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Home My WebLink AboutSPH94-0193 - SPL Application - 12/23/1994 MASON `COUNTY DEPARTMENT OF HEALTH SERVICES (,21 T OFFICE BOX 1666 fy93 9 W � D POSSHELTON, A 98584 -9670 APPLICATION FOR S96R4 �L EVALUATION FAX 427-8425 INSTRUCTIONS � _Oja EALTH SEA!°• ayment: r plication is considered complete when the fee is paid and the following elements have been addressed: ts 1 and 2 of the application form must be completed_properly excavated backhoe pit per Proposed parcel moat be ready for inspectlbn. Properly excavated pits 6 ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must slope up to the ground ace for easy ingress and egress. • A scaled plot plan moat be attached to the application. The scaled plot plan moat 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. 2. After a completed application is received, staff will inspect the property and Provide the applicant with a written report. if the project requires more assistance than the evaluation of four teat holes and completion of this report, an hourly rate of S37/hour as set forth by the Mason County Board of Health may be charged to the applicant. Revised 09/01/92 PART 1: APPLICANT/PARCEL IDENTIFICATION 01�SI ................. • NAME OF APPLICANT _ LE1Tf+ E Q LLE-re • TELEPHONE (U-6 ) 424,-13(00 • MAILING ADDRESS �,,� , 200 5NA4 0 or, �0� 10151 SHEi �+'+N , Wk mg0. ssn cjU15Z • ASSESSOR'S PARCEL NUMBER 2 I ?. C D1 - - 7pISo{ • LEGAL PROPERTY DESCRIPTION 5 EG 34 T Zt 1J 2 3 Li • LOT SIZES (ACRES OR SQ FT) 1.33 AL- l 34AG r'ec �S t.oc i IS zec ;� r.oc f ISO • �DI.RECTIONS FORLOCATING SITE 111W00 M/SOAK rptS• JEoAs HI u w&y ^ tMi ro MhOa LAK6Qp—� CATFISH LAKc Eg > OF On) a.r FISIL l a re 17 nA 0A 1 no POT ]bQW OFY To CUl-DE�SgL.t S.Vga Cr Fh2CCL ON LifT PART 2: INTENDED USE OF PARCEL .............................. • INTENDED USE OF PROPERTY (Check One) : - Single family residence Multi-family residence Other, specify: -- - . •�,,W��(ATTER>SOURCE FOR PARCELS (Check One) ; - v`�' Individual wells Community well ,+ Sham Plat Evaluation r y PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) ........................................................................................................................... ............................................................................... ..:::.............................................................................................................................. ....:::::... SOIL LOGS AND SITE CHARACTERISTICS r-3,- S sox 3-D ror . �3 loT , ;5 Teat Pit A Teat Pit A S,�i(;Lo:. .,: (7 - 36SS'/1/dC,c4 .c. Teat Pit A Depth of root pen.: Z-y Depth of root pen.: 31' Depth of root 3� 2� -- P pen.: Depth of root pen.: Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: Depth to rest. layer: 3y_ Depth to rest. layer: - Depth to rest. layer: 3J- Depth to rest. layer: �b Soil type (USDA): �_ soil type (USDA): � Soil_ type (USDA): 17_ soil type (USDA): /✓ Test Pit B Test Pit B -/"— Test Pit H Teat Pit e Depth of root pen.. __ Depth of root pen.: Depth of root pen.- Depth of root pen.. _ Depth of mottling: Depth of mottling- Depth of Depth to rest. la P mottling: Depth of rotting: Y�� __ Depth to rut. layer: Depth to rert. layer: Depth to rut. layer: Soil type (USDA): __ Soil type (USDA): Soil type (USDA): Soil type.(USDl1): - Curtain drain needed? N Carteln drain needed? J� Curtain drain needed? / Curtain drain needed7/�j Slope (t): '�) l S1� (t):. � Slope (f)-. G Slope (t): ?z Shoreline? (YIN). /= Shoreline? (YIN): /6/ Shoreline? (YIN): ,A/ Shoreline? (YIN): �W// Minimum �/ lot size:- Minimum lot size:a f Minimum lot aize:' Minimum lot size:- l' Minimum lot size applies to new subdivisions and is defined as the minimum allowable land area per residence or ruiden- tal equivalent (450 gallons per day). CO242ENTS _ Short Flnt Evaluation PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) MEETS REALTE 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. ® DOES NOT MSST HEALTH CODS 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 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 regulations until the following conditions are met: Condition(e) required prior! r-to approval have been cet by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE He h ff icial - - Date SHORT PLAT FOR SHORT PLAT # KEITH FULLER W. 200 SHADOW VALLEY DR. DATE APPROVED SHELTON, WA. 98584 (206)426-1360 DIRECTOR OF COMMUN I T Y BASIS OF BEARINGS DEVELOPMENT MAINTAIN.0 I Nil/ C OYMINVI.�t STY VOLUME 2 OF SURVEYS, PAGE 98 :wI'caLDtW FRIATr i�iom�OYtr OWFAIWD WIMIN RECORDS OF MASON COUNTY, WA. a*^rIM N TW SH m nr rsveRrr C0 p"VID IN 19 /IF T THE 7W FROPOM MAIM OF MrW•YaaO NR LEGAL DESCRIPTION J ter � MR=F AOW .,�.% AWL M A L .ram 0 rwm m mmm rasa. TRACT 15 OF VOLUME 2 OF SURVEYS, SCALE. 1'-100' PAGE 94 RECORDS OF MASON COUNTY, WASHINGTON. AS ADJUSTED UNDER MASON COUNTY SUPERIOR COURT 0 50 100 200 CAUSE 192-2-00152-1. AP 032134-75-00150 EQUIPMENT & PROCEDURE NO. DE TABLE NO. DELTA RADIUS LENGTH EQUIPMENT LEICA 1' TOTAL STATION ct 570.000 1577.35 148.83 AND CALIBRATED CHAIN PROCEDURE: FIELD TRAVERSE (KOPP) (LAZAKOWSKY) s erse zt�00 _— s1.3s / LOT 15A ^ AC — R Saw \ � a •N 87`J5'21- W 138287 aN / • If \ I '/ LOT 15B —I N 8755'2#- W 3DQoe LOT 15C � \ I 1,30 AR 00 �o EAASEMEN VATE E T FOR sues a/ef/as IN(peESS.EORES3, k r k✓ SHED AND um1T►Es I ®, LOT A�D � LEGEND • -5/8" REBAR W/PLASIIC CAP SET LSIF28237 I � O !FOUND 5/8' REBAREBAR W/PLASTIC CAP LS #18918 's _ ` $ ✓/ ® IFND 112' ►P W/PLAS7IC s°oa l sk�� (� --� ✓ CAP LS J15030 °` • ,� R5o Otl ® !SOIL LOG I""- Q °WELL-?aeposeo (GRABLE) Q =EXIS7ING WELL IN 12X12 SHED ea00' PRIVAtE�—T3aoo DRAWN sw AGATE LAND SURVEYING AND vT7UUW EASEMEN Far , SCALE „ 00' PROFESSIONAL LAND SURVEYOR EarESS, AL1T1ES PER VULUME 2 OF CHECKED BY: E. 2680 AGATE RD. (206)426-4172 SURVEYS PACE D8. 0 B. SHELTDN,WA. 98584