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Home My WebLink AboutSWG2020-00312 - SWG Application / Design - 7/7/2020 (3) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 J L BELFAIR:360-275-'I467,EXT 400 . •, Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2020-00312 APPLICANT GREEN, SHAWN Phone: 206-423-9650 Address: 8312 SIERRA DR EDMONDS, WA 98026 OWNER GREEN, SHAWN Phone: 206-423-9650 Address: 8312 SIERRA DR EDMONDS, WA 98026 SEWAGE DESIGNER TOM WEAVER* Phone: 360-620-7054 Address: 3912 STEELHEAD DRIVE NW BREMERTON, WA 98312 Site Address: 800 E Wood Ln Primary Parcel Number: 320215602041 Permit Description: NEW SFR -3BR- NuWater Permit Submitted Date: 07/07/2020 Permit Issued Date: 07/30/2020 Issued By: Jeff Wilmoth Current Permit Fees Paid: $630.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/07/2025 (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. : MASONO NT 4158, . SHELTON:360-427-9670.EXT.400 t P Public Health & Human Services BELFAIR:360-275-467. EXT.400 +,�ti.amrvc._.sv-aerP,c+-Maw*< .viasvwrws .._._•�. _...... _►�.—..._.r.. APPLICATION FOR EXTENSION LhOf Amount Paid: i (o�— MAR 0 6 2024 Receipt Number: RECEIVED Instructions: Applicant to complete Parts 1 and 2 and septic designer/engineer to complete Part 3. Submit application with extension permit fee. Make check payable to Mason County Treasurer. Staff will review your application ar d;determine if the extension can be approved. Conditions for approval are outlined in this application. Prior to or after expiration of an approved design, the applicant may apply for a permit extension. The permit extension shall extend trite expiration of the design for up to two years, but not exceed five years from the signature date of the Environmental Health Specialist's site inspection{Per WAC 246-272A-200(4)(e)} All approved septic designs may receive one a tension. Additional extensions shall not be accepted and would instead require a renewal. PART 1: APPLICANT AND PARCEL INFORMATION Name of Applicant: Shawn Green I I Phone: 206-423-9650 Mailing Address of Applicant; 8312 Sierra Dr City: Edmonds • State: WA Zip: 98026 12-digit Tax Parcel Number: 320215602041 I Site Address: 800 East Wood Lane Shelton, WA 98584 Permit Number: SWG 2020-00312 i I . PART 2: EXPLAIN WHY YOU NEED AN EXT SION I am requesting an extesion on this septic permit be ause work will now commence to accomodate the , manufactured home that was ordered in the summer o 2021. This form may be scanned and available for pu lic view on the Mason County Web site. 1 Page 1 o'2 , PART 3: ORIGINAL DESIGNER/ENGINEER RE IEW AND APPROVAL I, the undersigned original Designer/Engineer, ttest that I have reinspected the property and found the following conditions to be true as of t a date of my signature below: • NO part of the proposed Drainfie d or Rese a area has been altered or disturbed in such a way that may render the proposed desig invalid. • NO development has occurred on this parc I or neighboring parcels which would cause the proposed system to no longer meet mi imum setbacks. • NO Boundary line adjustments or subtlivisi i ns have occurred which would cause the property to fall below the minimu�•n Ia d area requirements of WAG 246-272A. I Designer/Engineer Stamp: -'---7 i // , -..• ,-- („ .1-i-eiL— & _e>t — 2- ; 0/r Signature of Designer/Engineer i Date 6 AHomvsAE •' � .ut NS O '1 NEA•• . f{ I %emso /fie /,-f i Comments/Conditions: 11 1 PART 4: HEA LTH DEPARTMENT DETERMINATION (staff use only) 0 Extension Deniedpi �� Extension A roved Comments: N-w Expiration Date: it ?l i pp `i",(,!', .. I ''RSO�C �� 6 l=' /, r-, Environmental Health Specialist Signature: ;-�,;,,,,,, ,j , . fAll ' This form may be scanned and available f.r'public view on the Mason;Gount 'Web site. Page 2 of 2 r