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HomeMy WebLinkAboutSWG2021-00610 - SWG Application / Design - 11/8/2021 (2) SHELTON, 584 MASON COUNTY 4I5NBTHELTON: , 0427-967 ,EXT 400 SHELTON:360-027-9670,EXT 300 BELFAIR:360.2]5-448],EXT 000 Public Health & Human Services ELMA:360-082-5269,EXT 400 FAX 360427-7787 On-Site Sewage System Permit: SWG2021-00610 APPLICANT M HALVERSON DESIGN LLC Phone: 360-490-6365 Address: P 0 BOX 1519 SHELTON, WA 98584 OWNER M HALVERSON DESIGN LLC Phone: 360-490-6365 Address: P 0 BOX 1519 SHELTON, WA 98584 SEPTIC DESIGNER M HALVERSON DESIGN LLC Phone: 360490-6365 Address: P O BOX 1519 SHELTON,WA 98584 Site Address: 211 E TRAILS END DR Primary Parcel Number: 222235102001 Permit Description: new 2br sfr-Glendon Bioffher w/waiver to water Permit Submitted Date: 11/08/2021 Permit Issued Date: 12/13/2021 Issued By: Jeff Wilmoth Current Permit Fees Paid: $640.00 (additional lees may W reawnm upon Installation or system). Permit Expiration Date: 12/08/2026 (eaaad on data orins9etllon) 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. 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/environmentallonsiteloss-inspection-request.php or call: 360-427-9670,extension 400. MASONCOUNTY 415 NSHELTON:360-427-96 0 EXT.400 BELFAIR:360-275-4467,EXT.400 Public Health & Human Services APPLICATION FOR EXTENSION Amount Paid: _� 1.(5_ SEP 2 c 2924 Receipt Number: 041loy BY-------------- 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 WAG 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: A, ,-kw�Jt.rc 1�es ghL_C C, Phone: 3C©'NgD- 6�(� Mailing Address of Applicant: S f 'N City: se t,��On State: Zip: g8S8�'I 124git Tax Parcel Number: �27 1 7 1 ' S 6 >h© ) Site Address: zk\ r L Z> Permit Number: SWG PART 2: EXPLAIN WHY YOU NEED AN EXTENSION /ie I T f++K A—Q ko This form may be scanned and available for public view on the Mason county Web site. Page 1 of 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. IAl)esign�r/EineerSignature of Designer/Engineer DateI Comments/Conditions: PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied olnnn� Extension Approved New Expiration Date: mments: Environmental Health Specialist Signature: WA bK' " ` This form may be scanned and available for public view on the mason county Web site. Page 2 of 2