HomeMy WebLinkAboutSWG2020-00068 - SWG Application / Design - 2/25/2020 (3) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
L BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2020-00068
APPLICANT Higgs, Jacob Phone: 360-621-0338
Address: 571 NE Trudeau Mountain Rd BELFAIR, WA 98528
OWNER Higgs, Jacob Phone: 360-621-0338
Address: 571 NE Trudeau Mountain Rd BELFAIR, WA 98528
SEPTIC DESIGNER Bob Paysse - Pioneer Digging Inc Phone: 360-426-1803
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
Site Address: 571 NE Trudeau Mountain Rd
Primary Parcel Number: 223027590123
Permit Description: NEW SFR -4BR -Gravity w/waiver to 18" vs
Permit Submitted Date: 02/25/2020
Permit Issued Date: 06/29/2020
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $625.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/29/2024 (based on date of inspection)
Permit Conditions:
1 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
2 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
3 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
4 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
5 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
9 `,. MASON COUNTY 415 N 6T"STREET, SHELTON WA 98584
r` SHELTON: 360-427-9670, EXT.400
.11. 11 COMMUNITY SERVICES BELFAIR: 360-275-4467, EXT.400
. ELMA: 360-482-5269, EXT.400
'fit ,.-/ Building Planning,Environmental Health,Community Health
� FAX: 360-427-7798
ji I II ' 7 IF u i \\7
��
PPLICATION FOR EXTENSION ,,
JUN '2 7 2023
JUN 3 0 2023 Amount Paid: GO , '" _
Receipt Number: 7-3�-1c{6S
RECEIVED
\ts, r
Instructions: Complete Parts 1 and 2. Submit application with extension permit fee. Make check payable to
Mason County Treasurer. Staff will review your application and determine if the extension can be approved. If
approved, the permit may be extended for up to one additional year from the original expiration date.
Extensions must be applied for prior to original expiration date. Multiple extensions on a single permit
will not be approved (one per design/permit).
PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: Jacob Higgs Phone: 1-360-621-0338
Mailing Address of Applicant: 571 NE Trudeau Mnt. Rd
City: Belfair State: WA Zip: 98528
12-digit Tax Parcel Number: 223027590123
Site Address: 571 NE Trudeau Mnt. Rd
Permit Number: SWG 2020-00068
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION.
0 I purchased the property in April of 2022. i had a garage/storage building built on the property, and going
that process i was waiting for it to be completed because the site plan and original placement of a
home was going to change. then winter and the wet months set in and didnt have good conditions to
have it installed now the weather is cooperating and am ready to have system installed
PART 3: HEALTH DEPARTMENT DETERMINATION (staff use only)
0 Extension Denied Extension Approved 6 New Expiration Date: �Z��ZO Z 'I
Comments:
En6irar1m2rrtdl ReQh 5pPt Signature: e •
This forminmb 9ganned and available for public view on the Mason County Web site.
MASON COUNTY ENVIRONMENTAL HEALTH Revised: 12/13/2019
DJA