HomeMy WebLinkAboutSWG2020-00312 - SWG Application / Design - 7/7/2020 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
t. 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
0
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:
9 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
2 Drainfield 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.
MASON COUNTY 415 N 6 ' STREET, SHELTON WA 98564
�• SHELTON: 360-427-9670, EXT.400
Public Health & Human Services BELFAIR 360-275-4467. EXT. 400
APPLICATION FOR EXTENSION
Amount Paid. 16S- MAR 0 6 2024
Receipt Number. RECEivED
Instructions: Applicant to complete Parts 1 and 2 and septic designerengineer to complete
Part 3. 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.
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 the 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 \A'AC 246-272A-200(4)(e)}
All approved septic designs may receive one extension Additional extensions shall not be
accepted and would instead require a renewal.
PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: Shawn Green Phone: 206-423-9650
Mailing Address of Applicant: 8312 Sierra Dr
City. Edmonds State- WA Zip: 98026
12-digit Tax Parcel Number 320215602041
Site Address: 800 East Wood Lane Shelton, WA 98584
Permit Number: SWG 2020-00312
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
I am requesting an extesion on this septic permit because work will now commence to accomodate the
manufactured home that was ordered in the summer of 2021
This form may be scanned and available for public view on the Mason County Web site.
File 1 o'2
PART 3: ORIGINAL DESIGNER/ENGINEER REVIEW AND APPROVAL
I, the undersigned original Designer/Engineer, attest that I have reinspected the property and
found the following conditions to be true as of the date of my signature below:
• NO part of the proposed Drainfield or Reserve area has been altered or disturbed in such
a way that may render the proposed design invalid.
• NO development has occurred on this parcel or neighboring parcels which would cause
the proposed system to no longer meet minimum setbacks.
• NO Boundary line adjustments or subdivisions have occurred which would cause the
property to fall below the minimum land area requirements of WAC 246-272A.
Designer/Engineer Stamp:
• /(v,
Signature of Designer/Engineer Date
• 5100333 vER.ftO
THous E.WFAN
EX 0 /Ls/y I
Comments/Conditions:
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
0 Extension Denied 7 7
Extension Approved New Expiration Date: i/ -/ 25
Comments:
Environmental Health Specialist Signature: M ®�
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This form may be scanned and available for public view on the Mason County Web site.
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