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Home My WebLink AboutSPH95-00028 SPL2596 - SPL Application - 3/29/1995 r .. �1IMSOIr COUNTY DEPARTMENT OF HEALTH SERVICES _ 321a. 1 _y�_�b�� POST OFFICE BOX 1666 y 1 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 MAR 2 9 JWPLICATION FOR SHORT PLAT EVALUATION Receipt No: "-� -- � Date of Payment: IN SERVICES 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 ft deep with a 4 ft deep shelf on one end of the pit. The 4 ft deep shelf must slops 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 inspect the property and provide the applicant with a written report. If the project requires more assistance than the evaluation of four test holes and completion of this report, an hourly rate of $37/dour as set forth by the Mason County Board of Health may be charged to the applicant. Revised 09/01/92 PART 1: APPLICANT/PARCEL IDENTIFICATION U ci ....................................... • NAME OF APPLICANT A4/?QLD /LhtTFIE_LA TELEPHONE (yo 5307 • MAILING ADDRESS 1 L K naLL) qo i7' 01 7 Z 51-F�L'r o N Lv Y-3 9 B 58 City 8t�t• Zip / O i -7 3 • ASSESSOR'S PARCEL NUMBER > • LEGAL PROPERTY DESCRIPTION '56c 3 4- T 7- 3 w w1 • LOT SIZES (ACRES OR SQ FT) /,4-2 AC / Z Ac. 9 7 Ac• Lot 1 Lot 2 Lot a Lot 4 • DIRECTIONS FOR LOCATING SITE 7S K P C4 TF,5a I/o Kr R of Ta KeT- 0 300/f sr za u 724 eG c TAe PART 2: INTENDED USE OF PARCEL ................ e IINTENDED USE OF PROPERTY (Check One) : 1 "ingle family residence Multi-family residence Other, specify: • WATER SOURCE FOR PARCELS (Check One) : Individual wells El Community well M-1 short Plat Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) SOIL LOGS AND SITE CHARACTERISTICS Lar f i LOT 8 Z- LOT ! 3 LOT i Test Pit A Test Pit A Test Pit A Test Pit A U-.?y S14 sys�.w- sys Depth of root pen.: Depth of root pen.: Depth of root pen.: 7 4 Depth of root pen.: P Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: Depth to rest. layer: Depth to rest. layer: Depth to rest. layer: ,2 Depth to rest. layer: Soil type (USDA): Soil type (USDA): soil type (USDA): 45L— soil type (USDA): Test Pit B Test Pit B Test Pit B Test Pit B r Depth of root pen.: Depth of root pen.: Depth of root pew s Depth of root pen.: Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: Depth to rest. layer: Depth to rest. layers Depth to rest. layer: Depth to rest. layer: Soil type (USDA): soil type (USDA): soil type (USDA): soil type (USDA): Curtain drain needed? Curtain drain needed? Curtain drain needed? � Curtain drain needed? Slope (i): Slope (_): Slope (i): a Slope (t): Shoreline? (YIN): Shoreline? (YIN): Shoreline? (YIN): N Shoreline? (YIN): Minimum lot size:' Minimum lot size:', Minimum lot size:' _Y__ Minimum lot size:' ' Minimum lot size applies to new subdivisions and is defined as the minimum allowable land area per residence or reside:l- tial equivalent (450 gallons per day). Colau TS short Plat Evaluation r PAR 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) - MEETS HEALTH CODS 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. ® 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. win factor s : llo � This determination is based on consideration of the following ® HOLD APPROVAL UNTIL pURTHER 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: condition(e) requited prior to approval have been met by the applicant. lth O!licial Date PART 5: REVIEWER SIGNATURE 7 J He h Official Date 'W'M `1SM Z 'd "N 2 dMl `-K N0li3IS `-V/ L 3S `t/ L IS NI a731:11dH 3173190h1 T 070HYH J 803 1N3mnNON 31383NOO ONn03 OLl00-5L—t�£'1Z� 'oN �3�?Jb'd 'ON NOISlA iasn s 1 MOHs UU p 5— -9 S32lIdX o D�I 1d� t� d1 o a sA3ANnS 30 96 30Vd f► Z 3Wn10A 83d •/. = .tip' 3did N081 „Z/L ONnoA r�s►A 0 •S 81681# •S'Td suJON •e pJDyol Q'13141VH 3133SO8 2? 