HomeMy WebLinkAboutSPH93-0032 - SPL Application - 2/1/1993 COUNTY DEPARTMENT OF HEALTH SERVICES
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POST OFFICE BOX 1666
SHELTON, WA 98584
(206) 427-9670
FAX 427-8425
�� ^ � LICAnTION FOR SHORT PLAT EVALUATION
I IV" Receipt NO:
INSTR IONS ate of Payment: -/
1- �AYA a�pp/lICACI G Is emaSOand�,/comp..l_mtt• when the ran is paid and the falla Ang elements Oaw bass addeemaadr
•. �' �a\L�ii}i �SE4VI .cSanypra must be completed.
• Ods pmperlY Uncovered haahos pit par Proposed Parcel nut be ready for laapectlm. Properly aweassted pits
ors 6 ft doep with a a It deep shelf on eds and of the pit. The a ft deep shelf aunt olepe Op to the graved
surface for "my Ingress and *gross.
• A sealed Plot plan must be attached to Cho application. The scaled plot plan most show the promise 1OOatioe
of tho test holds, dimwalona of the prop•rcy, and location of any smLttsg or proposed w ". zoo". w
buildings within 100 It of the property boundaries.
2. After a completed application in rmcmlwed, Utaff will !a•pmct the property add provide the epplteent with a
writtea report. If the ProJsct rsgnlrds onto assistance than the evaluntles of four test holes add odR1Wm
Of thin Import, an hourly rats of S31/hour as a" forth by the Mason County hoard of snalth m•y he ddegdd to
the applicant. herlesd OV01122
PART 1: APPLICANT/PARCEL IDENTIFICATION a�3
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• NAME OF APPLICANT Icl nd ,f,lY�,�- 1AS�C� TELE/P111ONE (7lXn (-F2Jo —Z(o�-((P
• NAILING ADDRESS -7
(•
)
h f ( r� i l 1^J W (J
• ASSESSOR'S PARCEL NUMBER 3 2. ( 3 Z
• Lsr.AL PROPERTY DESCRIPTION R W Sl l�!�4 .Y'G 3Z Z( V `•�j 2LJ
• LOT SIZES (ACRES OR SQ FT) 4- _ j0 � � I J J
tea i m. a rr. a sw •
• DXRZCTTONS FCkR LOCATIXG SITE e r L IPHn, O( +-Or I
S 2 - k'u
1 0
a r, V-+ — Sze Ynq-
PART 2: INTENDED USE OF PARCEL
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• INTENDED USE OF PROPERTY (check One) :
Single family residence Multi-family residence
Other, specify:
• WATER SOURCE FOR PARCELS (Check One) :
Individual wells Conununity well
PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
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SOIL LOGS AND SITE CHARACTERISTICS
lqf , 1 LDT ♦ 0 1.0 Ac ear , ).o �c. ypr , l 1 ,0
Test Pit A Toot Pit A Toot Pit A Test ?St A
-((I" O:�'IINI:
I 30' d clad 4 K _ a 1 Sol( 1�*qr »)Vj
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j 3p-3P' 3ah�J� S�4a0 C 25 -wx4^ cf`(" IMq'{•p� )fc,ri
cab�zs i�x=•s`�L
�arlS in 30
3cx -newly'
1 Depth of root pan.: , Depth of root pan.: Depth of root pan.: 44' Depth of tee? pae•s 52
-- Dpth of aoctlings ('{• Depth of soctllag: Depth of sottlings Depth of ehttlAugs
Depth to seat. layer: Depth to rut. layer: 3 5 Depth to net. layer: Depth to teat. layers
soli type (USDA): 1 Soil type (USDA): 1 Soil type (usDA): J_ Sail type CUM)I
Test Pit a het Pit E Teat Pit s Teat Pit s
0-`i5'i sync I
N� CclaeS
very CeAj -
,yw�4
Fvila raeK t4u�,'f Y
1 Depth of toot paid.: Depth of root pen.: 1�._ Depth of root pen.: OptD at soot pest•:
Depth of eottlingt Depth of Bottling: - Depth of nottling: Depth of watt ngs _
]f Depth to :set. layer: Depth to rest. layer: Depth to feet. layers Depth to set. lsyeet
f Mali type (usu)z Soil type (vSDA)s 1 soil type (Uwh): � tesl two tuxo4)s
+� call," dsaie "ad"? C t.i. draln headed? Mstala dr.ln naaaad? tJ McLain of iS ...Y.P N
Slap (.)s ,N/ slpe (.): slops
shoreline? (T/N)s 1`! Shoreline? (yfs): Shoreline? (y/N): e"acaLlme (T/>t)t
s..Y— lot elzat MY..Ys.. lot airax Minims: lot slZa: ::imam lot aims 1�
Mislshs lot size applies to new as:hdivisions and in defined as the aims:e anneals laml aiu pas reeldsocs cc Zealdeo-
tlal equivalent ({SO gallons par day).
ca"HI TS
L•4 soil o 1 C6 "4 w u+ 41-.
1 SI+ P- Ear A.1 A4G 0n .RA t4 -;VtAA+1M 164c,,� `CI Now (psitwv 1 will We /:wy-rcd
11 net �tTQ XAViL4g, ✓ a i
_Z[AIg(14�, FW +Wo Pf a we .A I W LA j S S� w d 11 ( /•pq kV-t4
Revised 09/01/92
PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEV_EWPMFNT USE)
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APPROVE
After examining lot size, proposed water source, and soil type, it is the de-
tarmination 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.
&QQ, CO(Mw�e v��S
® DHNY
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) :
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®' MUM APPROVAL UNTIL FUrMBR ACTIONS ARE TAI®f Br APPLIf90T
do-After examining lot size, proposed water source, and soil type, it is the
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:
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Cosaltlm(a) :+Gabes prior fo apps al hw era rt bf U16 appllesat.
6rlth aLL1ci.1 hats
PART 5: APPROVAL SIGNATURE
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Health Official Date
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