The URL can be used to link to this page

Home My WebLink AboutSWG2022-00134 APPLICATION FOR EXTENSION - SWG Application - 4/3/2026 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,EXT 400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2022-00134 APPLICANT BENNETT,JOHN A&JANET L Phone: Address: 204 EUCLID AVE SHELTON,WA 98584 OWNER BENNETT, JOHN A&JANET L Phone: Address: 204 EUCLID AVE SHELTON, WA 98584 SEPTIC DESIGNER PAULA JOHNSON* - Phone: 360-898-2255 Address: 171 E VUECREST DRIVE UNION, WA 98592 Site Address: E Hiawatha Blvd Primary Parcel Number: 320071490043 Permit Description: New SFR-4BR Pressure Bed Permit Submitted Date: 03/18/2022 Permit Issued Date: 04/15/2022 Issued By: Jeff Wilmoth Current Permit Fees Paid: $670.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/08/2027 (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. 1ASO N CO U NTY415 N 6TH STREET, SHELTON WA 98584 • SHELTON:360-427-9670, EXT.400 Public Health & Human Services BELFAIR:360-275-4467, EXT.400 APPLICATION FOR EXTENSION PR '3 ZQZQ , Amount Paid: A D � Receipt Number: By pplicant to complete Parts I 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 r_ Name of Applicant: J 04§x1 k 3fig lET 13 V, NN�TT Phone: ( ( O)O) 40 r 3' 8 Mailing Address of Applicant: t_a4 UC.L`D me City: S ykyL rD IJ State: VJ F\ Zip: 8584 12-digit Tax Parcel Number: 33 200-1— C4 Od bç7J Site Address: 100 E L U5 60 D�. St-kp�-c-cti , VJA i85QT Permit Number: SWG 2-ID 22- 00 ` $4 PART 2: EXPLAIN WHY YOU NEED AN EXTENSION New owner needs tee -k-;�nne +O Spat ± c This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 r , 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 )er Stamp: 4 ) Signature of Designer/Engineer Date. .10 49 PAULA JOY JOHNSON ••_ ti'� Comments/Conditions: ® = ® ® m PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) O Extension Denied fExtension Approved New Expiration Date: orriments: Environmental Health Specialist Signature: This form may be scanned and avah able for public view on the Mason County Web site. Page 2 of 2 K r r 1 � - Audio-Visual AIar :A ?toi- Piai• g Nr S£1JNET_ Clauout ga' V/A6 1� -F Jar _ C P 1200 Cz2flar weptic T2. Fr ' DR,Sly 2-Comp-tmef:with? �o p FUO�G N 5100349 ( {,, IiBLt FilterPAULA JOY J04NSUN - S C a 1'e � E Ft `�' b •• IZO0'Galoii Pump Comber EA s 9/951 0 30 40 90 !2� cP�.7x i 3Z b. 371 •ao• — i' $ s hit-- O2 • "; •e •t • • 1' -to ' / -r - u , vC7 4 3(0 ^(aO S -P- CM . 6i' dGMSCAcvoit) (oO -F AL' 59MA-flNG LMS r Well / 2 2 3 So. -r or lba-Mo�-'� • 3: fl1-t E Pv5 2- (�pprD ' 1>5 AT GUL" ,F . d` RE D c s� �r 5 � •OWr ��.�N J ��4•-h, fit.`�'6't�7�.