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HomeMy WebLinkAboutSWG2021-00333 APPLICATION FOR EXTENSION - SWG Application - 6/7/2021 rei41 .:• MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON: ,S 42 TON, ,EXT 400 584 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2021-00333 APPLICANT Dahill Dozhuk Phone: 253-709-6709 Address: 20213 71st St E SUMNER, WA 98391 APPLICANT NTS CONSTRUCTION LLC Phone: 206.651.6645 Address: 4317 S 347TH ST AUBURN, WA 98001 OWNER PIKE ET UX JAMES Phone: Address: JESSICA LEE NORMANDY PARK, WA 98166 SEPTIC DESIGNER PAULA JOHNSON* Phone: 360-898-2255 Address: 171 E VUECREST DRIVE UNION, WA 98592 SEPTIC INSTALLER MASON COUNTY EXCAVATING INC Phone: Address: 30 E WILLCHAR BLVD SHELTON, WA 98584 Site Address: 31 E Rhododendron Ct Primary Parcel Number: 321095000085 Permit Description: New SFR -2BR Nuwater+SSD with permit extension Permit Submitted Date: 06/07/2021 Permit Issued Date: 06/28/2021 Issued By: Jeff Wilmoth Current Permit Fees Paid: $640.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/07/2026 (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 Drain field 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. CH MASON COUNTY 415NSHELTONE 60-427-90 0 EXT.400 J�. Public Health & Human Services BELFAIR: 360-275-4467. EXT.400 -�- APPLICATION FOR EXTENSION p©MIIVir Amount Paid: 1,1-U 5 M AUG 2 6 2025 Receipt Number: ----___-_ 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 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: DIN 1J 1 S L 1 0 z.i--U K Phone: (2'5 3)-1 01 ' (S 1 0 1 Mailing Address of Applicant: 202 13 -7 1S' ST t=City: SoN N1=j State: W Zip: CiDD 3 !q 12-digit Tax Parcel Number:32109' SO-- DOBG Site Address: 31 1�1-f0DODENDg.ON t.3tCt-\ ) LC - ge5ct Permit Number: SWG 21)21 — ep-S -A PART 2: EXPLAIN WHY YOU NEED AN EXTENSION N? -c S rloRE TIME 'TV ih13[P LL SE PT1c 1Ai1D ELO P L ET. This form may be scanned and available for public view on the Mason County Web site. 7 ago` c'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. _ _ r S o — `tft s Star:.: Pr Signature of Designer/Engineer Date .f 51CJ349 =: •C;� PAULA JOY:OHNSON •. k.,s •tic ;✓• Ug4•P4VI** Comments/Conditions: PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) �jgsO 406' 0 'CO 29 El Extension Denied New Expiration Date: Extension Approvedp 6/7/4,34.,::: Co)8(mments: „,,,, ,fix, Environmental He pecialist Signature: This form m y be scanned and available for public view on the Mason County Web site. 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