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Home My WebLink AboutSPH96-0117 - SPL Application - 4/5/1996 a . MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (200 427-9670 ' PA 427-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: �. Date of Payment : INSTRUCTIONS 1. An application is considered complete when the fee is paid and the following elements have been a ressed: • Parts 1 and 2 of the application form must be compteted. • One properly excavated backhoe pit per proposed parcel must be ready for inspection. Properly excavated pits are b it deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf gust slope up to the ground surface for easy ingress and egress. • A scaled plot plan must be attached to the application. The scaled plot plan must show the prec se location of the test holes, dimensions of the property, and location of any existing or proposed wells, r ads, or buildings within 100 it of the property boundaries. 2. After a conpleted application is received, staff will inspect the property and provide the applicant with a written report. IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON THE PROPOSED PLAT MAP. PART 1: APPLICANT/PARCEL IDENTIFICATION Large Lot Subdivision o Short Plat Ej Subdivision Ej BLA (Office Review) $100 + $10/parcel $85 U $400 + $20/lot $10 W• NAME OF APPLICANT II LL 14M 9• 1 i LTV&AL I •. TELEPHONE &6-4u Ia • MAILING ADDRESS T 1.V 4W 1O1 AI C10 3 ZIDUP-78' 001 Q pi A ILA. st�t�rsozL ThrJ D ISO ' rram^, P • ASSESSOR'S PARCEL NUMBER • LEGAL PROPERTY DESCRIPTION 5 /2 Ski I b rZO k) 123Ld I.t).r1 15..Co 2 .0 3-5.00 4 - Soa S- . 5 fi-57m -7- �¢ • LOT SIZES (ACRES OR SQ FT) Cl - 5,06 it) -Sa5 11-5.00 11-5.00 13-sb9 -S.Pb l5-SSZ — 5r- — 1_moo Z Y—� —Z C _4 o • DIRECTIONS FOR LOCATING SITE U ARl, 01 IZ ---j. uY 0 0 )AvTeas6wwD r E. 91WN 1,J)&M Lo 0 0. So. o luu - SWi662 o Aur-VU 0W w 4 i SNO- l L 0n PART 2: INTENDED USE OF PARCEL INTENDED USE OF PROPERTY (Check One) : Single family residence _ Multi-family residence Other, specify: • WATER SOURCE FOR PARCELS (Check One) : n Individual wells u Community well H:\ON-SITE\LNDIISE.W Revise 12/05/9t L.nni u.r hv.ilv.if iru PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS 1 LOTH I LOT Ar I LOT H I LOT H Test Pit A I Test Pit A I Test Pit A I Test Pit A I I I ! I I I I I I I i I I I I I I I I I I I I I I ! I I I 1 Depth of root pen.: I Depth of root pen.: _ I Depth of root pen.: I Depth of rot pen.: 1 Depth of mottling: I Depth of mottling: I Depth of mottling: I Depth of w Wing: 1 Depth to rest. layer: I Depth to rest. layer: I Depth to rest. layer: I Depth to rest. Layer: 1 Soil type (USDA): I Sail type (USDA): I Soil type (USDA): I Soil type (USDA): 1 Test Pit B I Test Pit B I Test Pit B Test Pit B i I i I I I I I I I I I I I I I I I I ! I I I I Depth of root pen.: I Depth of root pen.: _ I Depth of root pen.: I Depth of root pen.: 1 Depth of mottling: I Depth of mottling: _ I Depth of mottling: _ I Depth of ttting: _ 1 Depth to rest. layer: I Depth to rest. layer: _ I Depth to rest. layer: _ I Depth to rest. layer: 1 Soil type (USDA): _ I Soft type (USDA): _ I Soft type (USDA): _ I Soft type (USDA): _ I I I I 1 Curtain drain needed? I Curtain drain needed? I Curtain drain needed? _ I Curtain drain needed? _ 1 jSlope (x): j Slope (x): j Slope (x): j Slope I I I I I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): _ 1 I I I I Mini mua lot size:A I Minimum tot size-A I Minimum lot size:A I Minimim tot size:A _ 1 I I I I A Miniu m lot size applies to new subdivisions and is defined as the minimum allowable land area per residence or residen- tial equivalent (450 gallons per day). COMMENTS N:\ON-S T]'F.\LN11 k1F.If rrr.^ed 12/0s/n4 Macturnal large lot subdivision lot #1 5 . 00 acre (217800 sq. ft. ) 0-48 sandy loam 6t slope lot #2 5 . 00 acre (217800 sq. ft. ) 0-51 sandy loam 2t slope Lot #3 5 . 00 acre (217800 sq. ft. ) 0-38 sandy loam 5t slope lot #4 5 . 00 acre (217800 sq. ft. ) 0-25 sandy loam 3t slope lot #5 5 . 15 acre (224334 sq. ft . ) 0-27 sandy loam 4? slope lot #6 5 . 00 acre (217800 sq. ft . ) 0-31 sandy loam 6%- slope lot #7 5 . 08 acre (221284 sq. ft. ) 0-36 sandy loam 8% slope Lot #8 6 . 74 acre (293594 sq. ft. ) 0-40 sandy loam 2% slope lot #9 5 . 00 acre (217800 sq. ft. ) 0-33 sandy loam 1°s slope lot #10 5 . 05 acre (219978 sq. ft . ) 0-38 sandy loam 4t slope lot #11 5 . 00 acre (217800 sq. ft. ) 0-42 sandy loam 6%- slope lot #12 5 . 00 acre (217800 sq. ft. ) 0-46 sandy loam 5% slope lot #13 5 . 68 acre (247420 sq. ft . ) 0-46 sandy loam 7t slope lot #14 5 . 86 acre (255261 sq. ft . ) 0-32 sandy loam 8% slope lot #15 5 . 52 acre (240451 Sq. ft. ) 0-29 sandy loam 3%� slope All test holes have till as limiting layer, all soil types Ehown are type 4 . PART 4: RI,VII W SUMMARY (COMMUNITY DIFVI LOPMGNT USI?) / M ETS 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 can support an on-site sewage disposal system meeting the requirements of state and local regulations. f� l� 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) : A l� HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN BY APPLICANT 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 until the following conditions are met: r� L_I Condition(s) required prior to approval have been met by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE Hea t official Date N:\ON-S1T8\1.NDtICF.if ae�i,ed 12/05/94