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HomeMy WebLinkAboutSWG2021-00107 - SWG Application - 3/10/2025 ® MASON COUNTY 415 NBHLFAIR. O-275-ON,WA98584 SHELTON:360427-%70,EXT 400 BELFAIR:360-2]SMB],FJ(T 400 Public Health & Human Services ELMA:360482-5268,EXT 400 FAX:361 On-Site Sewage System Permit: SWG2021-00107 APPLICANT NITS CONSTRUCTION LLC Phone: 206.651.6645 Address: 4317 S 347TH ST AUBURN, WA 98001 OWNER NITS CONSTRUCTION LLC Phone: 206.651,6645 Address: 4317 S 347TH ST AUBURN,WA 98001 SEPTIC DESIGNER PAULA JOHNSON• Phone: 360-898-2255 Address: 171 E VUECREST DRIVE UNION,WA98592 Site Address: 20 E SUSAN CT Primary Parcel Number: 321045800040 Permit Descnpticn: New three bdrm-Nuwater trench with local waiver Permit Submitted Date: 03/08/2021 Permit Issued Date: 03/1912021 Issued By: Luke Cencula Current Permit Fees Paid: $640.00 ( eeemalre �y bee 0w upon lMWll- ma IsWm) Permit Expiration Date: 03/16/2026 lessee o�aeu m I,uwaion) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning department sta6per 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 IT)and downslope(B)depth specified on design form. 4 Installer is responsible for obtaining Mason County installation approval prior to back(ll 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/onvimnmental/onsite/oss-inspection4equest.php or call: 360427-9670,extension 400. t MASON COUNTY 476 NSHELTO514 N 360427-B60 EX98400 BELFAIR: 360-275.4467.EXT.400 Public Health & Human Services APPLICATION FOR EXTENSION D D MAR 13 2025 .Amount Paid: llv .— Receipt Number: 20i - a y05 13y Instructions: Applicant to complete Parts 1 and 2 and septic designer/engineer o 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: �O.NA.��I oj-,� _ Phone: V52b--109- (JZ O"I Mailing Address of Applicant T 5I1 S 3'fT �k City: ^ 1owwXh State: kP1 - zip: 12-digit Tax Parcel Number: e32t O Lf —(` �S S- ©00� O Site Address: Eo C vU-SaV\- Permit Number: SWG 2XD7A - QOIO:? 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 t 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. Signature of Designer/Engineer Date I o 34a ';p•{ - PAULA JOY JO:{ySCN a�tit�sc 3—to-2S I Comments/Conditions: — — — — — — — — PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied Extension Approved Nev;Expiration Date: Comments. Environmental Health Specialist Signature: This forth may be scanned and available for public view on the Mason County Web site. Page 2&2