HomeMy WebLinkAboutSWG2023-00179 - SWG Application / Design - 5/9/2023 (2) y MASON 1�, COUNTY 415 N 6TH STREET,SHELTON,WA 98584
• SHELTON:360-427-9670,EXT 400
ifl, 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: SWG2023-00179
APPLICANT NUNN MICHAEL L& HAYLEY N Phone:
Address: 1515 DOCK ST, UNIT 402 TACOMA, WA 98402
OWNER NUNN MICHAEL L& HAYLEY N Phone:
Address: 1515 DOCK ST, UNIT 402 TACOMA, WA 98402
SEWAGE DESIGNER PAULA JOHNSON* Phone: 360-898-2255
Address: 171 E VUECREST DRIVE UNION, WA 98592
Site Address: 230 E BLACKBERRY LN
Primary Parcel Number: 321045900030
Permit Description: New 2bd ATU to pressure trench with permit expiration extension
Permit Submitted Date: 05/09/2023
Permit Issued Date: 05/11/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $695.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/10/2028 (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.
7 Property owner to comply with all requirements in Geotechnical report. Report to be
submitted with future building permit application.
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.
-, A.
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R � � 415 N 6TH STREET, SHELTON WA 98584
'ffiTtSHELTON:360-427-9670, EXT.400
Public Health & Human Services BELFAIR: 360-275-4467, EXT.400
APPLICATION FOR EXTENSION TCriir
Amount Paid: o '!
�� MAR (16 2026 -!
Receipt Number: a0_ i _Ot 13 '"
`Bv
Instructions: Applicant to complete Parts 1 and 2 and septic designer/en f
permit fee. Make check payable to Mason County--
Treasurer. J
Part 3. Submit application with extension p y
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: \\K-t-cikA4Lat, 4 VkQ ' I i(A)AY\.Phone: 2-53-(011
Mailing Address of Applicant: L S l S DD c.K &f.. 1��,'' ' 40 2-
City: a 01/4•OO01\k,. State: (1J - Zip: Q t't 2_
12-digit Tax Parcel Number: 32- 1004 59 - o e'o C
Site Address: 2-&° L ✓1
Permit Number: SWG 2023 - 00 1.-11
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
This form may be scanned and available for public view on the Mason County Web site.
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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.
Designer/ ,igi er Stamp:
Signature of Designer/Engineer Date PAULA JOY JOHNSON.:: )\
Q..'tafS8 'ri gitN " z
1s/
3-(-up
Comments/Conditions:
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied
C�' Extension Approved New Expiration Date: 0_5710(20 Z
Comments:
Environmental He th pecialist Signature: 1=' e
MAR
M4soN,„ UNTY 9 2026
This form may be scanned and available for public view on the Masg illgeb site.
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