HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 4/15/2025 HEALTH
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Mason County OSS Installation Report pg. 2 Parcel# 32o�j{',rA��Y�^
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- --- --- - -- -- -- ❑ YES NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? -- - -- - -- ❑ YES ❑ NO
RECORD DRAWING
This is a perm cant recurs am mu.he aauraM1 antl peacnptive enough to re-lecahe In the mod of melnbnance enWltlaa end fatun development. Typical ReweO
Dam ingscoma n. Dnanfaid amanllolo orlentation&layaul,SepliGpump lane location,xoftranow remarce dramfield,existing and pmpoass bUMirpa.bGliW o/walla.aatannals.
welb.obamationpoN daanouU and omermainbnance acmes pdnb. Inwmidela RBCIXd D2wMp maycnaleaddltioneit
l delays lnriMlillSWlatlw epprmal antl rNekdgmmh.
Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
P 4b5) ?57
Signet Installer Date
i NA
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
L4 li�zs
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated ernnme
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lamAord septic Repa/ieLLC
301E. Wallace Kneeland Blvd STER224-332 13607902364
Shelton, WA 96584
PROPERTYINFORMATION
Location:110 SE PICADILLY DR
SHELTON
Tax ID:320345000006
MERISHAEATON
110 SE PICADILLY DR Use:Residential,Single Family
SHELTON,WA
98584 GENERAL SYSTEM TYPE:Conventional(Non-Pnessurtred)
ON ID:320345000006
County Area:Oakland Bay MRA
Foa . . Xm
N.re
Inspected:WIW2025 - Inspection Type:ROUTINE- Correction Status:No correetlons needed
Company: Work Performed By. Submided 04FI520256y'
Bamford septic Repair LLC Thaddeus Bamford Thaddeus Bamford
COMMENTS 8 GENERAL INSPECTION NOTES
No Deflclencies Noted
Ran water to system for 20 minutes while using dames to locate drain field.No dl unad problems.
GENERAL SITE&SYSTEM CONDITIONS
The General Site and System Conditions were: Fully Inspected!
Com oenbaccessibleforservice'. YES
All required service pellormedl itno-somly omitted Inspection items in notes: YES
Sul etkent hum any com,,onent(including mound seeiPal NO
Comoonentsap rtobeweterti ht-noviaalleaks: YES
Impro rencmeUmeM stmQureslimpemous audepas NO
Al near lids seaumly fastened upon departure: YES
Elecbicalrepaimneeded 11YESdescnbeincomments: NO
In componentsappeartobein h siceltondaion'. YES
Root intrusion on any oom nenta. N YES describe in comments: NO
Setting blems observed If YES tleacnbe in consents: NO
The houselsbuotum was vacant or used inh ueMly,a®easmenl of tM1a tlreinfieH was cot Nbte. NO
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
Thlscam nant was'. FuN lnye�tl
Effluent level mthinc tonal llmit6 lifNO ex lain In comments: YES
All re uired belles'm lace WA=No belles uired: YES
con, artmsnt 1 Scum eaumuledl IncM1d,Ho1M1er
Com adment 1 Slutl a aaumulMion InMes,A otM1era J'.
Ful in moommentl N: NO
This component was: NM1mgCbU
D-So%In ocd condition'.
D-Box outlets set to allow a ual MOuant ismo Won:
This winnent Wes: FUIty InspMeE
Com OnentB aRlO betunconintenendad YES
Pondin resent2lf YES sin in comments: NO
Dminfield was vecuumed flusM1el orhdro-etted2PYES leinin cpmm.ts NO
ix repM lMoleswnaln clrenMnNu aunt ontihmwepayYsniMM tlme W wal A m•aYbau+npN.BwrtnMdin Mon Pa°•'^ate.
ReporeD:1393333 Wee inspection reports online at www.onlinetme.com Page 1 of