HomeMy WebLinkAboutSWG2023-00288 - SWG Application / Design - 7/6/2023 (2) MASON ill COUNTY
415 N 6TH STREET,SHELT E 98584
SHELTON:360-427-9670,EXT 400
f. 'yr BELFAIR:360-275-4467,EXT 400
'` .1-"`r't/ Public Health & Human Services ELMA:360-482-5269,EXT 400
,..W-"' FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00288
APPLICANT MINNICH TODD MATTHEW&SONA Phone:
TAMAZIAN
Address: 40 N TRITON HEAD DR LILLIWAUP, WA 98555
OWNER MINNICH TODD MATTHEW&SONA Phone:
TAMAZIAN
Address: 40 N TRITON HEAD DR LILLIWAUP, WA 98555
SEPTIC DESIGNER Tim Quayle-Quayle Septic Designs Phone: 360-440-4249
Address: 140 Maple Ln PORT LUDLOW, WA 98365
Site Address: 40 N Triton Head Dr
Primary Parcel Number: 224065000007
Permit Description: Table IX Repair-2BR Nuwater
Permit Submitted Date: 07/06/2023
Permit Issued Date: 08/04/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $695.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/30/2026 (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 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
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
7 Applicant must address issues with plumbing fixtures in shed prior to final approval of
septic system.
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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
oryer,L) MASON COUNTY 415 N 6TH STREET, SHELTON WA 98584
SHELT0N: 360-427-9670, EXT.400
Public Health & Human Services BELFAIR:360-275-4467, EXT.400
APPLICATION FOR EXTENSION p M (MME `�'2r
Amount Paid: 170.00 l: v 2 5 Lt .LJ
Receipt Number: R,(0 `D146
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 year from the signature date of the Environmental Health Specialist's
site inspection{Pe :1NAC 24-272A-200(4)(e)}
All approved septic`de'signs may receive one extension. Additional extensions shall not be
accepted and would ifistead require a renewal.
PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: Michael McCowan - owner Phone:Realtor Israel Jimenez 360-269-2083
Mailing Address of Applicant: 444 SE Carlesta Ave.
City: Chelalis State: WA Zip: 98532
12-digit Tax Parcel Number: 224065000007
Site Address: 40 N. Triton Head Dr. , Lilliwaup
Permit Number: SWG 2023-00288
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION
The new system was never installed. The repair design expired 7/17/2024.
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.
01,
Designer gin-11 Stamp:
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Signature of Designer/Engineer Date f F I
LICENSED DESIGNER le
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Comments/Conditions:
A site visit was performed on 2-3-26. The storage bldg has a kitchen sink and toilet inside that is not
connected at this time. These items were not approved on the original septic repair design. It was listed as
a shed with no plumbing. Adding plumbing would require a building permit and a possible septic re-
design. It appears that it may not be able to gravity over to the septic tank and might require a separate
sewage pump system. No additional bedrooms could ever be permitted as there is not room on this lot.
There is also no reserve drainficid area.
PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only)
O Extension Denied /
Extension Approved New Expiration Date: A/o V. '?V/ Z C'2-(
Co ments: s ,•j. ,.+� to ofd f' 4. G v (A4,0e✓k �Ac,
Environmental Health Specialist Signatt re: L.7
(71
This form ay be scanned and available for public view on the Mason County Web site.
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