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HomeMy WebLinkAboutSPH96-00155 - SPL Application - 5/17/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFMCE BOX 1666 SHELTON WA 98584 (24 427-9670 APPLICATION FOR LAND USE EVALUATION FAX 427-7798 Receipt No: -S-3 )2 J Date of Payment: INSTRUCTIONS �Q _n I- 4 11. An -Wicatim is —idared captete when the fee is Paid and the fa llewiry .(.is have been addressed I • Parts 1 am 2 of Me apptfcatim fore, east be completed. I One Properly aaaveted Wokhoe pit per proposed Parcet aust he ready for ff Wtim. Property excavated pits are 6 ft deep with a G ft deep shelf m me end of the pit. The A ft deep shelf mat -tape ip to the Orovd � surfs. for easy ireress and ",es.. I A stated plot plan mat W attached to the aMtiatlm. The scaled plat Pien mat show the precise toeatiot I of tM test holes, disessfofa of the property, and loatim of Why existirp or proposed welts, roads, or I buddies withfn 100 ft of Me property CnUdsrfes. 12. After a completed a{pliatim is received; staff wilt ifapect Me Property and provide Me eppliont with a written report. I DEELIIBIATED ASX10 OT AHO R TO TEST HOLEIO TXU®ER. THE IDEwTIFIED ST HOLES TESTT HOL w05 XY11E 4DtA 51 X i191 PROPOSED PUT W. Lul luJ IJ PART 1: APPLICANTIPARCEL IDENTIFICATION 4EALTH SERVICE° r� Large Lot Subdivision �( Short Plat r� Subdivision BLA (Office Review) tJ $200 + $10/parcel i[�l/�$$885, wY1 l ' �!�u $400 + $2011.t $10 -t NAME OF APPLICANT SIJ� YV'l jtVeYSNIt� - TELEPHONE MAILING ADDRESS (360) y2C,- 112 1 ASSESSOR'S PARCEL NUMBER �—)La09 - -2 �E- - ( Q LEGAL PROPERTY DESCRIPTION LO)T z ' > T- 1 V1 E\I VOL. ' 1 LOT SIZES (ACRES OR SO FT) 1 1- l �G' DIRECTIONS FOR LOCAT G SITE ttr l]c A7 is Nl� PF Alsara a.l f'cF� PART 2: INTENDED USE OF PARCEL INTENDED USE OF PROPERTY (Check One) : Single family residence u Multi-family residence Other, specify: W EAfTER SOURCE FOR PARCELS (Check One) �� : V��Individual wells u Coumunity well Y M:\OIPSITE\LXDO6E.w Revised IZIM/94 l� � / 4M Ode EYaluapaOn PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONL1) SOIL LOOS AND SIT& QTA} =ltlSTICS LOT N hU I LOT NWal I LOT N y I 10T N P / Test Pit A I Test Pit A I Test Pit A Test Pit A noel; �a71>?"a'VYl �- J' / otlery IDepth of not W.: I Depth a root pe.: I DepN of Dot pen.: j Depd of root pat.. Depth of aottlire: I Depth of snnlire: I Depth of zpttl ire: I DepM of aattitre: I Depth to rest. laver: I Depth to mt. layer. I Depth to rat. layer: I Depth to rest. layer. Soft type (IisDA>: 1 loll type N19A): I Soft type (MA): I Sett type (MA): Test Pic '�, I rest Pit D I Test Pit leI 40119 5 Test Pit D I ©�YIS/C � I I � �i7bLLl7 W� I I I I I I Depth of root per.: I Depth of root I DepM of root pane: I Depth pen.: = Depth of aottlire: WTI; I Dept t re: _ I Depth of aotttire: I of oat ire: I Depth To teat. layer:. I M to layer: _ I Depth to rest. layer: I th to net. layer: _ Solt type (=A): soil type ( A): _ I soil type ): Seit type (USDA): Olrt.fn drain needed? I Oeta1. dr.in needed? I arum drain needed? j Omntn drain neeaem (� slap. (x): I step. (x): 3' I stops (x): _ j $tape (x): I znen(ircr (rye): _ I shorelirot (YM): _[ 1 shanlinet (r/a): _ I shontiret n/a>: I /aµub^y I !