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Home My WebLink AboutSWG2020-00563 - SWG Application / Design - 10/21/2020 LTON, 584 MASON COUNTY 416Nfi SHELTON: ,SHE7-967 ,EXT 400 SHELTON:360-275-4467,EXT 400 BELFAIR:360-275-0467,EX7400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX 360427-7787 On-Site Sewage System Permit: SWG2020-00563 APPLICANT OLDRIGHT ROBERT&MARY J TRSE Phone. 253-677-0373 Address: PO Box 1197 MILTON,WA 98354 OWNER OLDRIGHT ROBERT&MARY J TRSE Phone: 253-677-0373 Address: PO Box 1197 MILTON,WA 98354 SEPTIC DESIGNER JUSTIN RUSSELV Phone: 360.956.7242 Address: PO BOX 14531 TUMWATER,WA 98511 Site Address: 9091 NE NORTH SHORE RD Primary Parcel Number: 222183400020 Permit Description: Upgrade 4bd pressure trench on easement w/permit expiration extension Permit Submitted Date: 1012112020 Permit Issued Date: 03/1112021 Issued By: Rhonda Thompson Current Permit Fees Paid: $630.00 (additional fees may as a ggmad upon mandnaron of sysleml. Permit Expiration Date: 11/02/2025 p,asae on gala mmspacuon) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning department staffper Mason County Title 17. 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 3 Dreinfield installation not to exceed designed upslope and downs/ope depth specified on design form. 4 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backffll ofsystem components. 6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OS& PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS. THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection visit: masoncountywa.govlhealth/envimnmerdallonsiteloss-inspection-request.php or call: 360-427-9670,extension 400. T,SHELTON WA 98584 MASON COUNTY 415 NSHE TONE 60427A6 0 EXT.4 0 Public Health & Human Services eELFAIR:360-275-4467.EXT.400 APPLICATION FOR EXTENSIJA;PRl �j Amount Paid: -#A6 5Receipt Number: ta$- g5l Ir 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: -;:�ObV4 Phone: Zs3 - 6-77-C�37? Mailing Address of Applicant: Ro. ?,p( I G7 City: M I LTOt.I State: W A- Zip: CI 12-digit Tax Parcel Number: ?- 7 i k`34pd726 Site Address: IR 04 1 O C rJOdLt-1 TS HOC-G Qp Permit Number: SWG 2-C20-00553 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 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/Engineer Stamp: 00,_�.CG/1 �{� 8�25 A Si nature of Designer/Engineer Date IC N I�F31 NFR Comments/Conditions: — — — — — — — — fie w•e.� curv,�Y [orli� . T j7c�uP z221$ 34-pooeo got/ N� NOFATH SNogeRD PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑/Extension Denied /� �,` / 4f Extension Approved NevTE'l t 3ate: 1 (Comments: I" ® - }e Environme Health Specialist Signature: SOg0 eNy�RNN O✓q MpNTq/HP This form may be scanned and available for public view on the k;ron County Web site. Page 2 or 2