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Home My WebLink AboutSPH95-0095 - SPL Application - 8/24/1995 _ � T Vz 3z)3q - '15 - G610I MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 '2061 427-9670 FAX 427-7798 APPLICATION FOR LAND USE EVALUATION < d-3 G Receipt No: _30 Date of Payment: `•' � L INSTRUCTIONS �� 5 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 property excavated backhoe pit per proposed parcel must be ready for inspection. Property excavated pits are 6 ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf oust slope up to the ground surface for easy ingress and egress. • A scaled plot plan gust 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. 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. I PART 1: APPLICANT/PARCEL IDENTIFICATION I-1 Large Lot Subdivision n Short Plat ❑ Subdivision ^ SLA (Office Review) u $100 + $10/parcel u $85 $400 + $20/lot u $10 NAME OF APPLICANT Q)GHA1Lb L67FFLEe 62iloA-L 2 LEPNONE i ) • MAILING ADDRESS Vavhelt_� Q��O 1D�0,3 City sFSt� 3.p 9Dw4A •'ASSESSOR'S PARCEL NUMBER 3 Z _L 33# - _L S • LEGAL PROPERTY DESCRIPTION AJ(J i/4,..,58 V4•0 SSG. 31 t 7—;VA).. ge 3W IA ti -- LOT SIZES (ACRES OR SQ FT) �b�• 1•13AC• c. .1Uc. fe jP5 W16C .ep • DIRECTIONS FOR LOCATING SITE ATr/IC hep 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 U Community well H:\ON-SITE\LNDUSE.W Revised 12/05/94 Land Use E aluatlon PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL yL;O�GS AND SITE CHARACTERISTICS LOT #/�._ I LOT # Hlly I LOT # in I LOT # )6 I 1 Test Pit A I Test Pit A I Test Pit A I Test Pit A 1 1ptFl7cLtf i � -ZS LuT �yS>QuP Q 5-,k4orMy 9N� I � ziSA4d7l. 4 « � IG— Z6 SXoa,+Cuaa.. A� ej ru�L j 2i-2v Sa vaE(�rvv�L � za-ev Ew/ I zs �rF1��w I Yy ioysC� I rnrw 1 1 �z1 �--6� Saro.4kG,.4„tt, I Yw-1 R I I � I I I 1 Depth of root pen.: P_v I Depth of root pen.: ''� Y I Depth of root pen.: rb I Depth of root pen.: Zc 1 1 Depth of mottling: _ I Depth of mottling: I Depth of mottling: I Depth of mottling: 1 1 Depth to rest. layer: Z V I Depth to rest. layer: I Depth to rest. layer: _5121 _ I Depth to rest. layer: Z,1 1 1 Soil type (USDA): Al I Soil type (USDA): — I Soil type (USDA): _ I Soil type (USDA): 1 Test Pit B I Test Pit B I Test Pit B I Test Pit B 1 I I I 1 Depth of root pen.: _ I Depth of root pen.: _ I Depth of root pen.: _ I Depth of root pen.: _ 1 Depth of mottling: _ I Depth of mottling: _ I Depth of mottling: _ I Depth of mottling: _ 1 Depth to rest. layer: _ I Depth to rest. layer: _ I Depth to rest. layer: _ I Depth to rest. layer: _ 1 1 Soil type (USDA): _ I Soil type (USDA),. _ I Soil type (USDA),. _ 1 Soil type (USDA): _ t T 1 Curtain drain needed? I Curtain drain needed? _� I Curtain drain needed? �_ I Curtain drain needed? jSlope (%): Cam_ j Slope (x): ,� I Slope (x): O j Slope (%>: 1 I I I 1 Shoreline? (Y/N): IJ I Shoreline? (Y/N): Shoreline? (Y/N): ) I Shoreline? (Y/N): N 1 Minimum lot size:A I Minimum lot size:A I Minimum lot size:A �_ ( Minimum lot size:A , 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 y� N:\ON-SITE.\LNDUSE.W Revised 12/05/94 Land Use F,valuation 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. 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) : �i HOLD APPROVAL UNTIL FARTHER ACTIONS ARE TAKEN BY APPLICA2Tr 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. Realth Official Date PART 5: REVIEWER SIGNATURE Healtv, ficial Date H:WN-SITE\LN USF..W Revised J2105194 Richard T Pffier Short Subdivision Assessor's P r 1 -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.