2912616
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#LA2.-0)i Z-— 55 OOO\7
RECORD DRAWING
Drainfiekf&manifold
orientation&layout
wtdimensions for
re-location, __ '
Trenchtbed --.__.�..
'" R �
1"" dimensions and
critical distances e t 'y ,
within layout \t
Septicipump tank / '
Location wldimen- �� f
sions for re-location 1p
Location of buildings °
existing/proposed � Q3
Jrl ,
Observation ports, t
clean-out locations,
&manifoldsld-boxes
JLfJ
Location of wells,
surface water,roads, ;6-.( +�
&waterlines.
Reserve areas}
F C North Arrow •
Loci rd ol
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
t certify that the information contained in this document is accurate to my knowledge. The drawing and information
has been obtained ro r oEramvtt±orating practices.
urrof Designer or Approved DIM 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 222o1s