Loading...
HomeMy WebLinkAboutSEP1978-00355r ire /a te Se lee-bt' a)/4z.. ( Z4 24 ,,f°7 JEFFERSON COUNTY HEALTH DEPARTMENT jj 802 SHERIDAN AVENUE INSTALLER RAbzr� c PORT TOWNSEND,WASHINGTON 98368 RECEIPT NO. 7f9' /D, (206)385.0722 BUILDER '2,1c•.r, C -ot.4.- DISPOSAL PERMIT DATE Ar/F,1-// -/f7� SEWAGEs Submit in Duplicate 66) 7g-40(55-6- 7?1, e.„/ `Y'. ciLok..cc c,20// /c�w,• /a�.�,rc.•� , Owner Address Phone r- / ��/ .,,0 rn ��/ 1y(e�.,r< O,✓ Z �c/`/1/1`1 ,�J�lji.�y /� Cri (�9rnyc e2 %%l�c/� iic� �/r. o Directions for locating s e / / eD.,,OOJd 9e rwr► /.,7 J 727(..-5 C1,Ntl.c.J0i7 CG�r /tp,if a O x INSTALL NEW SYSTEM El REPLACE SYSTEM 1:1 PARTIAL REPAIR IB TANK/DRAINFIELD Eld 0 z TYPE OFNO. OF SITE BUILDING, , NT� BEDROOMS BASEMENT 1,..5- SIZE /40 X�0 � 0 Cl) DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING AB E FOUNDATION FOOTING w CC)) SOIL LOGS g = < 0 70u.3G O UT NU t$'1 0 E,..4 ry0f)a-- 69 I/ $ < _ Yr 5 sid„ S-s ' .JJ$dx Ss- ' ' `` ,/o ' ;c /-� Z D r0 m Dig two holes per site. (min.) ,:, 0 4' deep -2' dia. -50' apart & flag .. APPLICANT Pr-A., a...--e- ..... N Drainfield Length /146-1 Width " Depth # Lines 3 Tank Size /a®o Gal. t N 0 COMMENTS: / (TWO COMPARTMENTS) a / p /�/�c u-S c-+Q O O drAi,✓ .vc.- c✓; s,1 c." /�U� Ove, 0 m OGi� z-2� C') /(A op 2'q ' ,rv, Reutck. c) ;'1-+ 70' C r spEcr-tom ' el 0Ioaf' &euu 4 \'� oa 5 /Lc'c e-E �j (-1 i ! - * 1 N APPRSVED A. DATE INSPECTED PAPyrIAL IfAL de-DAM co-o. fQ I certify at this`system was installed in a manner approved by the Health Department. '/ 928 & 4 INSTALLER'S SIGNATURE= DATE DATE INSTALLED JCHD/1-78 W 41 I , 1 4- 66)(upowl I I Div, K.. o t e)(.t s-rt,)G Th tc., I C 1.1 I ' 1( ,)7;ri1/244-15ROAA sst "D-solc\ II 551 I 4 , 551 3 IT - t TI 141-1-1 NE Fogf,tAl 0— 60 AfPO4 - .2,, POET- vir-(2,boob . b , — — — — , - \ \ \ \\ \\ L1(\)ES a....-b irim-- _. * • 00 0 ..,, „ 1,,u4s•? LiEuEL__ ottu. ,t,ettl-, , a%Q,N 0 00 0 s a tO --nkEma-1 DIVL) PvcE5-0c° '8D 1. 4 ----- bP-1.1t.,) e000ko c90 . , 4 903 East Caroline OLYMPIC HEAL"H DISTRICT Permit No , , Port Angeles Fee Paid SEWAGE DISPOSAL PE2 1T APPLICATION LI Submit in Du Licate II 24 NAME izAT 6,pu, ADDRESS ,ts' .24-1G DATE 7, LEGAL DESCRIPTION .,S16�7f- Eh eL ?7' 9.rodt, �,Z•-„�/1,/ PHONE S '7'Y DIRECTIONS FOR LOCATING SITE .,---- 1 i j L 10 j 4.:5 APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM.IREPAIR EXISTING SYSTEM —Vois•-•-t_ Yr c-i (1744-11-fr i 61/149. S°:' ''''---- 1 !'YPE OF BUILDING ISO, OF BEDROOMS BASEMENT • S 0 ITE SIZE NAME OF INSTALLER ON THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATION 1. Property lines 7. Driveways, patios, carport, etc. ' nn 