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Home My WebLink AboutLRG2023-00003 - LRG Application - 11/2/2023 LAG Z013 -oaoo3 MASON COUNTY 915N_e"'STREET SHELTON WA 98584 SHELTON W04239670. EXT.400 COMMUNITY SERVICES eetcaiR.36o_v6:4A7 EXT 400 ELMA 360482-5269 EXT 400 a,aai�g viannag.smLonm.malxeJ�hcommu,IyxwnM1 FAX 360427-7798 APPLICATION FOR LAND USE EVALUATION Amount Paid: , Receipt Number- instructions 1. An application is considered complete when the fee is paid and the following elements have been addressed: ➢ Parts 1 and 2ofthe application form must be completed. D One properly excavated test-hole per proposed parcel must be ready for inspection.Properly excavated pits are 5-feet deep with a 4-foot deep shelf on one end of pit.The 4-foot deep shelf must slope up to the ground surface for easy ingress and egress.(See the Mason County Public Health On-Site Standards) I > 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 locations of any existing or proposed wells,roads,or buildings within 100-feet 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 avald additional costs,be sure the rest holes and parcels are all flagged and dearly delineated as to lot and test bok number.The identifrcd test holes must match the locations shown on the proposed plot map. PART 1 : APPLICANT/PARCEL IDENTIFICATION ® Large Lot Subdivision 6 ,Subdivision 6 Short Subdivision 9 M Name of Applicant Dahl Properties LLC Phone 360.740.0345 Mailing Address of Applicant 261 N Hamilton RD City Chehalis State WA zoo 98532 12-digit Tax Parcel No. 52024-13-00000 Proper Legal Description Lot Sizes (Acres or Square Feet 5.999 7.210 6.895 5.256 5.033 9.530+5.51 LOT t LOT 2 LOT 3 LOT 4 LOT 5 LOT 6 Directions to Site Continue onto W Shelton Matlock Rd;Turn left onto W Highland Rd PART 2: INTENDED USE OF PARCEL Intended Use of Property(Check One): k7 Single Family Residence ❑ Multi-Family Residence ❑ Other, Specify Water Source for Parcels (Check One): E Individual wells D Community Well (Public Water System) This form Revised 3/2/2017 Part 3: Health Department Review (Official Use Only) Soil Logs and Site Characteristics t� Lot# i Lot# Z Lot# Lot# 1 Test Pit A Test Pit A Test Pit A Test Pit A 0-39" SL 0-3z SC 0-36 " S: L 0-37' FSL W of 3e" v/ffn lkiSf of 32" 4/-ktI ne5+ of 361 5+ 01 37' wf 4 mof- # Mill- Wl mot huvy Arif D>�of Mottling a th of Mottling Dpth of Mottling Depth of Mottling Deg(h to Rest. Layer De Rest. Layer Depth to Rest. Layer Depth to Rest. Layer Steil Type (USDA) Soil Type (USDA) Soil Type (USDA) Soil Type (USDA) Test 134 I-Of s' Test-r" Test Pit B Test Pit B 0-39'UL 0 39" Ul- W V 37" v/ ft54- aj 3ff" w! Ihof f�'ll j mof tf/q ►v/q. Depth of Mottling DepfJ1 of Mottling Depth of Mottling Depth of Mottling Depth to Rest. Layer a jh to Rest. Layer Depth to Rest. Layer Depth to Rest. Layer Soil Type (USDA) Soil Type (USDA) Soil Type (USDA) Soil Type (USDA) Curtain Drain urtain Drain rtain Drain rtain Drain Needed? NO ed?_ N\( ) Ne ed?_ Slop % Slope o SSlope Shoreline? (Y/N) Shoreline? ( N) SShoreline? (Y IV Minimum Lot Size` Minimum Lot Size` MMinimum Lot Size' This form may be scanned and available for public view on the Mason County Web site. ]:\EH Forms\ONSRE FORMS\Current Misc. Forms\2017 Land Use Evaluation Application.doo Updated:12/23/2016 1:32:00 PM Revised 12/30/2016 `Minimum lot size applies to new subdivisions and is defined as the minimum allowable land area per residence or residential equivalent(450 gallons per day). COMMENTS PAAR/T 4: REVIEW SUMMARY IXI MEETS HEALTH CODE !�' DOES NOT MEET HEALTH CODE After examining lot size, proposed water source and soil type, it is the determination of Mason County Public Health that each proposed parcel cannot support an on-site sewage disposal system meeting the requirements of state and local regulations. This determination is based on consideration of the following factor(a): ❑ HOLD APPROVAL UNTIL FURTHER ACTIONS ARE TAKEN BY APPLICANT After examining lot size, proposed water source and soil type, it is the determination of Mason County Public Health that each proposed parcel cannot support an on-site sewage disposal system meeting the requirements of state and local regulations until the following conditions are met: Condition (a) required prior to approval have been met by the applicant Health Official Date PART 5 RE WER SIGNATURE rl / Z /ZoZ2 ealth Official Date This form may be scanned and available for public view on the Mason County Web site. 3:\EH Forms\ONSrTE FORMS\Current Misc. Forms\20171and Use Evaluation Applic bon.dm Updated:12/23/20161:32:00 PM Revised 12/30/2016 F � G M.. F7l' Ali; Egli o +i (��7l�t�1i � ll o '� .. , 7 " _' �� m ➢t 9c t:h!!it! 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