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Home My WebLink AboutCRT2023-00005 - CRT Application - 8/1/2023 ON, 584 MASON COUNTY 415 N 6TH STREET,SHELT967 ,E 98400 SHELTON:360 427-9670,EXT 400 ,, BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 EH REVIEW: PROPERTY/TEST HOLE EVALUATION CRT2023-00005 APPLICANT Greg Woodard Phone: Address: 12102 122nd ave e PUYALLUP, WA 98374 OWNER SCHLITTLER MARLENE Phone: Address: PO BOX 2147 GEARHART, OR 97138 Site Address: E Agate Beach Dr Primary Parcel Number: 320245302011 Date Received: 08/01/2023 Date Inspected: 08/17/2023 Date Issued: 08/21/2023 Inspected By: Jeff Wilmoth Fees Paid: $350.00 Inspection Results: TEST HOLE#1 RESTRICTIVE LAYER DONE TEST HOLE#1 SHORELINE SETBACK AWAITING INSPECTION TEST HOLE#1 SLOPE DONE TEST HOLE#1 SOIL TYPE DONE TEST HOLE#2 RESTRICTIVE LAYER DONE TEST HOLE#2 SHORELINE SETBACK DONE TEST HOLE#2 SLOPE DONE TEST HOLE#2 SOIL TYPE DONE TEST HOLE#3 RESTRICTIVE LAYER DONE TEST HOLE#3 SHORELINE SETBACK DONE TEST HOLE#3 SLOPE DONE TEST HOLE#3 SOIL TYPE DONE Comments/Summary: Test hols 2, 3, and 4 on the southern portion of the property were found to have very shallow mottling in the soils, around the 5-6" mark, which usually indicates a high water table with insufficient soil for a septic system. If development in this area is proposed a Winter Observation review will be required (See Section E of Mason County On-site Standards) The test hole towards the center of the property had more soil, with 12" of sandy loam soil over mottling. With this soil depth, an above ground mound type system would be required. Please Note:Conditions reflect status at time of inspection and/or sampling. � � � 0 , MASON COUNT N 6TH STREET, SHELTON WA 98584 �023 SHELTON: 360 427 9670, EXT. 400 `� A tc, O 1 BELFAIR: 360-275-4467, EXT. 400 Public Health & Human Servic ELMA: 360-482-5269, EXT. 400 • 360-427-7798 By AUG 031023 RECEIVED APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW Permit Number Payment Information Type of Review 0 Septic and Water $430 CRT Receipt Number 1- ❑ Septic $255 �UZ3 Cash ❑ Water $255 (Individual and Two Party) / Check a� o '� I Group B WS $95.00 (+$95.00/hour beyond 1 hour) c� I Date of Payment �l `I Property Evaluation $350 Resample $30 lab fee Instructions: Complete Parts 1, 2, and 3 completely and accurately. With the application form, please submit the appropriate fee and the necessary documents such as a septic system maintenance report. If the application is for a property evaluation for septic, be sure the test holes have been dug and the location is clearly marked at the site. PART 1. APPLICANT AND PARCEL IDENTIFICATION Name of Applicant �' r'c'e‘21 U0OoDPrRD Phone ?53-- (7 3L3 71 7 Mailing Address of Applicant ► 2-1 G.z_ 1 ZZ N D } t, City --t t.t'* k Ll.i..l,,D State - ) Zip (I 5.3 7 LI 12-digit Tax Parcel No. -3 ZO 2.9 - S3 - 0•Zo ► I Site Address Ilya{e $c�ch pr Brief Legal Description AC', ..Ac4-1 E61- TE.S : 2- L i f 1 Driving Directions j-AICE E Sit-rr R,ti G 3 Tv 6- AGATE-RD (Tui 4 on) E r9Ei,t r RD T2' �LR,ti v Aditti AE,rtTE 5Jb ) ez)(91)A1u 57 fl i HT UNTO L,4/f7t/At.r.s RD i ST /EP nAf ro . r d-f D,. C o%Jl t-v/t L E tf,A/ ,e}Ui R 1 - 1qfeel*r 200 S%g/)..c.3 DocvAl A-4e-re: & (1F27 77/c tifr- Phi-5 37 A) LiNE5 on) •TP-/-f 1.0; - 6 f o -TY LI r12 S.,. Page 1 of 4 This form may be scanned and available for public view on the Mason County Web site. Revised 12/8/2022 4 PART 2: TYPE OF REVIEW ❑ Septic System • Age of system • Age of house • Number of bedrooms • Name of last owner • Is house currently occupied? YES I NO • If not occupied, how long has it been vacant? 0 Water System • Number of service connections on the water system? • If a public water system, name of system • WFI number 11(Property Evaluation (soil logs) Property evaluations provide, in general terms, the suitability for a parcel for septic system placement. THIS DOES NOT GUARANTEE FUTURE SEPTIC SYSTEM APPROVAL. • Describe the intended use of the property and the reason for requesting the review. fi.cYiigW- 1 .5I1)E/ve -57S r 4rt-— PART 3: PLOT PLAN Use the space below to draw a detailed plot plan, or attach a detailed plot plan to this application. The plot plan should include the following: North Arrow, Location of Test Holes, Location of Existing Septic System, Dimensions of Property, Location of any Drinking Water Sources(wells, springs, etc.) Roads, Easements, Surface Water, and Buildings on the property. (skip Part 3 for Group B water system review) LOT SIZE AiTk ab g s 1 \oL=ts Acres COMPASS Applicant's Signature: - (4 Date 7/2-Y 7� Page 2 of 4 This form may be scanned and available for public view on the Mason County Web site. Revised I2/8/2022 • • . . * W 4 4 r ,� __- 04 ' �C AST - 1 S— • ) . ... . J a� ,�• 13 :14 - 15 . - ' 11 'I�' /21 .