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Home My WebLink Aboutspl96-0148 - SPL Application - 4/29/1996 MASON C(JUNTY DEPARTIVI F NTOF IWAU141 SERVICES — 110S'1'0I'/%I ;Ii BOX IGGG SIIE1,7.0 , IVA 98584 (2I6 427-9670 1 427-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: —__ _ .— Date of Payment- : INSTRUCTIONS 1. An app(Ication is considered congplete uhen the fee is pold and the following elements have beenaddressed: • Parts 1 atd'2 of the appticntion form nest be completed. • One properly excnvnted bnckhoe pit per proposed pnrcel oust be ready for inspection. Properly excavated pits are 6 it deep with n 4 it deep shelf on ,tic crd of the fill. The 4 it deer, shelf aust slope Op to the groped surface for easy ingress myl cgr ass. . Ij L111 • A scaled plot plan nnrst be al tnt-had;to the ngpl icnlion. The sent J f e t. (t tht tt99 iFof the test holes, diornsions of tie property, O"dlocntlonofan tang or proposed wells, ror ne buildings within TOO it of file property lro(nylarics. �a(FpQ C�j 2. After a completed applicatiolt is received, staff will inspect the property end'hr'dvi�e"th� i ant with a written report.IMPORTANT: IN ORDER 10 AVUI1) ADDITIONAL COSTS, DE. SURE TEST HOLES AIR) P 6tltt-- M V4 5 DELINEATED AS 10 LOT ART) TEST TIUI.E NUMBER. THE IDENTIFIED TEST HOLES RUST 14ATC11 THE LOCATIONS SHOW Oil 111E PROPOSED PLAT RAP. PART 1: APPLICANT/PARCEL IDENTIFICATION ❑ Large Lot Subdivision 85 Plat t� $400 4ieion ❑ BL1l (Office Review) $100 .1 $10/parcel $85 u $400 �- $2o/lot $10 • NAME OF APPLICANT �C` L-�t ` C- C, �-i•- � 'TELEPHONE • MAILING ADDRESS �'C` �� (fie. •�� ` �� .' 3 •'�Q`C..)Z�J - SCaLe Zip l:il-y • 'ASSESSOR'S PARCEL NUMBER •-�- C� C-'1__ - —1 - — --- — • LEGAL PROPERTY DESCRIPTION • LOT SIZES CRES R SQ FT) E S/ —Lo�— DIRECTIONS FOR LOCIYPING SITE PART 2: INTENDED USE OF PARCEL - • I 'ENDED USE OF PROPERTY (Cfleck One) Single family residence Multi-family residence Other, specify: _ •T R SOURCE FOR PARCELS (Check OTTO ndividual welly, L Conuauuity well II:\UN-SIIE\LNOUSE.0 I1 vised 12/05/94 land Us rvaluatlon YAK'i' 3: meALTII lll.l'AK'1'nIEN'1' KEVIEVV (OFFICIAL USE ONLY) SOIL LOGS ANU SITE CHARACTERISTICS LOT a 1_ I 1.01 a -zi I Lur n .7 I LUT Of I I —I -- --t test Pit n I Test Pit n rest r Test pit n I un I Ilj-•lfs>euvfti�Aw l o-sr�s>allo�Gwt,.0 I° '`/s�tas'2u..,,,,��',rt.•C i �. �l.,.,.5'".tsAn1U(•�Wl>„lr I ) l4 i T- `S� Sd NFi k6)Keel I p.. / tq I I I I � Depth of rot en.: i p �-/ I Depth of root pen.: I p I Depth of root pen.: 11 I U">th of root en.: De mottling: _ I Depth of Witting. __ I Depth of mottling: Depth of Depth of naltling: I I Depth to rest. toyer: )1 _ I Deptlt to rest. layer: -� I Depth to rest. layer: �_ I Depth to rest. layer: _ Soil type (USDA): I Soil type (US I Solt type ( SDA): Solt type (USDA): �_ I _-1 I I I rest Pit n I felt Pit B I Test Pit B I I Test Pit B i I I I i I I I I I i I i I 1 I I I I Depth of root n.: I Depth of root pen.: 10eptlr of root pen.: __ I Depth of root pen.: _ I p I I I beryth of mottling: I Depth of rtattling: __. I Depth of rattling: — DePth Of sa lt Depth to rest. toyer: _ I Depth to rest. layer. __ _ I Depth to rest. layer: __ I th to r toyer: - Sol( type (USDA): I Solt type (USDA): I Solt type (USDA): __ I salt type USUSOA): Curtain drain needed? � I Curtain dr ain heeded) I Curtain drain needed? I Curtain dr in needed? •__ Slope M.