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Home My WebLink AboutADU2025-00006 Title Notice 2 Party Well - BLD Application - 3/20/2025 c CANCELLED For Mason County Permit Center use: quoMASON COUNTY ADU - DOb COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health Recv'd by: Ah y-1 { Planner:'S=ki�� 615 W Alder St.,Bldg 8,Shelton, WA 98584 Date Stamp Recv'd: Shelton Phone: (360)427-9670 ext 352 4 Fax (360)427-7798 ACCESSORY DWELLING UNIT PERMIT RECEIV`D (Special Use Permit with ADU criteria) MAR 2 0 202 615 W. Alder belt Permit and Fee: R�� ADU Special Use Permit application fee: $ ? *If ADU is within 200'of a shoreline you must apply for a Shoreline Substantial Development Permit(SHR)—fee: Fi�FQ $880.00 - Environmental Health fee: $ 140.00 In rural lands, accessory dwelling units (ADU) are subject to a special use permit, unless in the shoreline jurisdiction, it is subject to a shoreline permit. A "Special Use" is one that possesses unique characteristics due to size, nature, intensity of use, technological processes involved, demands upon public services, relationship to surrounding lands, or other factors. The purpose of this application is to provide for adequate oversight and review of such development proposals, in order to assure that such uses are developed in harmony with surrounding land uses, and in a manner consistent with the intent of the Development Regulations for Mason County; Ordinance No. 82-96. Acceptance of this application by Mason County does not guarantee approval of request. Applicants) Name:VANGELDER, KARMA M Mailing Address.2940 E Grapeview Loop Phone: 360-850-7076 E-mail: Tyler.Jones@legacyhomecenter.com Property Owners Name: (ifdifierent than applicant) VANGELDER, KARMA M Site Address: 2940 E Grapeview Loop Brief Legal Description: Legal Description: TRACT 13 OF SURVEY 7/64 12107 77 00130 RR5 Tax Parcel #: - - Zoning: Project Description: Prepare a strip foundation to install a 970 SQ FT manufactured home ADU. Install home and hook up to existing septic and well. Install power meter and hook home to power. Rev.January 2018 ADU Permit Page I of 4 ❑ SITE PLAN CHECK-LIST Please provide a site plan that includes the following: ❑ Indicate Scale and North Arrow. ❑ Property line dimensions, easements, and right-of-ways. ❑ The location of all existing and proposed structures. Include square footage of existing and proposed structures. ❑ Setback distance, in feet from all property lines and structures. ❑ Existing and proposed road access to and from the site. ❑ Parking spaces. ❑ Location of OnSite Sewage System (OSS) components (including tanks, drainfields, reserve areas, etc.) ❑ Location of existing and proposed wells, within 100ft. of property, shown with 100ft. radius. ❑ Location of existing and proposed waterlines. ❑ Steep bluffs, wetlands, streams, and bodies of water. ❑ Surface and storm water run-off routes. Mason County Code Title 17.03.029 requires the following criteria to be met for consideration of an Accessory Dwelling Unit (ADU) Permit: ACCESSORY DWELLING UNIT (ADU) REQUIREMENTS YES NO INFORMATION 1. Is the ADU in a shoreline jurisdiction? ❑ x❑ Please inquire with Mason County 1 a Are you in the Flood Plain? ❑ ❑� Communi Services staff, if unsure. 2. Will the owner of the lot reside in either the principal X❑ ❑ residence or the ADU? 3. Will till the ADU be located on the lot of the principal ❑ ❑ residence or be a conversion of an existing detatched structure (i.e. garage); 4. The ADU shall not exceed 80%of the habitable area of the primary residence or 1,200sq feet,whichever is smaller.An existing residence can ❑ be converted to an ADU with the development of a new primary residence, the ADU shall be no more than 80%of the area of the primary residence and up to 1,500sq ft.Will your proposed ADU meet this criteria? Please inquire with Mason County 5. Will the ADU meet all setback requirements? ❑ ❑ Community Services staff, if unsure. Please see last page of this packet 6. Will all applicable health district standards for water and ❑ ❑ titled "ADU Environmental Health sewer be met by the ADU? Requirements" Rev.January 2018 ADU Perini! Page 2 oj4 7. Recreational vehicles are not allowed as ADUs. Please El (with YES)that you are not submitting a Recreational vehicle for review. 