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HomeMy WebLinkAboutSPH93-0189 SPL2390 - SPL Application - 12/3/1993 a MASON COUNTY DEPARTMENT OF HEALTH SERVICES I oo POST OFFICE BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 APPLICATION FOR SHORT PLAT EVALUATION Receipt No: INSTRUCTIONS _01 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 end of the pit. The 4 ft deep shelf most slope up to the ground surface for easy ingress and egress. • A scaled plot plan moat be attached to the application. The scaled plot plan moat 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. If the project requires more assistance than the evaluation of four test holes and completion of this report, an hourly rate of $37/hour as set forth by the Mason County Board of Health may be charged to Revised 09/01/92 the applicant. PARCEL IDENT IFICATION CATION a� / — PART 1: APPLICANT/ `.. EEc:::1::::::::iiiiFiiEiiEi EisEEifsiEciiEc :................................................. ' 1 • NAME OF APPLICANT rl Oa YYlcAn -- Lc� `4on n-C TELEPHONE (--JDb) LI.1(o -"2`( C'V \ ICI man .4- �2550C - • MAILING ADDRESS " 1�1 v-� iZ� �I C'ac.cI s— nO VJ i D I OO SY1P I�u� l�. I� O`"( s�p �baoo J �I-lalwwn sQzscL� GfU�T00� �10`lDD • ASSESSOR'S PARCEL NUMBER - �' :2—L- • LEGAL PROPERTY DESCRIPTION S"-) /q /-4 • LOT SIZES ACRE OR SQ FT) �'I Sa !!. AA /� • DIRECTIONS FOR LOCATING SITE a, e- a. � '� Q c4 rd. CA o.. > .-o A' Sr �' kl Ccl . I n l G C 2 pncec NC . rd PART 2: INTENDED USE OF PARCEL • INT NDED USE OF PROPERTY (Check One) : Single family residence Multi-family residence Other, specify: • WATER SOURCE FOR PARCELS (Check One) : Individual wells Community well M, 1 Short Plat Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) ::: SOIL LAGS AND SITE CHARACTERISTICS LOT e ' wT i � LOT # LcT r � Test Pit A Teat Pit A Test Pit A Test Pit A t tryA w b yea ©�33` 9 0�N gilt g o 3 SvMd "Awlad �� 33�3b pled 33��13 w ev - wVtiw 40 Depth of root pen.: Depth of root pen.: 3(p Depth of root pen.: Depth of root pen.: Depth of mottling: Depth of mottling! I Depth of mottling: Depth of mottling: _ Depth to rest. layer: ��— Depth to rest. layer: „ _ Depth to meet. layer: 33 Depth to rest. layer: Soil type (USDA): Soil type (USDA): 3 Soil type (USDA): 3 Soil type (USDA): 4 Test Pit B Test Pit B Test Pit B Test Pit B Depth of rant 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. layer: Soil type (USDA): Soil type (USDA): Soil type (USDA): Soil type (USDA): /�/� curtain drain needed?�(/� Curtain drain needed? Curtain drain needed? � Curtain drain needed? �1 V Slope (S): 'tiJv=o. Slope (%): Lt� 4� im/,,Slope (i): Slope (B): 4�1�(J Shoreline? (YIN): Shoreline? (YIN): �j Shoreline? (YIN): \'- Shoreline? (YIN): Minimum lot size:' Minimum lot size:^ � Minimum lot size:" T Minimum lot size:' J— 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 � lav ✓'e ( 1 1 v Sal °Y�—�S�,/P��M� (iA+no/ JUP uV� n/� S .. Short plat Hvaluation PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) XMEETS 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. ® 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 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: Condition(e) required prior to approval have been met by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE Heath Offidial Date i i O N ,,, 6FWp�mJ JW2ti0 �.� +y n � � J bC O W q �Z�J 2NO;N�GON ?^ 02' Oy2 LJ L8a8 oW u02 I Q_ 1 V) ¢ y do J i OWE 1=i1 ¢ ci Vm-Zi 2 W 2 m 3 m -pd O J N gym.-ba^ oo�� 0000 oro ZZpp�¢�� ' � Qm W bnV1M Op W b 000001� 42> Dy 1i. 3 a yN. av nninn �bvh bvoibobro 3KaR Wo J Mao Q � 3m W3;V33W 3W W3333333 Ix Ul `J 4h VON!p OObM NMN!mf N;'I O MV? 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