HomeMy WebLinkAboutSPH95-0034 - SPL Application - 4/10/1995 MASON COUNTY DEPARTMENT OF no
APR 10 M POST OFFICE BOX 1666
SHELTON, WA 98584
L- FA TH SERVICES c 427-
FAX 427-8425
8425
9670
APPLICATION F ORT PLAT EVALUATION
Receipt No: �S
INSTRUCTIONS 5oq 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 moat be ready for inspection. Properly excavated pits
are 6 ft deep with a 4 ft deep shelf on one and of the pit. The 4 ft deep shelf must slope up to thR ground
surface for easy ingress and egress.
• A scaled plot plan must be attached to the application. The scaled plat 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 conpletion
of this report, an hourly rate of $37/hour as set forth by the Mason County Board of Health may be charged to
the applicant. Revised 09/01/92
PART 1: APPLICANT/PARCEL IDENTIFICATION
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/) nRK SILVL-M STL-44
• NAME OF APPLICANT MolzyAtiN • TELEPHONE `ZOL 2.7- 6.5
• MAILING ADDRESS S,N, 41 51414bOU,00D BLVD
S14 Q—Cr N u A 9BSB�
C1Cy 9tata Sip
• ASSESSOR'S PARCEL NUMBER 3 Z .34
• LEGAL PROPERTY DESCRIPTION /N y'ffE S�Z of THE SE%� 02= 5Rc. 34 G) i�I jWW/1')
ACRES OR S FT 2y0081,O 2- �00 L — lw83 11
• LOT SIZES
( 4 ) Ac. �)c. /oo qc. 1100 C .
Lot 1 Lot 2 L,elt 3 Lct 4
• DIRECTIONS FOR LOCATING SITE )Z Ln S I4E now 3 a
sO,v L Tu r Cp z f To CgTf/5/ L r
Q, 'Tp /,,Tt2sdLTioN, TORpJ LEFT 1 CG O. I t
To r%.ue Fca%S. /,I -_ Sr c 14T;,4ct4ep MAPS ,
PART 2: INTENDED USE OF PARCEL
• INTENDED USE OF PROPERTY (Check One) :
5 Single family residence Multi-family residence
El Other, specify:
• WATER SOURCE FOR PARCELS (Check One) :
J4 Individual wells ❑ Community well
M-1
Short Plat Evaliation
PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
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SOIL LOGS AND SITE CHARACTERISTICS
p.LOT LOT LOT 0/6 C At 3 LOT
Test Pit A Test Pit A Test Pit A Test Pit A
of CZ L)u. C)-.25'L SiliD 6) -3? Z 06A/CWA)D L'3-21 Loan. nex),,
6-- 26 SAAAAILcvxm -2 5--yam Z Lj C, h4 �?P-Iok SoAAbd6rauel .2 J -&C, 6",CAJ 0.46i G.Y.Le L
-(. / �,1/ "ICe-&-7 SAAjO46r�u�L e_7-1Pe_
LZ3A tZ j.; CT-/P(
Depth of root pen.: Zo Depth of mot pen.: Depth of mot pan.: Depth of root pen
Depth of mottling: Depth of mottling: Depth of mottling: Depth of wttiingii
Depth to rest. layer: Z<3 Depth to rest. layer: W4 2' Depth to rest. layer: Depth to rest. layer: 21
Sail type (USDA): y Soil type (USDA): 17 Soil type (USDA): 3 Sail type (USDA): 3
Test Pit B Test Pit B Test Pit B Test Pit B
Depth of root pen.: Depth of root pen.: Depth of root pan.: Depth of mot pen.;
Depth of mottling: Depth of mottling: Depth of mottling: Depth of nottlingi
Depth to rest. layer: Depth to rest. lay": Depth to rest. layer: Depth to rest. la"er:
Soil type (USDA): Soil type (USDA): Soil type (USDA): Soil type (USDA):
Curtain d..1. needed? Curtain drain neads,17 Curtain drain needed? N curtain drain needed?
Slope (%): Q slope 0 Slope (%); slope
Shoreline? (YIN): Shoreline? (YIN): Aj Shoreline? (YIN): Shoreline? (YIN): A)
Mini-ue, lot size:' Minimum lot size:' Y Minimum lot size:' Minimum lot size:- 4L
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).
0014MEMS
Short Plat Evaluation
PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE)
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MEETS BEAT TH CODE
After examining lot size, proposed water source, and soil type, it Ls the de-
termination of Mason County Department of Health Services that eaca 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 thB require-
ments of state and local regulations.
This determination is based an 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 s 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:
itiao's, r ired prior to approval have been mat by the applicant.
,4
lth
Official
Date
PART 5: REVIEWER SIGNATURE
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He Official
ckj
Date