Loading...
HomeMy WebLinkAboutSPH96-0173 - SPL Application - 6/7/1996 INTO nN MA, .,N COUNTY DEPARTME OF HEAL ERVICES Ifs A POST OFFICE BOX 1666 SHELTON WA 98584 Q 0) 427-9670 FAX 42 7-7798 APPLICATION FORLAND USE EVALUATION Receipt No: 41 Date of Payment: INSTRUCTIONS 1. An application is considered complete when the fee is paid and the following elements have been addressed: • Parts 1 and 2 of the application form must L completed. • One properly excavated backhoe pit per proposed parcel must be ready for inspection. Properly excavated pits are 6 ft deep with a 4 ft deep shelf on one end of the pit. The 4 it deep shelf must slope up to the ground surface for easy ingress and egress. • A scaled Pict plan muat 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. 2. After a completed application is received, staff will inspect the property and provide the applicant with a written report. MCPQRTANT: IN ORDER TO AVOID ADDITIORAL COSTS, BE SORB TEST HOLES AND PARCELS ARE ALL FLAOGBD AND CLEARLY ' DELINEATED AS TO LOT AHD TEST HOLE NUMBER. THE IDENTIFIED TEST BOLES MOST NATCH THE LOCATIONS Sw= ON THE PROPOSED PLAT NAP. PART 1: APPLICANT/PARC9L IDENTIFICATION n Large Lot Subdivision 11 Short Plat n Subdivision n BLA (Office Review) U $103 + $10/parcel �• $88 i--i $412 + $21/lot U $10 • NAME OF APPLICANT 1*}R-LOrJ Ki4JNS TELEPHONE (360 ) 4Z7-5j61 • MAILING ADDRESS (n031 {3720C.k LE /t LILT Lc/ R 5 e ASSESSOR'S PARCEL NUMBER 3 2-- / 3 _ 3 '© O _ LEGAL PROPERTY DESCRIPTION S�T)l-P.l 34- 7-1 /vI r1 fL 3 W�j LOT SIZES (ACRES OR SO FT) Z:38 A2�'S/, ;II Z L.11�SZ DES DIRECTIONS FOR LOCATING SITE /S�/G WM_ 3 '� NONtTii 3 P 'ST (3tty S/FaIZC m f3 owl L�1« fLD, U rt wl L_cTPTi� au r V m/LcrS . �usr- PAST 2D4lTLT Oxl R IG/+T AT tA.M LAIC S, PART 2: INTENDED USE OF PARCEL • INTENDED USE OF PROPERTY (Check One) : Single family residence U Multi-family residence f—I u Other, specify: • WATER SOURCE FOR PARCELS (Check One) : Individual wells U community well H:\ON-SITE\LNDUSE.W Revised 01107196 — Lend Use Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS LOT # _L I LOT # I LOT # _ I LOT # Test Pit A I Test Pit A _ I Test Pit A I Test Pit A I�j-Z�/GOAµY S.tND I 6-z61- dPq"V"VQ( I d ---IfX.a"saaP I d V7 Nf jZy (oU �.v0>16nr�1� 2c -sz 4y>m�C„� e zy -s'�saa 61 fI Type Trrti/ I I I I 1 I I I Depth of root pen.: y A I Depth of root pen.: Depth of root pen.: _ I Depth of root pen.: _ Depth of mottling: I Depth of mottling: I Depth of mottling: —��— I Depth-of mottling: _ I Depth to rest. Layer: I Depth to rest. layer: Depth to rest. Layer: _ �7� I Depth to rest. layer: Soil type (USDA): _ I Soil type (USDA): I Soil type (USDA): I Soil type (USDA): _ I Test Pit B I Test Pit B I Test Pit B , I Test Pit B I I I I 1 I I I I 1 Depth of root pen.: _ I Depth of root pen.: I Depth of root pen.: _ I Depth of root pen.: Depth 6f mottling: _ I Depth of mottling: I Depth of mottling: _ I Depth of mottling: _ I Depth to rest. layer: I Depth to rest. layer: I Depth to rest. layer: I Depth to rest. layer: _ Soil type (USDA): I Soil type (USDA): I Soil type (USDA): _ I Soil type (USDA): _ i i Curtain drain needed? ,� I Curtain drain needed? I Curtain drain needed? I Curtain drain needed? jSlope (%): j Slope (%): j Slope M: j slope M: - _ I (tJ I —01 I I Shoreline? (Y/N): � I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): — AI A I 1, A I A Miniamm lot size: I Mininmm lot size: I Mini mlm Lot size: I Minimm lot size. I A Minia m lot size applies to new subdivisions and is defined as the minimum allowable land area per residence or residen- tial equivalent (450 gallons per day). CON14ENTS N:\ON-SITE%LNDUSE.W Revised 01/07/96 Land Use Evaluation PART 4: 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. A d 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) : d 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: n u Condition(s) required prior to approval have been met by the applicant. I Health Official Date PART 5: REVIEWER SIGNATURE alth o icial Dato H:\ON-SITE%LNDUSE.W Revised 01/07/96 r r N 0127'Je' W 120.25' 111.96- CS uc 9 0 v { o � u u u 1� 0 y01.0o`00` m m 04 z f DT.O� \ CZrI= vDiO0 m �jo 2 O Z m Z yyyPPPT m i T Or p NN0r�.1 r a� OD 2 r W u;o u TOZN to mNf p n ' A \ rN ... .... \ Q 1nm a n SON\ A ^ Z m 0 T 0<Ao S✓ � 6£ra 2 � \;Z� s x1r�m m 1 M m0 C' 3 Oz? s A N It FN D;um m O1 a .9 0�11Z \� 'IOg92 A z m n zm� • 4�" ub -1L o C Zo m (All `// o EN � \ U a / FDA N \ N 9 m m 0 m ro « 9 o,z `o a D u o m UO N a n Or CG po G ce f m yAy N 1 `73 Z ni g 1 O O :°m mD A v 100.00 227.10 N 0128'5J" w Ln O Z OO 0m m om — + z O U A+ ZO m Z F N cc: In 2 1/1 2