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Home My WebLink AboutSPH93-0032 SP2263 - SPL Application - 2/1/1993 COUNTY DEPARTMENT OF HEALTH SERVICES nine POST OFFICE BOX 1666 SHELTON, WA 98584 (208) 427-9670 �LIC TAT'I FAX 427-94251ON FOR SHORT PLAT EVALUATION "@ 1 111 Receipt me: �D,y INSTR IONSLQ3 ate of Payment: -/ • 1. A. Gpplieatloo 1s cmaldarWcaaplsta When the fee is paid and the folloein0 atmeou paw pass addce""s . LTH �S&�lda�r/z-ara must be coapleted. • One p=parly atavatad pec��.ux ftne'��`'p1t par proposed parcel nut W :asdy f" inspection, tmpeely 4K�awud p1L as• B ft daap With a a ft deep shell on one end of tpa pit. 'IDe a ft deep spelt mat slope np to the geeum etrfau for easy ingress and egrees. • A sealed plot plan mat be attaaed to the application. The scaled plot plan ,At Aber the peeeiae laeetiaa of the teen poles, dl"anelow of the prnparty, and location of Goy Gtlat:aq ar Psppssed Walla. sped". Y landings Within 100 ft of the preparty boundaries. • 3. After a completed application is rsceiWed, scat[ Will inspect W property MW p"Wide cps applicant W1th a Written raport. if the project requires nets assincanca tpan the walostlm of feat test halm and Completion of tb" repo=, as hourly rate of 117/hour an set Larch by the Mason O:mty leasd at aeelth my M ChArr d to toe appliant. Swelsed n/01192 PART. 1: APPLICANT/PARCEL IDENTIFICATION :::::::::::s::::::::::::::•:::::::::::::u::::::::::::::::::::s:.. :::......:::-:.. xsr: -z :•:rmms:s: moms::non::us: ......ss::::^::..................................:..... ................................. ::•::::::::::::::::E3Ee ::...Y2_».zs.. :usus»3i suz.s NHIE i:ii:ili:.u.s::su • NAME OF APPLICANT IS^LInd SSD • TELEPHONE aart Lf?Jo -L,4(P • NAILING ADDRESS LF na 1 eiaY eaaa- aa.e /, • ASSESSOR•S PARCEL NDPTBER 3 2 II //``( 3Z// Y¢-�_3^ — —/`/I— ✓CfCX��1 • LEGAL PROPERTY DBSCRZPTION R Y4 LO St U XG �Z 1�1.�•� �� 2 • LOT SIZES (ACRES OR sQ Fr) 42)S�o , 1 u5 J c `e i •-- a sr.a a xw • D3MZCTION3 ZA=T G SITE e Y L a n ►--F — sze ry-)o,-P PART 2: INTENDED USE OF PARCEL ...::......:...................... ».. .•.....:::..::::::. r.::.:::::::::.:::::::E::::::::::::::::::::::isi:::::::::::::::::::::::^::2:::::::::::::...::...s:::a::::9i::::: ° ............im 3ie2ce3i9 uuu u: ::x:::::::::::::::::::::::::::............................................................. ....... ......... • INTENDED USE OF PROPERTY (Check One) : Single family residence Multi-family residence Other, specify: • WATER SOURCE FOR PARCELS (Check One) : Individual wells Community well PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) :: : : t3 : . : . ::M: .... ::::........,...£; ' is :• : 3 :; £ £ iii.li3iiiii:S332E2££ii££32££3ii£e3333££ii£3:::::3i3Sic3SSi3£3ii£3i3Siiii3i3ii3i£(£3ii£33i£3i£i(ct33....::::::::.:::..z••' •S.�ii£ts.i:.s.stl�lls£Il:lt£....s. SOIL LOGS AND SITS CHARACTERISTICS lOf0 I 3-ag3kc, ldf . t.o C. ,.ol• , � (.o Inc. ram , 1 .0 �9(. Test Pit A Test Pit A Test Pit A Test Pit A 0 -(Li" LLii}v 7 o Jr9N� J �I -is 11 �-�- (—CA i �\ � Cj..hvr�y 5Aq O, A*+131'11'w y�,�r-• !1_,� 1 ,,,a„/ �,,q„e•Il, �'{'�� w� ec✓��3- /t+-3i1 {_.I� l 5�11 Fj-44• - '1Pa.1 11 10-4-1 .3.94 59W '4,,,£ u.eti•zs Z�-52t tv��yy I j 30-3�' 3•w4'%JA S•RMP C 3S -w✓�^ Ifc.11 il�.:.