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Home My WebLink AboutSPH95-0094 - SPL Application - 8/24/1995 MASON COUNTY DEPARTMEN4T OF HEALTH SERVICES POST OFFICE BOX 1666 3Z13 - lid - gojoq 1 SHELTON, WA 98584 (2AX 427-7798 061427-9670' F APPLICATION FOR LAND USE EVALUATION / Receipt No: � `f/ Date of Payment: a g INSTRUCTIONS -p4q5 _ �( 4 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 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 it 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 plot plan must 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 It of the property boundaries. 2. After a completed application is received, staff will inspect the property and provide the applicant with a written report. IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON THE PROPOSED PLAT MAP. t PART 1: APPLICANT/PARCEL IDENTIFICATION Ei Large Lot Subdivision I�I Short Plat Ej Subdivision 0 BLA (Office Review) $100 + $10/parcel G•' $85 $400 + $20/lot $10 • NAME OF APPLICANT _ MAi1 joaw D- `/oyju TELEPHONE (X0 ) 537-2.WL • MAILING ADDRESS TA S 138t!i q*U gOb `00g3 • ASSESSOR'S PARCEL NUMBER • LEGAL PROPERTY DESCRIPTION NWV4� SE►/¢� SCC. ?4jT21A1jk30,(J.h• • LOT SIZES (ACRES OR SQ FT) IJS -f dal c. 1.13 At. 1 —Zgt==�qc- 1,or ILIA DIRECTIONS FOR LOCATING SITS A TT4L1100 PART 2: INTENDED USE OF PARCEL AGATE LAND SURVEYING E. 2680 Agate Road • INTENDED USE OF PROPERTY (Check One) : Shelton WA 98j84 Single family residence Multi-family residence Other, specify: WATER SOURCE FOR PARCELS (Check One) : Individual wells U Community well H:\ON-SITE\LNDUSE.w Revised 12/05/94 Land Use 8•aluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS LOT a T I COT a /3 I LOT a C I LOT a Test Pit A I Test Pit A I Test Pit A I Test Pit A I d i/O �i(n/:fy�.uaWt I O-6a/�ac.AgSA/14 I G-zgsa^'Rr[aa.. I 0.1-7 LG CHS4N tEGrlul I�~-fJ Sa�,tf�rc L I 2n4.0 Saner l9 owL I 1-7 fa [ r iN I rye )r I ry�. ia I j✓ E af17 I I I 4 _iZ 41— �2 I l x� I I Depth of root pen.: I Depth of root pen.: 39 I Depth of root pen.: I Depth of root pen.: l7 I Depth of mottling: I Depth of mottling: I Depth of mottling: I Depth of mottling: 1 7 Depth to rest. layer: tO I Depth to rest. layer: 3 9 I Depth to rest. layer. t o I Depth to rest. layer: jL Soil type (USDA): _11 I Solt type (USDA): 4 I Soil type (USDA): I 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 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: _ 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 Curtain drain needed? ,� I Curtain drain needed? I Curtain drain needed? ,� I Curtain drain needed? I Slope <x): i slope <x): i Slope (x): C� j Slope (x): Shoreline? (YIN): N i Shoreline? MR): i Shoreline? (Y/N): i Shoreline? (Y/N): I Minimum tot s1ze:A I Minimum lot size: I Minimum lot sixe:A f I Minimum lot size: 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). COIIffEMS "-k H w 7 „ N:ION-.STTRILNUUSR.W Revised 12/05/94 Land Uae FVa1Va[lm PAR'1' 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. f9 6=J 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) : A d HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN BY APPLICANP 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. Health Official Date PART 5: REVIEWER SIGNATURE ea th Official Date rl:1�N-srrFll,runUSF.w r:��t.<�d 12./05194 Madorie D. Young Short Subdivision Assessor's Parcel No 32134-75-00090 1. From Shelton NE on Highway 3 approximately 4 miles to Mason Lake Road on the left. 2. Turn left on Mason Lake Road and go approximately 0.75 miles(to top of Batstone Hill) to Catfish Lake Road on the right. 3. Turn right and go approximately 0.37 miles on Catfish Lake Road (gravel) to first intersection. 4. Turn left at intersection and go northerly on gravel road approximately 747 feet (0.14 miles)to new access road on the left (unfinished but driveable). 5. This access road runs down the property line between lots 9 and 10. 6. Test holes for Lot 9 are to the left of the road as shown on the accompanying short plat.