HomeMy WebLinkAboutSWG2021-00318 - SWG Application / Design - 6/1/2021 (2) ® MASON COUNTY d15N6SHELTON:STREET,SHELTO70,VIA
EXT 684
SHELTOR:360-d27-9670,EXT 000
BELFAIR:380-2]6i08],EXT 400
Public Health & Human Services ELM 380i82-526e,EXTd00
FAX:360427-7787
On-Site Sewage System Permit: SWG2021-00318
_ APPLICANT ARKUSH ET VIR NILE Phone:
Address: 1905 99th Ave SE LAKE STEVENS,WA 98258
OWNER ARKUSH ET VIR NILE Phone:
Address: 1905 99th Ave BE LAKE STEVENS,WA 98258
SEPTIC DESIGNER JIM HUNTER' Phone: 360-753-1226
Address: PO BOX 162 OLYMPIA,WA 98507
Site Address: 250 N Mountain View Dr
Primary Parcel Number: 422095400051
Permit Description: New SFR-3BR Pressure and Sand Lined Bed
Permit Submitted Dale: 0 6101/2 0 21
Permit Issued Date: 06128/2021
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $640.00 (addn�onei lees mey oe a�Ioneaupon molanalanoi syslam).
Permit Expiration Date: 06/28/2026 (n sW on daM of nadeorwo)
Permit Conditions:
1 Pmposed 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 pdor written
authorization from Mason County is obtained.
3 Drainrreld installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installeris responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installeris responsible for obtaining Septic Designer/Engineer installation approval prior to
ball of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation tee 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/onsiteloss4nspection-request.php or call:
360427-9670, extension 400.
MASON COUNTY 415 N 6TH STREET,SHELTON WA 98584
SHELTON:36OA27-9670, EXT.400
Public Health & Human Services eELFAIR:360-275-0467, EXT.400
APPLICATION FOR EXTENSION Rog
Amount Paid: MAY 1
Receipt Number: ;a na �c 41�14
P u RECEIVED
Instructions: Applicant to complete Parts 1 and 2 and septic designer/engineer to comple
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.
j Prior to or after expiration of an approved design, the applicant may apply for a permit
11 extension. The permit extension shall extend the expiration of the design for up to two years, W -
but not exceed five years from the signature date of the Environmental Health Specialist's ..�
site inspection(Per WAC 246-272A-200(4)(e)) r
All approved septic designs may receive one extension. Additional extensions shall not be i ^'
accepted and would instead require a renewal. J LEI
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PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: tV i to- Art[ %\-. Phone: 20(0 43y- 8747
Mailing Address of Applicant: 19o5 99Tw A* SF-
city: Loke S)reyer`-s State: WA zip: 98268
12-digit Tax Parcel Number: L1220954 00o el i
Site Address: 2S0 N moynke.im View Drr t-1ooc mWo - wA 9Ao4a
Permit Number: SWG 202 t 00 3 t 9
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
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This form may be scanned and available for public view on the Mason County Web site.
Pagel of 2
PART 3:ORIGINAL DESIGNERIENGINEER REVIEW AND APPROVAL
I,the undersigned original Deslgner/Engineer,attest that I have reinspected the property and
found the following condifions to be true as of the date of my signature below:
• NO part of the proposed Drainfleld 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.
Ir Deslgner/Enplpeer5ta
s e
SI n re of Deslgner/Engineer Date I i,
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Comments/Conditions:
Mo STUMPS —% Ar_6ws lrt
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied
1W Extension Approved New Expiration Date: Z z
Comments:
APpl?
Envirol �ntal He th Specialist Signature: OV ED
nn��uuMAY 181014
Is form may be scanned and available tar puWlc view on the Ma oo Counry "rWENrADJA I HEALTH
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