� I Mlniiaaa lot slur I Minlau lot slza A mini. tot eiie[A I Miniam set sixe:A I I I I s Xininam lot site applles to nou *W ivtsfois srd is definni .a the atniasia el teu.hle led area Per residence or ran len- !I ties eaaivelent (450 Otiose; per clay). CONNS[(TS 1 � Ht lee-SSTYILQA1Se.N eevLM WWI. Bhett plot p.matav FART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL'USE ONLY) :::::.:.:.:...... _...... .... .. ::t••titt::?t•»ti ,i?:z?x itiil3i??r:::?::::•:::::::::::::•:r.::::: .. .. 1 ::::::::::?ti;ti;i?iiiiiiii?i ................ : 1..........?iit ? ... .... v:?:::. SOIL LOGS AND SITS CRItRACT RISTICS Test P1[ A h Test Plt A 4 ([a��" Test Pit A Test Pit N to?m Devil of root pen., Depth he .wt pen., Depth of toot pen.l Depth of settlIn Depth of root own.: 9: Depth of .nttlinq: Depth o[ cttlim, Depth et ..[al Sngt Depth to t..L LY.n Depth to t..t. I. .tt oil t r Depth to teet. I.yert Depth to r..t, 1.Yoe IVewl: Belt eyes (tlmAl: Boll type (NMI, Y.c: —� oV` ao11 type (WpBI: Test 11y1 Test Pit a — (r/r�J1'.(�� /q'tLl��\1I To[ P1[ B Test PI[ 0 • \L Auq Depth of toot Is., Depth I root psn.l _ Depth of toot pee., De pee e[ .we Depths[ ettllnpt M a[ ...tlingt Oepe2 a[ evttll.pt D.pth of settilnpt Depth t. pot. Ape pte to to.. i.y.0 D. sou t - luaw.l: Bell t Ste b test. Lon -- Depth m tot. 1Rot yp. (ueDAl: Be11 type Imaill ae11 t}p. IVOA)t Cousin "taln nweawal mtt.tn "role n.eaeai -- 1 Guinn anlo n..e.ay cutt.tn "rote u..e.et _ Slope (\It slope (t), -a 'IN elwe 1\It Slope I\I: _ .n.t.11mr (T/nit SMt.11n.r (upl, ehstell..r (Tel. NInIW let .1..:. Nn1... lot .lt.i N1.1W lot .lol" IRnaW tot aai mll . let .lr. .ppl te. to no ..halvf.ioe one 1. a.[Ltl tial .qule.l.nt (a30 .11pne .. the uWW ellosesK. Loa ates pet te.lGnc. or thel, - tLl q ph, S.yl, CommmTS t 1 1 _ 4nG Vae Eve lua[ion PART 4: REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) J BEETS HEALTH CODE After examining lot size, proposed water source, and soil type, it is the de I termination of Mason County Department of Health Services that each proposed parcel can support an on-site sewage disposal system meeting the requirement: of state and local regulations. d DOES NOT HRET HEALTH CODE j 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 cn-site sewage disposal system meeting the require- ments of state and local regulations. This determination is based on consideration of the following factor(s) : I i i HOLD APPROVAL DNTSL PDRTHER 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 proposef, parcel cannot support an on-site sewage disposal system meeting the require- m is f state and local regulations until the following condit'ons are met: IV Yv C ftf q "red pr i« to ew.t have been wet the epplt nt. Y 1 He O dat PART 5: REVIEWER SI N TURE I Hea Offibldl Date X:\pN.grT$\1A91Ke.N Rev1eA WWI- I- § § ) § & ) ) IL : � ■ § e ■ ` § ; � ■ § | ; - � | ! , � % � = ® e ; & � ■ m t . ■ � \ / / 2 § § m EL � ` ■ ` E , G § § | § 2m ■ jf ( | ; / / ) ( e § §# ; � ■ - ! � § § a ! 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