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Home My WebLink AboutSWG2021-00100 - SWG Application / Design - 3/1/2021 (2) MASON COUNTY 415 N 6TH STREET,SHELTON, , E 98584 SHELTON:360 427-9679670 EXT 400 .,, n,, ,.. ., , BELFAIR:360-275-4467, EXT 400 d3 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2021-00100 APPLICANT ZENK, TIMOTHY Phone: 206.226.2417 Address: PO Box 516 GRAPEVIEW, WA 98546 OWNER ZENK, TIMOTHY Phone: 206.226.2417 Address: PO Box 516 GRAPEVIEW, WA 98546 SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 236 E Treasure Ln Primary Parcel Number: 121085200028 Permit Description: New SFR -3BR Nuwater w/ local shoreline waiver to 75' Permit Submitted Date: 03/01/2021 Permit Issued Date: 05/07/2021 Issued By: Jeff Wilmoth Current Permit Fees Paid: $640.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/01/2026 (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. 6 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. fir_ 1,T [ CS.* - ` MAR u 4 2024 MASSC`4�!(��U i 6 'ECE/vED415 N 6T STREET,SHELTON WA 98584 Public ELTON:360-427-9670,EXT. 400 Pu b is Health & Human Services ELFAIR: 360-275-4467,EXT.400 lal I APPLICATION FOR EXTENSION ULi FEB 2 9 2024 U 1 Cal Amount Paid: �or; gy Receipt Number: � 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: Mlkr 2 ZR // ., Ae�S LCC Phone: 36o-3yp- zyq p Mailing Address of Applicant: PO . o,C 5-/6 City: 'R.4115tVitlAi - State: Vi/ 61- Zip: S54, 12-digit Tax Parcel Number: i 21Dg-6-2 - 000 Z Site Address: .236 E -712epsva !- , 6R9ec�vicr 7, t„/y 9r7g6 Permit Number: SWG -Q 0100 PART 2: EXPLAIN WHY YOU NEED AN EXTENSION PO/Nlia>' ,9ee4 &Wet, CoArta-vc,nov l ems' Nor ) -Fie" 76. /NyTL This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 -.- -•.._^_�^'�.=�..____.-mil PART 3: ORIGINAL DESIGNER/ENGINEER REVIEW AND APPROVAL 1, 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. C • 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. iq Desi:or jEn1,1 or Stamp: AY r� Fri:s. f.$ / L---2 _,,;_: . . „ , ,/,2_, 1 ,,,,e 0. ukt ,c1I'itt Signature f Designer/Engineer Date 1 r yr, ,,,,, 004 s 1 u C NDY E WAITE ,1I 9 + LICENSED DESIGNER 1, LTI'IRLS J510, Comments/Conditions: I� l 2 Y/ Y Pp PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) 414savCo Mq/?0y 0 0 Extension Denied U�✓TyFN�� ?4 �31 Extension Approved / / RO New Expiration Date: ,3/ I ! Zt� z(� o✓A N�FNTq(yFg4 Comments: ly Environmental Health Specialist Signature: • 1 This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2