HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 6/28/2026 AFTER THE FACT RECORD DRAWING, pg t MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name { V\ -t \ Assessor Parcel# t3^3 a -t "1 WL?t
Mailing Address OIM Spedaist Name
City.state,Zip Ny ds� �3 Gi gS tS Installer Name
SaeAddress `-t0 tJ (-YY. f ¼n \\ W` Designer Name
Please complete this checklist to the best ofyour knowledge. If items are unknown leave blank
INSTALLATION CHECKLIST
System Type 'rC'V Pretreatment Type V\
Ln.Ft. OO Drainfidd Sq-Ft- Drainfield depth 3I cl l
>5ftfrom foundation? -_________________________- ❑WA f3ns ❑ NO
>50Rfrom wells? -------- -------------t ❑ ui ❑
_ >50 R from surface wateR -___ - �141R 4" tR ❑ [ ❑
F CleanaR between baiting and talc?- T�+ r e>i -- I��I{ ❑ ❑
Tank battles present?---- -----------IIAtl�i I Itii�l
52YG-' ❑ 6 ❑
W EMuentusri inssovd?----argrarimar d*.,- -----I, ❑ ' ❑
W ENNhant fdter'ens[aAed?-_________, _______1 fit_-lv 0 ❑
septictalcsee (ltih gal BY Uv�k-_owvl
o D-bok war leveland speedlevekrs used? --------------- ❑ NIA DYES NO
DOLL MangdSD-box acces*le from surface?--- - ❑ 0 ❑
--------
6Z Checkk installed? ------------- — ---------- ❑ ❑ ❑
Transport tine S¢e Schedle/Class
Bedroorns installed(I known) ❑2 ❑3 O4 ❑5 ❑6 ❑Commerciavo(her
>10A.fromkwndation?-________________________- ❑ WA ❑m NO
p >100ft.fromwells?-___________________________- ❑ ❑ ❑
W >100Rfromsurtacewater?-_______-- _-__. ❑ ❑ ❑
rL 510 ff.from potable water lines?----------- - -----. ❑ ❑ ❑
Qz >5ft.from property lines and easemernts?---------------- ❑ 0 0
>30 fL from do wgradhent curtauffoundation drains?---------- 0 ❑ O
Obseivarpn pods present? ------- ❑ ❑ ❑
❑ Graveless dranbew or 0 Clean gravel used? (check one)
Propercover instatedoverdrainfield?___________________ ❑ ❑ ❑
Puny tank setbadcsoaaiatan(with septic talc?------------- ❑ au DYES 0 N
Pump tank s¢e eat Manufacturer
Z
F 24"access riser(s)arM accessbla from sunface?--------- 0__. ❑ ❑
a Alann or Control Panel Instaled?----------- .qj - 0 ❑ ❑
Control Panel equpped with Teter/ETM I Counter-__ _!-,_ _- ❑ ❑ ❑
- Pump instaled n ❑ Budcel or ❑ On Block or ❑ Other
IL Pump MakelModel ❑Floats or ❑Transducer
Talc draw down inhnin Pump capacity gpm Squirt Height ft
Puny on hnte Punpofttine Daily fow sat of and
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AFTER THE FACT RECORD DRAWING,pg 2 Assessor Palcel S `1 ZZ 1 N Z `'% ��(� I
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