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Home My WebLink AboutSWG2020-00676 - SWG Application / Design - 12/29/2020 (3) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 BELFAIR:360-275-4467,EXT 400 ry ' 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 Drainfield 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 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. _514/6/ 2010 -006' n. MASON COUNTY 415 N 6TH STREET, SHELTON WA 98584 SHELTON: 360-427-9670, EXT.400 Public Health & Human Services BELFAIR: 360-275-4467, EXT. 400 �G.i APPLICATION FOR EXTENSION wSJ, �AN Amount Paid: I l�D 2 `,e :1 NsReceipt Number: /i01S. QGjg3 ' Instructions: Applicant to complete Parts 1 and 2 and septic designer/engineer to c. '� •lete D 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 approve . 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 invalic • 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. r.r Designer/E.f r,,_ft Stanir) t /.,°* c.. // iir i� / �e,23 i tin Signature of Designer/Engineer Date t't 1, 20100609 0.41/ 0 Frank A.Marcinko LICENSED DESIGNER t „ram .�7a-# Comments/Conditions: /1,7,11//j/ d '/ fir" tv at -/-14 J� 1/L ✓r' y'4,4,t_ /S � y / /ti 9 � �- a t n o t GDGF eat a? e f/9,t.cr i t re-p r4 /0 eo /kk s- re-zofJo/19/1-s/ri', -,2 •..0r Me ,N. PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) 0 Extension Denied t( Extension Approved New Expiration Date: ` / ?/ 2 d 16j Comments: APp �o V Environmental Health Specialist Signature: 'MEN°3 �® MASON CO�N ry 2024 This form may be scanned and available for public view on the Mason Co*W tte. HE-4/rH Page 2 of 2