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Home My WebLink AboutSPH95-0095 - SPL Application - 8/24/1995 f y 3Z13�1 - r15- qM I MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 '2061427-9670 FAX 427-7798 AP(PLICATION FOR LAND USE EVALUATION �1 G Receipt No: d-3-XJ Date of Payment: � � `•' l INSTRUCTIONS 1. An application is considered coaplete when the fee is paid and the following elements have been addressed: • Parts 1 and 2 of the application form must be comp(eted. I • 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 ft deep shelf must slope up to the ground surface for easy ingress and egress. i • A scaled plot plan must be attached to the application. The scaled plot plan oust 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. IMPORTANT: IN ORDER TO AVOID ADDITIONAL COSTS, BE SURE TEST HOLES AND PARCELS ARE ALL FLAGGED AND CLEARLY I DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON THE PROPOSED PLAT MAP. PART 1: APPLICANT/PARCEL IDENTIFICATION E1 Large Lot Subdivision I—I Short Plat Subdivision f�7 BLA (Office Review) u $100 + $SO/parcel u $85 C $400 + $20/lot u $10 • NAME OF APPLICANT RICHA2b CEFfL67e 121)Y-L 2 LEPAONE I ) • MAILING ADDRESS c n01� (Oia �G�U3 1 y �,� . 9v)�a 9dlo� - — - st-ate— • ASSESSOR'S PARCEL NUMBER � 2 � - .2— LEGAL PROPERTY DESCRIPTION AIQV+, .5'104; $'6L. 34-, 7-;VA)�. /L3W 4Ah, • LOT SIZES (ACRES OR SR FT) 1.42 Az- 1•13AC• _JJLA o U?Ac. ' /b JOB lot i/EC AOp • DIRECTIONS FOR LOCATING SITE ATrAUl5b PART 2: INTENDED USE OF PARCEL INTENDED USE OF PROPERTY (Check One) : Single family residence Multi-family residence Other, specify: • WATER SOURCE FOR PARCELS (Check One) : Individual wells I__I Community well H:\ON-SITE\LNDUSE.W Revised 12/05/94 0 Land Use Evaluatlon PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS 1 LOT #/=L I LOT for # �., I LOT a 10 D 1 Test Pit A I Test Pit A I Test Pit A I Test Pit A o rYDc-FF 16-ZS"<wi SQu�P O - 5_5� I G zi Sdta7l�a 1W I ]�—L9 5a nE(y rriv�l IG- 26 SiC(1Qy�Guam.. I I I I tY)wrR I I IL1b G7 5AN.4E�wvcL Depth of root pen.: f I Depth of root pen.: ''� Y I Depth of root pen.: Sa I Depth of root pen.: Z-c-� Depth of mottling: _ I Depth of mottling: I Depth of mottling: I Depth of mottling: _ Depth to rest. layer: ZV 1 Depth to rest. layer: I Depth to rest. layer: Depth to rest. Layer: Soil type (USDA): �_ I Soil type (USDA): Y I Soil type (USDA): _1 I Soil type (USDA): Test Pit 8 I Test Pit B I Test Pit B I Test Pit 8 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 Solt 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 j slope (x>: Cam_ j slope m- Imo_ i Slope a): o j stop@ (x): d I Shoreline? (Y/N): 1`1 I Shoreline? (Y/N): I Shoreline? (Y/N): ) I shoreline? (YIN).- minimum lot size:A I Minimum lot size:A I Minimmm lot size:A �_ ( Mintmm lot size:A I a Mininmm lot size applies to new subdivisions and is defined as the miniamm allowable Lard area per residence or residen- tial equivalent (450 gallons per day). COMMENTS n H:1ON-S1TF\LNDUSE.W Revised 12/05/94 ' Land Use Evaluation PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) MEETS HEALTH CODE jX 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. F� d DOSS 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) : ® 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 lJ Condition(s) required prior to approval have been aet by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE HealtvIficial Date H:WN-SITE\LNDUSF,.W Revised 12/05/94 Richard Leffler Short Subdivision Assessor's Parcel No 32134-75-00100 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 10 are to the right of the road as shown on the accompanying short plat.