HomeMy WebLinkAboutSWG2021-00535 - SWG Application / Design - 9/17/2021 (2) 584
® MASON COUNTY 415NBSHELTON: , 0427-970,EXT 400
SHELFAIR 360d754467,EXT400
BELFAIR:360.2r5i48],E%T 400
Public Health & Human Services ELMA:360482-5280:EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2021-00535
APPLICANT HOUGLAND EDWARD L&TERESA J Phone:
Address: P 0 BOX 1629 OCEAN SHORES,WA 98569
OWNER HOUGLAND EDWARD L&TERESAJ Phone:
Address: P O BOX 1629 OCEAN SHORES,WA 98569
SEWAGE DESIGNER PAULAJOHNSONa Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION,WA 98592
Site Address: E Smith Cove Way
Primary Parcel Number: 120195000015
Permit Description: New SFR-2BR Pressure Bed
Permit Submitted Date: 09117/2021
Permit Issued Date: 10/08/2021
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $640.00 (ddditd .I reed may be 1e1mred upon inmalletan ar ayalam).
Permit Expiration Date: 10/06/2026 ¢awned dale mmscactan) .
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staffper 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 fomr.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Insta/leris responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbullt 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/onsite/oss-inspection4equest.php or call:
I 360-427-9670, extension 400.
40 MASON COUNTY <,SNSHE`TORE�2's��wEX�
Public Health & Human Services
APPLICATION FOR EXTENSION
Amount Paid: l G,3S�'
Receipt Number= -.-----
Inetructio S. Applicant to complete Parts 1 and 2 and septic designer/engineer to complete
application and determine if the extension can be approved.
Part 3. Submit
appliption with extension permit fee. Make check payable to Mason County
Treasurer. Staff will review your app
Conditions for approval are outlined in this application.
roved design, the applicant may apply for a permit
Prior to or after expiration of an app
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 inspecton(Per WAC 246-272A-200(4)(e)}
All approved
p ro and would resigns May
require one extension. Additional extensions shall not be
tead
l.
PART 1: APPLICANT ANDPARCEL INFORMATION
IFIE�A n�?nr'� Phone: .J..�� llLi S�',J(et�
Name of Applicant V
Mailing Address of Apple n_ 1112()
city:
n c chn,o5 Stele. WR zip: L F I I
12-digit Tax Parcel Number
x s r �'t �^mt.1y1�+%SrG J7 V is I' L a k.� S 4t1i, y
Site Address: [�
Permit Number: S%W
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
This torn may be sooned and available for Public view oo the Mason County Web site.
off"1 of 2
PART 3: ORIGINAL DESIGNERIENGINEER 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.
• 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/f reer Stn:�p'.
Signature of Designer/Engineer Date I
0
VAVLA JOYY JO JONNSON .
'CrC SE f
r
Comments/Conditions,
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use Orly)
❑ Extension Denied
/WZdension Approved New Expiration Date:
Zto
Commanra:
Environmental.Health Specialist Signature:
T�y be sunned and available for public view on the Mason County Web sits.
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