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Home My WebLink AboutSPH96-0082 - SPL Application - 3/28/1996 t . MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFF CE BOX 1666 SHELTO , WA 98584 ( 60) 427-9670 FAX 42 7-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: Va Date of Payment; INSTRUCTIONS G�_ G� _( 7 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 b ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must 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 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 with a written report. I I IRPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLYI , DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON TH8 PROPOSED PLAT MAP. I � PART 1: APPLICANTTARCEL IDENTIFICATION n Large Lot Subdivision n Short Plat n Subdivision I—I BLA (Office Review) " $103 + $10/parcel LX $.88 u $412 + $21))/lot U $10 NAME OF APPLICANT 6&"� +� Y� C 2i c A4 Na k2 1S/ . TELEPHONE ( 2}2 7-S S-34 • MAILING ADDRESS 140, x3e X 3 c! 7 - ,-n.sI_ 'Y:2q/ e.L7c ^j W e, 4 8 S$4 5y �•f p(Ul tYi y 5 a'1-1;e iZ p • ASSESSOR'S PARCEL NUMBER Z L 3 S - Z 3 - LEGAL PROPERTY DESCRIPTION 5'e e 3 5' T L! N R. 3 LJ W ✓�� q • LOT SIZES (ACRES OR SQ FT) - y �z Ac- Afi h`G �� A c ' `Z L �— � 3 • DIRECTIONS FOR LOCATING SITE 60 00"nu /47i K K G 6 3e/J R40 Al B&C'4Neft E 36o -SOS 1A2,AKeC.Seri Rol. Gv Om �u�[rlJe2 57`a /Cr. mr. QKe wrTN �L..,e i4Ro �J • FO�OOJ QL4e /c.i /f/,jaN$- PART 2: INTENDED USE OF PARCEL • INTENDED USE OF PROPERTY (Check One) : n Single family residence LJ Multi-family residence n U other, specify: rg • WATER SOURCE FOR PARCEL heck one) : Individual wells MAR 2 8 199t Community well tPAL TH SERVICE% H:\ON-SITE\LNDUSE.W Reed 01107196 Land Use Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS ))�( p LOT # I LOT # -7_ LOT # .f LOT p Test Pit A Test Pit A I Test Pit A Test Pit A p I �'4- S)iLo� I I I I I I I I I I I I by l z I 31 I Depth of root pen.: Depth of root pen.: Depth of root pen.: I Depth of root pen.: p p Depth of mottling: Depth of mottling: Y- Depth of mottling: �� I Depth of mottling: _ p Depth to rest. layer: Z Depth to rest. Layer: -t- Depth to rest. Layer: _ Lf__ I Depth to regt. Layer: ,Ly Soil type (USDA): Soil type (USDA): _ Soil type (USDA): Soil type (USDA): + p Test Pit B Test Pit B Test Pit B Test Pit B p 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 p I I I I p Depth of root pen.: Depth of root pen.: I Depth of root pen.: I Depth of root pen.: p p Depth of mottling: Depth of mottling: Depth of mottling: I Depth of mottling: p Depth to rest. layer: Depth to rest. layer: Depth to rest. Layer: I Depth to re t. layer: p Soil type (USDA): I Soil type (USDA):- Soil type (USDA): I Soil type (USDA): i Curtain drain needed? I Curtain drain needed? Curtain drain needed? I Curtain drain needed? �, p I Slope (%): I slope <X): j Slope (x): 9 j slope (x): p I Shoreline? (Y/N): Shoreline? (Y/N): ,� I Shoreline? (Y/N): _� I Shoreline? Y/N): , ) p Mini m Lot size:A Minimum lot size:A I Mini mum Lot size:A I Minimum lot size:mumA p I I I I A Minimum tot size applies to new subdivisions and is defined as the minimum allowable Land area per'iresidence or resid•an- tial equivalent (450 gallons per day), I, COMMENTS H:WN-S1TEtLNDUSE.W Revised 01107196 ...ems.-.... _. ._ _._ _..=s..�--•...�._-...�.�.... �--....-..... ._-......,..»..,..,,..,.•.,.K _,... ,._,..�,...__�....�..�..._. ......,,.,..... Land Use Evaluation PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) Y-� MEETS 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 vequirements of state and local regulations. 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 e}ch 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) : II' 6AJ 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 condition are met: (� Conditions required prior to approval have been met by the applicant. HidLth 0 ficia D l PART 5: REVIEWER SIGNATURE '�v ') �'14 He Offi to H:\0N-SITE\LN USE.W Revieed 01107196 TION: SHORT SUBDIVISION IN sT NALs(E 1//�S)of THE sauTNwEn auARTEN SW 1/4, NW 1/4, SECTION 35, 4R RANGE ET,HREE(3) rg�EsrCT.. wx 1i1`E tss TWP. 21 N., R. 3 WEST, W.M. ITS-a-WAY. O A NON-E%CIDWT[EASEMENT FOR W RE55. - BED IN NSTRUMENT RECORDED NOVEMBER 14. t INGRESS.EGRESS AND UWUTIM 40 FEET . V. AS DESCRIBED N NSTRUIIENTS RECORDED CRANBERRY y� 234390 AND 234391. CREEN� �- a N BE'061,7 w (7�X7Q 33J.61 T LOT I 5.32 ACRES 100'R I e P059BLE I wELL SIZE R � i yy ✓ p 1' mmi MY MEET n N 3J'50'4t' W 2]3 BB' F qy 0 « L 5 , IOTR •:,%1 &J �` V �� „$ 1.32 ACRES A, (N 66761J E O hP� f /4001 (,� .3s d f t \ 1.36 ACRES _ P0598LE PRNFIE ROAD ! : U1RIn EASEMENT J_G`�1TABLE M(A'KeCse� �iF � j�Rapoes roo i' r MERIDI N: R�� — 5 _ w{M L s _3.24•E 'S9'1B'E BASED ON ORT PUT 0243 N MASON Nn,WASHNGTON. L-1 48'37' (L- 3.44' -2 PRIVATE ROAD! C-2 ((M.I}r`+]Y,6' i' \UMW EASFMFIIT (L-M2.26' o \ W q POSSIBLE WELL SITE ONE T i / q 1 4 COW4R �\ 1W'R EEON PPE PER J L20 ASS FOUND LOMTT BAR!CAP 6 PAGE 77 SURVEYS \�/ S W43'22' W 2.4W 34 35 1033.30' 34 AW 4aI6. )' 200' S W16 46 E 35� ?,)ESTATES O'+q RLSON `I 51 50 BR. c / SI ON TB CO. xGrav FOG SKOH L I ASSOC. SIIN f° TO iON TOR G. SKOK G. SSKOK; ASSOC. b ASSOC \ 0u r ce w _- R't S''�i h nocfi r:H. ST. 4 °I1404 sp'4 5 I �«,ta AC.iI Tei / G.R. KIRK CO. •4 SIMP ON TBR.CO. 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