HomeMy WebLinkAboutLand Use Evaluation - CRT Application - 3/12/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES
POST 017A CE BOX 1666
SHELT , WA 98584
( 06) 427-9670
APPLICATION FOR LAND USE EVALUATION AX 42 7-7798
(
Receipt No: sq / Date of Payment:
INSTRUCTIONS 5P _
j 1. An application is considered complete when the fee is paid and the following elements have been addressed:
• Parts 1 and 2 of the application form must be completed.
• One properly excavated backhoe pit per proposed parcel oust be ready for inspection. Properl excavated pits
are 6 ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must slope tq to the ground
surface for easy ingress and egress.
• A scaled plot plan must be attached to the application. The scaled plot plan oust show the precise location
of the test holes, dimensions of the property, and location of any existing or proposed wells, roads, or
buildings within 100 ft of the property boundaries.
2. After a completed application is received, staff will inspect the property and provide the applicant with a
written report.
IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, HE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY
DELINEATED AS TO LOT AND TEST HOLE NUMGER. THE IDENTIFIED TEST HOLES MUST HATCH THE LOCATIONS SH06M ON THE
PROPOSED PLAT NAP.
PART 1: APPLICANT/PARCEL IDENTIFICATION
EiLarge Lot Subdivision EX] Short Plat Subdivision BLA (Of ice Review)
$100 + $10/parcel $85 $400 + $20/lot $10
• NAME OF APPLICANT Stephen W. Stermolle TELEPHONE 360 275-
• MAILING ADDRESS P.O. Box 274
Belfair, WA 98528
i y state ZIP
• 'ASSESSOR'S PARCEL NUMBER 1 2 3 3 1 2 3 9 0 0 5 0
• LEGAL PROPERTY DESCRIPTION Lot C of Short Plat Number 490, Per AFN 358021
• LOT SIZES (ACRES OR SQ FT) 79,138 13,049 12,929
- -Bar-r— �
• DIRECTIONS FOR LOCATING SITE From intersection of Larson Lake Road and SR 300
Northeasterly approx. 5/8 mile on Larson Lake Road to property on Southeasterly
side of road.
PART 2: INTENDED USE OF PARCEL
• INTENDED USE OF PROPERTY (Check One) :
Single family residence Multi-family residence
El Other, specify:
WATER SOURCE FOR PARCELS (Check One) :
LJ Individual wells U Community well
H:\ON-SITE\LNDUSE.0 Revi ed 12/05/94
� iand se Eva]uaei on
PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
SOIL LOGS AND SITE CHARACTERISTICS /1
LOT # I LOT # I LOT k 3— f d� I LOT a ✓� �� I
Test Pit A I Test Pit A I Test Pit A I Test Pit
1
I I q I y
1 I ^•3�� �(*ft 6-2YJ n—*,'1 1. I Q r r►l I
rn�
l0 /mod. I ` ,7d
I 1
I Depth of root pen.: _ I Depth of root pen.: ,]�G I Depth of root pen.: I Depth of mot pen.:
Depth of mottling: _ I Depth of mottling: �i// I Depth of mottling: I Depth of ttling:
Depth to rest. layer: _ I Depth to rest. layer: I Depth to rest. layer: I Depth to rest. Layer: I
I Soil type (USDA): I Soil type (USDA): _ I Soil type (USDA): _ I Soil type (USDA):
Test Pit 8 I Test Pit B I Test Pit B I Test Pit
I
I I I &aA
1 I I I e
rE
I Depth of root pen.: _ I Depth of root pen.: I Depth of root pen.: _ I Depth r t pen.: I
Depth of mottling: I Depth of mottling: I Depth of mottling: I Depth of ttling: I 1
I Depth to rest. layer: _ I Depth to rest. layer: I Depth to rest. layer: I Depth to rest. layer: I
Soft type (USDA): I Soil type (USDA): _°� I Soil type (USDA): I Soil type USDA): —
( Curtain drain needed? _ I Curtain drain needed? .LI[— I Curtain drain needed? _[IL. I Curtain dr in I
Slope (%): i Slope Me i Slope M: eML j slope (%):
I.Shoretine? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (YIN):C�
A Minimua let si ze: i Nininmm lot size:A i Minimum lot size:A �I Minimum to size:
A I 1'�T� I I
A Minimum tot size applies to new subdivisions and is defined as the minimum allowable land area pe residence or residen-
tial equivalent (450 gallons per day).
