HomeMy WebLinkAboutSWG2021-00429 - SWG Application / Design - 7/21/2021 (2) MASON COUNTY 415NBSHELTON: , 0427-97 ,EXT 404
SHELTON:360J274467,EXT 400
BELFAIR:380-275-0467,EXT 400
Public Health & Human Services ELMA:3604823289,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2021-00429
APPLICANT CASTEEL KYLE A&KELLY A Phone: 1.206.353.6847
Address: 7338 28TH AVE SW SEATTLE, WA 98126
OWNER CASTEEL KYLE A&KELLY A Phone: 1.206.353.6847
Address: 7338 28TH AVE SW SEATTLE,WA 98126
SEPTIC DESIGNER PAULA JOHNSON' Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION,WA 96592
Site Address: UNKNOWN
Primary Parcel Number: 221321190300
Permit Description: New three bdrm-Nuwater trench
Permit Submitted Date: 0712112021
Permit Issued Dale: 0811012021
Issued By: Luke Cencula
Current Permit Fees Paid: $640.00 (adddianslWsmeybemquin upn lnmautionarswem).
Permit Expiration Date: 08/05/2026 Ibasea on dab onnsoec ion)
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(10) and downslope(9) 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
backfi/l of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
7 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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-inspGction4equest.php or call:
360.427-9670,extension 400.
MASON COUNTY 415 N 6T1 STREET,SHELTON WA 98584
SHELTON 360-427-9670, EXT.400
Public Health & Human Services BELFAIR.360-2754467, EXT 400
APPLICATION IIFOR EXTENSION
Amount Paidar lr-�
Receipt Number:S�[ a.1%
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: -s'X�A �N7-CV_x Phone: LO6- 3SS- G !S f 1 y
Mailing Address of
oa�f ,Apppli�licant: :u,
City: �Tc.uS'Ct-`�+— State: { -NPS Zip: �$I�
12-digit Tax Parcel Number: 2.2{32 - 4
fft�k k — 1 0 300
Site Address: r+I
Permit Number SWG
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
L �OuNiQ ASS 0' "S+ A-0,^ I COSA"�
This form may be scanned and available for public view on the Mason County Web site.
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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 Drainfeld 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.
I� UrtiignE nc" Si aril, I
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Signature of Designer/Engineer Date
O
PAULA JOY JOHNSN �1
I
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Comments/Conditions: — — — - - — — —
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied e�
+Extension Approved New Expiration Date
`
omments:
Environmental Health Specialist Signature:
This form may be scanned and available for public view on the Mason County Web site.
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