8. Your property will only have one 1 ADU? 9. You have provided an additional off-street parking space ❑ El for the ADU? (Ord. 108-05 Attach B.(part),2005) ❑ On a separate piece of paper(#of pages: ), state your reasons for requesting an Accessory Dwelling Permit and be sure to address the following six criteria. Your request will be evaluated based on these criteria and the Accessory Dwelling Unit Requirements from the previous section. 1. Will the proposed use be detrimental to public health, safety, and welfare? 2. Will the proposed use be consistent and compatible with the intent of the Comprehensive Plan? 3. Will the proposed use introduce hazardous conditions, at the site, that cannot be mitigated through appropriate measures to protect adjacent properties and the community at large? 4. Is the proposed use served by adequate public facilities, which are in place, planned as a condition of approval or as an identified item in the County's Capital Facilities Plan? 5. Will the proposed use have a significant impact upon existing uses on adjacent lands? 6. If located outside of an Urban Growth Area, will the proposal result in the need to extend urban services? Applicant's Signature Ka'llv� kl/ /�A Date LTC --, Rev.January 2018 ADU Permit Page 3 of 4 MASON COUNTY COMMUNITY SERVICES Ruddmq Plann.nq Fmi�onmcntal Healtl+.Commwry Health ADU ENVIRONMENTAL HEALTH REQUIREMENTS YES NO INFORMATION 1.Will the ADU be served by an EXISTING Onsite Sewage System(OSS)? O O OSS's are sized off bedrooms. Refer to the onsite sewage records 1(a). Total bedroom count from existing and proposed connected structures on file with Mason County to find match the approved OSS records on file? O O your OSS approved size. If bedroom count exceeds system size, contact a licensed septic designer for upgrade options. OSS application and design permit 2. Will the ADU be served by a NEW Onsite Sewage System(OSS)? O O must be submitted and approved prior to EH approval of ADU nermits -Foundation to Dramfield(s):I Oft -Foundation to Reserve Area(s): loft 3. Will the ADU meet all setbacks to new or existing OSS components? Q O -Foundation to Septic Tank(s): 5ft Down gradient Foundation/perimeter drains must maintain 30ft to Drainfields. Attach a signed Sewer Adequacy 4. Will the ADU be served by a NEW or EXISTING sewer connection? O O Form from Sewer System Manager to this application. 5. Will the ADU be served by a NEW or EXISTING public water system Attach a signed Water Adequacy (over 3 connections)? O O Form from Water System Manager to this application 6. Will the ADU be served by an EXISTING private well? O O Well must be permitted and 7. Will the ADU be served by a NEW well that is not constructed yet? O O constructed prior to EH approval of ADU permits. Mason County Code Title 17.03.029 requires EH approval prior to approval of ADU permit. Environmental Health Review Pre-approval: Comments: (EH approval stamp with Initials of EHS) ADU Permit Page 4 of 4 1. Will the proposed use be detrimental to public health, safety, and welfare? 0 2. Will the proposed use be consistent and compatible with the intent of the Comprehensive Plan? 3. Will the proposed use introduce hazardous conditions, at the site, that cannot be mitigated through appropriate measures to protect adjacent properties and the community at large? M 4. Is the proposed use served by adequate public facilities, which are in place, planned as a condition of approval or as an identified item in the County's Capital Facilities Plan? 5. Will the proposed use have a significant impact upon existing uses on adjacent lands? 