2. Location of building 8. Streams or bodies of water nearby V 3. Location of septic tank 9. Location of percolatio test holes 0) 4. Location of drainfield 10. Septic tank size gallo2s ijr 5. Slope of land 11. Length of proposed rainfield 6. Water lines & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS Depth Time require. to Percolation rate ype of soil t,4 of hole+ eep last 6 in. (d 'de time bye I- Perc. No. 1 $ ) Perc. No. 2 7 Perc. No. 3. hRAINFIELD LENGTH 7o D r DEPTH 4 NO. OF LINES ) „, -� WIDTH - IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER- l AS DESIGNED AND APPROVED ON THIS APPLICATION. ' �j ignat re of Applicant APPROX. DATE OF INSTALLATION ,cam c SANITARIAN'S COMMENTS: THIS CONSTITUTE PERMIT WHEN HEALTH OFFICER S SIGNATURE APPEARS AS APPROVED PLAN APPROVED •/` -” DISAPPROVED DATE , DATE INSPECTED \ 9' SANITARIAN 31) REMARKS: �e a Q 5-68 c \aV N-&A\ c� \ , a a :� .,1 A-..,-;. k SKETCH PLAN ON GRID BELOW SCy 1O FEET BETWEEN LINES INDICATE NORTH ki v r '7 7'C r°4*/ ..+6 , 1 I j }} , I 1‘71 N11.1111.'s1 . ,3, =-_---------- 111111M puipiiii=11111111 MI ►� n i 1NmiMlii-'e k fit, 1E11 f 11 r IMO"11111111111111111111.1111111111 : iiimi I i l' ill1 a '', 1 1.. . ,_ 1 :. .i1 , ,.,,.....i,, j s , k C /O se-, ie:, h y- Gc1/4 L. (3zsC. coo . ^' wt,'°`) JEFFERSON COUNTY HEALTH DEPARTMENT 802 SHERIDAN AVENUE INSTALLER c__ PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. 7f7-2-. �/ c /�� (206)385-0722 BUILDER ldp,(tcr/ q (�- 4"-s- DATE /64i// -/ 7f SEWAGE DISPOSAL PERMIT Submit in Duplicate 3i) (/i/' 5 5 .5619 7240 4'r(7 l L O u-SL p�0// !��W✓o ,2::) ,Tc,.0 Owner Address Phone rm P 14166 Arc. oN /Hf- A IT A/1I- rilf,-,67 O� cry- C.74trifc;c2 grgc// J7-:',Cf Alec o 4•°' rD Directions for locating si / _ __ Q.,,vo, se rw?'�:,, T� / /1neke:Z-1i 177 co-5 �vcr ba44r pit xi INSTALL NEW SYSTEM 0 REPLACE SYSTEM ❑ PARTIAL REPAIR rX TANK/DRAINFIELD❑ = 0 z TYPE OF NO. OF SITE BUILDING idi,�.T,9( BEDROOMS BASEMENT ..5 SIZE X40 X�'o' c m DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING AB FOUNDATION FOOTING w o SOIL LOGS v_ Cn Iktcv-S G p Z " Ail V y t$'-)1, 0 -1 0\-)Va-- LC9Pi ‘-Of - I < O i' cAt f" S's ' adrdnx s-s_ ' //o ' 7";V:97—)-- D z m 0 Dig two holes per site. (min.) - przy., --� n n4 deep- 2 dia. -50 apart & flag APPLICANTE Drainfield Length §451 Width ` Depth_ # Lines 3 Tank Size /a®' Gal. t Ni p COMMENTS: • (TWO COMPARTMENTS) c !7% cG, .Lj i c. C') /(oS'1 OF l cnol,k(v,f", -/leisiut e,_ - -1 33 ' C </,O t UIEUG et, / r2l(lrV Gcn7 (544../€0, 1or,JS L ( /cV Fi tot IF-0261,07 i/i' oS pn \ ` QQ j � � l�S'PectG� 6101k, � lue 4 z. �A � i Air i �� � � � �l c7.Q Li N APPR•VED DATE INSPECTED PA IAL IfAL 4e--DA <'d"214c -,, & I certify ,at this system was installed in a manner approved by the Health Department. 