(wLr 1 Depth of rooe pa.: Depth of root pen.: I Depth of coot pan.: 444 Depth of coot pas.s 52 -- Depth of sottli.ngs (IV Depth of sotulag: - Depth of sottling: Depth of Dettlieys Depth to met. layer: 14% Depth to rut. layer: 35 Depth to met. layer: Depth to rsst. layers _ j; Pali type (UPDA)t I Soil type (USDA): 1 Soil type (USDA): �� sail type (g✓ogmt Test Pit B Test Pit B Teat Pit B Tat Pit P 0-45r1 +,jot I 'J�I NO CaLbe3 Vp Jy Cd AJ'it ,Tq�£ 1 aPTb of root pan.: Depth of race pen.: Depth of soot peD.s DepeD at soot pes.s Depth of tooling: Depth of sottlleg: - Depth of tottllag: Depth of oetungs Depth to most. layers Depth to rat. layer: Depth to tat. layers Depth to Cat. layers = Pail type (UMA)t Soil type (UPDA)3 I Soil type (USDA)t Pell type (Ulm►)s C..._'e 4ze121 nee-ed? cvrtel. -rein headed? �L Costal. ased. needed? wN� Mrt.la Atelss doebea" /= •lope (.3t N :hope (t): Slope Phozellhe? (Y/e)t Shoreline? (Y/P): Shoreline? (Y/D): Iy Phesellae? (T/✓/)t I tn`�eno let elzet" mint— lot aim:^ � Mini.a let sire: I sl i— let eim, a 1 s� lot eisa applies to new eobdivislons and is defined an the alniats allowable land Area Par zNldseae or zrlden- 01-1 agolvalsat (450 gallons par day). COHHE=S 1� 1cL1S 2. 3 t4 I,.AV\J. Soil ✓+ 1 CIS M4 wu+ 41---c I Si• - rnr A-1 Il t 5Q^ .w� w av a�{1^ UL, (,fk -U-z.. =S1,AN ) LwlA We JYe()1fd 44 Nktw ..i j U A J _31aW(IoV.� 1=-✓ f+lni< ro„ttc>•, �rnn .41•I?"Inq}Il� S�SAL Revised 09/01/92 PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) ::iisii::i:::ti::::::iii:i:::::::::::::::::..;...;..:::::•...::.........::.........::.........:::::•...;;.;.;.......f:::::::::::::::::::::::::..........................................................................•............................• •••..........................i£FF. £ £. :tiSii:t[i:•••.i.ii::::::::::::::::::::::::::::::::::::::::::::::::::::::£::::::::::::.......::::::::£::£::: i:£:::::Sii:i::i::i:::ii:i::::::::S:I:i::i APPROVE �( After examining lot size, proposed water source, and soil type, it is the do- 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. &`C1L. CAIr.w�e v� S ® DENY 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 VU= Br APPLICUM After examining lot size, proposed water source, and soil type, it is the de- j termination of Mason county Department of Health Services that each propossd parcel cannot support an on-site sewage disposal system meeting the regnite- ments of state and local regulations until the following conditions are met: i i I 1 Cmdltlm(•) rega12a/ pzl= m appi Aa haw bass a hT thD appllraat 8rlim orfl.,.i Dau PART 8: APPROVAL SIGNATURE . ••.i.ii.� ...................... ....................... . ....... ..............::.::.....................::::::£:£::::::: .•:::'.::£:::£:::::£.'£.". ......... . ................ ............................... Health official Date i I devised 34/0:i9: