HomeMy WebLinkAboutSWG2021-00646 - SWG Application / Design - 11/30/2024 WA
® MASON COUNTY 415NBTBELFAI STREET, , ,EXT 400
SHELTON:360427-9670,EXT 400
BELFAIR:380-2754467,E%T d00
Public Health & Human Services ELMA:360482-5269,EXT 600
FAX 360427-7787
On-Site Sewage System Permit: SWG202"0646
APPLICANT CATHRYN WALL-ZUNDAL Phone:
Address: PO BOX 1186 ELMA,WA 98541
OWNER LEOPPARD GARRICK R&SARAH R Phone:
Address: 8324 48TH CT SE LACEY,WA 98503
SEWAGE DESIGNER CHRIS ELSTROTT' Phone: 360-5615000
Address: 128 NORTH RIVER STREET MONTESANO,WA 98563
SEWAGE INSTALLER SO RUSSELL-septic Installer Phone: 360.589.7957
Address: PO Box 336 MONTESANO,WA 98563
Site Address: 1370 W Satsop Maple Gin
Primary Parcel Number. 619307600110
Permit Description: AG BUILDING -2BR Gravity
Permit Submitted Date: 1113012021
Permit Issued Date: 12/03/2024
Issued By: Jett Wilmoth
Current Permit Fees Paid: $870.00 laddd� [fees may x,mui� upon MwlN of sya ).
Permit Expiration Date: 01/18/2027 (b�an Eau a lnal>aMon)
Permit Conditions:
1 Proposed development sub/'ect to zoning requirements and approval by the planning
department stagper Mason County Tide 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 specked on
design form.
4 Installaros responsible to 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 o/system components.
6 Mason County Asbuitt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
7 According to design, the proposed building for this septic is an exempt storage building.
Plumbing not allowed in exempt structures.
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:ma"ncountywa.gov/health/environmentallonsiteloss4nspectiont quest.php or call:
360-427-9670, extension 400.
T ,
MASON COUNTY 415 NT, SHELTON WA 985a4
SHELTONE 60427-96 0 EXT 4 0
Public Health & Human Services BELFAIR 360-275-4467, UT 400
APPLICATION FOR EXTENSION
Amount Paid: L .5�
Receipt Number:,54
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: Aa r(- 1 r 11-12 noo p a c Phone: A53 - h
Mailing Address of Applicant:
city: �GY C' P.r A State: 1/)A . Zip:
12-digit Tax Parcel Number: 0-50' 7h-
Site Address: 13'%D /i�o C-{ �af$ p �LlLI
Permit Number: SWG a a,2 I - o o,6 g6
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION /
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This form may be scanned and available for public view on the Mason County web site.
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PART 3: ORIGINAL DESIGNERIENGINEER 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.
Designer/ p:
Signature of f Designer/Engineer Dale I p W
28506� r
8B70NE _ �_tint
2 _d
Comments/Conditions: — —
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied v
Extension Approved New Expiration Date: - D 2-7
Comments:
Enviro ental Health Specialist Signature:
Y
Is t Jay be scanned Ad available for public view on the Mason County Web site.
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