HomeMy WebLinkAboutSWG2026-00208-ASBUILT - SWG As-Built - 8/18/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number swG 2026-00208 Parcel# 12233-50-00029
Applicant Name RICHARD/LAURA ROBBERS Subdivision (Name/Div/Block/Lot)
Applicant Address 5540 E STATE ROUTE 302
City, State, Zip BELFAIR, WA. 98528 Installer Name SCHOENING EXCAVATION
Site Address 5540 E STATE'ROUTE 302 Designer Name CINDY WAITE
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only Q. rainfield Only ❑Repair ❑Other
System Type OSCAR COILr Pretreatment Type X02
>5 ft.from foundation? ---------------------------- ❑NIA Nl,,1r yES NO
>50 ft.from wells? -- ---- -____ (� ❑ LS ❑
ZY >50 ft.from surface wateR -- --___ P 'd-r,
Cleanout between building and tank? • ❑ ' ❑
a Tank baffles present? - -- ---------- _' _f �nr i ❑ ,.-J ❑
a24"access risers over each compartme ?--- - - - ❑ g ❑
fW Effluent filter installed?------____� - _ , ❑ ❑
Septic tank capacity(working) /2.71 Oal Manufacturer tA1 tr.{OY 1250
o D-box water level and speed levelers used? - - - - - - - - - - -- -- - - -- 0 YES ❑ NO
C0 Manifold/D-box accessible from surface?- - - - - --- --- ----- - 0 Ef W - ❑
NCheck valves installed? -_ ________.- ❑ ❑
r
2 Transport Line Size I Schedule/Class SL644
Bedrooms installed (check one) 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commerciauother
>70ft.from foundation?- - __ _ __ _ ___ _ _ _ ___________-- ❑ WA DYES [T'NO
0 >100 ft.from wells?- __________________ _________- ❑ ❑
W >100 ft.from surface water? -_______________________ ❑ ❑
M >10ft.from potable water lines?-_________ ___________- ❑ ❑
>5 ft.from property lines and easements?- -_ _ ___________ - ❑ 91 0
>30 ft.from downgradient curtain/foundation drains?---------- ❑ 0
Drainfield level and observation ports present -- ----------- ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (Aleck one)
Proper cover installed over drainfield?----- ------------- - ❑ p� ❑
Pump tank setbacks consistent with septic tank?------------- ❑ WWA .'Es ❑ NO
ZPump tank capacity(flood) t Mt'D gal Manufacturer r VZ5d
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 CJ Other XCQ ust daevlk vçJve.
Pump Make/Model Floats or ❑ Transducer
Tank draw down in/min Pump capacity opm Squirt Height ft
Pump on time 1? SCG Pump off time 1r.Y .Cc., . Daily flow set at pd
UraadW2,aO,a�
Vein tat s)X J 4'..414) Put- ,CO2 P*ds R e&Mr crmr.*
i
Mason County OSS Installation Report pg. 2 Parcel# 12233-50-00029
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? -- - - - - - -- - - -- - - yEg ❑ NO
If yes, please describe; . i,1
Were all components pumped out and properly abandoned per gWAC246-272A- 00? YES ❑ NO
RECORD DRAWING
This Is a wrmanam record and must b•scums and descriptive enough to re-hoot.In the need of maintenance sdgltlea and Nmre development Typical Record
Draumgs contain: oromneld&manifold orientation&layout.septk/pump any lotion,North Dance,reserve d2meehl ewsung and proposed ecadmgq Iocadoo or well.,waterlines,
wells,observation prx4.deanouls and other maintenance access polnle. Incomplete R.c d Drawings may create addltlonel delays in final Installllon approval and related permits.
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ ENGINEER
1 certify that I installed the system in accordance with /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.
Sig�of Installer Date
p Lo
Prrntetl Name of Signee J
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and ! if 2
Record Drawing on behalf of Mason County Public
Health:
Ltfc Wi'%t 6
Signs ure of Environme tai Health Specialist Date (stamp,signature and date)
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updated e2V201e
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To:
Subject
Subnritt;l rr,tu.'st tor: Robbers Richard L& Laura A'I-
Site -Lidress: 5540 E State Route 302
r'errnit Number: SWG2026-00208
Parcel Number: 122335000029
Installer Name: Schoening Excavating / "' ; r
Jr 4
Installer Phone Number: 3607422982 nr
< gR'f8
Installer Email Address: brayden@schoeningex.com
Designer Name: Cindy Waite
Designer Email Address: cindyewaite@msn.com
Inspection Request Date: 2026-08-12
Inspection Type: Full System
Comment \ Notes: Repair. X02 tanks & drainfield. Tanks partially backfilled due to grou
Thank you for submitting your final install request. The install should be complete and re
Request Date' and remain uncovered for three business days to allow staff time to inspect. Poor weather
be accommodated by contacting onsite staff. Installer is responsible for obtaining Septic Designer/Engine
approval prior to backfill of system components. If no contact is made by the health department within t
business days of notice, the installer may cover. Mason County Asbuilt Form, Record Drawing, and Install .
• itted for final installation approval.
jthMASON COUNTY
Public Health & Human Services
FINAL INSPECTION:
SWG2026-00208
ADDRESS: 5540 E State Route 302
PARCEL: 122335000029
DATE: 8/12/2026
..rill ` ".
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HOUSE TO DRAINFIELD
DRAINFIELD TO HOUSE