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Home My WebLink AboutSWH2022-00185 - SWG Application - 3/17/2020 ® MASON COUNTY 415NBSHELTON ,SHELTO70,EXT 684 SH STREET, SHELTON, EXT5M 400 BELFAIR:360-275-0467,EXT 40o Public Health & Human Services ELMA 360-482-5269,EXT 400 FAX:W0427-7787 On-Site Sewage System Permit: SWG2022-00185 APPLICANT Lilley,Dan Phone: Address: PO Box 1031 GIG HARBOR,WA 98335 OWNER Lilley,Dan Phone: Address: PO Box 1031 GIG HARBOR,WA 98335 SEPTIC DESIGNER CINDY WAITS' Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON,WA 98584 Site Address: 940 W Schafer Park Rd Primary Parcel Number: 619304400070 Permit Description: New SFR-3BR Pressure-Sand Lined Permit Submitted Date: 04/07/2022 Permit Issued Date: 04/26/2022 Issued By: Jeff Wilmoth Current Permit Fees Paid: $665.00 (aedlaonel rave may be"I upon imblliaan d 3obem). Permit Expiration Date: "142027 (ba.aaondmedhmpanron) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning department staflper 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 ofsystem 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/onvironmentallonsite/"sinspection+ quest.php or wll: 360.427.9670,extension 400. ark STREET,SHELTON WA 98584 MASON COUNTY 45NSHELTON:360-427-9670,EXT.40 Public Health & Human Services eELFAIR:360-275.4467,EXT.40 APPLICATION FOR EXTENSION MAR 17 2025 D Amount Paid: S Receipt Number: ZOZi • UI 45? 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 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: 04.� Lr /(e4 Phone: �.S3- a57- 34� Mailing Address of�Applicant: Pv Ba [63� City:_ 61 i fa`>4 4,604, State: ko Zip: 17e32s- 12-digit Tax Parcel Number: �o /c? 3b - N64-000 -7O Site Address: Permh Number: SWG 2 0 -22- 60 1 PC— PART 2: EXPLAIN WHY YOU NEED AN EXTENSION r 4 Ai�Jrn/^ 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 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/E eer Stamp: I � �l .311-722o2s I 1Zo Signature of Designer/Engineer Date LICENSED WMf E.R� IEF'i4E5 OSId I Comments/Conditions: — — — — — — — — h Cau�ue/.td 1}Li t-irrl on. 3��/Zn2o— .7 Well A r k1l sa cbl) M e-{r SV L.L-.s Y � Pe ,_1 rJX,J ie I PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied yyp'p Extension Approved New Expiration Date: 2� Comments Environmental Health Specialist Signature: This form may be scanned and available for public view on the Mason County Web site. Page 2 of 2