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Home My WebLink AboutSWG2024-00064 - SWG As-Built - 10/2/2026 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/PERMIT INFORMATION Permit Number SWG 2024-00064 Parcel# 32021-56-02003 Applicant Name Andres Francisco Juan Subdivision (Name/Div/Block/Lot) Applicant Address 31 E Sea Breeze Dr SHORECREST TERRACE 3RD ADD BLK:2 LOT: 3 City, State, Zip Grapeview,WA 98546 Installer Name South Shore Construction Site Address 461 E Panorama Dr, Shelton Designer Name Arrow Septic Designs INSTALLATION CHECKLIST Q Full System Installation ❑Tank(s)Only- L Drainfield Only ❑Repair El Other System Type OSCAk XO2 - Pretreatment Type XO2 >5 ft.from foundation? -- ------/- - - - - - --- - ❑N/A ® YES NO >50 ft.from wells? --- - -- - - -- t1' - f) -- 'Ifll ❑ W El z >50 ft.from surface water? - - -- - - ----- 1926-- ❑ ❑ Cleanout between building and tank Bjr------ - - - ❑ Ii ❑ Tank baffles present? -- - ----- --- — - - -- ❑ ® El 1- 24"access risers over each compartment?--- - -- - -- ❑ EJ ❑ rw Effluent filter installed?-- ----- ----- --- ------------ ❑ ❑ Septic tank capacity(working) 1060 pal Manufacturer Infiltrator C D-box water level and speed levelers used? - -------------- ❑ Nu DYES NO 0OManifold/D-box accessible from surface?----- - ---- - - -- - -- ❑ ❑ mz Check valves installed? - - - - - - - - ---- -- --- - -- - - - --- ❑ ❑ ❑fi 04 Transport Line Size 1 inch Schedule/Class 40 Bedrooms installed(check one) ❑ 2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?-- - - - - - - - ❑ NIA EYES No >100 ft.from wells?---- ---- -------- - ------------ ❑ ® El ly >100ft. fromsurfacewater?- ---- --- ----------- ----- ❑ 8 El LL >10ft.from potable water lines?- - ----- ---- ---------- - ❑ 0 ❑ Z > 5ft.from property fines and easements?---- - ---------- - ❑ 0 ❑ £ > 30 ft.from tlowngradientcurtain/foundation tlreins?----- - -- - - ❑ El Drainfield level and observation ports present ❑ 5 ❑ El_c_ __-_ _t-_.--- -- r-1 Clean -_..-, us-.n ( h_-,__t e) Proper cover installed over drainfield?---- - ----- -- ------ - ❑ ® ❑ Pump tank setbacks consistent with septic tank?- - ❑ NIA Q YES ❑ NO Pump tank capacity(flood) 1.060 pal Manufacturer Infiltrator s4•......riser(s)and.......1.Iron,.,.race? ❑ MI ❑ Alarm or Control Panel Installed? - - -- -------- - - - ---- -- ❑ Ii ❑ Control Panel equipped with Timer/ETM/Counter-- - -- ---- -- ❑ (] ❑ Pump installed in ❑ Bucket or ❑ On Block or ® Other on bottom of tank Pump Make/Model AYMcDonald E-30ppm, 1/2hp. 115v Ili Floats or ❑ Transducer Tank draw down — in/min Pump capacity 6.2 gpm Squirt Height — ft Pump on time 30 sec Pump off time 3 min Daily flow set at 360 gpd VWaW MllN,e Mason County OSS Installation Report pg. 2 parcel a 3202 -5(p- fj200 3 . ABANDONMENT RECORD Were existing septic components,abandoned as part of this project? --------------. ❑ YES NO If yes,please describe: were all components pumped out and property abandoned per WAC246272A-03009-------- ❑ ❑ NO RECORD DRAWING >r r• 1 .ak,.wd aM rue t..ccmm and a.,atWn cocoon m meuee m ne n.ed a maNrwra aaMwa®d xmo.a...rea.a. 1,cl Irma piwNgamivue olfl d 6 mr*ad oWJ.a a l.y ..$[fa >Yak Y£atm. kth fl.2M M%WC dCUY61}.Ioc1 fl E�4.aYlbw. re.meawCm Yam.de 'oa W rimer mamrvo caeca Gar Irmnprb wad tre mak they aura.NIEurl Slay'n5rnrorYtlm appwa W ieMed Drab. Record Drawing Attached _ ç; .: ...: .CERTIFICATION,OF INSTALLATION ..G5:' INSTALLER DESIGNER/ENGINEER I car*that I installed the system in accordance with )certify that the system has been installed in scoor- 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 deared/approved by both the designer shown here have been deared/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 Cocos i furthercettiy that all information contained on this I fudhercertify that all information contained on mis ft n atta ed Re cawing is a curate. form and attached Record Drawing is accurate. QQ�y26 Signature oflnstal(er Date Printed Name of Signee . MASON COUNTY PUBLIC HEALTH The undersigned approves tins Installation Renoir and '+,. .r RBLVrd Drawing on Denafr Or Mason county Pubic `PAULA JOY JOHNSON Health: NEYt.. W�Vn la12(ZG a-z4_zir Signature ofEnvironnrental eaten Specialist Date (stamp.signature and date) THIS FORM MAY 6E SCANNED AND AVAILABLE FOR PUBLIC vrEW ON THE MASON CO)4tY WEa SRE unem emena yet &CtAt t Y\ groan- D i5 � 5 PPPct p21o26 NEALZ '', p5�R� QR,MR�y I MENZP� oAHiNftE�� ' ..s-� .. MPS0NC0NNrENy�E�N � � ' i 05LPK `FiFiD�'P t � . P pc O «o-vm�; i= @ CSCfi.R XOa You.'O-'P=te= T O Rirkrz 43 F °AN pit klj SCA , Q W PPoSED uAJSK 53.55 i; e 0 2e 30 alp it -- __AS ll ll '' t__ BoLL-r Pmtat3202�,-% 02003 1!J ttl .,. PAUV.JOY JOP.NSON 'I,IINvJJ DO NOT REPLY <noreply@masoncountywa.gov> Wednesday, August 12,2026 10:30 AM Environmentalhealth Subject: OSS Inspection request for J&E CAPITAL -SWG2024.00064 Submittal request for:J&E CAPITAL �.e N 44 Site Addres ANOs: PANORAMbA R Permit Number: SWG2024-00064 Parcel Number: 32021-56-02003 Installer Name: RICHARD MOORE 1221 Installer Phone Number:360-509-1342 Installer Email Address:southshorebelfair@gmail.com Designer Name: Paula Johnson Designer Email Address: paulaj@hctc.com Inspection Request Date:2026-08-12 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'Inspection Request Date'and remain uncovered for three business days to allow staff time to inspect.Poor weather situa ' be approcallp Dodaoebackfill otf system components.t l l taining Septic if no contact is responsible made by t rhe health department the business days of notice,the installer may cover. Mason County Asbuili Form,Record Drawing,and Installati be submitted for final installation approval. pp ay I. { DRAIN . .