HomeMy WebLinkAboutSWG2026-00088-ASBUILT - SWG As-Built - 6/15/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 26 Parcel # z �v— j m2r-z
Applicant Name 71 1i Subdivision (Name/Div/Block/Lot)
Applicant Address �/ Sr 14 "&ifo L_
City. State, Zip j1k `1a t A ��8 `/ Installer Name LLL
Site Address ! � Ii 1�- KI "-&- Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation Tank(s)Only ❑ Drainfield Only Repair ❑ Other
System Type GgA1rr Pretreatment Type Ai Fl
>5ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - -- ❑ N/A YES 0 N
>50ft. from : : e ;;
ll ? - - - - - -
>50 ft. from - - - - - - 4 L-1 rl( ll.Wi1*� ❑ ❑
Z Cleancut between building and tank? -
+� i - ❑ ❑
Tank baffles present? - - - - - - - - - -JUN-t22Q26__ V ❑ ❑
d24" access risers over each compartm nt?-- - - - - - - ❑ ❑
W Effluent filter installed?- - - - - - - - -J -- -- - _._- ❑ ❑
Septic tank capacity (working) /Z gal Manufacturer J1,'IU '.a'ly: /,4.1-
D-box
water level and speed levelers used? - - - - - - - - - - - - - - - ❑ N/A YES ❑ NO
oO Manifold/D-box accessible from surface?- - - - - - - - - - - - - - - - - ❑
mz Check valves installed? - - - - - - - - - - - - - - - - - - - - - - - - - - ❑ ❑
0Q
E Transport Line Size Tit Schedule/Class -"`__
Bedrooms installed (check one) ❑ 2 ❑ 3 4 4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation? - - - - - - - - - - - - - - - - - - - - - - - - - ❑ NO
N/A- YES- - - - - - - - - - - - - - - - - - - - - - - - - - - -- °
� - 1U0 ft. from wells.? ❑ ❑
W >100 ft. from surface water? - - - - - - - - - - - - - - - - - - - - - - -- ❑ ❑
u- >10fl. frompotablewaterlines?- - - - - - - - - - - - - - - - -- - - - -- ❑ ❑
Z > 5 It. from property lines arid easements?- - - - - - - - - - - - - - - - ❑ L+i1, ❑
W > 30 ft. from downgradient curtain/foundation drains? - - - - - - - - - - ❑ ❑
D
Drainfield level and observation ports present - - - - - - - - - - - - - - ❑ ❑
❑ Graveless chambers or g Clean gravel used? (check one)
Proper cover installed over drainfield? - - - - - - - - - - - - - - - - -- ❑ ( ❑
Pump tank setbacks consistent with septic tank? - - - - - - - - - - - -- NIA ❑ YES ❑ NO
ZPump tank capacity (flood) gal Manufacturer`
Z 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
n- Pump Make/Model ❑ Floats or ❑ Transducer
ri
CL Tank draw down in/min Pump capacity gpm Squirt Height ft
a
Pump on time Pump off time - Daily flow set at qpd
tJp:.11ed ii 11/[17171
;:Mason County OSS trstahatio!i Report pig. 2 32o - OOI. C3
ABANDONMENT RECORD
Were existing septic oornpor.ents abanconeo as r, cr pro - f Ne
iT yes, please aescnice: ark �
Were al components pumpec cut anc property acandcr,ed per WAC 2?o-2'2A-C3CG? ----- - - - 'YES No
RECORD DRAWING
:his is a pormanent record anc must be accstate anc descr,ptiva anougn to re-iocato in the need of:nair.tenancc activities and future development. Tyr.cai Reco,-e
a:•/�s:a^tarn: Draiaf.e o&"cn.,a:e:Arta^:a::cn d la :.Sep arx Iocat.on..crh arrow,r9se'!e cra nd exis:Iry^artl rrop3se0 D:.ildings,Kcal;on of wes,waterlines•
.. is.o,servation pegs,clear.o s.anc.^.''P access w3'::5 :nxrnpiete Record Drawings may create accitcna ce�ays in 5nal installation approval and related pera s.
