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Home My WebLink AboutSPH95-0049 - SPL Application - 5/12/1995 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 42 7-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: / G 7 / Date of Payment: CC�_ INSTRUCTIONS lAq 5 _�[ 1. An application is considered conptete 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 ft of the property boundaries. 2. After a completed application is received, staff will impact the property and provide the applicant with a written report. I I I 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. PART 1: APPLICANT/PARCEL IDENTIFICATION u Large Lot Subdivision ro Short Plat u Subdivision C BLA (Office Review) $100 + $10/parcel L $85\\ II $400 + $20/lot $10 • NAME OF APPLICANT STEP I-t A1J �-r)N S 00 PJ TELEPHONE (360 ) 2.7 5- 671 • MAILING ADDRESS NE 70� �(551��.) -fc��K l`D '�M___>*_4'O0 Z > y L ff IIZ 3 1p Z 8 qI p00 Z •'ASSESSOR'S PARCEL NUMBER Z 3 3 (0 - Z - _ • LEGAL PROPERTY DESCRIPTION Sic 30 , T Z-3 /\/ lei &J W rVI • LOT SIZES (ACRES OR SQ FT) 01e s Ac. O, 8 5 . z5 T --rot- —rar-w— • DIRECTIONS FOR LOCATING SITE FK O, 156L.Fq i Yt 4,)e ST N vicl f Sr!oRr � h'1 LNS ` T"a L-Ht2ScN LAKI� 9D. ?L(TL T f, 0 !2. /)11 TO C U"'L ASS ,) 4Y T=I22-1 LLJFT N40 T-o eNN oi= Cw -ri-A55rtiAV. CV0 / 8Ct.,4T 0.3 11 r'NS'i 1_01ZSdv T3cY4) . CiN CLe?1R. CL(T /4t2t+`T4 PART 2: INTENDED USE OF PARCEL INTENDED USE OF PROPERTY (Check One) : u n D A::-'I-Single family residence Multi-family resi Other, specify: M ` Y 1 2 1995 WATER SOURCE FOR PARCELS (Check One) : T ' SERVICE FAL Individual wells ul. Community well H:\ON-SITE\LNDUSE.W Revised 12/05/94 Land Use Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS LOT # I LOT # I LOT # LOT # Test Pit A,' I Tot Pit A i Test Pit A i Test Pit A � 6- Kk s� l an o I i I I I I I Depth of root pen.: t, I Depth of root pen.: I Depth of root pen.: _ I Depth of root pen.: _ Depth of mottling: 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: I Soft type WSW: ( soil type (USDA): �` _ I soil type (USDA): I sort type (USDA): I 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 I I I I I I I 1 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): - _ I soil type (USDA): Curtain drain needed? I Curtain drain needed? I Curtain drain needed? _ I Curtain drain needed? jslope (x): _ I Slope (x): I slope (x): _ I slope Shoreline? (Y/M): I Shoreline? (Y/N): .LIB I Shoreline? (Y/M): _ I Shoreline? (Y/M): Minimum tot size: / I Minion lot size:A / /�C I Minion tot size:A _ I Minion lot size:A IOr 15JC /�ri l�,l�B� 15+ �Om 1e�1 Minimum lot size applies to new subdivisions and is defined as the minion allowable Land area per residence or residen- tial equivalent (450 gallons per day). Cobud=S �. , l a H:\ON-SITE\LNDUSE.w Revised 12/05/94 Land Use Evaluation PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) MEETS HEALTH CODE /5A; After examining 1 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. i9 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) : Ida 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 U iti (s) r fired for to approval have been met by the aqpticant. He Official Date PART 5: REVIE R SIGNATURE Heal f icial Date N:\ON-SITE\LNDUSE.W Revised 12/05/94 .�. <✓. aL✓. n✓✓ IVrtJ f1LG IV O. 41IJ`JO. S 89'58'56" W 20.00' N 00101'04" W 8.20' 10.00' N 00'01'04" W 20.00' S189-58'06- W 800' I ---------- ------ 300.00' �j _T------- Sc I r 1.80'J1�• — FOUND 1/20 BAR & CAP LS #14076 I FOUND 1/2" BAR &S 69'52'07" E LS #14076 0.4' I S 1530'38' W •.N 89'59'03' E 1 .12' 0.6' PER VOLUME 7 PAGE 276.1 137.02' OF SURVEYS S` N 19'28'57" E -IVA9 100' R / 76.80' 3 ri OS 0.85 AC ES FOUND 3/4" IRON PI O/ F ; O PER VOLUME 7 PAGE n 389_13' S 89'58'56" OF SURVEYS tO �- --- — N 07'30'10" W ao. 277.78HAC 1 .35 T10N CORNER PROJECTED $ 1 10'Gmenu I 21.31' VOLUME 7 PAGE 19 rl OMMUNITY WELL SURVEYS z a. SYSTEM EASEMENT.` OoFOUND 3/4- IRON 0.37' WEST OF LINE 84.98'•... ......... 194.48' 120.80' I 400.26' N 89*58'49 E I 2044.80' I � I I I OUND 3/4" IRON w I 0.14' WEST OF LINT Ln I Ln yn Z 40' PRIVATE ROAD & 385' CREATED BY JOHN J( i PROPOSED SHORT PL FOUND 3/ I Z ON PROPE Z I o � N I W o Lo I FOUND IR BAR & CAP I PER SHORTT OUND 3/4" IF PLAT 0.1' WEST OF I #2448 (118.77') I FOUND 3/4- li 85.05 118.76' 80 N 7'30'09" 385.06' N 89'58'49" E I FOUND BEC