6. If located outside of an Urban Growth Area, will the proposal result in the need to extend urban services? 0 96fT16 . d� z I ,3 Cam• �-- IU L-JL-J 0 ; l2Pi s 70 ' I I D :7 -� .) m r -1 �l r-- D t--- r rTl z � rn _� a 28011 CANCELLE D �- - Storage Room r 36" 13 0 Sta i rs 0 b r 8' 0" 8' 0" r 3611 Garage Door Garage Door xterior Door 2/14/25,1:20 PM sammy mdgeis floor Man.gff CANCELLED Orr WrAv I WALX-IN ol CL05f r BEDROOM#2 KITCHEN BATH 0 DINING UTILITY AREA Orr DOOR ENMANCE 27-0" % PORCH LIVING ROOM 17'-1 VX 13'-2" BEDROOM 01 C 72'-10'X 13'-0" WALK-IN 'I Orr CEILING CLL)5Er FAN 02023 PALM HARBOR HOMES INC. ALL RJOH15 RESERVED A J(ZJW https://drive.google.coffi/drive/folders/liGEWIWNZH4AcYJEdGzpSvWHVrF—IW673 { Site Plan fH. -tl �O Sabia A, D . 0 2940 E Grapeview Loop bOC�O -Proposed ADU install `ng Septic/ Install Strip Foundatio ,field -Install power meter -Hook up to exsisting well and septic CANCELLED ------ ...... T Radii us Prop ' ADU �.. 5 LEGACY ' r HOME CENTER r �4 2222905 MASON CO WA 03!1812025 02 00 PM NOTCE KARMA KROGH i207548 Rec Fee $304.50 Pages 2 Retum To CANCELLED -f"q�4_t_ V ,k Grantor(s): (1) k�1*11A-k KY'� �� (2) Grantee(s): (1) PUBLIC Legal Description (1)_ S�; i'Z�� (Z1_ (Abbreviated form:i.e. lot, block,platorsection, township, range) Assessor's Tax Parcel: (1) 1210`1.='7 -- 0()130 NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM I (We)the undersigned grantor(s), certify that the water source located on the above-described real estate under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason County, State of Washington, has been designated to serve a source of water to the following parcels situated in Mason County, State of Washington; herein described: Tax Parcel: (Connection 1) ��(� -1 �]- Q01__ Tax Parcel: (Connection 2) Z�b "l=j "(- (}fj 130 The system owner is responsible for keeping this system in compliance. The name of the water system is: yi Q) This system is designed to provide for two service connections. Planning and design approvals must be obtained from the department prior to expanding beyond this number of services. Additionally, a water right, obtained from the Department of Ecology, is required if the water system exceeds exemption standards. This system (has/ has not) been granted one or more waivers from specific provisions of the regulations. Dated on this -day of AA ckccy% 20_L'�L. Signature of Grantor(s): (1) o (2) Page 1 of 2 CANCELLED State of Washington County of Mason I, the undersigned4a , ry Public ' and for he above named County and State, do hereby certi that on thisay of-.. f- r" 20_42M, personally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she (they) signed it. GIVEN under my hand and official seal the day and ye last ve wr e . Y , of u is ' for ate of Washington, o NOTARY �N'; siding at ;U 23038426 ; My commission expires: P U B U 'p2 Page 2 of 2 Spectra Labs - Kitsap, LLC (Poulsbo) SPECTRA Laboratories -Kitsap 26276 Twelve Trees Ln NW Ste. C ...Where experience,naners Poulsbo,WA 98370 Phone: (360)779-5141 www.spectra-lab.com CANCELLED Spectra Labs- Kitsap, LLC (Poulsbo)received samples for Evergreen Water Treatment on Tuesday, February 11, 2025 at 2:00 pm. Unless otherwise noted, all samples were received in good condition and were tested in accordance with the laboratory's quality control procedures. A summary of the samples received are outlined below. Sample No. Description Location Sampled 248517-01 Tyler Kitchen Sink 02/11/2025 8:00 This report package contains laboratory sample results and any