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Home My WebLink AboutSWG2026-00065 - SWG As-Built - 4/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2o 2k' '" OOO 4' Parcel# Applicant Name I'-ô,. F1O1 Subdivision (Name/Div/Block/Lot) Applicant Address 17 70�/ C -�Di>} j •a0 �, ' 3'(' City, State, Zip 'J �t� /` 7WA- %,jcl Installer Name 1i42 ) X 1fljD'1tc Site'Address 5'/ G i/'1 /V7 1/t L1 Designer Name INSTALLATION CHECKLIST ❑ Full System\installation XTank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type /4 "GO - - Pretreatment Type >5 ft.from foundation? - - - - - - - - - - - - L ft ❑ N/A ES ❑ NO >50ft.fromwells? - - - - - - - - - - - - - Z >50ft, fromsurfacewater? - - - - - - - - - - - - > 6- - ❑ ❑ ff Cleanout between building and tank? -By- - - - - - - - - - - ❑ ❑ V Tank baffles present? - - - - - - - - - - - - - - - - - - - ❑ ❑ 24" access risers over each compartment?- - - - -- - - - - - - - -- ❑ ❑ W Effluent filter installed?--- - - - - - - -- - - -- - - --- - - - - --- - - ❑ ❑ Septic tank capacity(working) /i _gal Manufacturer � �� ® D-box water level and speed levelers used? - - - - - - - - - - - • ❑ N/A ❑ YES ❑ No ®® Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - •- - ❑ ❑ ❑ � Check valves installed? - - ❑ ❑ 2 Transport Line Size 2- Schedule/Class 4642 Bedrooms installed (check one) ❑ 2 3 ❑4 [] 5 ❑-S n Commercial/Other >10ft. fromfoundation?- - - - - - - - - - - - - -- - - - - - - - - -- - -. I-`J ;•?!A EYES ❑ NO >100ft.fromwells?- -- - - - - -- -- - - - - - - - - - - - - - - - - - - (�; ❑ >1006. from surface water? - - - - - - - - - - - - - - - - -- - - - - - -- - LI ❑ 1a. >10ft.frompotab!ewaterlines?- - - - - - - - - - - - - - - - - - - - -- El > 5 ft. from property lines and easements?- - - - - - - - - - -- - - -- - - i-1 ❑ d° > 30 ft. from downgradient curtain/foundation drains? - -- - - - - - - - l ❑ Drainfield level and observation ports present - - - - - - - .. - _ _ . ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - - - -- - - - - - - -- -- [] ., ❑ Pump tank setbacks consistent with septic tank? - -- - - - -- -- - —i❑ NIA J1 YES ❑ NO Pump tank capacity(flood) )2. 7 gal ~ C/ Ai /,'I- '0v 24"access riser(s)and accessible from surface?- ------------- - - -- - - - ❑ ❑ Alarm or Control Panel Installed? - - - - - - - - - - - - - - - - - - -- - - ❑ ❑ Control Panel equipped with Timer/ ETM/Counter- - - - - - - - - -- ❑ ❑ Pump installed in ❑ Bucket or 'On Block or ❑ Other Pump Make/Model w/{��' +1 .f' ✓ 7-- Floats or ❑ Transducer Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time D' ' 0 Re Daily flow set at gpd updated af2u2o;s Mason County OSS Installafaon•Report•pcg.-2•- Parcel# 3Z' / - Y' ' o� ABANDONMENT RECORD Were existing septic components a andoned as part of this project? - - - - - - - - - -- - - -- YES NO If yes, please desce: �'ii2' 1.� Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - -- YES [] NO RECORD DRAWING This Is a permanent record and must be accurate and cescri,five enough to re-locate In the need of maintenance.activltios end future development. Typical Record Drawings contaiti: Drainfield&manifold orientation&layout,Sep!,;,.snp tunic locaton.North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,ciednouts,and other maintonarice access p mrs. Incompcete Record Drawin.�c may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFQCAT ON Op 9�'� r.TS�d�.L TIO'N' _ __._...._.�___.___....__—.._--�...�.�.... i ob•..^...V; ..�.o..� - .. INSTALLER ;)ESI NER N> It Ei_ti I certify that/installed the system in accordance with c : :;c£t;hc system has been installed in y J � accor- the septic design stamped 'APPROVED"by Mason s:u:;:s 'ri:i iii septic design stamped APPROVED"by County Public Health and that any deviations shown ivias%in Cocrzy Public Health and that any deviations here have been cleared/approved by both the designer shown hers'have been cleared/approved by both and Mason County Public Health and meet all State r, ?f and r'/r;z'sn^ County Public Health and meet all and Mason County Codes. taste and Mason County Codes 1 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. Signature of Installer r r Dare _-- 14 Printed Name of Signee MASON COUNTY PUBLIC KEA!:!1-i The undersigned appro',?es this ii tstailatiarr R-pc,i cad Record Drawing on behalf of Mason County Pubic Health: Signature of Environmental HeaIui SxD5 iatist Data (stamp, signature and date) THIS FORM MAY CE SCANNEDAND/ "AILA.Bl-E FOR PUBl.IC>VIEW ON THE MASON COUNTY WEB SITE Updated 812112018 y,,�(�� .q 2:.4:• .ix,�.'::h:. .;m 2S::<'.�2: •`1�:3;;i.,riiS>S; �'Y•iay�?^:.::J�'r .'w �: 1:t`V`.. y ..,zH>...:i�D'%Ya .,t, ..3. u�,`.?'fti�A�:\.'Y �'�::�,i �..oM��,t•>2A:...W �� ' +��,, x+ro�,�:.•' : ri Y�:5 .�,::Ycb�. .l'yj'.�y�,. \). y;^ ''\�+•,'..% rE3L�!LT; IRI4WlNG:. ,.. `�:...:�, ..; M .R ??} .,`"G.3Isgf•;3.. yv;>-.•.,,��.Lt -+ ,: •,>•R ., '� sR. ^" •i.�n.•..`z � �'sx:�t�;:mac;n<`��y �3,h a .�� a. •kJ'v g ,.