HomeMy WebLinkAboutAPPLICATION FOR EXTENSION-SWG2023-00348 - SWG Application - 9/9/2026 MASON COUNTY 5N6THELTON , 0427-9N ,EXT 404
SHELTON:360-027-9670,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: SWG2023-00348
APPLICANT DRYER CHRISTOPHER A Phone: 715-661-1628
Address: 961 NE TAHUYA RIVER RD TAHUYA, WA 98588
OWNER DRYER CHRISTOPHER A Phone: 715-661-1628
Address: 961 NE TAHUYA RIVER RD TAHUYA, WA 98588
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 windflower pl nw Seebeck,WA 98380
Site Address: 961 NE Tahuya River Rd
Primary Parcel Number: 322127500100
Permit Description: New SFR 3-bedroom gravity system with permit expiration extension
Permit Submitted Date: 08/21/2023
Permil Issued Date: 09112/2023
Issued By: David Anderson
Current Permit Fees Paid: $695.00 (additional fees may 6e requred upon installation of system).
Permit Expiration Date: 08/23/2028 (based on data ofinspeenom
Permit Conditions:
I 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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670,extension 400.
MASON COUNTY 415 STREET. SHELTON WA 99584
SHELTON' 360427-9674 EXT. 400
Public Health & Human Services eeLFAiR 360-275-4467.EXT 400
APPLICATION FOR EXTENSION
Amount Paid. P f 7Q SEP `,'. 7
026 1:
Instructions: Applicant to complete Parts 1 and 2 and septic designerlengine*4q complete
Part 3. Submit application with extension permit fee. Make check payable to Maason- tun€y-=-=_--_
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: Jason Campbell Phone: (564) 546-0742
Mailing Address of Applicant. 406 108th St S
City: Tacoma State. WA Zip.98444
12-digit Tax Parcel Number 322127500100
Site Address. 961 NE Tahuya River Rd. Tahuya WA 98588
Permit Number. SWG 2023-00348
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
Property is in building permit process for a new manufactured home
This form may be scanned and available for public view on the Mason County Web site.
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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.
Signature of D�signer/Engineer Date a/ s
L'CEU CO ilyONM �y
cvzv"" 1'iC�TSE
Comments/Conditions:
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
0 Extension Denied
Extension Approved New Expiration Date Ofl/ Z
omments:
Environme eat Specialist Signature.
Thi om+may be scanned and available for public view on the Mason County Web site.
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