HomeMy WebLinkAboutSWG2020-00676 - SWG Application / Design - 12/29/2020 (2) a: MASON COUNTY 415N6THELTON:STREET,SHELTO70,EXT400
$B ELTON:360-42T-96]Q EXT 400
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:360-482-5269, EXT 400
- _ FAX:360-427-7787
On-Site Sewage System Permit: SWG2020-00676
APPLICANT Nick Costello Phone: 253-293-4943
Address: 6223 Mount Tacoma Dr SW LAKEWOOD, WA 98499
OWNER COSTELLO PACIFIC LLC Phone: 253-293-4943
Address: 6223 MOUNT TACOMA DR SW LAKEWOOD, WA 98499
SEPTIC DESIGNER FRANK MARCINKO -Allied Septic Phone: 360-801-0147
Design and Excavating
Address: 5677 Minnig LN NW SEABECK,WA 98380
Site Address: 3110 E Rasor Rd W
Primary Parcel Number: 222137890074
Permit Description: New five bed SFR-gravity trench with waiver
Permit Submitted Date: 12/29/2020
Permit Issued Date: 01/20/2021
Issued By: Luke Cencula
Current Permit Fees Paid: $625.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/07/2026 (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 (16') and downslope (15') 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 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF 055.
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.govlhealthlenvironmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
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A MASON COUNTY 415 NSHELTON: 360-427-9670 EXT.4 0
___--= Public Health & Human Services BELFAIR 360-275-4467, EXT.400
1[ ±GU APPLICATION FOR EXTENSION %/ %
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JAR 0 3Z�_ Amount Paid: l(QO �0 F 2y �.
RECEIVED Receipt Number: __ gt_3- %6333 - �0eo, �`,/.
Instructions: Applicant to complete Parts 1 and 2 and septic designer/engineer to Ldni leteC/
Part 3. Submit application with extension permit fee. Make check payable to Mason Co
Treasurer. Staff will review your application and determine if the extension can be approv
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: Nick Costello Phone: (253) 293-4943
Mailing Address of Applicant: 6223 Mount Tacoma Dr SW
City: Lakewood State: WA Zip: 98499
12-digit Tax Parcel Number: 22213-78-90074
Site Address: 3110 E Rasor Rd West, Belfair, WA 98528
Permit Number: SWG 2020-00676
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
Several construction delays that began with covid. Manufactured home is scheduled
to arrive in March. Lot purchased with less than 2 years remaining on septic permit.
This form may be scanned and available for public view on the Mason County Web site.
Page 1 of 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.
_ _ - -' — — —
Designer/E ' .11 Stamp-
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Signature of Designer/Engineer Date 11
20103609
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LICENSED DESIGNER 1
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Comments/Conditions:�/
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PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied 7
e Extension Approved New Expiration Date: I / T2/ 2 01 D
Comments: ^
Environmental Health Specialist Signature: „1 ppfr®freo
4dasovcoONryAN 03 2024
This form may be scanned and available for public view on the Mason Cosi#414ttsite.
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