HomeMy WebLinkAboutSPH93-0016 SP2272 - SPL Application - 1/28/1993 IVESW COUNTY DEPARTMENT OF HEALTH SERVICES
i
32i32- Z - �1ooy I POST OFFICE SOX 1666
SHELTON, WA 98584
(206) 427-9670
APPLICATION FOR SHORT PLAT EVALUATION FAX 4.27-8425
Receipt No:
INSTRUCTIONS _ Date of Payment:
• 1. An application 14 Considered complete whoa the fee is paid add the follatidg elesseL have bees addressed:
• Pare 1 and 2 of the application fon must >• completed.
• One properly "elevated backhoe pit par proposed parcel must be reedy for lnspentim. pro y awvaiad pate
are 6 ft deep with a { It deep 'half on one end of the pit. The t It deep Well Met slop• up to the gromd
•Urfa[• for •nay Ingram• and agrees.
• A "al ad plot plan moat be atZAChed to the application. The scaled plot plan suet show the praelse lmatlnn
Of the test holam, d'—pSiO:u Of the property, and loca:1on of any cdAtlnq d, proposed walls. made• or
buildings within 100 It d1 the property boundarles.
2. After a COaplated application is received, staff will inspatt the pmparty add provide the appllcant with a
wrlttan report. If the project require. Mrs aselstamce roan the evaluatim of four test holes add cogLLetim
Of this report, an hourly rate of 117/hour as met forth by rim Mason Cnpoty Board of Baalth say be dhargad to
tbs applleant• Bevlaad 09/01/92
PART I: APPLICANT/PARCEL IDENTIFICATION /J�/1"1t��'�
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• NAME OF -APPLICANT �� _ 7��� gg Sj� TELEPHONE ((�vf�M Z..�O`Za�d
• NAILING ADDRESS
yQ
r/Y� -/ I`I
r)aW 9M43
aa.ay � • e<_._ 2
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• ASSESSOR•S PARCEL NUMER Li I 3 2 - 3 z
• LEGAL PROPERTY DESCRIPTION r 52-). )L.0 Y( 2I k i ., Z ) W/W (• -
i ��2n., /�
• Lox SIZES (ACRES OR SQ FT) -r�'7vO L V
i.e. i rose a n A ua a sow
• 07=tzc=ION FOR LOCATING SITE NA�� l� 40
r nh �7— ) -(-LQ02mx (Zd y)l c C14P 7 h r-4-
PART 2: INTENDED USE OF PARCEL
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• INTENDED USE OF PROPERTY (Check One) :
Single family residence Multi-family residence
11 Other, specify:
• WATER SOURCE FOR ?ARCELS (Check One) :
Individual wells Coo unity well
DART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
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SOIL LOGS AND SITE CHARACTERISTICS
LOT I L= I
Test Pit A Test Pit A f�st Mt A Test Pit A
0-0�'4 Y-(?JWZ��4 g 10C 4-Lj-' A�y 1_&,LL He 4 r
6&+VG',-f 1514AIJ 1 .414CM
f44
L
.at it A It A z
gto
t
6 We_�Ce -f
tj
-4L' tI
toot
f4 -,0 Twe M- ��i A
kat Wen-7
PC I—SCiA P10-
-V rs Met � AL-Z9L
Depth Of mot pan.: d— Depth of root pen. M -,Mh of root pan.: Depth f root Pen.:
a4 ; f'le
i -;FT DFF
Depth Of mottling: 1414- Depth Of mottling: Depth or mottling: Depth :f unttlin9l
Depth to root. layer: 4+ Depth to rest. layer: Unprh to rest. layer: Depth to rest. loymur: 40"
1 Boll type (USDA): soil type (USDA): I soil type (USDA): Soil type (USDA)I-
Test Pit S Toot Pit 8 Get Pit B Test Pit 3
Depth of root pan.; Depth of root pen.: Depth of root pan.: Depth of root Pmu.Z
Depth of mottlingr Depth of mottling: Depth Of muzzling: Depth of wwcling3
D"th to mat. layer: � Depth to rut. layer: Depth to mat. layer.- Depth to coast. layer:
GGLI type (USDA): — Soil type (USDA)- soil type (U30AI: 3011 type (USDA).
Curtain drain ndd7 Curtain drain nommieu? Curtain drain n000ded? Curtain drain namods,47 J�L
Slop. (1k)3 slop. 3lop. Slope (%)I
Shocaline? (Y/"): Shoreline? (Y/N)Z Sh.r.!.n.? (YIN): Sb=*11467 (Y/N)S
Kinimmum lot alzo:A Midi— lot aiza;" lot size:- Minim— lot iza;a
KIDIMAIM lot size applies to nse subdivision. and le :fl= rh. -ZAA.- .7.ble land area, par residence W x,maidect-
ti&l equivalent (450 gallons per day).
COMICKNTS
Le TL Lw qAA ij NJ,,---4-z,V- Y Or/— Aw,44
A- CIAIIJO;Z1 o(-- Le--/"4 a Ae--LarT
le- CC 1c.
W,I,fv—ill�l -
Revised 09/01,'�-
PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE)
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APPROVE
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.
® DENY
j 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 �.onsideration of the following factor(s) :
i
® Hd1.D APPROVAL UNTIL PVRTBSR ACTIONS ARE TAKEN BS 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:
emtltlm(s) rvwil prior to sppro ai yw a� �c a7 me appiio t.
F
CW o.ta
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PART 5: APPROV RE
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Health O;:icta= Date
Rev.sed J4 7