HomeMy WebLinkAboutSPH93-0032 SP2263 - SPL Application - 2/1/1993 COUNTY DEPARTMENT OF HEALTH SERVICES
J
POST OFFICE BOX 1666
SHELTON, WA 98584
(206) 427-9670
�� ^ � LICATION FOR SHORT PLAT EVALUATION FAX 427-8425
1 Iv" LI J! ►`JJ tea, D Receipt No:
INSTR IONS 60-g3-a ate of Payment: -/ -
1. (den aapppliumclan Is considered complete ramp raw fee 1s Paid 4" the following elements Oar hoed address",
address",
�' ALPi ��5 s pyprm must be cosplsctl.
• Oes properly excavated becxhca pit per Proposed parcel must be ready far Snspmotion. properly saearted pica
Arm B ft deep with a 4 ft deep shelf on one and of the pit. The 4 ft deep shalt mesa step. op to tin ground
surface for gamy !agree• and agrees.
• A scaled plot plan most he attached to the application. The scaled plat plan meet Yaw the paealr location
Of the test holee, dimensions of tam property, and loeaclos of my eslsting ar proposed walla, loads, Y
buildings within 100 ft of the property boundaries.
2. After a conplacsd application Is rscelvad, etaCf w111 inspect the Property and pivvlde the ePPlleasL dti a
written report. U toe project requires more assistante than the evaluation of four test hmism end completion
of this repnre, ad hourly rate of S37/hour as not forth by the named County Board of Bealth any be dargad to
=0 applicant. Sorts" 09/01/22
PART 1: APPLICANT/PARCEL IDENTIFICATION a�3
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• JAILING ADDRESS n6
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• ASSESSOR'S PARCEL NUMBER 3 Z II //,,I 3 - _3 ��7� 2�
- LEGAL PROPERTY DESCRIPTION Iq UO V4 �( U y4 �G 3� 1 1 V )
- LOT SIZES (ACRES OR SQ FT) �O o
- DZZISCTIO1gS mA rocA G SITE e r L oc t+-oC i
a n E-+ — szz YN-1 o,-P
PART 2: INTENDED USE OF PARCEL
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•,,,,��*I1��/TENDED USE OF PROPERTY (check One) :
Single family residence Multi-family residence
uL Other, specify:
• HATER SOURCE FOR PARCELS (Check One) :
Individual wells Community well
PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY)
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SOIL iLOGS AND SITS C9ARAc=RISTICS
1 LOT P 3.a.9 LOT t 1.0 ac. L= [ -.5— (.o +(. 70f P — 1 .0
Taut Pit A Test Pit A Test Pit A Test Pit A
0..���
SA ad, ^w 5 sue : c-2)„ At,41
Al-d4ad aAV�" ,8-35" _ *7Fz t scii $-4K"—+ ICI .xl(
S" ., y uMdal 21-52t r I
j 30-3P' 3ak�/� sa�bt 35`a -w�
Y`'C.TI rinti a•d{i
fi CdbM2l
r, -V4 ww Ra✓Vs }„ 3C7
Depth of ziw ee ILL tiepin of soot pee yDepthS2
.: � Depth of not pes.s =
Depth of sottlims 1 y Depth of Settling: Depth of mttling. Depth of wattling
Depth to teat. layer: IS(M Depth to rest. layer: 35 Depth to mat. layer: Depth to neat• layers
1 :toil type (DiDA)z I soil type (USDA): 1 3011 type (USDA): �� sail two (OSDA)s �
i
Seat Pit S Teat Pit a Test Pit S Test Pit 8
0
ND cosbis
Vp� cd AJ'
,Ywr4
F of
f1 Depth Of soot pes.s Depth of root pan.: -), Depth of mot pan.: Depth at soot pest•[
g/ Depth of sottlingz Depth of wattling: - Depth of Bottling; Depth of aottlieQ[ _
Depth to Last. layers Depth to rest. layer: Depth to rat. layer: Depth to teat• lSyett —
sall type (UM): Soil type (USDA): 1 soil type (XM-A)t zbil type (Omh)t ,{
Castel, Auld laded? N tvrtaln drain na"ed? �L tartaln drain needed? PN Carta" arm aowde" nJ
a]epe c.)t ,N/ Slope (•i: slope (t): P1�"� Slopes (.):
shoceitaw? (Tn): I`f shoralloe? (yew): shomline? (r/w): IV Shoreline? (T/,)t
I1`se lot vital M4n4a1. let aim:^ Mini— lot SLZei+ I2••1� 2 s lot aims 122
a. MleJ� lot size applies to bar Subdivisions and is defined as the alai,uw allwahle I&M dies pat Les da ee ualdes-
tlal egSivalest (450 gallons pSr day).
COIKB=S
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f. Soil Oud C6 00 vv\u+ A,c :. ,1*, I6+
Si�2 • EV �4S n 450L VRA w -k-OAliln 164C%., (,C1,&*Nd� =SS,.vt 1 Wilt 4 /Y Uwd .
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� w. -w iti „f it ✓' -v 1✓1
304 l���l9;l FVJ J/Ni< re V11 .414VLAJ+ /A S•.( w�y,,,d
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ReviSed 09/01/92
PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE)
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APPROVE
!lliii After examining lot size, proposed water source, and soil type, it is the der-
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. SCX.
CO�w�e v��S
® DERY
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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APPROVAL QATIL lQRTHSRR ACTZOES ARE TRION Or APPLICWM
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 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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conatim(s) re"Lrtl ➢r1w m &OPi Ad Ewe bpi se by the argli Y
9YLtb Official Date
PART 5: APPROVAL SIGNATURE
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o2 8 3
Health official Date
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devised �4!O:iS