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Home My WebLink AboutSPH96-0082 - SPL Application - 3/28/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (360) 427-9670 FAX 427-7798 APPLICATION FOR LAND USE EVALUATION Receipt NO: Va Date of Payment: �� INSTRUCTIONS 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 plar, 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 IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL PLAGGED AND CLEARLY DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCB THE LOCATIONS SHOWN ON THE PROPOSED PLAT NAP. � I PART 1: APPLICANT/PARCEL IDENTIFICATION I—I Large Lot Subdivision n Short Plat n Subdivision I—I BLA (Office Review) u $103 + $10/parcel $88 U $412 + $21))/lot U $10 //'' N� NAME OF APPLICANT C /�+ Y'e C2i°y N 2 o2fS/- TELEPHONE ( ;) �lZ7-Se-3(3 MAILING ADDRESS /QV•00, Bo X 3 5( 7 ��„i`^V /Y7� SHe- LTo tit W4 Q $ S$4 i y S a'f-1:e iL p ASSESSOR'S PARCEL NUMBER Z 3 S - Z 3 - C, U D O LEGAL PROPERTY DESCRIPTION 57e�lcyyvp3j� :S ; T L/ /J QR- W ✓�� 7, LOT SIZES (ACRES OR SQ FT) - �J, 1 RL Y��LI�� Y, �C �Za L 1 _=-ot-2— _� • DIRECTIONS FOR LOCATING SITE 60 00 w e e 3&AJ k am 0 5a m 4 .a, 6&Cyt1e 60 -,S"oS (6. A /CC 2 Kqe w,TN 13 L I' ,V O tca " 64e PART 2: INTENDED USE OF PARCEL INTENDED USE OF PROPERTY (Check One) : n 7- Single family residence LJ Multi-family residence n tJ Other, specify: WATER SOURCE FOR PARCEL-4heck One) : Individual wells MAR 2 8 199fC Community well 'FAITH SERVICEF H:\0N-SITE\LNDUSE.W Revised 01107196 Land Use Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS - I p LOT # _I LOT # I LOT # 1 LOT # 'I p p�Test Pit A Test Pit A Test Pit A I Test Pi t A p G-23SA -iqsaNWLDA-^^i b21�� s/C�Gu�w. 23-3Z AtoK' -5il44(,, � I I I I I I I I I I I I p Depth of root pen.: Depth of root pen.: I Depth of root pen.: �_ I Depth of root pen.: p Depth of mottling: Depth of mottling: f- I Depth of mottling: _ I Depth of mottling: p Depth to rest. Layer: I Depth to rest. layer: -Z- I Depth to rest. layer: I Depth to re . Layer: iL p Soil type (USDA): I Soil type (USDA): I Soil type (USDA): I Soil type (USDA): _ p e i I i e p Test Pit B I Test Pit B Test Pit B I Test Pit B p I I I p I I I I I I I I N I I I N 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.: p Depth of mottling: I Depth of mottling: I Depth of Bottling: I Depth of mottling: p Depth to rest. layer: I Depth to rest. layer: I Depth to rest. layer: Depth to re#t. Layer: p Soil type (USDA): I Soil type (USDA): I Soil type (USDA): Soil type (USDA): ! i p Curtain drain needed? Curtain drain needed? I Curtain drain needed? Curtain drain needed? l� p Slope (%): I Slope (%): �_ j Slope (%): 2 j Slope p Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): 0 I Shoreline? Y/N): I Minimum Lot size:A I Minimum Lot size:A I Minimum lot size:A I Minimum lotsize:A L p I I I I I e I I I A A Minimum lot size applies to new subdivisions and is defined as the minimum al lovable Land area per residence or res+d^n- tial equivalent (450 gallons per day). COMMENTS H:\ON-SITE\LN USE.W Reviged 01107196 Land Use Evaluation PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) YX 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 requirements of state and local regulations. L=J 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) : 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 e*ch proposed parcel cannot support an on-site sewage disposal system meeting the require- ments of state and locale regulations until the following condition$ are met: Condition(s) required prior to approval have been met by the applicant. tth 0 ficia Date C PART 5: REVIEWER SIGNATURE He Offi to H:\ON-SITE\LNUUSE.W Revised 01/07/96 TION: SHORT SUBDIVISION IN V NALP 11 THE+ 1 sautNW6T OIlAR110R SW 1/4, NW 1/4, SECTION 35, RANGE THREE(3)GE WE t.Wx css). TWP. 21 N., R. 3 WEST, W.M. O . A NON-E CUME EASEMENT 11OR INGRESS, • BED W MMUENT RECORDED NOVEMBER 14. E a m=ECRE53 AND UT"VES•10 I= 4 24AS DESCRIBED 390 N RISDNMFNR RECORDED BERRY � --�"T N 8506'I]'W (XXX) n L i 5.32 ACRES I low \ '0 1 P SS LE WELL SITE I n \ / a Y�CRANBERRY CRLTNCREER rA \ N 87'SO'H•w . 21188' 157.15 N O h O 1.532ACRES A, -N B8"]8 11 E V h Re so %osa J 100' R mow/ s LnT 1 n? P Q 1.38 ACRES RH a y\ P ATE ROAD Ar A 1✓ WELL 97F UTEITY EASEMENT P`�� -Wolf TAB LE Mix' ;(s qp� \ / SjaK74 a 3 Eeo ,;,� MERIDI N• 2 watt L�{yR sBOzrz, E •� +n -3 ..�I�_ 5 60_Sal' E C-1 S rTC, aY l-i N 8539'18•E BASED ON ORT PUT/2]IS nr �1 (((R-M.IY N MASON TY,WASNIIIGTON. L-1 .\ - C_I {pL-7]-=8'16'ST T C< .N _Z PRIVATE RDAD t C-] ({G�3 15?,_2 UTDITY EASE1 T (L.E228' P059BLE WEll 91E I • Ad`ry m �. 1 1 COPIER \\ 100'R 0LOLA AC NON PIPE PEA E 16 PAGE 77 \\ / f u0 ACRES EWNO LONTT BM kiW 91RVFYS .✓/ S BO'IY21• W 216' 34 35 10.u]0' )' 200' 5 W161 E 1018. 351 Y ESTATES 6. SKOK t Dr RCson sit so Ba. c 51 on Ta co. /lJ 'E9 . sIM N /ry/ GravelPi£ 30N TBR f9 G. SKOK J(I G, SKOK! 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