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Home My WebLink AboutSPH95-0094 - SPL Application - 8/24/1995 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 3Z131 _ 76 _ gooq I SHELTON, WA 98584 ( 427-9670' M 42 7-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: 0,28 ( Date of Payment: INSTRUCTIONS c'- p4q _ � 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 ft 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. r PART 1: APPLICANT/PARCEL IDENTIFICATION d Large Lot Subdivision ^ Short Plat Subdivision BLA (Office Review) ❑ $100 + $10/parcelL,t `—.I $85 ❑ $400 + $20/.lot El • NAME OF APPLICANT _I AJA 10IL/G D. fOWU(. TELEPHONE (X0 ) 537-2- L • MAILING ADDRESS S 138� #U 706q i rlceg3 Ct4k 1 Fare— .� 9009A 9cx59� • ASSESSOR'S PARCEL NUMBER 34 - 7 S - • LEGAL PROPERTY DESCRIPTION Nwy4, 5'64, SGC. 34J21AIA-30,W-11- • LOT SIZES (ACRES OR SQ FT) 1.3—t e. .13 A(.• 1.3 • DIRECTIONS FOR LOCATING SITE �¢TTAL aBo 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: •Q�WATER SOURCE FOR PARCELS (Check One) : yy Individual wells U Community well H:\ON-SITE\LNOUSE.W Revised 12/05/94 Land Use Vvsbmtion PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS LOT F / I LOT u i3 ( LOT a C I LOT m Test Pit A I Test Pit A I Test Pit A ( Test Pit A I �GH,SQNo((GrLu-1, I� y6 34SANdj�rc�,.L I Z �4o;srtNe lPrawt I /6c.n,( rbL•/H�[(:w�•✓I I I I 17 40 -1Z-e5— a� I ( Depth of root pen.: _ I Depth of root pen.: ; I Depth of root pen.: _ I Depth of root pen.: 17 I Depth of mottling: I Depth of mottling: I Depth of mottling: I Depth of mottling: 1 7 Depth to rest. layer: 2u I Depth to rest. layer: 3? I Depth to rest. layer: 10 I Depth to rest. layer- _t-r Soft type (USDA): 14 I Sail type (USDA): 14 I soil type (USDA): `I I Soil type (USDA): Test Pit g I Test Pit g I Test Pit g I Test Pit 0 I I I I I I 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 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 Soft type (USDA): _ I Soil type (USDA): Soil t � � Yf1e (USDA): I Curtain drain needed? I Curtain drain needed? I Curtain drain needed? I Curtain drain needed? I I I I I I Slope (x): U11 I Slope (x): d i slope (x): C� i slope <x>: Shoreline? (Y/N): N I Shoreline? (Y/N): L I Shoreline? (Y/N): V I Shoreline? (Y/N): I Minimum Lot s1ze:A I Minimman lot size:A I Mini" tot size:A ! I Minimm lot Minimumsize .A ,� I I I I I I .A Minimum lot size applies to new subdivisions and is defined as the minimun allowable lard area per residence or residen- tial equivalent (450 gallons.per day). CObUdENTS 17 i z 9 s" eP �' rf:\om SrTF%Lronuse.w Reviaed 12/05194 Land Use Fvaluatlon 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 l� 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) : F9 F� HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN SY 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. Health Official Date PART 5: REVIEWER SIGNATURE ea th Official Date n:Iom- zrTrliwv11.9r.W Frviv,d 12105194 Manorie 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.