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HomeMy WebLinkAboutSPH95-0034 - SPL Application - 4/10/1995 MASON COUNTY DEPARTMENT OF D APR I5 POST OFFICE BOX 1666 SHELTON WA 98584 {N TH SERVICES (20 ) 427-9670 FAX 427-8425 8425 APPLICATION F ORT PLAT EVALUATION /✓�� Receipt No: �.5 INSTRUCTIONS 511/-H -am Date of Payment: 1. An application is considered complete 7when the fee is paid and the following elements have been addre sed: • 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 excav ted 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 th ground - surface for easy ingress and egress. • A scaled plot plan moat be attached to the application. The scaled plot plan must show the precise ocation 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 wLth a written report. If the project requires more assistance than the evaluation of four teat holes and com,letion of this report, an hourly rate of j17/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 ......................: ...... ....................... .................. .................. ............ .................. ................................................................................ .................. h' PRK VGXzS-M ,l • NAME OF APPLICANT W gR1?ANN `IL✓a"tCSl`EAI Q • TELEPHONEZ.0(, Z7- 8583 • MAILING ADDRESS :E e, z// S/-/r}`yOLIIOOD ILL VD S14:LrrrN uiA 98584 a.t<y a<a,<a zsy • ASSESSOR'S PARCEL NUMBER 3 Z 3 4 - _2 5 - ® O 0 8 Q • LEGAL PROPERTY DESCRIPTION //✓ YffE Siz OF THE SE%4 OF StsC, 34 2 ho 3ww�7 —700 et —1008z- — `oLn !_�bq • LOT SIZES (ACRES OR SQ FT) 2• © Z Qf, /.00 AC, /.00 AC. t,00 C . Lot 1 Let 2 Lot 3 Ze< 6 • DIRECTIONS FOR LOCATING SITE 1z U7 SHE O/'J ? S� Z4,kLE Rb, TU c ( z .f' -ro C/9T�/5/ O. 7?D /N TEfLSecTON, AIZW LEFT CG O, 7VII F TU F4f444;. % Gso SrE I9T'AcKeD YY1FkPS , 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) : 0 Individual wells Community well M-1 Short Plat Svaliation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) ...................................... .................. ..................................................................................................................... SOIL LOGS AND SITE CHARACTERISTICS q. LOT LOT # ta-0 LOT #/6 C At 3 LOT # LQ-J.) Test Pit A Test Pit A Test Pit A Test Pit A ,!�7 f I.? L)u D-.2 5'L(ja vwl Si i)i') t-1) -3'�' Z ocim C?ND G--21 6- 20 sd/.LIYLckzm -25--11� ZocAd -f�-/oP SoAx).i6 raueL- .2j -6c 4 t, I/ SAAJO�araueL e--I-ype- 1,q) U-)A r/Y� CT.',,e( i A) Depth of root pen.: Zo Depth of root pen.; Depth of root pen.: Depth of root pen Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling Depth to rest. layer: ZC3 Depth to rest. layer: Depth to Mgt. layer: Depth to rest. la er: Soil type (USDA): y Soil type (USDA): Soil type (USDA): Soil type (USDA): Test Pit B Test Pit B Test Pit B Test Pit B Depth of root pen Depth of root pen.: Depth of root pen.. 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 rest. layer: Depth to rest. la,er; Soil type (USDA): Soil type (USDA): Soil type (USDA): Soil type (USDA): Curtain drain needed? A/ Curtain drainneeded? Curtain drain needed? N Curtain drain needed? Slope (%): tJ slope (%): Slope (%): 40 Slope (%): 0 Shoreline? (YIN): Shoreline? (YIN): A) Shoreline? (YIN): Shoreline? (YIN): Minimum lot size: i" 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 Eva nation PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOP USE) MEETS HEALTH CODE After examining lot size, proposed water source, and soil type, it 's 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 's the de- termination of Mason County Department of Health Services that eac 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) : ® 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: tion(o) r ireA prior to approval have been met by the applicant. H lth Official Date PART 5: REVIEWER SIGNATURE .......................................................................................................................................................... ................... Her Official Date