Loading...
HomeMy WebLinkAboutSPH96-0173 - SPL Application - 6/7/1996 ,... _ _ r.� ..�. MA .,N COUNTY DEPAR OF HEAL ERVICES POST OFFICE BOX 1666 SHELTON WA 98584 (36)427--9670 (" FAX 42 7-7798 APPLICATION FOR LAND USE EVALUATION Receipt NO: 4 :..,/ `T'O 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 gust be completed. • One properly excavated backhoe pit per proposed parcel must be ready for inspection. Properly excavated pits are 6 it deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must slope up to the ground surface for easy ingress and egress. • A sealed plot plan oust 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. I I � I MWORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST SOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY DELINEATED AS TO LOT ACID TEST HOLE RUBBER. THE IDENTIFIED TEST ROLES BUST NATC9 THE LOCATIONS SNOW ON MR PROPOSED PLAT HAP. 1 � PART 1: APPLICANT/PAR&L IDENTIFICATION 5 ° 11 Large Lot Subdivision IK Short Plat n Subdivision r1 BLA (Office Review) u $103 + $301parcel $88 u $412 + $21/lot $10 • NAME OF APPLICANT I)-) fLL OrJ iz o'1N S TELEPHONE (360) -Z,7,5 01 MAILING ADDRESS �Ofl 3I (3ROCk LF kD LrLTo GaJ R e • ASSESSOR'S PARCEL NUMBER 3 Z / 3 - 3 - © O n ¢ O _ • LEGAL PROPERTY DESCRIPTION 5 C'P-i L�//3 d- Z/�> N 2 3 &/ LOT SIZES (ACRES OR SQ FT) Z,38 A 2tSl, LUE-1-- .ToL-Z— DIRECTIONS FOR LOCATING SITE /C�/�l./rTy 3 '4,_rJa'Yl_TF( PF1S"T Ql'<Y TO mA50eJ LWKtr rLt- filTtN C_tFT�� RlBo 4r Ply mic.crs . �uST 74,sf n71trKELStT ISR-0PL�T`/ �`TJ 2lGNT AT PONAITIL_L�AJ� S. PART 2: INTENDED USE OF PARCEL • INTENDED USE OF PROPERTY (Check One) : f"-1 Single family residence I__I Multi-family residence i—i Other, specify: WATER SOURCE FOR PARCELS (Check One) : f-1 Individual wells U Community well N:1ON-S1TE\LNDUSE.W Revised 01107196 Lard Use 1 aluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS LOT # I LOT # I LOT # _ I LOT # Test Pit A I Test Pit A - I Test Pit A I Test Pit A i AMYS�END i0--"6 art^ny&av�/ i p -z¢6` S�ocP I 2G — 'Z Ik.a/rt.r. SRa� j2y` (oU �.vOTf6n�cal� w/ Cox--A � zr - s�.SAoofGlu .f I I I i ( I I I 1 ( Depth of root pen.: Depth of root pen.: )Jo I Depth of root pen.: Depth of root pen.: ( Depth of mottling: I Depth of mottling: I Depth of mottling: —ram I Depth*of mottling: _ Depth to rest. layer: I Depth to rest. layer: .& I Depth to rest. layer: 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 8 , I Test Pit 8 I I I i 1 I I i 1 I I I i Depth of root pen.: _ I Depth of root pen.: _ I Depth of root pen.: I Depth of root pen.: I Depth of 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): i I f/ I I ( Curtain drain needed? ,� I Curtain drain needed? _ I Curtain drain needed? _ I Curtain drain needed? _ I jSlope (x): j Slope (x): j Slope (x): j slope (x): - I Shoreline? (Y/N): � I Shoreline? (Y/N): I Shoreline? (Y/N): I Shoreline? (Y/N): ( I Minima lot size:A I Minimtm lot si ie:A I Minivan lot size:A I Nininaan lot size:A A Miniaaa lot size applies to new subdivisions and is defined as the minimm allowable land area per residence or residen- tial equivalent (450 gallons per day). CONMENPS R:\ON-SITEILNUUSE.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) : ff9 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: r� _ iJ Condition(s) required prior to appr oval have been met by the applicant. I a Health Official Date PART 5: REVIEWER SIGNATURE / alth Ofticial Da H:WN-SZTEWOUSE.W Revised 01/07/96 / \ N 01'27*38' W OW z T X-k—x 120.25' of C 111.96' � / S 0Tp 'x—X \ XJ u�Jo u'^ i� �'/ �, _raid mN y\/Sj 'bt O�v' \ n � a \ r\ sc> 'vs'. \ r Z f D 1.O NOO�m co C ?� io. =ozmz m2 O\QQO.• AX N 47A -Ow O1� 9.t. .Zp N r0 \� �.\4.......... Oy n Or W r m0�� m Om VI Z v " r� ro uN m A ems\o B o ... m D za .m N z '���• \...... ..\ .0rn \ N r nQ ni F`...... Ao f rn O V l� n 4 A \ r N 4 � v mm m SO10— n A Z o Z7 v 6r ra0Z N 9 s . 3 0i z 0 ? a O rn x m O °' m 9 0�"Z n D RI A i O�WO v Ci\F; zm _.g .. On m Z* e �'r OWN= C Z-4m 0 ZO �N O N / a N \ D N a � WD? 1 \ O u0 u 0 NQ and N y dam. w 4Z N Q o SO^ J3 W u�o a \ ND N m �� k N ZN 6 06 W m O] m0 O 22Zia O m 100.00 M N 01.2853" W (AO Z O O K KC m a Nm Om Z_ N Ai O O D F Z�1 Z �C f>m< N t1 S V1