0108VH jo �sanbaJ ay} ;D ;o y buipJooaa XanJnS ay} p jo s;uawaiinbaJ ay; y;lM aouDwJO}uOD ui uo►;oaJlp Xw Japun Jo aw Xq apDw I(anJns o s;uasaJdaJ ll;oaJJoo dow slyl 31 r*►d►lb130 s.hf0A3Ahfns '00L = „l 3S213AV8i MIA/ 31VOS W•Q•3 V NOI1d1S �l` i01 .2 S383V 68•L N 8.2� AS 071HO :38na3008d/'din03 c 10l 56 — C 31va S l(C` z)tvc -ON sor O " " AG NMa -P9998 NOIDNIHSVM 'N0113HS " " " �` " '� z z O£S'S—LZ* (90Z) L6£ X08 '0•d K a a 4 4 {';' z Ln 'S'I'd SI88ON '8 (INVH018 s� ,� .� � �p sA3n8ns aNeI ls380A _` z , . : y . No o '� LA ce .1 •Jo;lpn y X;unoj uosow H '00 L ———————————— -ON ally s,Jo p pn y --3't88L3A-'��83f8— jo ;sanbaJ ay} 4o ----- a6Dd 'S}old �JoyS JO --- •loil w 'w •--- ;D 9661 ----------- jo XDp------ sly; pJOoaJ JOJ pall_ 1N3W3SV3 113M 3181SSOd 31YOULLY30 s.d01►Onr panoJddy a;op ;uawdolanap X;lunwwoj jo Jo;oaJi(7 sA3nans 3o 96 30Vd 100'OOZ Z 3WnlOA N3d ' 3dld N081 .,Z/L ONnoJ g!C•g l a pLL X;uno j uoso pV o; ;uonsJnd bulpJooaJ Joj 1DnOJddy 7YAOUdd r CA10133MIG •uol;dposep jo purl XUD ;o e6Dgjo6 .jo 'e;soM snopiozoy 'seplol}oesul 'soplol"4 'e60Jo;s IDOIWe140 Asp Jo pinbll 'ajnuow lDwiuD .10 iMo; 6ululo}ulow Jo; seinsoloue 'slDLuluo 6ulzDJ6 'suol;D;s pae; 'su,Ioq 'sNuo; a6Djo;s puno.j6-tepun 'saullJaMas 'spleUulDJp puD SNUD} co of;des sD yons 'uol;Dulwo;uoo ;o somos Iol;ua;od Auo 6ulpnloul 'je}DM ysluln; o; pe}Diedo sl lleM tO ay} so 6u01 os 'soinos je;om ay; ;o ;aa; OO L C uly;lM peulD;uloW Jo pe;oni;suoo eq o} jsgns Jo 'paulD;uIDW 'pa;oru;suoo aq UDo 6uly10N *ON ali} s�o;ipny uolslnlpgnS }Joys o; uOI;DJD/oap 'J' 3dld N08I .b/£ dNnO3 •apoj X4unoD uosDIN }o gf•gl Ja;dDgO jo s;uawaimbaJ ay; o; ;oafgns aq 1lDys uois►nlpgnS ;JoyS sly; u►gpm s;ol jo uorslnlp Jaypnj Xuy •Z 30Nd1S14 V ON18VIO (180038 (XXX) sJauMo ;ol ay; y;lM ;sal lloys (qua;& s pDOJ s,,f;unoj ay; o;ul pa;da000 uaaq M94 S� dd0 :DLSd�d (INV �Ib832i „9/9 13S • anoy spool yons ssalun)) uorslnlpnnS ;JoyS sly; L ►igpm s;ol 6ulnJas Jo o; S3�OH OM 110S 6ulpoal spool a;onrJd puD s;uawasoa jo aououa;ulow Jo s;uawanoJdwl 'bulpllnq 0310N Sb' aN(10j S213N2J00 O Joj aouadxa puo X11►91suodsad •1 LEGAL DESCRIPTION : SHORT SUBDIVISIO, IN THAT PORTION OF THE SOUTHEAST QUARTER (SE 1/4) OF SECTION THIRTYFOUR (34), TOWNSHIP TWENTYONE (21) NORTH, RANGE THREE (3) WEST, W.M., SE 1 /4, SE 1 /4, S E C TS O f PARTICULARLY DESCRIBED AS FOLLOWS: T WP. 21 N., R. 3 WE S T, COMMENCING AT THE SOUTHEAST CORNER OF SAID SECTION THIRTYFOUR (34); THENCE NORTH 0'37'47" WEST, ALONG THE EAST LINE OF SAID SECTION THIRTYFOUR (34). 555.00 FEET, TO THE POINT OF BEGINNING OF THE TRACT OF LAND HEREBY DESCRIBED; THENCE CONTINUING NORTH 0'37'47" WEST, ALONG SAID EAST UNE, 455.00 FEET; THENCE SOUTH 89'09'23" WEST, 626.50 FEET; THENCE SOUTH 57'46'58" WEST, 215.00 FEET, THENCE SOUTH 67*50*52" EAST, 878.14 FEET, TO THE POINT OF BEGINNING; EXCEPTING THEREFROM ROAD RIGHTS—OF—WAY. SAID LAND BEING ALSO KNOWN AN DESCRIBED AS TRACT 17 OF SURVEY RECORDED OCTOBER 11, 1976, IN VOLUME 3 OF SURVEYS, PAGE 98, AUDITOR'S FILE No. 320189. TOGETHER WITH AND SUBJECT TO AN EASEMENT FOR ROAD AND UTILITY PURPOSES, 60 FEET IN WIDTH, AS SHOWN ON SURVEY RECORDED IN VOLUME 2 OF SURVEYS, PAGE 98, AUDITOR'S FILE No. 320189, AND AS DESCRIBED IN CATFISH LAKE EASEMENT AGREEMENT RECORDED MAY 16, 1977, AUDITOR'S FILE No. 328401. FOUND NORRIS BAR & I 115.33'X \ El =68'06'100 . F. o \ L=309.04' N ti o0 SHED \ \ 1 \ �Q EXISTING WELL 6" CASING +� LOT \ 01, PQ 1.42 ACRES. HOUSE 1 60 — FOUNID-•-+/2"•---RON P4PE SEPTIC SYSTEM �— UT PER VOLUME 2 I I PAGE 98 i OF SURVEYS 2�8 3S, 422.s'' I I � GARAGEI i / GREEN HOUSE I I (R) 3�2S �• •20• FOUND NORRIS BAR & CAP PER PREVIOUS SURVEY 30' PRIVATE ROAD AND UTILITY EASEM 7PD T.