attachments listed below. If you have any questions please call (360) 779-5141 or email us at www.spectra-lab.com. Attachments 01) This report is issued solely for the use of the person or company to whom it is addressed.Any use,copying or disclosure other than by the intended recipient is unauthorized.If you have received this report in error,please notify the sender immediately at 360-443-7845 and destroy this report promptly. These results relate only to the items tested and the sample(s)as received by the laboratory. This report shall not be reproduced except in full,without prior express written approval by Spectra Laboratories. 02/15/2025 Page i of 1 26276 Twelve Trees La NW Stec 1( SPECTRA Laboratvrics - Kit%ap p � WA ._ _^ CANCELLED 98370 ...Mere rs triares nwrrrrs (s6a)779-514t COLIFORM BACTERIA ANALYSIS FORM Data Sample Collected Tone Sample County collected f � °tM Q$ flu o� Day f'rlr.Sc�tr� Type of Water System(check only one box) ❑Group A ❑Group B 10(),jr V I-A C Group A and Group B Systems-Provide from Water Facilities tfwentory(WFQ: IDS System Name: �- � r Corhtad Person: N tA c0i Day Phone: Cell Phone Email: Eve.Phone: Send rest&to:Tmd rul name,address and ap code or*Mali above for eNdrade copy of Must) C SAMPLE INFORMATION Sample collected by(name): aid S d Specific location where sample collected: Special instructions or comments: ;4-dNe I,\ SI rlk Type of Sample(check only one box) 1.P)Routlne Distribution Sample(AIP) 2.❑ Repeat Sample(W) Chlofahated:Yes ❑ No W (imm won syst°'n after a"mum) Chlorine Residual:Total_Free_ llruatisbefory routine lab number 3.Ground Water Rule Source Sample ———_———— Unsatisfactory routine collect date: S I I I1 Chlorinated:Yes No ❑Trigpred(W) Chlorine Residual:Total Free_ ❑Assessment(AIP) 4.Surface or GM Raw Source Water Sample(Enumeration) S I S ❑ E cob ❑Fecal gyred Yes_No_ 5.YDwqie Collected for Wormation Ouch. LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Cotdonn Present and Satisfactory ❑Ecok present ❑Eco6 absent Bacterial Density Results:Total CoHform mprd100rrd.Eco6 mpnl100mL Fecal Cdbnn du1100m1. HPC dtdtrrd. Replacement Sample Required: ❑TNTC ❑Sample too old ❑ Sample Volume, ❑DamagnMed��Container ❑ Daterrhme Received_ �'\`�.r Lab Rem Nw bw Z! t tZ5`— / O� Rec*Temp C`: `Q•� McMod Cod OT-COl1NU SM9271D Tlsnpea"s' order pmm�W awVVY: FE5 i 1 Zc�'15 ° e FEB 12 .hm,a:,sb.eralare0.mq:asrerlaeae,rbi,hMer noa.e:aMrad araehswnwide:.rrei, aQ vrru�oe�re.ati.r.rawymseo-r+ssur.d es*oye:wpel�raipy. DOH Laf)-, e i 7LenMW nbharrbar ft mm:d W the m pYk.1 a 010- S_ p"° '.rnwar. �+�oaeran.m.rsod.ona� ooxr..ssnaroressRem>) Z��`�,'eJ� c - Nov 22 04 09: 53a Bob & Patti Passe 360-427-2353 p. 2 AS-BUILT FORM CANCELLED RvisedJu=wl 4. >.l..o.7i ,. o-h.,.--Ma- IM'- .r.. •.�'��7:iko`e'.s. 6..3z.... ,R Y Applicant KA ►vNA,VOt,45 c(o -r Assessor's Permit Number 5WGO�� ' Parcel (�1 01 _- O.O9 } (Tw41ve-01Qtt Number) Instaner Pj o N tc— L Subdivision �` (NamelDivfslorVt3toeklT.ot) Designer 3 4> ' f� �y _ •'xZ�?"�. ,:a:.y�§`�u��`}'i:J- ._r,. ..,�,5,�. »{X�J'�'�� +.�$�_•. .� aX •}'�:'.�`k� •3 >i' ,'c '4 Nix Y N G .:Kt� �' ..2..c;fX,.'.:��,v..>.d>..?;�ao..,.�£�•,q...,...c.-x•w2=yT.•,'t a•: .':"�,.i�,�,,.,,.,.,...->y.� V UJ�� 2{vv� �.ef �f.'w (. S EPT(C TANK NIA Yes Prior to Ccmplesor A) >5fL From foundation? . . .... .. .. .. .. .. . . ... .. . . . . . . . . ..... .. ... . Q/ p B) >50 ft from wells and surface water? . ... . .. . . .. . . . .. _ . . . . . . . ... .. .. Q Q' ❑ C) Bldg stub-out to septic tank ckan-out if not 1-2%? . .. . . . . .. . . . . . .... .. G D) Baffles intact and clean? . .. ... Q E) Dividing wall intact,? .. ......... .... .. . . . ....... .. . . . . .. . . . . ... .. .. ❑ F) Risers installed for access? . .. .... .... ... .... ❑ Lam' Q G) Tank Size:�gal.;Manufacture ..,.r .�.