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Home My WebLink AboutCRT2024-00001 - CRT Loan Cert. / EH Review - 3/12/2024 415 N 6TH STREET,SHELTON,WA 96584 SHELTON 360-42]-96]O,EXT 400 MASON COUNTY BE ELMA 360 82-526➢,EXT 400 Public Health & Human Services ELMA 360 FAX 369,EXT 400 FAX 360<2]-]]6] EH REVIEW: PROPERTYITEST HOLE EVALUATION CRT2024-00001 APPLICANT BANG STEPHEN L& DESOLEE J Phone: Address: PO BOX 62 SHELTON,WA 98584 OWNER BANG STEPHEN L& DESOLEE J Phone: Address: PO BOX 62 SHELTON, WA 98584 Site Address: 30 E Pine Tree Pt Primary Parcel Number: 221321190313 Date Received: 0311212024 Date Inspected: 03/14/2024 Date Issued: 03/19/2024 Inspected By. Jeff Wilmoth Fees Paid: $366.00 Inspection Results: TEST HOLE#1 RESTRICTIVE LAYER DONE NIA TEST HOLE#1 SHORELINE SETBACK NOT TEST HOLE#1 SLOPE OBSERVED DONE TEST HOLE#1 SOIL TYPE DONE TEST HOLE#2 RESTRICTIVE LAYER NIA TEST HOLE#2 SHORELINE SETBACK NOT TEST HOLE 92 SLOPE OBSERVED DONE TEST HOLE#2 SOIL TYPE NOT TEST HOLE#3 RESTRICTIVE LAYER OBSERVED NOT TEST HOLE#3 SHORELINE SETBACK OBSERVED NOT TEST HOLE#3 SLOPE OBSERVED NOT TEST HOLE#3 SOIL TYPE OBSERVED Commentsl Summary: Test hole 1 -26"Sandy Loam to Mottling Test hole 2 -32"front 26" back SL to dry/compacted Please Note.Conditions reflect status at time of inspection and/or sampling. 6�STREET,SHELTON WA 584 MASON COUNTY 415 NSHELTON:380-427-9670 EXTT400 BELFAIR:360-276-4467, EXT.400 Public Health & Human Services ELMA:36048A2-5269, Z7 7ia APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW Permit Number Payment Information Type of Review ❑ Septic and Water $430 ALL-- Receipt N 1"([I Septic $255 Cash ❑ Cash ❑ Water $255(individual and Two Party) V�OG I Y Check yyy , ((( ❑ Group 11 INS$95,001495.01"hour beyond 1 hour) l Date of Payment ❑ Property Evaluation fee _ ❑ Resample $30 lab fee Instructions: Complete Parts 1, 2,and 3 completely and accurately. With the application form, please submit the appropriate fee and the necessary documents such as a septic system maintenance report. If the application is for a property evaluation for septic, be sure the test holes have been dug and the location is Beady marked at the site. PART I. APPLICANT AND PARCEL IDENTIFICATION Narne of Applicant Phone 20fo S S 5 Mailing Address 11ofApplicant IDt L 'L:)(".a city State LO R Zip Q 1S S 12-digit Tax Parcel No. 2213Z t l Site Address 50 '4-- (lt Brief Legal Description SR JAZIo 3(b �Tu b� U4 ul s L11 1�+� g 1 Z-7 Driving Directions �( v�( 3 —vbu�Qy�S 4g � A+ f-k b Vee- J I k tTree Cove b Page 1 of This form may be scanned and available for public view on the Mason County WebRevised 12/8rzo22 PART 2: TYPE OF REVIEW ❑ Septic System • Age of system • Age of house • Number of bedrooms • Name of last owner • Is house currently occupied? ❑YES ❑ NO • If not occupied, how long has it been vacant? ❑ Water System • Number of service connections on the water system? • If a public water system, name of system • WFI number Property Evaluation (soil logs) Property evaluations provide, in general terms,the suitability for a parcel for septic system placement. THIS DOES NOT GUARANTEE FUTURE SEPTIC SYSTEM APPROVAL. • Describe the intended use of the properly and the reason for requesting the review. 47 De,3, VODri� PART 3: PLOT PLAN Use the space below to draw a detailed plot plan, or attach a detailed plot plan to this application. The plot plan should tion of xisting Septic System, Property, Lude the ocalon oft ny Dnnla g Wng: North Aater Sourceson of s(wells,springs, etc.)Roads, Easements, Surface Water, and Dimensions of Buildings on the property. (skip Part 3 for Group B water system review) LOT SIZE 3 . S Acres COMPASS a Applicants Signature: Date Page 2 of 4 This form may be scanned and available for public view on the Mason County Web sit Revised 12/82022 PART 4: HEALTH DEPARTMENT FINDINGS — OFFICIAL USE ONLY Septic System Yes No The septic system was inspected by an appropriate maintenance provider and the submitted report ❑ ❑ is current. ❑ ❑ Records for this property contain a septic permit, design, final approval and as as-built drawing. ❑ ❑ The site was inspected and the system location appears to be consistent with recorded documents. ❑ ❑ The area of the on-site system appears to be maintained in an acceptable manner. ❑ ❑ Was Operation and Maintenance a condition of permit approval? ❑ ❑ Is a copy of a current Operation and Maintenance report attached? Water System Yes No Individual Water System A water sample was taken by Public Health staff.Total colifonn bacteria were determined to be ❑ ❑ absent. Laboratory results are attached to this report. ❑ ❑ The well cap was inspected.The sanitary seal appears satisfactory. The well casing was inspected. The casing projected above ground and the ground sloped away ❑ ❑ from the casing. The well site was inspected. No septic systems, chemical storage facilities, manure pile, animal ❑ ❑ feedlots or other obvious sources of contamination appeared within a 100-foot radius of the well. Yes No Public Water System ❑ ❑ Records indicate water-sampling requirements are being satisfied. ❑ ❑ Records indicate the Water Facility Inventory form is current. ❑ ❑ Department files contain water system design and letter of approval. Soil Conditions Test Hole#1 Test Hole#2 Te4- R ole#3 I' ( ou.k Soil Type: SC--J% (01( e: Soil Type: �� ,.,yJ. Restrictive layer. / n o"°� Restrictive la s G di otive layer.Slope: Slope:Distance to Shoreline: Distance to Shoreline-. ce to Shoreline: Page 3 of 4 This form may be scanned and available for public view on the Mason County Web site.Revised 12l8/2022 PART 5: HEALTH DEPARTMENT OBSERVATIONS — FOR OFFICIAL USE ONLY Primary Drainfield Yes No The system appears to be functioning adequately at the time of the inspection. (Only applicable if ❑ ❑ system has been in use on a regular basis for the last 6 months.) ❑ ❑ Sanitary survey? ❑ Pass ❑ Fail ❑ Suspect ❑ Not applicable Water System Yes No The water source consists of an individual (or a two-party)well that appears to be a satisfactory source of potable water for a single-family(or two single family) residence(s). The water was ❑ ❑ sampled and ooliform bacteria were absent. The water source is a public water system that appears to be in compliance with applicable ❑ ❑ regulations. ❑ ❑ Well Construction Permit ❑ Pass [] Fail PART 6: Comments Inspector Date Important Notice: Findings&determinations of this review reflect observed conditions as they exist on the day the evaluation was performed.Absolutely no claim is made by this office, expressed or implied concerning the future success, failure or permit approval of the system and site evaluated. Page 4 of 4 This form may be scanned and available for public view on the Mason County Web site. Revised tzitnozz