// 7.:�c£s23asa�� .�szZex' >•� 'r:.t. a. u 0 D:ainfield&manifold orientation &layout ' / . ! O €rertch/bed dimensions i and critical distances / • / / within layoutfj SeptuJpump tank I / • nviacement. - • 0 Location of buildings. I O Observation port&clean- —� "` g out location. . O Location of wells& roads. e L+`" " O Undisturbed native soil a • v between trenches. - 1 c North arrow ,� tJC 1 ". 1 ¢ v 4/ 1 y .�cc Gin r;A,rR i i CAUTION:Minor adjustments to septic talk location and drainficld orientation made in the field by the instrJler are generally acceptable to both the department and the designer,but could in certain cases compromise the viability of the system. 1l is the installer's responsibility to obtain prior wnttci approval from either the health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the proved design must be shown above. . L T Installer Check a box from Row"A"and"B",sign and date the certification. A. O 1 certify that I installed the system without any O 1 certify that all deviations from the desi istamped deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown abe e. MCDHS B. 0 1 certify that I contacted the designer and left the U 1 did not contact the designer prior 14 fatal cover because the system open for inspection up to 48 hrs prior to designer waived the notification requirement. cover. I further certify that all information cont ained on this form is accurate. I understand that if the information ccn!edherein is not accurate,there will be just cause for immediate suspension of my installer certification. I ) 205 Siatur of la11ep ,/ • Iau The undersigned approves this installation on behalf of Mason County DrthJntOfHe31tiCC5. fl - . owe anttartan Bamford septic Repalr,LLG 301 E. Wallace Kneeland Blvd STE#224-332 13607902364 Shelton, WA 98584 PROPERTY INFORMATION Location:51 E VINE MAPLE LN Union Tax ID:321045600002 r.imno CLYDE W&CHRISTINE MORI 51 VINE MAPLE LN Use: UNION,WA 98592 - GENERAL SYSTEM TYPE:Aerobic(Singulair) ON ID:321045600002 County Area: Case Inlet Fold Fold Here here Inspected:03/31/2026 - Inspection Type:PROPERTY SALE - Correction Status:No corrections needed Company: Work Performed By: Submitted 04/01/2026 by: Bamford septic Repair,LLC Thaddeus Bamford Thaddeus Bamford COMMENTS&GENERAL INSPECTION NOTES No Deficiencies Noted Pump Tank replacement complete. No observed problems. r� System requires yearly maintenance and service. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: _ ! Fully Inspected Components accessible for service: YES All required service performed(if no-specify omitted inspection items In notes): -- YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(structures/impervious surfaces) NO All riser lids securely fastened upon departure: YES Electrical repairs needed. If YES describe in comments: NO If a reserve area is designated on the property,is it undisturbed?(select N/A only if no reserve has been YES designated) Inspected components appear to be In good physical condition: — YES Root intrusion on any components. If YES describe in comments: NO Settling problems observed. If YES describe in comments: NO The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO The system is operating as designed based on existing records,such as record drawing,previous reports YES or other documents?(NA if no existing records) ONSITE SEWAGE SYSTEM INSPECTION DETAIL Manufacturer:Norweco Model:Singulair 960.500 - This component was: -Fully Inspected Service-Pro Control panel functioning as Intended(if not currently operating,cycle unit with"On!Off YES switch for verification): Aerobic Mechanism a ears to be functionin er manufacturers s ecifications: YES Aerator air delive working pro erl : YES Stainless steel as irator shaft and as irator ti cleaned: YES Cleaned perimeter air vent within air vent cover. YES Removed,deaned the Bio-Kenetic system: YES Aerobic chamber settleable solids test greater than 75%(If Yes,then pumping needed): NO Pumping needed: NO Manufacturer•InfiltratorSystems,Inc.Model:IM-1060 This com onent was: Fully Inspected Com artment 1 Scum accumulation Inches,if other s eci : Compartment 1 Slud a accumulation Inches,if other specify): Pum in recommended: NO ReportlD:1509382 View inspection reports online at www.onlinerm6.com Page 1 of 2 This component was: Fully Inspected Lateral lines flushed: YES Average squirt height(if performed)(feet,if other specify): Not tested Pondinq resent?If YES explain in comments: NO This component was: Fully Inspected Alarm mechanism functioning as intended: YES This component was: Fully Inspected Controls functioning: YES Tested allons er minute flow: Not tested Manufacturer:SJE Rhombus Model;Tank Alert XT This component was: Fully Inspected Alarm mechanism functioning as Intended: YES This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportiD:1509382 View inspection reports online at www.onlinerme.com Page 2 of 2