� ._ • s.t.a _^'tip '� � � •• V r/I �•3 •• f- t/J - . rr O� \;.1 s I 4 l 1 a . , a,• ri .F .%� 7 },C. _. R cio 4 55-0 '• S IIIf = , _ _�► 5 ' , ti Go.b Fb. • mast :vim . • t -- Mason County WA GIS Web Map N E AGA i E BE AC �`� p o2400c0000 w-F g 4 32024530201Z ,^l 320245302012 �t320_4530201 i� 320245302010 320245302009 (-2) GD-7 J y � - 7D;1 320243020 i` _-_ 320245302019 r- 320245302020 32ti245302�121 320 EAGAT®BEACH DR 320245602022 7/12/2023, 2:00:47 PM 1:384 0 0 0.01 0.01 mi L County Boundary I ' r r • I , 0 0.01 0.01 0.02 km No Filled ° Site Address (Zoom in to 1:3,000) Sources:Esri,HERE,Garmin.Intermap,increment P Corp..GEBCO.USGS. FAO.NPS, NRCAN, GeoBase, IGN,Kaeaster NL. Ordnance Survey. Esri j Tax Parcels (Zoom in to 1:30,000) Japan,METI,Esri China(Hong Kong).(c)OpenStreetMap contributors.and the GIS User Community Mason County WA GIS Web Map Application Bureau of Land Management,Esri Canada,Esri,HERE.Garmin,INCREMENT P.USGS.EPA,USDA PART 4: HEALTH DEPARTMENT FINDINGS — OFFICIAL USE ONLY Septic System Yes No The septic system was inspected by an appropriate maintenance provider and the submitted report ❑ ❑ is current. ❑ ❑ Records for this property contain a septic permit, design, final approval and as as-built drawing. ❑ ❑ The site was inspected and the system location appears to be consistent with recorded documents. ❑ ❑ The area of the on-site system appears to be maintained in an acceptable manner. ❑ ❑ Was Operation and Maintenance a condition of permit approval? ❑ ❑ Is a copy of a current Operation and Maintenance report attached? Water System Yes No Individual Water System A water sample was taken by Public Health staff. Total coliform bacteria were determined to be ❑ ❑ absent. Laboratory results are attached to this report. ❑ ❑ The well cap was inspected. The sanitary seal appears satisfactory. The well casing was inspected. The casing projected above ground and the ground sloped away ❑ ❑ from the casing. The well site was inspected. No septic systems, chemical storage facilities, manure pile, animal ❑ ❑ feedlots or other obvious sources of contamination appeared within a 100-foot radius of the well. Yes No Public Water System ❑ ❑ Records indicate water-sampling requirements are being satisfied. ❑ ❑ Records indicate the Water Facility Inventory form is current. ❑ ❑ Department files contain water system design and letter of approval. Soil Conditions Test Hole#1 Test Hole#2 Test Hole#37(1, • -atiovirr7,0„. 0 — VA/Ce e;(--- k_ fast Soil Type: `'f Soil Type: Soil Type: Restrictive layer: 1l-• Restrictive layer: Restrictive layer: Slope: Slope: Slope: Distance to Shoreline: "I/ Distance to Shoreline: Distance to Shoreline: Page 3 of 4 This form may be scanned and available for public view on the Mason County Web site. Revised 12/8/2022 PART 5: HEALTH DEPARTMENT OBSERVATIONS — FOR OFFICIAL USE ONLY Primary Drainfield Yes No The system appears to be functioning adequately at the time of the inspection. (Only applicable if ❑ 1 system has been in use on a regular basis for the last 6 months.) ❑ ❑ Sanitary survey? L Pass L7 Fail n Suspect Not applicable Water System Yes No The water source consists of an individual (or a two-party)well that appears to be a satisfactory source of potable water for a single-family (or two single family) residence(s). The water was ❑ sampled and coliform bacteria were absent. The water source is a public water system that appears to be in compliance with applicable ❑ ❑ regulations. ❑ LI Well Construction Permit Ti Pass I i Fail PART 6: Comments ee-, 4,444GIe4 Sv, 1 / P 7 5 dir,,'Inspector %ce, e(014 Date '.2 /- .)_- Important Notice. i I • &determinations of this review reflect observed conditions as they exist on the day the evaluation was p•rfo feb. Absolutely no claim is made by this office, expressed or implied concerning the future success. failure or permi -pproval of the system and site evaluated. Page 4 of 4 This form may be scanned and available for public view on the Mason County Web site. Revised 12/8/2022 4