HomeMy WebLinkAboutSWG2020-00491 - SWG Application / Design - 9/23/2020 (2) MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 400 98
SHELTON:360 427-9679670 EXT 400
BELFAIR:360-275-4467, EXT 400
1.4 Public Health & Human Services ELMA:360-482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2020-00491
APPLICANT TAYLOR WINTERWOOD LLC Phone:
Address: 2704 PARKWAY DR UNIVERSITY PLACE, WA 98466
OWNER TAYLOR WINTERWOOD LLC Phone:
Address: 2704 PARKWAY DR UNIVERSITY PLACE, WA 98466
SEPTIC DESIGNER MIKE JERKOVICH- Harborstone Phone: 253-514-0958
Consulting LLC
Address: PO BOX 296 GIG HARBOR, WA 98335
SEPTIC INSTALLER AARON SHUMAKER Phone: 360.509.1222
Address: PO BOX 3378 BELFAIR, WA 98528-3378
Site Address: UNKNOWN
Primary Parcel Number: 121181190170
Permit Description: New five bed- Nuwater drip
Permit Submitted Date: 09/23/2020
Permit Issued Date: 12/01/2020
Issued By: Luke Cencula
Current Permit Fees Paid: $625.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/19/2025 (based on date of inspection)
Permit Conditions:
1 Total capacity of septic tank(s) must be minimum 1,500 gallons per county regulations.
2 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
5 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
6 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
7 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.
MASON COUNTY 415 N 6T"STREET, SHELTON WA 98584
irM-
SHELTON: 360-427-9670, EXT.400
Public Health & Human Services BELFAIR: 360 275 4467, EXT. 400
/011 ,APPLICATION FOR EXTENSION
C 7,1 Amount Paid: <��
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1 'O23 Receipt Number: l�s
Instructions: Applicant to complete Parts 1 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
Name of Applicant: Sesame Land, LLC Phone: 360-271-2800
Mailing Address of Applicant: 21199 Brevik PI NW
City: Poulsbo State: WA Zip: 98370
12-digit Tax Parcel Number: 1 21 1 8-1 1-901 70
Site Address: Undeveloped Land
Permit Number: SWG 2020-00491
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
The septic design has expired prior to the system installation.
This form may be scanned and available for public view on the Mason County Web site.
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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/Engineer Stamp:
MikeJerl2ovi,ch 11/30/2023
Signature of Designer/Engineer Date - rr
g
o. 5100385
41ICHAEL D.JERKOVICH
ED DESIGNER
EXPIRES:01-19-2025
Comments/Conditions:
Dry weather install only. All tanks to be installed according to manufacturer requirements.
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
El Extension Denied
"3( Extension Approved New Expiration Date: 1 ' 1 IQ 2_,S-
Comments:
Environmental Health Specialist Signature:
This form may be scanned and available for public view on the Mason County Web site.
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