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0 <br />4PQ SNOHOMISH Application For An On -site Sewage System Permit <br />HEALTH DISTRICT pp �ication 9 Y <br />WWW.SNOHD.ORG Supplemental Information Report <br />The following information concerns an on -site sewage disposal system application approval. If you have <br />any questions, please call the Snohomish Health District (Health District) at 425.339.5250. <br />This approval is limited to a Health District determination as to compliance with Health District and <br />Washington State regulations applicable to on -site systems. The Health District makes no <br />representations/determinations as to full compliance with other land use/disturbance regulations <br />including, but not limited to, the Indian Graves and Records Act (Chapter 27.44 RCW), the <br />Archeological Resources Protection Act (Chapter 27.53 RCW), or the necessity for compliance with any <br />other regulatory entity's regulations relative thereto. <br />• An application approval is not a permit for installation of the on -site sewage disposal system. <br />• As a precaution, the soil in the designated drainfield and reserve areas should remain <br />undisturbed. <br />• Application approvals are contingent upon placement of the proposed structure as shown on the <br />approved on -site sewage disposal system plot plan and design (attached). Contact your <br />designer if changes or revisions are contemplated. All revisions are subject to review and <br />approval by the Health District, and payment of fee when applicable. <br />• Upon expiration an approved application may be renewed for an additional two year period. <br />This requires designer or engineer submittal of a renewal application and payment of fee, and <br />review and approval by the Health District. (Renewal must be received within 30 days from the <br />date of expiration). Applications that are renewed and revised are subject to both fees. Expired <br />application approvals require designer or engineer submittal of a new application and payment <br />of fee. <br />• Prior to issuance of your building permit and on -site sewage disposal permit, your proposed <br />source of drinking water may be subject to Health District requirements and the requirements of <br />RCW 19.27.097 regarding demonstration of an adequate and potable water supply (see <br />attached GMA Memo for details). <br />• Prior to permit issuance a pre -construction conference between designer/engineer, certified <br />installer and the Health District will be held at which time agreement will be made concerning: <br />1. Adherence to construction plan details. <br />2. Supervision by designer/engineer on site. <br />3. Installation during dry weather and soil conditions. <br />4. With the exception of the dispersal component, entire system is to be constructed and <br />installed in such a manner as to be watertight. <br />5. Pressure testing of the distribution system with all holes up and unobstructed (when <br />applicable). <br />6. Adherence to design; allowing changes to be made only with prior written submittal to, <br />and approval by, the Health District. <br />-more- <br />Environmental Health Division <br />3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 0 fax: 425.339.5254 0 tel:425.339.5250 <br />