- C I Slope (S): I Slope M, O Slope m: / I Sborel tre7 (Y/N): I Shoreline? (Y/N): �_ I Shoreline? Shoreline? Will' V I I I A I Hinirum lot size:A I Hioinun lot size: I Hinimun t t size:A _ I Hinimtm tot size: I I I I I A Hininu:n lot size applies to slew Subdivisions and is defined as the mpnimim allowable lend area 1mr residence or residen tial equivalent (450 gallons per day). COMMENTS 11:\UN-SITE\LNUDSE.w Re lead 12105194 Land Us Evaluation P7�R'1' 4: REVIIs'W SU��1n�lAKl' ((.;OnI��IUNI'1'1' 1)1l.VE1.0PAHeNT USE) MEETS HEALTH CODE After examining lot size, p1T7p`-'sed water source, and soil type, it is the de- termination of "as"" Ccnurl.y Department of Health Services that each proposed parcel can support all on-sil:e s,wag_ e disposal system meeting the requirements of state and local reguJ.ati.on.s,. d 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 caiuwt:, support: all on-si e sewage disposal system meeting he require- ments of state and local regulations. This determination is based on consideration of the following fact r(s) : 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 ch proposed parcel cannot support all en-site sewage disposal system meeting 'he require- ments of state and local regul.ati_ons until the following condition are met: *eOt ) r quired prior to approval have been nret by the eppliceat.4 cial PART 5: REVIEWER SIGNATURE h Of Date Iie t R:\UN-57]'E\LNUII.SG.If R vl sed 12/05/94 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTO , WA 98584 (3 0) 427-9670 AX 427-7798 APPLICATION FOR RE-INSPECTION - ON-SITE SEWAGE PROGRAM - DIRECTIONS 1. Complete Part 1-3 and submit to the Director of Health Services, PO Box 1666, Shelton, WA 98584. 2. The on-site lead will make a determination in Part 4 whether a re-inspection is just' ied. When a re- inspection is made, the findings of the second Environmental Health Specialist are w v0n in Part 5. A final determination by the lead is recorded in Part 6. 3. Applicants are billed $77 when a re-inspection is required, and are expected�l. y for any �ry laboratory costs associated with soil tests, unless prior arrangements are m� with t( althh� t- ment. �� CA\ 4. Findings and determinations of the lead may be appealed to the Mason�:nty Heal Off the ad- dress listed above. �0 �C \7 �O PART 1: REQUEST FOR RE-INSPECTION ^L� Applicant's Name: a-cw • Address: • Telephone: � � C) 0� �3 C7C::,0Q _ — ssessor's ParcZ' Numaer u ivision Name ana Lotu er Health Department finding being disputed by applicant: M n r-1 L_J Anticipated depth of watertable LJ Soil type/application rate U Depth or presence of mottling r� n u New drainfield area to evaluate u Other (please specify) a M.p 'S 1 6o r. PART A HORIZATIONr- �J APPLICANT DATE H:ON-SITE\RE-EVAL.W Rev'sed 01107196 PART 3: PLOT PLAN Use this space to draw a detailed plot plan, or attach one to this application. A detailed ptol plan is one that shows the precise location of the test holes, existing septic systems, dimensions of the property, ard location of any wells, roads, or other buildings on the property. PART 4: DETERMINATION OF LEAD r-, U Re-inspection is justified. r1 u Re-inspection is not justified, for the following reason(s) : On-Site Lead Date H:ON-SITE\RE-E AL.W Re 'sed 02/07/96 PART 5: RE-INSPECTION FINDINGS SOIL LOGS TEST HOLE #1 TEST HOLE #2 I 6 /,E 5A"dGw,-� I I I I � j I DESIGNER DESIGNATION SCORES Depth from original grade to restrictive layer: Parameter I Finding I Score f Soil Type 0p 1 3 I vertical separation I pin. I �f I Slope I O % I I Parcel Size I Ac. l I Distance to Shoreline I ft. l I Total: i MINIMUM SYSTEM REQUIREMENTS Parameter I Requirement Designer Level Septic Tank Capacity I gal. Daily Flow I gpd I Applicaition Rate I gpd/ft2 Infiltrative Area ft2 i I � OTHER COMMENTS E 'ronm al f� lth Specialist D to PART 6: RE-INSPECTION DETERDIINATION On-Site Lead Date $ -Sit Billing Amount Receipt Number H:ON-SITE\RE-E AL.W Rev'sed 01107196