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Home My WebLink AboutSWG2024-00341 - SWG Application / Design - 7/17/2020 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 J{� BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2020-00341 APPLICANT MEYERS RACHEL Phone: Address: 3190 HARRIS RD SE PORT ORCHARD, WA 98366 OWNER AARON VELMA A Phone: Address: 715 NW GARY ST PULLMAN, WA 99163 SEPTIC DESIGNER TOM WEAVER* Phone: 360-620-7054 Address: 3912 STEELHEAD DRIVE NW BREMERTON, WA 98312 Site Address: UNKNOWN Primary Parcel Number: 220185000194 Permit Description: New three bed SFR- pressure trench Permit Submitted Date: 07/17/2020 Permit Issued Date: 08/07/2020 Issued By: Luke Cencula Current Permit Fees Paid: $630.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/03/2025 (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 Drainfield installation not to exceed designed upslope (10') and downslope (8') 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. 6 Pump tank requires 2nd riser to grade with capacity over 1000 gal. 7 Filter fabric required if rock installed in drain field. 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. MASONCOUNTY 415 N 6T"STREET,SHELTON WA 98584 LP • SHELTON:360-427-9670, DCT.400 Public Health & Human Services BELFAIR: 360-275-4467.EXT.400 kt, nit , APPLICATION FOR EXTENSION FEB 21 2024 Amo nt Pain ! Receipt Number: ,� U Z - By e_ 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 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 WAC 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: �a_c_V1Q NALL6 Phone(3(oO) (Q(p — Co? Mailing Address of Applicant 31 e o {-4(x,>ms ad S City: PO f t O ter ' ICk cl State: Lifik Zip: q 17310 fo _ 12-digit Tax Parcel Number: ciao% s 000 114 Site Address: 1J a J Permit Number: SWG acaO-QO 3 -1 PART 2: EXPLAIN WHY YOU NEED AN EXTENSION ►j 1\'n perrnr VIov expircci and Loot_ j vs+ purchaxd piw+ G_�1�YX.iI l i b vi�� tab This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 PART 3: ORIGINAL DESIGNERJENGINEER 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 Grainfield 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: id 42 Y/i-C)Ar /(/IN Signature of Designer/Engineer Date 1 ..... 5141333 TuOMAS E.WEAVER'.. .1.' E .n NEW' 4..z%y t Comments/Conditions: - - --- PART 4: HEALTH DEPARTMENT i s MiNATT(jN (staff-,_ ..,,.:. 0 Extension Denied t(--- Extension Approved New Expiration Date: 'Z� Comments- Environmental Health Specialist Signature: G This form may be scanned available for public view on the Mason County Web site. Page 2of2