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Home My WebLink AboutSPH94-0193 - SPL Application - 12/23/1994 MASON `COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, W98584 27 APPLICATION FOR SH6R4 MWEVALUATION FAX 427-8425 INSTRUCTIONS c _ EALTH SERM'J° �-3 ayment: r.: lication is considered complete when the fee is paid and the following elements have been addressed: 1 and 2 of the application form must be completed.roperly sxnavatad backhoe pit per proposed parcel must be ready for inspection. properly excavated pits ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must slope up to the gmund ce for easy ingress and egress. • A scaled plot plan Host be attached to the application.- The scaled plot plan most 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 font test holes and completion Of this report, an hourly rate of f37/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 0�551 .......................... • NAME OF APPLICANT �,E�'r}} �(� 1. F� TELEPHONE 12Lk ) 4246-121(aQ • MAILING ADDRESS OD 0 D2. hOu-) cjOts� Y 8C� 21y • ASSESSOR'S PARCEL NUMBER Z. ?, q 0153 • LEGAL PROPERTY DESCRIPTION _ 5 EGG 34 r Zt N Li • LOT SIZES (ACRES OR SQ FT) 1.33 RL• 1 3q'hC• J�36/tC• �,O�AC z_< aXAR zoc i is z.oc ;I x.e� a ISO • D1IR, 1ECTIONS FOR LOCATING SITE FROM SH LTOL) NE pN HI u SAY 3 EMI TO HAZAJ LAKERD-> 1S1 W 0►� MasoA1 LK /�a ti 0.7 n l t CATFISµ LAKG RO� oIJ � µ p R 1� N O 4 I Do NOT Mehl OrP- To COL-DU-SAL;SG14jE'CT Pk2GCL OAl L.cT ' PART 2: INTENDED USE OF PARCEL .......................................... • INTENDED USE OF PROPERTY (Check One) : ErSingle family residence Multi-family residence Other, specify: -- • WATER-SOURCE FOR PARCELS (Check One) : vIndividual wells Community well ,{ Short Plat Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) •--.-- SOIL ZAGS AND SITS CHARACTERISTICS LOT ,Z$'� / LOT , /S-C� Lor , �1313-1Depth lpen. 2-9� Test Pit A Test Pit A Test Pit A 0-2y S?CU �.z 0 36 ^NOI,�< �. n -�35,</,II Depth of root pen.: 29Depth of root pen.: 3� Depth of root pen. of root : _ Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: Depth to zest. layer: q y _ Depth to rest. layer: 3_Z Depth to rest. layer: Depth to rest. layer- c- Soil type (USDA): soil type (USDA): _ Soil type (USDA): ' soil type (USDA): L/ Test Pit B Test Pit B Test Pit H Teat Pit H Depth of root pen- __ Depth of root pen.: Depth of root pane Depth of root pen.: _Depth of mottling: __ Depth of milling: Depth of mottling: Depth of mottling: _ Depth to rest, layer: _ Depth to rear, layer: _ Depth to "at. layer: _ Depth to rest. layer: _ Soil type (USDA): __ Soil type (USDA): Soil type (USDA): Soil typs.(USDA): Curtain drain needed? Cnrtain drain needed? (J Curtain drain needed? /vim/ Curtain drain needed?/ Slope (Yj: Z '. Slope (t):. Iv 7 Slope (t): G slope (s): Shoreline? (YIN): shoreline? (Y/F): i(/ Shoreline? (Y/lP): Shoreline? (Y/H):Minimum lot size:- �_ Mini-nm lot visa:' / Minimum lot size:- y Minimum lot size.' L' Minimum lot size applies to new subdivisions and Is defined as the minimum allowable land area par r,sidenee or reeid, tial equivalent (450 gallons per day). COMMENTS sfi rt Plat &valuation PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) MEETS 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. ® 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): ® 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: Canditica(s) required Prior toapproval have been net by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE � � D J �Q ) C I -- He h�df f icial - - --- Date SHORT PLAT FOR SHORT PLAT # KEITH FULLER W. 200 SHADOW VALLEY DR. DATE APPROVED SHELTON, WA. 98584 (206)426-1360 DIRECTOR OF COMMUNITY BASIS OF BEARINGS Dt VEL OPMENT M VJIl rLsw oN IURM NN NO�oallll171• SE VOLUME 2 OF SURVEYS, PAGE 98 ai VICE fir'"neIrv.�A W"O n IWD WIMIN RECORDS OF MASON COUNTY, WA. DE r� M No wwia m FLAT. PNO[Rii OR PROMO IN m DMOti PLAT. IM FNOMM LOBIOON OF Jff=*MW MR LEGAL DESCRIPTION Je,��, � ," AM AOW O NISCOOA'NUdi I NT7m 1011 PNI0f1 ro fwAm Pm" 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 f92-2-00152-1. AP #32134-75-00150 EQUIPMENT & PROCEDURE N NO DE TABLE . oEI.rA RAo►us LENGTH EQUIPMENT LEICA 1' TOTAL STATION cf 570'00' 1577.35 148.83 AND CALIBRATED CHAIN PROCEDURE: FIELD TRAVERSE (KOPP) (LAZAKOWSKY) S 875621' E 371100 51.35® 318:85 LOT 15A AG �-- --aw- I N 8778'21' WI 381117 LOT B.34 AG � 1 BECx?, C N 87W'2#' W 398.0E b� ai.. LOT 15C t. — � \ I I 1.30AC. _ \ I �9 / 9 situ 4aW PRIVATE "V EASEIUENr foR r WORMEGRI= \ �� _ sNEn AND UnlU7XS 7j / LOT 15D + , LEGEND I I 1.00 A� • -5/8' REBAR W/0LAS77C CAP SET LS 128237 I � p FOUND 5/8' REBAR W/PLASTIC CAP LS J18918 0 FND 1/2' IP p, nl yo ` wm W/P LASTIC aRo- �— ——� _ $ ✓ CAP LS J1503 > \ • ,�— R30.0tl ® !SOIL LOG 0 eWELL—PRep�seo (GRABLE) Q mEXIS77NG WELL IN 12X12 SHED 60.00' PRIVATE 3aoo c RAYVN > AGATE LAND SURVEYING Er W E14 VA AND UTQ111ES fOR INGRESS, SCALE: 00' PROFESSIONAL LAND SURVEYOR RSS, PER VOLUME 2 OF CHECKED 9Y.' E. 2880 AGATE RD. (206)426-4172 SURVEYS PAGE Del SGB., SHELTON.WA. 98584