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Home My WebLink AboutSPH96-0173 - SPL Application - 6/7/1996 u6 MA ..N COUNTY DEPARTME OF HEAD SERVICES POST OFFICE BOX 1666 SHELTON WA 98584 f=AITN CFRS./;( < 427-9670 AX427--7798 APPLICATION y,/FOR LAND USE EVALUATION Receipt No: �:..T Date of Payment: INSTRUCTIONS SP 1-�e(o _ rl 3 t. An application is considered complete when the fee is paid and the following elements have been addressed: • Parts t and 2 of the application form must be completed. • one properly excavated backhoe pit per proposed parcel aunt be ready for inspection. Properly excavated pits are 6 ft deep with a 4 ft deep shelf on one and of the pit. The 4 it deep shelf must slope up to the ground surface for easy ingress and egress. I • A waled plct plan must be ettechrd to the appLicaticn. 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 � I IMPORTANT: ID ORDER To AVOID ADDITIONAL COSTS, HE SORE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY DHLnmATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST HATCH TIM LOCATIONS SHOWN ON THE PROPOSED PLAT NAP. I I I PART 1: APPLICANT/PARCE'L IDENTIFICATION n Large Lot Subdivision 1K Short Plat n Subdivision i--i ELA (Office Review) $103 + $10/parcel $88 lJ $412 + $21/lot LJ $10 • NAME OF APPLICANT [),I �'}V-L*rJ kgwS TELEPHONE (360) ¢Z7-5761 • MAILING ADDRESS 10031 E3R0C.kA L6 /tD t"�eLTcT i '/S aLe fi ASSESSOR'S PARCEL NUMBER 3 z -3 T -- 3 _ _0 0 0 le • LEGAL PROPERTY DESCRIPTION S T1f� 3 T Z yyN 23 W LOT SIZES (ACRES OR S4 FT) 7_ 38 A °a�el/, l,1 Z NA /, O 6s • DIRECTIONS FOR LOCATING SITE iJPh 3 o-fI.TH PRS l'ty S RC mAsoe.) LAKE- fL-6 ItTtj L VT �Ar I G45-5 usr PAs� m�/fKecS� )�4 r ( LAk•2 LtAJ S PART 2: INTENDED USE OF PARCEL • INTENDED USE OF PROPERTY (Check One) : n Single family residence LJ Multi-family residence n u Other, specify: • WATER SOURCE FOR PARCELS (Check One) : 11 Individual wells u Community well H:\ON-SZTE\LNDUSE.W Revised 02/07/96 Land Use Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS ( LOT a I LOT s _ I LOT u _ I LOT 9 ( Test Pit A I Test Pit A I Test Pit A I Test Pit A 7 mae,k,� sr.� I ¢GHC s.0 I I �US9.vo�6nr(�/� ' cyC�x e zY —s�satiof („ I 1 �• .fl ( 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: y-- I Depth-of mottling: —, ( Depth to rest. layer: I Depth to rest. layer: /a I Depth to rest. layer: _ r I Depth to rest. layer: _ ( Soil type (USDA): I Soil type (USDA): I Soil type (USDA): _ I 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 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 6f 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 Soil type (USDA): I Soil type (USDA): _ I Soil type (USDA): _ Curtain drain needed? I Curtain drain needed? N I Curtain drain needed? I Curtain drain needed? I j Slope (x): j Slope (x): Q j j slope (x): Slope (x): ( Shoreline? (Y/M): �/_ I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): Minimum lot size:A I Minimum lot size:A I Miniuman lot size:A I Minimum lot size:A I I I I I A Minimum 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). COMMENTS H:%ON-S1TElL VUSE.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) : f'i d HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKHN 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: r, U Condition(s) required prior to appr oval have been met by the applicant. I Health Official Date PART 5: REVIEWER SIGNATURE alth Oifticial Da N:\ON-SITE\LNDOSE.W Revised 01/07/96 N 0127'38" W s . zT 120.25' .._ qz 111.98' aC �V ,n gig 9 O \ m\m 'D A N � /S ��, � \ zo �^1 E t°do�2ca A 41 �czM= 20 2OZmt T mi m��0• o�x \ ` H T Or Z�NZN r m l N \2\ \ Oo r mO L40 rri o mms A �,r�a ��tm. \ n N % rn0rn r- mo not A c^...... Aao O .. i O'iNf 0 E `ja p \ Nm ... ...\... co 7 Fn y0'OZ N 91Zy O<O� :1A 4V � T A �_ 9� m Sa p C=r*t aNm• Z — a 41 aBL Z am y� \� o•. 00➢n p m\ J O� L z r ➢N m> • • l� F'i s O 4 n ZN= Z o 0 O A �� $ N N \ N .... a / N r A ➢ \ o y N cT h Id) 0 O O NO ,0 m (Nj� 9 '4O• N Z Z Q C L4 U O p� \ Z N Z � O w mm m➢ nm A p /00.00 227.10 N Ol'.8'S3• W NO Z • 00 K C M T U 0m Q ` Z_ Q 0 + 0V N z z E i N <C m K 2 Vl