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HomeMy WebLinkAboutswg2024-00142 - SWG Application / Design - 11/18/2025 Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC J APPLICANT/ PERMIT INFORMATION ii-rul w �. Permit Number SWG 2024-00142 Parcel # 22309-77-00260 N + Applicant Name Dennis& Darlene Stickle Subdivision (Name/Div/Block/Lot) o Z Applicant Address 12902 122nd Ave Ct E 1 City, State, Zip Puyallup, WA 98374 Installer Name Bob Curlee ��� `� a O. Site Address 160 NE Mahogany Ct, Belfair,WA Designer Name Rod Left ----I CO INSTALLATION CHECKLIST UI Full System Installation El Tank(s)Only ❑ Drainfield Only ❑Repair El Other System Type Gravity -atment Type >5 ft.from foundation? - ` ❑ N/A Q YES ❑ NO >50 ft. from wells? ❑ 0 ❑ Y >50 ft.from surface water? - - t....e9_ :- - _� .- - 0 ❑ z • Cleanout between building and tank? -- % - - A 1- -- ■❑ ❑ U Tank baffles present? - \ CC'"` - 0 El P 24"access risers over each compartment?- ! --- ❑ UI ❑ a rW Effluent filter installed?- ��-- ❑ I .vS ❑ 15 _{__ Septic tank size gal k.L ` _-nufacturer L4lIIo .�►■ LL ,n a D-box water level and speed levelers used? - ❑ N/A ❑■ YES ElNO oO Manifold/D-box accessible from surface?- - CI NI CI o0Z Check valves installed? - - ❑ 0 X ❑Q Transport Line Size 4" Schedule/Class 40 Bedrooms installed (check one) El 2 ❑■ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑■ YES ❑ NO >100 ft. from wells?- - ❑ 1=1 ❑ o W >100 ft. from surface water? - - Cl ❑� El LL >10 ft.from potable water lines?- - El Cl ❑ Z >5 ft. from property lines and easements?- - ❑ CI ❑ Q ce >30 ft.from downgradient curtain/foundation drains? - - ❑ ❑■ ❑ ❑ Drainfield level and observation ports present - - ❑ 0 ❑ ❑ Graveless chambers or U] Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 ❑ Pump tank setbacks consistant with septic tank?- - ❑] N/A El YES El NO • Pump tank size gal Manufacturer < 24" access riser(s)and accessible from surface?- - U] ❑ El 1— d Alarm or Control Panel Installed? El CI CI • Control Panel equipped with Timer/ETM/Counter- - 0 ❑ Cl D EL Pump installed in El Bucket or ❑ On Block or ❑ Other a-• Pump Make/Model ❑ Floats or El Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8,21/2018 Mason County OSS Installation Report pg. 2 Parcel# 22309-77-00260 Were existing septic components abandoned as part of this project? - - 1=1 YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES [] NO 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 - _��. . �-::. �s�,��z--� ' RC�F�TI.C�►T[tON=OF_INSTALLATION � _�� �-=-- - --- 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 forma ched R ord Drawing is accurate. form and attached Record Drawing is accurate. 5/28/25 Signature of Installer Date ut Bob Curlee r. AI Printed Name of Signee tL re- trot+ MASON COUNTY PUBLIC HEALTH I, 4, =h# f= The undersigned approves this Installation Report and S . J l? Record Drawing on behalf of Mason County Public ,�AlWAIM IWAIWI M Health: _- EXPIRES 12115t • Signature of Environmental-lealth Specialist Date I (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018 4 • \ • \ \ \ • \ ' \ • \ \ • \ • \ \ • \ \ \ \ . \ • \ • \ \ • \ • \ • \ • \ _ \ • \ . \ • \ • \ . \ • \ • \ • \ • \ •\ •• \ •\ • \ . \ \ .\ .\ •• \ '• \ •\ •\ \ '\ •\.•\. \ • \ ' \ • \ ' \ ' \ . •\ •\ ••\ •\ • \ • \ •• \ • \ • \ • \ • \ ••\ ••\ \ • \ • \ \ \ \ \ • \ • \ • \ • ` • ` • \ • • \ \ \ \ . \ • \ • \ • \ . \ \ •\• \ \ \ \ . \ . \ • \ • \ \ • \ STRE \ \ •\ \ •\ • \ • \ \ • \ • \ \ \ \ \ \ \ •\ \ • \ . \ ' qM • \ \ . \ \ . \ • \ • \ • \ • \ • \ • `\ 4� , • \ ••\ • \ ••\ ••\ • \ • \ \ \ \ . \ . \ . \ .•\ \ \ • \ ' \ . \ Z III \ � \ \ • \ • \ • • \ • \ • \ • \ • \ • \ • \ • \ • \ • \ • \ \\ \\ \\ ` ` ` \ \ \ \ \ \ \ ` \• \• \• \ ' \ • \ • \• . \• \ . \. • • •\. \. \. \ ' \ ' \ • \ • \ • \ ' \ • \ • ` • \ • \ •• \ •• \ \ \ \• \ ` • \ •• • • • \ • \ \ . \ • \ \ • \ • \ • ` • ` • \• \ \ \ \ \ \ \ \ \ \ \ \ \ \ _ \ .\• .\• .\ \ •\ •\ \ • \ • \ . •• \ •\ \ \ \ •\ • \ • \ . \ . \ \ \ \ \ _ \ . \ . \ ••\ ••\ ••\ •\ •\ • \ • \ • \ • \ • \ \ •\ .•\ • \ •\ •\ . \ \ • \ • \ \ •\ •\ \ . \ \ • \ • \\ . \ .\ . \ \ . \ . \ . \ . ` C \ \ . \ • \ . \ • \ \ \ • \ • \ • \ • \ • \ • \ • \ m \ . \ . \ . \ . \ . \ \ • \ \ • \ • \ \ \ • \ • ` H \ \ \ • \ • \ \ \ • \ \ • \ • \ • \ • \ \ \ \ • \ ` • \ • \ • \ • \ • \ \ \ . \ • \ z \ • \ \ \ \ \ \ . , \ \ • \ • \ \ \ \ \ Cl) \ . \ . \ . \ . \ . \ \ \ \ ' \ • \ • \ \ \ • \ • \ \ C0 \ \ \ \ \ \ \ \ \ \ \ \ o ' \ \• \ \ • \ • \ \ . \ . . \ \ i o. \ \ \ \ \ \ \ \ \ \\ \ \ \ \ . \ \ . \ • \ z 2 \ • \ • \ • \ • ` \ . \ • \ • \ • \ \ ' \ • \. \. \ -c- m cc) • \ \ •\ • \ • \ • \ . . z `n rn • \ \ \ • \ \ 7 \ • \ • \ ' \ . \ . \ • s • \ \ \ \ • \ • ` • \ . \ . \ • \ \ \ --4 ` • \ • \ • \ • \ •• \ • \ \ • \ • \ • \ • ` • ` ' \ \ \ \ • \ • \ • ` • \ \ \ \ • \ ' \ ' \ • \ • \ \ • \ ' \ • \ \ • \ • \ • \ • \ • \ • ` • \ . \ • \ ' \ ' \ • \ ' \ \ \ • \ • \ ' \ ' \ • \ \ • \ • \ • \ • ` • \ \ . \ • \ \ \ • \ • \ • \ . \ • \ \ • \ \ _ \ . \ rn 10 .01 I7 0 m o 0 < All � 0 m 7:,e • "ap, ° c .• i 0 n n.. 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