17 i"1 � 44 INSTALLER'S SIGNATURE AIL DATE DATE INSTALLED JCHD/1-78 W A. I 4- 6 &bwr.) D It, . vi , h ik) I Li I "T1 Gpo-rwrot. -. 1 • `, (?)t re1*1)Q6%OtA 556 "b-60'4 ` 1 55s i + r. TI es mi-t-%roc Fieovn 0` Co A-PP0 . •a F€E 1,1-rz0.30b . b I _ _ bice-Krtc-c..... \\\\\\ it IPI ( \ \\' \\ N L s --J "�,.JA-.? EUE L ,a=b s ' • C� CD ay,0 r} �" CEJ `-t aEnscc- Q 4 1!2-C a` a s � -® o 4 �0© 903 East Caroline OLYMPIC HEALT1 DISTRICT Permit No (1 , 1 Port Angeles Fee Paid / SEWAGE DISPOSAL PE2MIT APPLICATION Submit in Du 1p 'ate caV NAME giE.c� C�.,4 ou.SE ADDRESS /..(4.. .247‘ DATE.i&p.Z2 LEGAL DESCRIPTION .,s- ‘-7f- Bio el— .72257 froJ,. .„2A-41.•/.." PHONE ia3c77 DIRECTIONS FOR LOCATING SITE -A4.41 /Fzhoja1 J _ APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM_REPAIR EXISTING SYSTEM YPE OF BUILDING X10, OF BEDROOMS BAS EMENT Too ! TO v Orjr49' ee"'"---- I Vimarsirmwai SITE SIZE NAME OF INSTALLER bN THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIOZ 1. Property lines 7. Driveways, patios, carport, etc. 2. Location of building 8. Streams or bodies of water nearby 3. Location of septic tank 9. Location of percolatio test holes dj 4. Location of drainfield 10. Septic tank sizegalloas i 5. Slope of land 11. Length of proposed' arainfield �' 6. Water lines & well(if applicable) 12. Depth to water if encountered. i PERCOLATION TEST RESULTS Depth Time required to r Percolation rate ' Type of soil --- tt �,, of hole Q E? eep last 6 in. (d. 'de time by .....( Perc. No. 1 41$V Pero. No. 2 Perc. No. 3. DRAINFIELD LENGTH r (' � ! ��- `6 D WIDTH DEPTH NO. OF LINES ) / !� IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER r AS DESIGNED AND APPROVED ON THIS APPLICATION. (. i 9 Ii .1 ignat re of Applicant APPROX. DATE OF INSTALLATION 1 t SANITARIAN'S COMMENTS: THIS CONSTITUTE PERMITWHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED_ PLAN APPROVED 717Z; DISAPPROVEDDATE 71 ..C) DATE INSPECTED \ lf' SANITARIAN 9J REMARKS: -41N Q O 5-68 c__,<-. \a,�y\A . , a 0 I 1 i ,16".• ‘ . it ix SKETCH PLAN ON GRID BELOW SC -i- _ -.-10 FEET BETWEEN LINES i INDICATE NORTH 'Es — .77,- -,-, 0,e7 7 1 7 1' ' I "44 f` • . .„ . t 1 ... , IIIII 1 III .i So , 111 * .4011116umIV , ~4«^-., SIPii11111111111111111111111011111 ElMI 11111111 II\ 11111kill ... .. INV vow- 4171 r It ill Mk i 2_• tr‘ c:. I --r----,- 1 'il , II 1 i 1 • ---t-iv j% . I i i 1 1 Kt‘ iiiii 4•••••••••••••..00100 IL . t , I I I . .. t _ 1 ! I 4011 447 i•:0 t••• - 1 1 i . I 1 1 1 1 i I ...____