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Home My WebLink AboutSPH96-0004 - SPL Application - 1/10/1996 MASON COUNTY DEPARTMENT OF I-IEALTII SERVICES POST OFFICE BOX 1666 SHELT'ON, WA 98584 (206) 427-9670 FAX 427-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: 3•../w Date of Payment: LJ 0 INSTRUCTIONS C �( 1 arI 10 1. An application is considered cmptete Mien the fee is paid and the following etemennts hLve been addressed: • Parts 1 end 2 of the application form gust be colleted. • One properly excavated backhoe pit per proposed parcel gust be ready for inspection. Properly excavated pits are 6 It deep with a 4 It deep shelf on one end of the pit. The 4 It deep shelf must slope up to the ground surface for easy ingress aid egress. I - A scaled plot plan must be attached•to the application. The scaled plot plan must show the precise location of the test holes, dimensions of the property, and location of any existing or proposed wells, roads, or buildings within 100 ft of the property boundaries. I 2. After a completed application is received, staff will inspect the property and provide the applicant with a written report. I I IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY I DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON THE PROPOSED PLAT MAP. PART 1: APPLICANT/PARCEL IDENTIFICATION ElLarge Lot Subdivision Short Plat Subdivision El BLA (Office Review) $100 + $10/parcel $85 $400 + $20/lot u $10 4 0 • NAME OF APPLICANT C"1 c�-'�-�7 �-."`��LT� 6A-d TELEPHONE (3lcq -I-" _:1 `7`)o • MAILING ADDRESS ��I� ( C' c I SA City ae ip ••ASSESSOR'S PARCEL NUMBER • LEGAL PROPERTY DESCRIPTION �91 9o3gZ �0�93 � g� `f • LOT SIZES (A`CR OR f0 SQ FT) ( .3_2 ( J L_01ff-T— • DIRECTIONS FOR LOCATING SITE Ina Wo ran nf7 PART 2: INTENDED USE OF PARCEL ` k1 0 9 1996 I NDED USE OF PROPERTY (Check One) : ��L Single family residence Multi-family resaee�q$e�WEl Other, specify: • WATER SOURCE FOR PARCELS (Check One) : n dividual wells u Community well II:\ON-SITE\LNDUSE.w Revised 12/05/94 ' Land Use Evaluatlon PART 3: IIEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS I LOT a I LOT a I LOT a 3 1 LOT a I Test Pit A I Test Pit A I Test Pit A I Test Pit A Q'jl ' o,e ten i O- fisqnd, �-3s'�s l� tOo`ti I toa/� I -�L �0� &tnC�d(nl fog ►! �44e I i M ?MA 136 -fi e Cl�� I j�or�l Q,x oo�j . die ' i 57►7c� f 0 e�le Scat /I ` � I'tG 1 IT1 ,wnS''pe�I I0 3 e� 'I @Qm CGYh'ol,I //a,,+//� rod I co T I 4�+s I Depth of root pen.: P I Deof aW"root pen.: I Depth of r pen.: I Depth of root pen.- Depth of mottling: �_ I Depth of mottling: I Depth of mottting: jam" ) I Depth of mottling: Depth to rest. layer: I Depth to rest. toyer:3lejLt Depth to rest. layer j I Depth to rest. layer: Soft type (USDA): I soft type (USDA): ( Soft type (USDA): ( Soil type (USDA): Test Pit B I Test Pit B I Test Pit B I Test Pit B I I I I I I I I I I Depth of root pen.: I Depth of root pen.: _ I Depth of root pen.: _ I Depth of root pen.: _ Depth of mottling: _ I Depth of mottling: I Depth of mottling: _ I Depth of mottling: _ Depth to rest. layer: I Depth to rest. layer: _ I Depth to rest. layer: _ I Depth to rest. layer: Soil type (USDA): _ I Soft type (USDA): _ I Soil type (USDA): _ ( Son type (USDA): _ Curtain drain needed? I Curtain drain needed? —N— I curtain drain needed? I curtain drain needed? j I w Shoreline? (YIN): S_h oreliSlope Slope Slope (z): Slope M Shoreline? ( /N): Shoreline? (YIN): I (YIN): Hinin m tot size:A / I Minims lot size:A 'Jj.(; I Minirm tot size: A !� I Xin(nzm lot size:A / I I I I I I A. Hinimm lot size applies to new subdivisions and is defined as the minimin allowable land area per residence or residen- tial equivalent (450 gattons per day). COMMENTS rN. 2- V I I r18 es• V 2d or, H:\ON-SI7'E1LhWSE.W Revised 12105194 Wnd Use Evaluation PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) NEETS HEALTH CODE 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. A lJ DOES NOT MEET HEALTH CODE 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) : 1� HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN BY 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 regula Tons until the following condition are met: J� r l� 2C` 17 iy iti ) it prior to approval have been met by th applicant. L He t Official D'41e. PART 5: REVIE 411 INATURE C- Healt Official Date N:ION-SITE\I USE.W Revised 12105194