HomeMy WebLinkAboutAFTER THE FACT RECORD DRAWING - SWG As-Built 'C C9 P to Qt0ct. d'CAW/riy
CX/' S/# i, rye'/Y..,.
AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name BOBBI/JERRY LOUDON Assessor Parcel 4 22017-50-00036
Mailing Address 7754 SE MONTE BELLA PL O/M Specialist Name
City, State, Zip PORT ORCHARD, WA. 98366 Installer Name
Site Address 581 E LAKESHORE DR E Designer Name
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type GRAVITY Pretreatment Type
Drainfield Ln. Ft. 80 Drainfield Sq. Ft.24O Drainfield depth *)ot- k&8 A.0
>5 ft. from foundation? - -- - - - - - - - - ❑ NIA ®YES ❑ NO
>50 ft. from wells? - - _ _ _ _ _ _ _ __ �;liS��-� 't}�� - ❑ ® ❑
z . >50 ft.from surfacewater? - - - - - - 11+- - - - -- ---- -Lb ❑ ® ❑
Cleanout between building and tank? -/4i -- ? -- ❑ ® ❑
U Tank baffles present? - - - - - - - - -L - - - -- -- - -- -- - - - ❑ ❑ ❑
24"access risers over each compad e1ø_- ;._.-< -1-�;-. - - - ❑ ❑ El
s�'C
W EPouent filter installedl- -- - - --- - - - - -`--_ -=—�- - ❑ ❑
to 1000 NOT KNOWN
Septic tank size gal Manufacturer
0 D-box water level and speed levelers used? - -- - - -- - --- - - - - j N/A ❑YES ❑ NO
�O Manifold/D-box accessible from surface?- - - -- - - - - - - - - - - - - - ❑ ❑
en= Check valves installed? - - - - - -- - - - - - - -- - -- - - -- - - - - ❑ ❑
❑Q
f Transport Line Size 4" Schedule/Class NOT KNOWN
Bedrooms installed(if known) ®2 ❑3 Li ❑5 ❑6 ❑Commercial/Other
>10ft.from foundation?-- ---- --- - - - -- - - - - - -- - - - - ❑ wA ®YES NO
>100 ft. from wells?- - - - -- -- --- - - -- - - ❑ ® ❑
W >100 ft. from surface water? -- - - - -- - - - -- - - - - - - -- - - - - ❑ ® ❑
I >10 ft.from potable water lines? -- - - - - - - - - - - - - - -- - - -- ❑ ® ❑
QZ > 5 ft. from property lines and easements?- ❑ ® ❑
>30 ft.from downgradient curtain/foundation drains? - - -- - - - - - - ® ❑ ❑
Observation ports present? ❑ ❑
❑ Graveless chambers or ® Clean gravel used? (check one)
Proper cover installed over drainfteld?-- - -- ---- - - - -- - - - -- ❑ ® ❑
Pump tank setbacks consistant with septic tank?-------- - - -- - ❑ N/A YES ® NO
Pump tank size gal Manufacturer
Q24 access riser(s) and accessible from surface?- ❑ ❑ ❑
F
ll Alarm or Control Panel Installed? -- - - - - - - - -- - -- - - - - - - - ❑ ❑ ❑
Control Panel equipped with Timer!ETM/Counter - ❑ ❑ ❑
Pump installed in ❑ Bucket or ❑ On Block or ❑ Other
ll Pump Make/Model ❑ Floats or ❑Transducer
Tank draw down in/min Pump capacity gpm Squirt Height ft
a
Pump on time Pump off time Daily flow set at gpd
Ilpdtled]119IM19
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel#
RECORD DRAWING
121 Drainfield&manifold
orientation&layout
w/dimensions for
re-Iocation.
Trench/bed
dimensions and
critical distances
within layout
�(J Septic/pump tank
Location.1d,..e-
aces for re location L exo tiro/Moposied Bs P4dpo J / rrU bM! lrar♦ UN fi f1e d'}. f l'YYIC "b
/L� Observation ports, Q« j Jt0.s✓r"j
dean-outlocalions, VVIW
&manitolds/d-boxes
r 1Locatlon of wells, Co M m.41 11 W5
sunace water,roads.
&waterlines.
[]/ servo area(s)
North Arrow
If needed drawing may be attached on a separate page No. Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER!APPROVED O/M SPECIALIST
I certify that the information contained in this document is accurate to my knowledge. The drawing and information
has beeA o' blained t rough common locating practices.
/( _ � n / 7( I3/ 2a21
Signature of esignerorApproved O/M Specialist Dale
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which mayor 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 uoda.d Wec.a a.��
J
LoT 4 =r a0
c,NmE wn
L�GENSED�S'SiGNEN
I Proposed residence
l\ I 2 1000 gallon septic tank
3 Transport line
Primary
drainfield(installed
4 1971 w/ permit and
record drawing on
.l - file)
kl _ _ _ 5 Reserve drainfield
6 Waterline
I 1
I a�
I '7"
20 ' ���
io
C > m
d O r
A i D
C A Z
i a O N
O
z
O �T m
9 m
ca C
r 3i y A
m Z O
Q O ry r
'3 y
QO 33^- N
3 E "
Omq 3y
3my33�4
5�.oy—ya�ag�
d age
�Ha
�3n
O tl
•a Z� m .., •�. 9 .>
0 0 m
n
� w �
m O m O P Q W N N
O
c' o D 1 4 Co 0
U 0 Q
CD C i o
Q '
} O D
O r rt D
o
CD