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HomeMy WebLinkAboutSWG2019-00316 - SWG Application - 8/30/2019 MASON COUNTY 415N 6THSTREET. 0427-97 ,E98584 SHE ,SHE TON, ,EXT564 400 BELFAIR:360-2754467,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX 360A27-7787 On-Site Sewage System Permit: SWG2019-00316 APPLICANT KYU HOON LEE Phone: Address: 5532 37th Ave SE LACEY,WA 98503 OWNER KYU HOON LEE Phone: Address: 5532 37th Ave SE LACEY,WA 98503 SEPTIC DESIGNER PAULAJOHNSON• Phone: 360-898-2255 Address: 171 E VUECREST DRIVE UNION,WA 98592 �. Site Address: 490 E Pinedirosa Rd Primary Parcel Number: 321207500070 Permit Description: NEW SFR-3BR+ADU -Pressure Permit Submitted Date: 08/13/2019 Permit Issued Date: 0 9/1 312 01 9 Issued By: Jeff Wilmoth Current Permit Fees Paid: $620.00 (additional ees may be required uao, aM.11abonmrysmm). Permit Expiration Date: 08/27/2024 (basedoadateornsb on) Permit Conditions: 1 permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 2 Drainfie/d 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 backfrll 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-inspection4equest.php or call: 360-427-9670, extension 400. MASON COUNTY 4,5NSHETON:360-Q;96;oEXT;00 Public Health & Human Services BELFAIR:360-2754467, EXT.400 APPLICATION FOR EXTENSION D JUL 18 2024 Amount Paid:[(.C-- ReceiptNumber: �.�- /L G� sy- 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 ccPARCEL INFORMATION Name of Applicant: , k*3) .V� L%S,-- Phone: (3bOw g10'ZIl`�' Mailing Address of Applicant: City: _ v++� State: k'N-?r Zip:,_ J � 12-digit Tax Parcel Number: ( tio — 7 J — ©n�pt7 Z fl Site Address: L4,q D Permit Number: SWG 7 fl\q — o Ol to PART 2: EXPLAIN WHY YOU NEED AN EXTENSION racta¢.nh. This form may be scanned and ava� able for public view on the Mason County Web site. Page 1 &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. Signature of Designer/Engineer Date PAuL Joy JOMNSON Comments/Conditions: — — — — — — — — PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied /^�,_7 Extension Approved New Expiration Date: I Comments: Environmental Health hSSpecialist Signature: This form may be scanned and available for public view on the Mason County Web site. Page 2 d 2