The URL can be used to link to this page

Home My WebLink AboutSPH95-0120 - PLN General - 11/2/1995 MASOA COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 427-7798 APPLICATION FOR LAND USE EVALUATION Receipt No: mil/ �V Date of Payment: INSTRUCTIONS - fig Es _ o1ao 1 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 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 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 DELINEATED AS TO LOT AND TEST HOLE NUMBER. THE IDENTIFIED TEST HOLES MUST MATCH THE LOCATIONS SHOWN ON THE PROPOSED PLAT MAP. Y- I 3 9 ,Ie V-0 � ' Y � 7 SL �8sg� PART 1: APPLICANT/PARCEL IDENTIFICATION 1-1 Large Lot Subdivision � Short Plat n Subdivision I- 1 BLA (Office Review) " $100 + $10/parcel L ' $85 U $1400 + $20/1ot U $10 NAME OF APPLICANT - /7�L e� /'1 I►1 D tyy-5 Q N • TELEPHONE ( 3G0) T�-�-B 8 6 7 MAILING ADDRESS L D Z0 S It 1.C.TovJ - " ^TLOC K (z�> HeLTO-N lv 1')- 9858 Li ybtate Y,1p ASSESSOR'S PARCEL NUMBER • LEGAL PROPERTY DESCRIPTION S T Z OAJ 'IL W • LOT SIZES (ACRES OR SQ FT) fc Lot 1. Uot0 ,o t- DIRECTIONS FOR LOCATING SITE 1- &7ST 0 ►J S d G L.TB ln&TLO lC y� /d AJ _ 0 U 00 ' c i �I Vr�W [Lo&J LL4ff S _ " P&,i-L S//axT Pt R PART 2: INTENDED USE OF PARCEL n E W od l INTENDED USE OF PROPERTY (Check One) : Single family residence LJ Multi-family residence ❑ Other, specify: WATER SOURCE FOR PARCELS (Check One) : I—i 19 Individual wells U 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 # I LOT # I Test Pit A Q I Test Pit A I Test Pit A Test Pit A I p- « 75 S LU .Q1!� I I i ti i ,�,oc�n►a, Depth of root pen.: "1 I Depth of root pen.: r 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 Soil type (USDA): I Soil type (USDA): I Soil type (USDA): 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 I I I I I I I I I I I I 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 Soil type (USDA): I Soil type (USDA): I Soil type (USDA): Curtain drain needed? -)'. I Curtain drain needed? Y. I Curtain drain needed? I Curtain drain needed? jSlope (x): j Slope (x): j Slope (x): j Slope A I I Shoreline? (Y/N): I Shoreline? (Y/N): /V r IShorelirw? (Y/N): IShoreline? (Y/N): I I I I 1 Minimum lot size:A I Minimum lot size:A _QL I Minimum lot size:A I Minimum lot size:A I I I I 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). CON24ENTS -64 Al H:\ON-SITE\LNDUSE.W Revised 12105194 Land Use Evaluation 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. 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) : d 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: n u Condition(s) required prior to approval have been met by the applicant. Health Official Date PART 5: REVIEWER SIGNATURE Health Of is al Date H:\ON-SITE\LNDUSE.W Revised 12105194 4O ^ FOUND DNR MONUMENT MAY1988 TOWNSHIP 20 N ., RAID SCALE 2 IN. - t MILE MASON COUNTY, W S=H � ST DA D PARALLEL ZZ i3i-3e 1 29.78 I z6.26 .72 z4.84 25.13 25.4S 25.77, 26.09 26.61 I G 831 27• 27. 7 27.02 27.E -� — -,— — - / STATI_ ~ THOMA` J. GRUVER STATE sq �C N N. ART/ p„ SIMPSON T1MBE. STATE MASON CO ~ pBcademy �, PORT �COMPANY —O HOFFERT CO. s�Mpyo J. HOFFEAT CO. SHELT W Gravel Pit o SIMPSON T BR- ' CO. K. RAU05T � J. Rifle Rarxje KE L9R. CO. a \ � o� o' ®b • , ® INC. GROBSl/AN d' N0.[WAN Q'�A t � 7 P 4 j ga�v ' Q Im Q, I WES COAST \, V O 0: 1O k SMPSON T Co. �0`"! 1TTRvi Cr 9Ti `Lm L L �i,"1 �� WASHING CORRECTION CNTR. F L W IV a _ TBR.CO. n IMPSON TIMBER CO. J u+ It D. T Q. �, O JQ PORT OF XCXIA O Soldb0 SHELTON r �� z• � Go -- p wtcr n- c r� oL61AN 5IMPSON tJ •tom' g0 h z F 4' IMB@R Co. St PSON TBR.CO, sIT�`P 0 8B ti HOOL DIST. u1cE5 c 309 LV �.,t1• =S �' .-/� J. KNEELP J> ^ J HuSTON i 4. • v O. 1" No,. HAvoEt . M. N N I L.LIAMS SIMPSON CNAPPELL y z 0 �, W D. I N4 BER CO. DM 6S•9 yl H. LEVIKL W000! { 1 O L Em a I �+cy �. 4r �t }05bOr r H W ` `Q GO SIMPSON .KIAMS, UFTLE D. Qp BORDF SIMPSON 'P TBR. CO. S1M Gaging SIMPSON TBR. SIMPSON TIMBER Co. A• Istatlon S W L.0 B LES W BOONE EVERS NOIAN PS N A.LC.AOJVR i 641K I, o ` RUDDOLL Iy ,g. �D L. EVANS SIMPSON T6R. CO. tK o 'J q,INN MINCH 1' 2. �. C. �• ` do L. SIMPSON TS 4 D NHITE �r s 0u Y J. NI.RVE1 N. a EVANS m MILL, EROWN o. i D. E.JOSIIN RVDEEN � I• U Jill W _��% SIMPSON TIMBER CO F 3 r It 9 x Quarry 28 27 o- z 7 0 = 'yii. s�i�J3 ►r MHE o. 5 Ul < - >vvj IMPS014 Taft. C. 0. L RSON �a '. 0io�Da n Peak \ J'