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Home My WebLink AboutSWG2025-00353 - SWG As-Built - 5/27/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2025-00353 Parcel# 22133-50-00019 Applicant Name Joeseph Mott Subdivision (Name/Div/Block/Lot) Applicant Address 250 E. Osprey Lane City, State, Zip Shelton,Wa 98584 Installer Name Schoenning Excavation LLC Site Address Z SQ L Designer Name Bob Paysse INSTALLATION CHECKLIST ❑ Full System Installation ❑■ Tank(s)Only ❑ Drainfield Only ❑Repair ❑Other System Type Pretreatment Type >5 ft.from foundation? ---------- ❑ N/A ❑■ YES ❑ NO >50ft.fromwells? -------- --- Z >50ft.fromsurfacewater? ------- -------- -- ❑ 0 ❑ Cleanout between building and tank? R�02-6_ ❑ 0 ❑ o Tank baffles present? -- -------- ---- --- ----- ❑ ❑■ ❑ 24"access risers over each ❑ ❑ N Effluent filter installed?---- ------ --- ---------- ❑ ❑■ ❑ Septic tank capacity(working) 1500 gal Manufacturer Haggerman D-box water level and speed levelers used? -- ------------- % N/A ❑YES ❑ NO BOLL Manifold/D-box accessible from surface? ---- ------------ ❑■ ❑ ❑ CQCheck valves installed? ------ ----- --------------- ❑■ ❑ ❑ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?----------- - -------------- ❑■ N/A DYES ❑ NO in >100ft.fromwells?----------------------------- ❑■ ❑ ❑ W >100ft.fromsurfacewater?------------------------ R ❑ ❑ Z >10ft.frompotablewaterlines?---------------------- ❑■ ❑ ❑ >5ft.frompropertylinesandeasements?---------------- ❑■ ❑ ❑ >30 ft.from downgradient curtain/foundation drains?----- - ---- ❑■ ❑ ❑ 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?------------- ❑ N/A ❑E YES ❑ NO Pump tank capacity(flood) 1500 gal Manufacturer Haggerman Q24"access riser(s)and accessible from surface?------------- ❑ ■❑ ❑ dAlarm or Control Panel Installed? --------------------- ❑ UI ❑ D Control Panel equipped with Timer/ETM/Counter--- - - -- ---- ❑ ❑ i- Pump installed in ❑■ Bucket or ❑ On Block or ❑ Other Pump Make/Model Liberty FL 100 ❑■ Floats or ❑Transducer Tank draw down 2 in/min Pump capacity 60 gpm Squirt Height 24"+ ft Pump on time 1.25 min Pump off time 4 hrs Daily flow set at 480 gpd Updated 8/21/2018 I Mason County OSS Installation Report pg. 2 Parcel# 22133-50-00019 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 permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. Record Drawing Attached CERTIFICATION OFINSTALLATION 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 tached Record Drawing is accurate. form and attached Record Drawing is accurate. 5/8/26 Sig ature of Installer Date Brayden Schoenning 4=. Printed Name of Signee MASON COUNTY PUBLIC HEALTH ` •. The undersigned approves this Installation ' .Jd 1 5100917 Record Drawing on behalf of Mason County Public a°,. RoaeRt H w,vssE I I Hea EXPIRES .>� 27170 Z ��So 20?6 ignature of Environmental Health Specialist D W'YF'Ikq , (stamp,signature and date) THIS FORM MAY BE SCANNED AND AVAILABL 4OR PU r'1N THE MASON COUNTY WEB SITE Updated 8/21/2018 1 e � DISCONNECT EXi5TING TANKS AN D RELOCATE SOUTH OF HOME. EXTEND 4"3034 SEWER LINE&2"SCH.d0 TRANSPORT LINE DOWN BACK OF HOME&RECONNECT. INSTALL CLEANOUT BETWEEN TANK&HOME. KEEP TANKS&LINES 50'+FROM PRIVATE WELL& 100'+ FROM COMMUNITY WELL. ii �• ' f 1 - .'' r / `' rid •> � < ° 1 i,f 'EXISTING \ 1 p. �� F. PRAINFI E+LP p j 1 Ill - �, v `r -- f � I \yl I 4e k, COMMUNITY WELL -I. COMMUNITY a EXISTING I I 11� I WELL I +' " 1 Ap, l EW 10.M`E "lAY PROPOSED i �v`,e-5 t- o /�e�` 2 ? 2026 TANKS . e--0 0 10 SEP 162025 ,��; RCCE611 h FAY'ssa IASCN COUNT T E iROh4!Et TAL HEALTH RET AN ASBUILTI INSTALL SIGNOFF FEE WILL BE CHARGED AT TIME OF INSTALLATION C.LL'T� JOSEPH MO T 7'l l�?LG I: PIONEER.DING, INC P:'NRC x:3213330-00019 1�17R rs&750 E:OSPR�EY LANEt- �,rm SrP .IC IDES S r; __ y� ��. g s, ,v a .,�[� ��' MAU OREA. &Y'lf'ATg1Wi'hl''96KRH1LF3IlpJ$)C.APAIWN1fAilNiTM CRCNO� fli ¢'.3liiL�r 4A! \ FN'C1\ RDU'�`GRtA.PE 1EW 1►:A92i5 -1D �1{u'l`J.'1Zt+KbBEKT IiPAYSSE wcisoRsm:v'rs.F.Fie�r.FasuaF xTaafoe rrvcY ossicrmrcnnaFonaane gcaarses erav vfarasry nen�oFt+�n� ptv ae wsrtcT to TMT0 Z'Ff1{lE C1 C17 3 ta5{°�!` ,3 iS127 3 3[}t{�Qr}� DEIGN PAGE PLAN 5—\l.f 1:50 �o�aec a nsAacY+a.: cA oTREsaassraeFotsE7ek,su uiFnTO