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Home My WebLink AboutCRT2024-00002 - CRT Application - 6/13/2024 JUN 13 2024 D 41 N 6T STREET,SHELTON WA 98584 %0 MASON COUNTY By SHELTON:360-427-9670, EXT.400 COMMUNITY SER BEEMA 3360-482-5269,EXT.44600 awldnanar,nirg,sovoanmenm umm,,ca .stbHmth FAX:360-427-7798 APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW I Permit Number Payment Information Tyne of Review a f Septic and Water $405 CRT Receipt Number_ I Septic $240 w��- ❑ Cash ! i Water $240(Individual and Two Party) /� l Check i L Group B WS$90.00(+$90.00/hour beyond 1 hour) 6a Property Evaluation$335 menu Date of Pay (Ll(� �L�pf I CJ Resample $30 lab fee .I � Instruct-Ions: Complete Parts 1,2,and 3 completely and accurately.With the application form,please submit the appropriate fee and the necessary documents such as a septic system maintenance report. If the application is for a property evaluation for septic, be sure the test holes have been dug and the location is clearly marked at the site. PART 1. APPLICANT AND PARCEL IDENTIFICATION Name of Applicant U..S iA.JI! S Phone 3t"0 5 b yly(p Mailing Address of Applicant 9 ZsfO NE old ;r i{4Vy city &kaif State WY4 zip 985Zf 12-digit Tax Parcel No. /2310 - 33- 03070 Site Address I Gea+eA tME Ndl Rd — llA add(eSl/VO - Brief Legal Description I ^ /'rG ajrf A Driving Directions A1010 ri:er Ph1Beb, Pub Av¢ i 111,1111 )a raWla 11AR, rPdA Ad 0- ydd Oat- }Q_$&L- r!41rl o� Flnt- hLu�_ Nou le n + 4lv ,elnd . OW Flaamej , �! Pege l of4 This form may be scanned and availa for ew on the Mason County Web site. Revised 1/2/I8 PART 2: TYPE OF REVIEW ❑ Septic System • Age of system • Age of house • Number of bedrooms • Name of last owner • Is house currently occupied? 0 YES ❑ NO • If not occupied, how long has it been vacant? I Water System . Number of service connections on the water system? • If a public water system, name of system • WFl number 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. hO"Q . 5 P tble PART 3: PLOT PLAN 1 )\N S1'11A4i5 On p-t V r--eAW O�- CLQ4LJ.,1 Use the space below to draw a detailed plot plan,or attach a detailed plot plan to this application.The pld(plan should include the following: North Arm, 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) eithAl� LOT SIZE 0 30 oywtb watt X U4- Cltcvih� 0.3 Z Acres X X 6� b v1 1 0-17 MPASS 3.0-n fa Applicant's Signalure: Data �O G Page 2 44 This form may be scanned and available for public view on the Mason County Web site. Revised 12.18 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 resuhs 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 0 •CJe- Test Hole#t Test Hole#2 Test Hole#3 b-lt� (' col o tz 16+ ;,-�tD�Q 5�tlhe S�-��- � Soil Type: S Soil Type: Soil Type: 1 Restrictive layer:j Restrictive layer: Restrictive layer: Slope: 0 -2 t7 Slope: Slope: Distance to Shoreline: J DAB 4- Distance to Shoreline:_ Distance to Shoreline: Page 3 of This form may be scanned and available for public view on the Mason County Web site. Revised IP2/18 PART 5: HEALTH DEPARTMENT OBSERVATIONS — FOR OFFICIAL USE ONLY Primary Drainfield Yes No The system appears to be functioning adequately of the time of the inspection.(Only applicable if ❑ ❑ system has been in use on a regular basis for the last 6 months.) ❑ ❑ Sanitary survey? ❑ Pass ❑ Fail ❑ 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. ❑ ❑ Well Construction Permit [] Pass [] Fail PART 6: omments P�Eilie- SRf S j DES vl MOda&k f �.holo 1 Inspector CKQ `Iv �'' , 1 Date 6 1zie I Z4 Important Notice: Findings&determinations of this review reflect observed conditions as they exist on the day the evaluation was performed.Absolutely no claim is made by this office,expressed or implied conceming the future success, failure or permit approval 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 1/2/18 Rhonda Thompson From: Rhonda Thompson Sent Wednesday,June 26,2024 11:08 AM To: 'Rachel96w@yahoo.com' Subject: CRT2024-00002 Hi Rachel and Douglas Raines, I inspected soil logs on your property at 12316-33-03020 on 6124/24.There were about 11 test holes I found,but nothing was labeled so I will do my best to describe location and what I found: Two holes to the left as you enterthe clearing: TH1:0-16 ClayLoam with roots 16+mottlin compact restrictive 8, P (restrictive) TH2:0-12 Clay Loam, 12+restrictive A cluster of three more test holes still on the left but past the first two. TH3:0-9 Clay Loam,9+restrictive TH4:0-12 Clay Loam,12+restrictive THIS:Clay Loam with mottling throughout(unsuitable) On the other side of the clearing, I found about 6 more test holes clustered together TH6:0-30 Very Gravelly Medium Sand TH7:0-26 Very Gravelly Medium Sand,but back of the test hole was more Clay Loam,26+restrictive TH8:0-18 Clay Loam, 18+restrictive TH9:0-16 Clay Loam, 16+restrictive TH10:0-12 Clay Loam, 12+restrictive . TH11:0-18 Clay Loam, 18+restrictive The soils here are mostly shallow Type 5 soils.The minimum depth of native undisturbed original soil required for an onsite septic system is 12". There were a couple test holes with Type 3 soils and I think it would be wise to try and explore that area more for suitable drainfield area. Please consult with a septic designer on next steps. Please let me know if you have any questions.Thank you, Rhonda Thompson, RS Senior Environmental Health Specialist Mason County Public Health 415 N 6"'St.Shelton,WA 98584 360-427-9670 ext.581 Rthompson@masoncountywa.gov t