HomeMy WebLinkAboutSPH95-0034 - SPL Application - 4/10/1995 MASON COUNTY DEPARTMENT OF no
APR 10 M POST OFFICE BOX 1666
SHELTON, WA 98584
9670
I-I TH SERVICES (FA 427-8425
FAX 427-8425
APPLICATION F ORT PLAT EVALUATION r
Receipt No: 4 cy J t
INSTRUCTIONS 5f)-H C _ Date of Payment:
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 must be ready for inspection. Properly 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 up to ths ground
surface for easy ingress and egress.
• A scaled plot plan must be attached to the application. The scaled plot plan must 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 w th a
written report. If the project requires more assistance than the evaluation of four test holes and co letion
of this report, an hourly rate of $37/hour as set forth by the Mason County Board of Health may be ch&7ged to
the applicant. Revised 09/01/92
PART 1: APPLICANT/PARCEL IDENTIFICATION
........................................................................................................................................................... ..................
yM�� /)RK SILVCRSTLsCI
• NAME OF APPLICANT / ogI ANN SbL✓6tL5I`c r.I • TELEPHONE
q( ZtO�y(e) 42.7- BSE$
• MAILING ADDRESS - S,N, !// 5/4r)bOu,OGD BLVD
9B58
c f.cr 'I acete zip
• ASSESSOR'S PARCEL NUMBER 3 Z .34 - 7 5 - O O O & O
• LEGAL PROPERTY DESCRIPTION 11V T// S�'Z uF THE Sf 0 SETC. 3� Z� �I .3✓M lit/1'J
-700sr -9a084 - �tos3 �Q
• LOT SIZES (ACRES OR SQ FT) 2. 02_ AC. /.00 Ac. /,00 AC. .00 lqc .
Lo< 1 Lot 2 L-1 3 L_t 4
• DIRECTIONS FOR LOCATING SITE F)L,11 SHE O/� AW 3 D
son✓ cr 'Tu r Co z t TO C TF/5/ L Kr
Q, i ± TO /n/TaRst?r_TiON, TVIRCJ GtrFT ` CO O. +
TU SLUE FtFbS. / Ls0 5t c /97 ,9CNt (j ✓mil PS ,
PART 2: INTENDED USE OF PARCEL
• INTENDED USE OF PROPERTY (Check One) :
0 Single family residence Multi-family residence
El Other, specify:
• WATER SOURCE FOR PARCELS (Check One) :
93 Individual wells ❑ Community well
M-1
Short Plat rvallation
PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
........................................................................................................................................................... ..................
SOIL LOGS AND SITE CHARACTERISTICS
L7 4
LaT #142 10� T&f, '), LOT 0/0 C At 3 LOT # Lq-0 fe
Test Pit A ✓ Test Pit A Test Pit A Test Pit A
of I? L)U 0-25�LuavwISIon ef) -j? Z6ctmY"CWA)b ifS--71
6-- 26 SW/vvLx-xn4 -2 57-lr � Z o c, t" /L)k SP444b,16raueL �j -(,c,
(.,/ e-, 1/ 'K—&-7 SAIJ04-6raueL
CT--ip( iA)
Depth of root pen.: Zo Depth of root pen.: Depth of Mot Pen.: a Depth of root pen
Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottlingi
Depth to rest. layer: Zo Depth to rest. layer! Depth to rest. layer-3 r Depth to rest. la l er: 21
Soil type (USDA): Y Soil type (USDA): Soil type (USDA): Soil type (USDA): 3
Test Pit B Test Pit B Test Pit 3 Test Pit B
Depth of root pen.: Depth of root pen.: Depth of Mot pan.: Depth of root pen.:
Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: —
Depth to rest. layer: Depth to rest. layer: Depth to Met. layer: _ Depth to rest. la l er: _
Soil type (USDA): Soil type (USDA): Soil type (USDA): Soil type (USDA):
Curtain drain needed? Al Curtain drain needed? Curtain drain needed? N Curtain drain neec ad?
Slope (%): J slope (%): Slope (%): 40 Slope (%):
Shoreline? (YIN): Shoreline? (YIN): A/ Shoreline? (YIN): ff Shoreline? (YIN): tj
Minimum lot size minimum lot size:' Minimum lot size:- minimum lot size:`
Minimum 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
Short Plat Evaluation
PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE)
.............................
......................................................................................................... ................ ...................
62-4- MEETS HEALTH CODE
After examining lot size, proposed water source, and soil type, it Ls the de-
termination of Mason County Department of Health Services that eaci proposed
parcel can support an on-site sewage disposal system meeting the rejuirements
of state and local regulations.
DOES NOT MEET HEALTH CODE
After examining lot size, proposed water source, and soil type, it Ls the de-
termination of Mason County Department of Health Services that eacl proposed
parcel cannot support an on-site sewage disposal system meeting th require-
ments of state and local regulations.
This determination is based on consideration of the following factor(s)
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:
.1 tioa'o) iced prior to appr-al have been mat by the applicant.
Official
Date
PART 5: REVIEWER SIGNATURE
.......................................................................................................................................................... ...................
He Official Date