� (l. O-Sox A) Leveled with water? . . . . . .. . ..... . . . . . . . ... .. .. . . . . . . . . . . . .... .. . ci B) Speed leveler used? . . ... . .. .. .. .. . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . G (f f. DRAINFiELD — / A) >10 ft from foundation and>5 ft from prope.-,y lines? . .. . .. .. . . . .. .. .. . ❑ B) >I00 ft from wells and surface water`? [l C) >10 ft from potable water lines? .... .. . .. . .. . .. ... . ... .. . . . . . . .. ... C3 D) L r=a1s level to±I inch&end cis present if net lopped? .. ❑ ar' G E) Graveiless chamhers utuized? ...... .. . . .. ... ...... . . .. . IF) System dime sicas the same as shown on the design^. ... . .... . .. . .... 2,--, —(z G) Gravel clean,pre erly sized,and proper depth? . .. . .. . . . .. . . . . . . .. . .. . C h7 PasssUrtu SYsT,�,_ s 1) Sand quality AS7M C-::? ❑ C C 2) Dead height tmiform and i24 Actual herd height Q ❑ C :) CIean-outs and obse^ oa ports prtieat? ..... . . . . . . . .. . . . . . . . . . . ❑ C G 4) Mound_ S' ece3:1? . . ... ... .. . . . . .... .. . . . . . . . . . . . . . . .. . G C C ormed electrical ccnuec i:ans must be made owner or licensed electrician and inspected by Uo . .. . . . . . . . . . . . ❑ 1r, G (V, PUMPIPUMP CHAMBER A) Sevin bask or effluent Biter(c•:rc:c cue) ,stziled^ 1. Cl C C B) Rise installed fee . . . ... ... .. . . . ... .. . . ... . . ..... . . . . .. .. .. Q C C C) AlarniIIs`alk::? .. . . . .. .... ..... ...... . .. ..... . . . ....... .. ..... . C G E) C oe:siw S'-� galrit:ch; e:Mattuf3e e I F7 P=p csa b—_ draw inches pc m:acte; Height of rump off boacm of puma r:amber G) P• :1-=cr(Cr)El=scd TSme Mee. (e:re'e If installed); If in;e:is nsw:Pt=D Ca off I Nov 22 04 09: 53a Bob a Patty Payssp 360-427-2353 P. 3 •P.:.��S�i.��'��x?�tY x4� a �''�'i, ��i3e '#r>g,�a-S+Y�a3',d a;,'< F � 0., - ti �8- s eye- 'f5`I�#i 3>;t-'�tSe'•�crrY:.�"�jvt�S...3eS ii`� s <Rg< �. r<a:� r Sta -¢ $.3�i� ... ?''a00�. 4�+ ,i`�a<fi`J �s.4.R.. mat � � 2`� ��y��c.�'FZ''�6 t�r31tt ;,3yN! �yZh4. �� .. y:�,; c p•9Fi. -:,'%e9en.ea.....ise?N .�3�xexx'�5'�fY..4`.�w.?s;,.e<"� �F-4C. js�,a:s'�,f�$:N:�:S-B�JIL�';�RAWING �2��•<' ss 4�'A¢� i,,i�s:�s�t��,�`�`�<;g<�u�.-"��3.��'�. �.i3�'V ❑ Drainfcld&manifold �� C U.`t'"C' •�C F-�-v" � Y`'� ' orientation &layout , � ❑ Treneb/bed dimensioas and critical distances --.within layout - ❑ Septidpump tank placement. ❑ Location of buildings. ❑ Observation port&clean- . cut location_ Q Location of wells& roads Q Unds.s*z native soil be.we-_n trmches_ ❑ North arrow CAiJ i 1 ON:Minor idjur---ia to srrie r3ak locdca ssd drzinfie:d orcu�on made in me 5e1d acd •oy;he iaraller as gcaenay&=Cp�k to boCh� G bur tailed a c:ta,n�rsses eom_-mm'se''te viability of the sysrrn. It is the:.•rsW1='s rmwnubility to comin prior wrcaea approval T'm �e or ter dmip=before maEig my d.-viziicas_'�m the desire tbat tffc_the sy==visbuity. Aay deviations-tom She approved shown abave !rs'�aller C'ae-;.lc a box from Row"A"aad"B", sib and date tlic cc:�n A. ❑ I c��that I iasailed the sysem•�irheut any ICE c;;,;.fy that all deviaiioas �•om the desi�sired dev+.aCen from the design stzcsged"At'?FOVEJ" by ",�?QovED" by MCD!=S �ti1CDES are shown above. S. Q I certify tl%at I contacted the desig-rr and IcL die CRYI d.d rot contact t<`:e desimer prior to final cover System open for inspe tea u, to 43 h.s prcr to desiz=er waived t.`.e ncdne;Iton recuire raL cover. I ft.^'tcr -wry that all informaton cont3i^d on this form is ac.-^.inta I und==nd that if the in.fcrmaticn contained he=-'- :ct zc=.,-x. the.-will'x jus:catLc for s•ar c•-sion of my ias�alIc; _:ncar: p of r. ai~ The uad=-,gre-r=proves this inst—alIxtica on bcrzff of Mason County Dr eat ofT th c;s• 4 11122' Ll taran .- art Nov 22 04 09: 54a Bob 6 Patty Paysse 360-427-2353 p. 4 f All un,n Lzgt f ei-s L 041- 00 Lid 7 1 ;L10'7 I f ,.r3 J- a � tc llC c�G i~ �iAy i 3