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Home My WebLink AboutSWG2022-00571 - SWG Application / Design - 11/10/2022 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 er4 .: SHELTON: 360-427-9670,EXT 400 BELFAIR: 360-275-4467,EXT 400 Public Health & Human Services ELMA: 360-482-5269, EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2022-00571 APPLICANT Alex Ackley Phone: Address: 1903 Norma Rd NE TACOMA, WA 98422 SEPTIC DESIGNER PAULA JOHNSON* Phone: 360-898-2255 Address: 171 E VUECREST DRIVE UNION, WA 98592 SEPTIC INSTALLER Aaron Shumaker-septic installer Phone: 360-509-1222 Address: PO BOX 3378 BELFAIR, WA 98528 Site Address: 2820 NE Tahuya Blacksmith Rd Primary Parcel Number: 223195000062 Permit Description: New 2bd ATU to subsurface drip with waivers Permit Submitted Date: 11/10/2022 Permit Issued Date: 03/08/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $825.00 (additional fees may be required upon installation of system). Permit Expiration Date: 12/09/2028 (based on date of inspection) 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/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. J L MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR: 360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 7 Waterproof surface barrier must be applied to concrete tank consistent with Manual of Concrete Practice ACI 515.1 R. Flexible rubber boots or compression seals meeting ASTM C 1644, or flexible couplings meeting ASTM C 1173 used for inlet and outlet connections to provide flexibility in case of tank settlement while still maintaining a watertight seal. An approved double-wall fiberglass tank may be used in lieu of a concrete tank. Concrete tank tested for water-tightness consistent with ASTM C 1227. Fiberglass tank tested for water-tightness consistent with IAPMO/ANSI Z1000-2007. 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/environmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. NMMASON COUNTY 415 N 6TH STREET, SHELTON WA 98584 , SHELTON: 360-427-9670, EXT. 400 Public Health & Human Services BELFAIR. 360-275-4467, EXT.400 APPLICATION FOR EXTENSIONf Ce, ' ,; 15 :) Amount Paid: \--" Receipt Number: Ov1-J ' 031( Instructions: Applicant to complete Parts 1 and 2 and septic designer/enginee ed e Part 3. Submit application with extension permit fee. Make check payable to Ma n 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 Specialists 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: k `§i^ `s2L Phone: ZYJ3 " 1 9-1-(0 S` Mailing Address of Applicant: ti O3 Wy. Q- L tK.)-. City: 0C LAY'- State: Zip: 9Si+U2.. 12-digit Tax Parcel Number: 223 cl - SO - 000(p.Z, Site Address: 2 L O IQ E-- .�.v`-vy e -1vs�lct'\ ( ) ' '\ Permit Number: SWG 9X2:1 (O 1 l PART 2: EXPLAIN WHY YOU NEED AN EXTENSION NITA.i0 Ok.) --- C Lk3-63‘1 V('QQ- --%1-,-S t,,) VyC6kcL, Y-k`-*,\ANik.vN) rs).s ,n c ue -A-\i,( e__ cbc:)N- .s- ^c \ .. � available for u61ic view on the Mason CountyWeb site. This form may be scanned and p 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. otP Or '' t....A.N.,, , 1 • WA I ."4.4\ t ' S `• •Af .4\ Signature of Designer/Engineer Date ��+? 5100 as /f PAULA JOY JOHNSON •'. ‘ g 7-Z4-e_.S 1 Comments/Conditions: \Z)\1\(9Q•iNS4i-CS.k_'. N- \o-t_ Ci.ack-tiL \I(S S-(AC:fk_, _ mac'. PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied 11(Extension Approved New Expiration Date: 11 -.2-,f omments: Envir ntal Health pecialist Signature: illli '--V-N, 7'2 q25 Thii fo 0 may be scanned and available for public view on the Mason County Web site. i Page 2 of 2