Fillable This checklist must be submitted with a Geological

Fill Online, Printable, Fillable, Blank This checklist must be submitted with a Geological Form

Use Fill to complete blank online OTHERS (US) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

This checklist must be submitted with a Geological

On average this form takes 6 minutes to complete

The This checklist must be submitted with a Geological form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

BROWSE OTHERS (US) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Rev. February 2018
Submittal Checklist
Geological Assessment
Instructions:
This checklist must be submitted with a Geological Assessment and completed, signed, and stamped by the licensed
professional(s) who prepared the Geological Assessment for review by Mason County pursuant to the Mason County
Resource Ordinance. If an item is found not applicable, the report should explain the basis for the conclusion.
Note: Unless specifically documented, this report does not provide compliance to the International Residential Code Sections
R403.1.7 for foundations on or adjacent to slopes, Section R403.1.8 for expansive soils or section 1808.7.1 of the International
Building Code Section for Foundations on or adjacent to slopes.
Applicant/Owner ___________________________________ Parcel # _________________________________
Site Address ________________________________________________________________________________
(1) A discussion of geologic conditions in the general vicinity of the proposed development, with geologic unit
designation based on referenced maps.
Located on page(s)
(2) (a) A discussion of the ground water conditions at the site,
Located on page(s)
(b) A discussion of the estimated depth to water,
Located on page(s)
(c) A discussion of the quantity of surface seepage,
Located on page(s)
(d) A discussion of the upslope geomorphology,
Located on page(s)
(e) A discussion of location of upland waterbodies and wetlands.
Located on page(s)
(3) The approximate depth to hard or dense competent soil, e.g. glacial till or outwash sand.
Located on page(s)
(4) A discussion of any geomorphic expression of past slope instability (presence of hummocky ground or ground
cracks, terraced topography indicative of landslide block movement, bowed or arched trees indicating
downslope movement, etc.).
Located on page(s)
(5) A discussion of the history of landslide activity in the vicinity, as available in the referenced maps and records.
Located on page(s)
(6) An opinion on whether the proposed development is within the landslide hazard area or its associated buffer or
setback and the potential for landslide activity at the site in light of the proposed development.
Located on page(s)
(7) A recommendation by the preparer whether a Geotechnical Report should be required to further evaluate site
conditions and the proposed development of the subject property.
Page 2 of 2
Disclaimer: Mason County does not certify the quality of the work done in this Geological Assessment.
Located on page(s)
(8) If the presence of a hazard is determined within 300 feet of the proposed development, then the following are
delineated on a geologic map/ site map:
(a) the area of the proposed development,
Located on Map(s)
(b) the boundaries of the landslide hazard area (top, both sides, and toe),
Located on Map(s)
(c) the associated buffers (top, both sides, and toe),
Located on Map(s)
(d) building or other setbacks (top, both sides, and toe).
Located on Map(s)
(9) A site map drawn to scale showing the property boundaries, scale, north arrow, and the location and nature of
existing and proposed development on the site.
Located on Map(s)
I, ____________________________________hereby certify under penalty of perjury that I am a
civil engineer licensed in the State of Washington with specialized knowledge of geotechnical/geological engineering
or a geologist or engineering geologist licensed in the State of Washington with special knowledge of the local
conditions. I also certify that the Geological Assessment, dated ___________________ and entitled
___________________________________________________________ meets all the
requirements of the Mason County Resource Ordinance, Geologically Hazardous Areas Section, is complete and true,
that the assessment demonstrates conclusively that the risks posed by the landslide hazard can be mitigated through
the included geotechnical design recommendations, and that all hazards are mitigated in such a manner as to prevent
harm to property and public health and safety.
(Signature and Stamp)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

This checklist must be submitted with a Geological

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 November 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document