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Home My WebLink AboutSPH94-0193 SPL2551 - SPL Application - 12/23/1994` ' •t �Z�� -fig- io►51 MASON `COUNTY DEPARTMENT OF HEALTH SERVICES )� D POST OFFICE BOX 1666 SHELTON, A 8584 670 APPLICATION FOR S§6 4 MWEVALUATION FAX 427-8425 INSTRUCTIONS c _ EALTH SE�q° 23 W ayment: 1. An application is considered complete when the fee is paid and the following elements have been addreslgxo=d • Parts 1 and 2 of the application form must be completed. • One properly excavated backboe pit per proposed parcel must be ready for inspection, properly excav are 6 ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf moat slope up to thsurface for easy ingress and egress. A scaled plot plan moat be attached to the application. The scaled plot plan moat show the precise Of the teat 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 $37/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 ................ • NAME OF APPLICANT V-e ft i F()LL ere a TELEPHONE L)6 ) 4UG,-1SGQ • MAILING ADDRESS Op 5RAPOWDg klou) g0151 g0162- • ASSESSOR'S PARCEL NUMBER 2 3 q D) • LEGAL PROPERTY DESCRIPTION 5 EL. S4 -r zt •1 �! ?, • LOT SIZES (ACRES OR SQ FT) 1.33 4L I�1 34i}c. �.3(ogt. 1,00Al'- zet o6h r.o� i IS zec �, ry a ISO • D1I1,R,�11ECTILO�NS FOR LOCATING SITE rROH S7HFSTDu� NE Oa HIGH 6j- AM1 To Hftvu LAKcRb-> Jfl W OMI / I SO :i LK N v O•7/71 tb CATFISH LAKE 120--1 QF On) sr(=ISK )AICC- 120 V 0.4. HI (Oo NOT =RA) OPF) To CUI.-p F-SA(„• SUB 16, T PR2f�, n l 1 a.r PART 2: INTENDED USE OF PARCEL .................... • INTENDED USE OF PROPERTY (Check One) : - ETSingle family residence Multi-family residence Other, specify: •��W/ATTER-SOURCE FOR PARCELS (Check One) : V"-' Individual wells Community well Short Plat Evaluation r . PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) ..-•...........•...........................................•...........-...................................................-...........-...........-.............-.........- .......................................................................................................................................... ................................ ........................................................................................................................................... -------------- SOIL LOGS AND SITE CHARACTERISTICS Lar LOT i / S P �3 wT + is LOT i Test Pit A Test Pit A Test Pit A Teat Pit A 0 3c SCNoG.�< .t. n -3 3 Sri Depth of root pen.: 2-9 Depth of root pen.. 3L Depth of zmt } .2L P pen.: J Depth of root pen.: Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling- Depth to rest. layer: 3L Depth to rest. layer: - Depth to rest. layer: 37Y Depth to rest. layer: G_ Soil type (USDA)- Soil type (USDA): Soil type (USDA): 7 Soil type (USDA): 4-1 Test Pit H Test Pit H Test Pit S Test Pit S Depth of root Pm.: __ Depth of root pen.: Depth of root pen.: Depth of root pen.: _ Depth of mottling: _- Depth of mottling: Depth of mottling: Depth of mottling: Depth to seat. layer: __ Depth to rest. layer: Depth to rest. L Soil type (USDA): Sou Yam: �- Depth to rest. layer: . /_ type (USDA): soil type (USDA): Soil type.(USDA): Curtain drain needed? N Certain drain needed? V Curtain drain needed? /V Curtain drain needed? Slope (i): a l Slope (t):. al"?, Slope (t).- ') slope (t): �- Shoreline? (Y/D): t Shoreline? (Y/N): /0 Shoreline? (Y/U): _ Shoreline? (Y/N): Minimum lot size:" �_ minimum lot size:^ / Minimum lot size:' >1 minimum lot size: O Minimum lot size applies to new subdivisions and is defined as the minimum slldwable land area per residence or residen- tial equivalent (450 gailom per day). . CO2g1SNT5 sfi r Plat Evaluation 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 PORTHER 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: Candition(s) required prior -tc approval Lave been net by tha applicant. Health Official Date PART 5: REVIEWER SIGNATURE jo�l� — J He h ff icial � - --- � D / e �'— � , 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 DEVELOPMENT - RARRIIDI M"W DDIRRY IUf M INC94"IRILITY TO WILD. INFAIN. OWMW ON VOLUME 2 OF SURVEYS, PAGE 98 MVIQ tWWPRIVATf ROM OWWAIM WHOM RECORDS OF MASON COUNTY, WA. a P IMW IN Vff S I ro LAr.PRO[R/Y OEMRWID IN= M T RAT. Rf PR?DM)LDGDW OP RPM MOD Alf LEGAL DESCRIPTION AW„��, RP,LNAWrM ,RWAAD RDTD mR n:e=A RIDE R[AP ON A PO! PRRf Io D,IDND POW. TRACT 15 OF VOLUME 2 OF SURVEYS, , PAGE 94 RECORDS OF MASON COUNTY, SCALE. 1 -100 WASHINGTON. AS ADJUSTED UNDER � ijmlmm%iiii� MASON COUNTY SUPERIOR COURT 0 50 100 200 CAUSE J92-2-00152-1. AP #32134-75-00150 EQUIPMENT & PROCEDURE CURVE TABLE NO. DELTA RADIUS LENGTH EQUIPMENT LEICA 1' TOTAL STATION cl 570'000 1877.35 146.83 AND CALIBRATED CHAIN PROCEDURE: FIELD TRAVERSE (KOPP) (LAZAKOWSKY) S 87W'21' E 370LW stss� slam LOT 15A N 8738'21' WI 3e2Q7 1 vI7 9 \ 1 ,// L 11..34 AC.B ~ �G,BECh.T --1 N 8736'2�' W M&08 cot :• LOT 15C ` I 1.30 AC 8 40.00 PRIVATE 1q EA mwwr FOR SHED INORESS.EDRESS. _ —AND UTILITIES I ®, LOST A�D_,rt � LEGEND I ® � g►�� • 0 REBAR W/PLASTIC CAP SET LS 128237 1 Q -FOUND 5/8R REBAR WIIPLAS71C CAP LS 118918 6 �— ✓ / • —FND 1/20 IP "LASTIC Ewa iM Rol ——� _ $ ✓ CAP LS 115030 ~� ��— MOD ® mSOIL LOG cl Oi T (GRABLE) Q —EXISTING WELL IN 12X12 SHED eyo MOO' I"VAIE�- J00° E 'v AGATE LAND SURVEYING EOREWSS A EAA AND UTILITIES SCALE: R+ 00' PROFESSIONAL LAND SURVEYOR PER VOLUME 2 OF CHECKED BY,' E. 2880 AGATE RD. (208)426-4172 SURVEYS PAGE D& S C B..,fit. SHELTON.WA. 98584 •'..r Mw • w��