ON t •• / 1
f;
- f
Record Drawing 1.1:tached J
CERTI:iCATtON OF INSTAL? NON -
------- ----- - - - -
i INSTALLER DES-GNERi 'NIGINEER
r, the cco r r that has •� n
1.,l;rtify that 1 installed system fr, a....vrdan.;0 r91.r. i Cr.1F%ry .2.+78 system been insta%,ed in a..cor-
t� the septic design stamped APPROVED"ny Mason r•:,. ce with the septic design stamped'•APPRO•✓ED"by
County Public Health and:het any deviations shown M,•asoa Cow7.),Publlic Health and that any deviations
here have oeen Clearedlapprovad by both tlhc desg.:ar ( ::r:oi�r:mare taia been ciearad/approved by .GtfL►
and Mason County Public Health and mee: i Sec ,rysa.r=n;t p.ason Cc'umy Pudic Heaitr, and meet all ..
and Mason County Codes. Stare 6;rd r-.fsson C:.inty Codes
I further certify that 8: r ^`!'r antairc on:' -n3r::gr'i't that aIi information contained or, this
form and attach Re�c:r i rawir•g is acc:.rtte. .dim and a racnec Record Drawing is accurate-
:5127 iZ ,
Signa'Jre of Installs'
Printed Name of Sionee yaQ'
T!e undersigned cep pro 'e=this r�ta•'IgtrC.' '.rJv't arty' rpm 51 0 7$ t�<`''
Recd-d Drawing on bera'T o!"!.' P'i3ilr NDY E WAITE
LICE'4•SED DE,5IGNER
C��� c5 ,iS 10• S
re O'cn lirc.aasnf-' pe ie is .a gnature and dare)
THIS FcRi,t MAY BE SCANNED AC A.V'r: A3.E X'DR P'02-; :!c:W.Ol HE'..\SO COL TY WEB SITE exams 8?t:�,e
171 SE Vic King Rd, Shelton, WA 98584, USA, Shelton Township, Parcel Id: 320304300200
I UistriUClti "I Menlo
BENCH MARK f J
Foundation 1 100.00 LN`a C` �� 1 Residence -
Septic tank -- -- -----�
pt 2 98.00_ i � V (lu J aec. 2 Lined small ardflcal pond
®-box 3 97 3 Lined artificial pond
ottoma of drainfleld• 4 96.00 �i 5 4 4 1200 Septic tank
j 5 Clean out
_ 6 Transport !
/ 7 primary drainfield
/ 8 Reserve drainfield _ — --
N W1 9 Decommission existing septic tank
N = s Z 10 Failed drainfield
O
L! s W 11 Well
12 Water;ome
i2 - \ 13 D-box
A _
ell 1
L la ��
GI S Legend
Buffers
Parcel Lines Buffer 5 ft
WA Mason 10 it. Contours
L__. Scale => 1 in . 30 ft"" �' N
MASON COUNTY
Public Health & Human Services
FINAL INSPECTION:
SWG2026-00088
ADDRESS: 191 SE Vic King Rd
PARCEL: 32030-43-00200
DATE: 5/26/2026
:.�Ls�;�M�'►�.�".`'vl+�r�`�`u�`
HOUSE TO DRAINFIELD
DRAINFIELD TO HOUSE
Rhonda Thompson
From:
Sent: DO NOT REPLY <
noreply@ masoncountywa.gov>
To: Tuesday, May 26, 2026 6:22 AM
Subject: Environmentalhealth
OSS Inspection request for Matt Bradley-swg202600088
Submittal request for: Matt Bradley
Site Address: 191 SE Vic King Rd. Shelton, WA 98584
Permit Number: swg202600088
Parcel Number: 32030-43-00200
Installer Name: Bamford Septic
Installer Phone Number: 3607902364
Installer Email Address: bamfordseptic@yahoo.com
Designer Name: cindy Waite
Designer Email Address: cindyewaite@msn.com
Inspection Request Date: 2026-05-26
Inspection Type: Full System
Comment\ Notes:
Thank you for submitting your final install request.The install should be complete and ready to inspect on the 'Inspecti(
Request Date and remain uncovered for three business days to allow staff time to inspect. Poor weather situations ma,
be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engineer installation
approval prior to backfill of system components. If no contact is made by the health department within the three
business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Installation fee
be submitted for final installation approval.
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