HomeMy WebLinkAboutSWG2021-00435 - SWG Application / Design - 7/23/2021 (2) MASON COUNTY 415NBTH 380420�27-97 ,EXT 400
STREET
, TON,WA 98584
SHELTON:
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:380482-5269,EXT 400
FAX:360427-7787
On-Site Sewage System Permit: SWG2021-00435
APPLICANT GEDORA BUSINESS COMPANY Phone: 253.209.2941
Address: 121 W SENTRY CT SHELTON,WA 98584
OWNER GEDORA BUSINESS COMPANY Phone: 253.209.2841
Address: 121 W SENTRY CT SHELTON, WA 98584
SEPTIC DESIGNER PAULAJOHNSON' Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION, WA 98592
Site Address: 121 W SENTRY CT
Primary Parcel Number: 420243100140
Permit Description: New commercial-shallow pressure beds
9 Permit Submitted Date: 07/2312021
11 Permit Issued Date: 08/31/2021
Issued By: Luke Cencula
Current Permit Fees Paid: $1,535.00 (additional fees may W maenad aydn ms imon or syslaml.
Permit Expiration Date: 08102/2026 (basedandabofinwwtxm)
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.
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/oss4nspection-request.php or call:
360427.9670,extension 400.
( 1
MASON COUNTY 415 N 6`STREET, 584
SHELTON:360427L960 EXTON WA 98400
Public Health & Human Services BELFAIR: 360-2754467.EXT.400
APPLICATION FOR EXTENSION
Amount Paid:
Receipt Number: _
Instructions: Applicant to complete Pans 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: I-QLLs;LN6 Phone: 3(co-41?p -204-5
Mailing Address of Applicant: S� A.9 cSN•v�'tr`1. p1
City: S -oQ N'o I , State: hA. Zip: N'
' 12-digit Tax Parcel Number: '-t to 2-4 - 3 t- CC)
{LfO 1 ,
Site Address: 17 I W • S
Permit Number: SWG 2-0`Lt - 00LB�
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
This form may be scanned and available for public view on the Mason County Web site.
Page 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.
IDe3ig c Ra I
RQL"- R"t4-z� I I
Signature of Designer/Engineer Date I `� PAULA JOY JOMNSON .
CiE r 10r.9i
Comments/Conditions: — — —
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
`❑ Extension Denied
YExtension Approved New Expiration Date:
omments:
Environmental�Health
hSSpecialist
,Signature:
This form may be scanned and available for public view on the Mason county Web site.
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