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Home My WebLink AboutSWG2021-00085 - SWG Application / Design - 2/17/2021 (2) 415 NTH STREET, SHEON, A98584MASON COUNTY SH LTOW 0427-97 ,EXT400 BELFAIR:360-275 67,EXT 400 Public Health & Human Services ELMA:360482-5269,EXT 400 FAX W0427-7787 On-Site Sewage System Permit: SWG2021-00085 APPLICANT BANKS ANDERS&MEGAN Phone: 253-590-3386 Address: 1900 BLACK LAKE BLVD SW APT CC7 OLYMPIA, WA 98512 OWNER BANKS ANDERS &MEGAN Phone: 253-590-3386 Address: 1900 BLACK LAKE BLVD SW APT CC7 OLYMPIA, WA 98512 SEPTIC DESIGNER Lawrence Purdum-Apex Septic Design Phone: 253-609-9922 Address: PO Box 801 GIG HARBOR, WA 98335 Site Address: UNKNOWN Primary Parcel Number: 320233490064 Permit Description: New two bdrm-glendon Permit Submitted Date: 02117/2021 Permit Issued Date: 0310812021 Issued By: Luke Cencula Current Permit Fees Paid: $640.00 (addnional fees may ee required upon InotalloWn of sysrem). Permit Expiration Date: 02126/2026 (basedoodaledinapetlion) 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 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 backfilf of system components. 6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 7 If 1,200 gal pump tank installed, two risers to grade required per county standards. THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OS& 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/environmentaVonsiteloss-inspection4squest.php or call: 360-427-9670,extension 400. MASONCOUNTY 415 N6'"STREET, SHELTON WA 96584 SHELTON:360427-9670, EXT,400 Public Health & Human Services BELFAIR:360-275-4467, EXT, 400 APPLICATION FOR EXTENSION F DAmountPaid: 1( 5 2 2024 Receipt Number: By 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: Megan Banks Phone: Mailing Address of Applicant: 1900 Black Lake Blvd SW,Apt CC7 City: Olympia State: WA Zip: 98512 12-digit Tax Parcel Number: 32023-34.90064 Site Address: Unassigned Permit Number: SWG 2021-00085 PART 2: EXPLAIN WHY YOU NEED AN EXTENSION 4designer, Jim Henry, Has refired. Per Rhonda Thompson, a design extension and change 0 signerwi elf ealfowed. This form maybe 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. 9/9/2024 I Signature of Designer/Engineer Date I I I s,aoam ' ;;lyK�g M.PulduR ' IICEN9ED DE810 �R Comments/Conditions: — _�rtM��t, —On 9 September2024 I made a site visit to APN 32023-34-90064 at SE Mallard Beach Ln to assess site/soil conditions shown on the approved design of SWG2021-00085. Site and soil conditions appear commensurate with those indicated on the approved septic design of 8 March 2021. a� PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied �,( 7 (� I xtension Approved New Expiration Date: �' 1 ' Cbmments: Environmental Health Specialist Signature: This formmay be be scanned for public view on the Mason County Web site. Page 2 of 2 6 September 2024 Mason County Public Health 416 N 6th Street Shelton, Washington, 98584 Subject: Change of septic designer, SWG2021-00085,APN 32023-34-90064, BE Mallard Beach Ln, To Whom It May Concern: I am requesting a change of septic designer for SWG2021-00085,APN 32023-34-90064, BE Mallard Beach Ln. The septic designer of the approved septic design, Jim Henry (Lie No 5100121), has retired. Lawrence Purdum/Apex Septic Design, LLC(Lie No 5100383)has agreed to take over design renewal, final inspection, and asbuilt/record drawing responsibilities. Sincerely, Megan Banks Property owner ®APE SEPTIC DESIGN, LLC PO Ban 801,Og Horbor,WA 98385 253.509.8822 9 September 2024 Mason County Public Health 415 N 6th Street Shelton,Washington, 98584 Subject: Soil/site conditions, Parcel Number 32023-34-90064,SE Mallard Beach Lane To Whom It May Concern: On 9 September 2024 1 made a site visit to the aforementioned property to assess the soil/site conditions in the primary drainfield area as shown on the OSS design submitted to MCPH on 12 Feb 2021, and approved on 8 March 2021 under SWG2021-00085. Site and soil conditions have not changed from those indicated on the original design. Soil logs have been backfilled. Please let me know if you have any questions regarding this assessment. Sincerely, LA.6-'--- Lawrence Purdum Apex Septic Design, LLC