COMMENTS n Obcewlton ;
ASS
H:\ON-SITE\L USE.w Rev sad 12105194
Land Use Evaluation
PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE)
A
d MEETS HEALTH CODE
After examining lot size, proposed water source, and soil type, t is the de-
termination of Mason County Department of Health Services that ach proposed
parcel can support an on-site sewage disposal system meeting the requirements
of state and local regulations.
DOES NOT MEET HEALTH CODE -
After examining lot size, proposed water source, and soil type, It is the de-
termination of Mason County Department of Health Services that each proposed
parcel cannot support an on-site sewage disposal system meeting the require-
ments of state and local regulations.
This determination is based on consideration of the following factor(s) :
c
AJAR-
Y
HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN BY APPLICANT
After examining lot size, proposed water source, and soil type, i is the de-
termination of Mason County Department of Health Services that a ich proposed
parcel cannot support an on-site sewage disposal system meeting he require-
mentg of state and local regu ation until th ollowing condit' n are met:
cry
n
L_1 Condition(c) required prior to approval have been set by the applicant.
Health Official Date
PART 5: REVIEWER SIGNATURE
oz��� ,
Health Of 'cial Datfa
N:\ON-SITEILNDUSE.W Revi ed 121o5199 p
F
, : MRSON COUNTY
f�PR-08='�fL.M4N_3�.1 ._.1.A_DOH SW DRIWING H2O TEL N0:360 664-8058 #654 P02
WSDOH-SOUTHWEST REGIONAL DRINKING WATER OPERATION'; FORM S
SUBDIVISION ADEQUACY REWONSE FORM
Phone: (360) 664-0769 FAX: (360) 66WSS
RESPONSE FROM WSDOH TO LOCAL JURISDICTION
The purpose of this form is to provide information to focal jurisdictions for evaluating of adequacy
of public water supplies supplying proposed subdivisions. The information provided lowin provides
guidance to officials to determine whether appropriate provisions have been made for potable water
supplies.
Response Date: 4-8-96 DOH Reviewed By: toall Orr
System Name: Rainier View _ ID #: 26649
System Type; NEW: EXPANDING: X
"PRELEMINARY PLAT ADEQUACY" (Preliminary Plat water system adequacy det rudnation)
ADEQUACY: ADEQUATE INADEQUATE
"FINAL PLAT ADEQUACY" Mnal Plat Water System Adequacy Determination)
ADEQUACY: ADEQUATE INADEQUATE
i
i
NOTES/REASONS:
According to DOR records- Rainier View Water District is a a[= B By= v
The
1L incorrect for the R on a is
unable r thl
Mason CaM.
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• rJ Right 1'e—It I<e. AAD0<7
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¢ahod: ROTARY 1 at0 east o of ntr nor t.c 1n cacf st racm, Y.a:
