HomeMy WebLinkAboutSPH93-0016 - SPL Application - 1/28/1993 MASON COUNTY DEPARTMENT OF HEALTH SERVICES
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3zi32- 52 - �iooy I POST OFFICE FOX 1666
SHELTON, WA 98584
(206) 427-9670
APPLICATION FOR SHORT PLAT EVALUATION FAX 437-8425
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Receipt No:
INSTRUCTIONS Date of Payment:
1. An application 14 cmalderad coWl.ta when the fee is paid and the f111dw119 e1000hs,ts bore gas sddr eseds
• Part 1 and 2 of me applicacion fors must > cmplacan.
Oa properly eacavated backhoe pit par proposed pgresl aunt a ready ton inspattlm, propsrly eseavatad ping
are 6 ft deep with a a ft deep shelf on one and of tn. pit. Th. a ft deep shelf Mgt slope up to the ptound
•urfac• for easy Ingress add egrea..
• A angled plot plan must he attended to the application. The scaled plot pigs, Met ahw the pseeim location
of the test hole, dlmangiong of the proparty, and location of any existing or proposed walls, toads. or
hulldldgs within 100 ft of the property boundaries.
2. After a Cmpleted application is recalved, surf will lngpect the property and provide the appllcaet with a
written report. If the project r"uLr.s mro assistance Chad the evaivatlon of four test holes and completion
Of this :•part, en hourly rate of f17/hour as get forth by the Mason County Board of Health say be eharpW to
the applic t. Hev1sW 09/O1/92
PART 1: APPLICANT/PARCEL IDENTIFICATION
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I • NAME OP APPLICANT k,,, 1(�o U G�� • TELEPHONE ( Db M Vo`�ZQ4O
:Crake e NAILING ADDRESS �( ��Y CrU a�tOssKJ
n o - z7 naW 94oy 1 , r100'13
• ASSESSOR'S PARCEL NUMER 5 II ,' - I 32 - - v VI 4- L2 \ y�,,
• LSCAL PROPERTY DESCRIPTION LOM(ICJ ('�,
• LOT SIZES (ACRES OR SQ FT) 43-7vO Ck3��Q
rasa a r.»• a /� sew a raw
• DIRECTZONj� POR LOCATING SITE ���. (c.{X TU
Yam- bh'17) �P.I�St(Yi -a rLIX �(4 171 c C�-JP 75h �"�--
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 PARCELS (Check One) :
r
Individual wells community well
ART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
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SOIL LOGS AND SITE CHARACTERISTICS
LOT a
Toot Pit A Teat Pit A r-.t Pit A 010C Tut Pit A
71 c�J_�tja_Ho 4 r AaM
I S;,a41jf7!4 14, olf 4-o
14r),L 1b-4 4 I'Ll
41 FrC
,z
e4J-S-,,TQ ,
0 . I . %
Sol "Act-6+,
Depth of root pan.;
Depth of mot pan.: Depth of root -S 7ef AWP' Depth of rmc Pon's40
pen.: &tip r �bd
Depth of nettling: Depth Of nettling: Depth or susctiinq; Depth of wttlinql
Depth w root. layer: 4+ Depth w root. layer: Dapto to rest. layer: Depth w root. layour2
soil type (USDA): 3011 type (USDA): Soil typo (USDA); Soil type (USDA)$
Toast Pit B Test Pit B i Ias. Pit a Test Pit B
Depth of sno,st pen.: Depth of root pan.: Depth of root pan.; Depth of rcscst pent
Depth of nettling: Depth or nettling: Depth of mottling: Depth of mottling:
Dept: to "at. layers — Depth to rest. layer: Depth to mot. layer: Depth w reset. laysim::
8"1 type (Usm)s — Soil type (USDA): soil type (USDA). 301-L type (1,M)l
Curtain drain need"? Certain drain noode,17 Curtain drain nodded? l curtain drain "wesded?
slop. (%)3 slop. (t): :110P. (%I: Slope (a)3
Shoreline? (YIN): Shoreline? (YIN): (Y/N): Shoreline? (Y/R)s
minl,,,, lot oil.:^ Minimum lot wiz.:' ,I== lot A1V m I aiza:� Kin4-1- lot
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KI-11-M lot -ito applies to n.v iausoolviaj... and 1a defined as the o1ni, all,,able land area par maidmwace w iommidect-
tl&1 squivalm t (450 gallon. per day).
COMMMiTs
Leoq- LW 4A+ 1-j I'NillA-/,tVr
-a rill I ;z lya
0711
411V Or- G-to
Revised 09/0-,'S.-
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.
i ® DENY
i 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-
manta of state and local regulations.
This determination is based on (:onuideration of the following factor(s) :
®' BOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN Br 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:
Cmdltim(s) ruquired prior to app[ al rc by !ate applie t.
i
9rlrb 'Scial pare
PART 5: APPRe
RE
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Health offic_a: Date