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Home My WebLink AboutSWG2022-00190 - SWG Application / Design - 4/8/2022 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,967 WA 98584 SHELTON: , EXT 400 it.rilJBELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2022-00190 APPLICANT RAINEY TESTAMENTARY TRUST Phone: GRANT ARNOLD Address: ALEXANDRA CONSTANCE CHEERVA TRUSTEE PROSPECT, KY 40059 OWNER RAINEY TESTAMENTARY TRUST Phone: GRANT ARNOLD Address: ALEXANDRA CONSTANCE CHEERVA TRUSTEE PROSPECT, KY 40059 SEPTIC DESIGNER MICAH HALVERSON-M. Halverson Phone: 360-490-6365 Design LLC Address: PO BOX 1519 SHELTON, WA 98584 SEPTIC INSTALLER SCOTT JOHNSON-Weather Tight Phone: 360-490-5408 Construction Address: 8639 Salty DR NW OLYMPIA, WA 98502 Site Address: 26474 N US Highway 101 Primary Parcel Number: 323313390970 Permit Description: Repair upgrade five bdrm-Glendon Permit Submitted Date: 04/08/2022 Permit Issued Date: 09/05/2023 Issued By: David Anderson Current Permit Fees Paid: $820.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/14/2024 (based on date of inspection) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 3 Drainfield installation not to exceed designed upslope and downslope depth specified on design form. 4 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. 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. MASON 415 N 6TH STREET, SHELTON,WA 98584 • COUNTY SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 7 The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. All applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and/or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report/assessment shall remain attached to the approved building plans. 8 No native vegetation removal is authorized within the wetland or stream buffer 9 Non-conforming septic repair. The septic system may need to be brought into full compliance before future permits can be approved. Detail: Drain field 75'from surface water(septic treatment level A), drainfield 2'from edge of easement, and effluent transport line 25'from well. 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. y�:��\ 415 N 6T" STREET, SHELTON WA 98584 ' "' "� SHELTON: 360-427-9670, EXT.400 � �� MASON COUNTY gELFAIR: 360-275-4467, EXT.400 ; _la;.,�r1 COMMUNITY SERVICES ELMA: 360-275-5467, EXT. 400 .,» j FAX 360-427-7798 ' � LL Building.Planning.EnvuonmcntalHcalth,COmmunilyHealth q ri_i APPLICATION FOR EXTENSION JG Amount Paid: �.c0 U . Number: �.� -'2,9 —1'Co `S�/j 95 7 Receipt Numb _ U?�, y/fr able o Instructions: Complete Parts 1 and 2. Submit application with extension permit fee. Make che y If Mason County Treasurer. Staff will review your application and determine if the extension can be app . • - 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 (��j-L7 Name of Applicant: A /�q(e ch e V a Phone: J V -S5Q ` 7633 Mailing Address of Applicant: 00 8 tiotrievi Licoci5 Pr City: Prcspec � State: � Zip: ( (/0J) 12-digit Tax Parcel Number: 3 7 33 ( 33 Oo g- I Site Address: for $7 IoCQ 'U' 074 20 F ( k 1,/ l U J Permit Number: SWG 5 /C zO -7 —Co 170 PART 2: EXPLAIN WHY YOU NEED AN EXTENSION. 0! t'a 61/v 3 k'(Yh c/e - 1I) and t°57'c(b(6-A1 eq #4s ANIIMINION PART 3: HEALTH DEPARTMENT DETERMINATION (staff use only) DLFit!?: '` 7f"/ ir i ❑ Extension Denied L/ HY( ) ii 1 Zd�i rP Ot5 202..; �UExtension Approved New Expiration Date: f EIf Comments: Environmental Health Specialist Signature: This form may be scanned and available for pu tc view on the Mason County Web site. Revised: 12/13/2019