_____________________________________________V__________________1 at )test one entry for each ehacec .n forma
i
<S) DIY.=V5107:5: Duster Of ..<)I f Irchcs - t!c
Drilled 1)[ it. u ch of c -_._
p -------- cll lJ6 ft. � I'.;.7FRIAL __
____________-___________________-+_._____________________.._____.+ HRONIt Q.AY c C7UVffi. � :nCr.
(6) CONSfRUCrIo1: DETAILS: I CRAP CL>Y c G7UVXI. ' 0 ( 1
Casing inacalled: a • Dig. from .1 ft. to 136 ft. I GRAY CLAY 11 I 1
rIIAIDJ • Dig. from ft. to ft. I eR01ot CMAY. I 16 I I
i • Dig. from it. to ft. I CRAY Q.AY 121.5 1 ]
1T1 I ]
----------------------------------------------------------- HAOtQt 1'JRD PAX
- Perforations: m 123 I r
GRAY GRAD DAN
SIZE of perforator used I CRAP C7.11Y I 25 I ]
SIZE of perforations 1 21 {-
� Sn. by in. I DAO102 CLAY I
1 <] I <-
p<rfOratlOns from ft_ CO Lt. I BROW 81AD PAH I lS I S:
perforations from ft. to ft. I HZI.VIHO WMY SA:iD 1 S2 ( a:
—perforations_fDpA____ t. to ft. I HARD CRAY CLXY I a4 17:
_ _____________________________cl GRAY Q.AY ( 71 I ]r
Sercetus rr3
INnufaetucer-a Name HOOSTON I BARDD YCRA QdY 1 76 1 a,
Type aL Twz:n model NO. I HROKK !ur a00 I $0.5 I 6:
Dim. a .lot A1u .024 from 33a ft. ro 133 ft. - 1 as 1 a•
Dram. ,lot nice from ft. to ft. 1 HARD HAOW FXXT BOO 1 a6 13-
___ _ 11<.s I r
. .____�_�_____-__-_________________�________________I BRAD GRAY CLAY
Gravel packed:-no 117 I !'
♦ 512< of gravel I HROIat CLAY ( 1 Gravel plat:-- from ft. to LC. I GRAY a 91 1,
ar i GRAVEL ( ZOO .I 11
_
«---«--------------—2___________ «--------------------I HARD CRAY < dy
SurfaceMte ,east ed To chat d 1209 ( 11
-depth? 7a ft. ( CN.Y CLAY CRIWa.
Dist "al tired in seal %snumable 1101 I 1:
I >Sf.A4 6Alm CAAYIO. 4 10.TDt
Did say seraea Contain unusable vaCEYl Ito I i 11! 11•
ft.
of %stcz�2
Iiet.)iod of seal Depth of rtrata I
sealing strata off
(7) POWs Name
Type R.P. 1 I I
taI NA1tR LEVEfd1 Land_ «-•«-«I surtax elfwaeifln
above mcaa sea level ... ft. 1 I Static level 314 it- belov tOp Of Well Date 47/2a/23 I .
ALClB1an.Preeaure Use. per sfivara fsteh Date I I I
ArteBian weer oont:ollaq by ( ( I
I Boric started 07/24/33 feted 47/24/23
(fl =M TES1i1 D mwdom it amotmt Water level is tottered baler ( UM;M;2ROCDOR CER271'ZGiTONi
at:atic laver. I Z constructed and/or
3tas a puap teat aWe7 ll0 St yes• by Naea7 li and
ibi sacs for onn-
liasdi gas•/mist With tt. dmidom attar hta• 1 washieiaa at this well. Bad its teriWitt an
• I wahilgtaa rail emBeraGeim ttateri.ala rse(
1 sad the lstfornatiost reported are trnn to uV beat
Reeaver'1'data I knowledge and belief.
Time weer Level Time rater Level Tiafe 'wear Level I JUM Dp.464M 32M.
1 (Person( firs, cr corporaticts) Hype or print)
I I Date ADDRESS of EeeC / /
Sailer teat yal/mist. ft. draWera steer brr. 1 (SZ1S✓ID1 cease Ian. 2053
'Air teat 37 'gal/aln. r/ stem Bet at 22a ft. for 1 bra.l
Artesian flow g.p.m. Date I Contractor',
Tesperature of ester we a ahemloel aoalyaiB made? NO I Registration No. Date 07/27/93
.J`.MASON COUNTY
APR-0 '96 MON 15:14 ID:DW SW'DRIWIM HmFM
�..
/PWSROIPI PWSOOIMI D W A I N
REVIEW A PWS 04/08/96
14:33
SYSTEM IDS 649 W COUNTY: MASON UPDATE:
GROUP YPE: WRIA: 15 POP RENEWAL QTR: NOT UPDATED
EFFECTIVE DATES 01 1985 INACTIVE DATE: —
GRP ACTIVE DATE: 02 01 1985
SYSTEM NAMES RAINIER VIEW WATER DISTRICT
STREET ADDRESSs PO 591 NE 550 LARSON IN RD.
P.O.BOX:
CITY: BELFAIR STATE: WA ZIP: 98528
OWNER NUMBER: 010882 SMA IDS
CONTACT: HARRY M. SNAVER
TITLE:
DAY PHONE: 360 275 5818 EVENING PHONE:
OWNERSHIP: PP GROUP OWNERSHIP:
CHARACTERISTIC: R —
PRINT WFI Y
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