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HomeMy WebLinkAboutSEP1973-00262 ' Jefferson County Department of Community Development Office Use Only 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 Date ' Evaluation of an Existing Onsite Sewage System Fee Attach plot plan showing location of: Structures, Drainfield, Septic Tank, Well, etc Recpt ALL SPACES MUST BE FILLED IN EXCEPT AS NOTED. Indicate in space if information is not available (NV) or not li4blC(l i).D U L5 Check Cas ( : Type of uatio�1 1 1 �1 Reason for Evaluation --/3_ /,n G Routine 0 & M Inspection li t5Z Evaluation of on-site sewage-system_ SON COUNTY O Real Estate Transaction O Evaluation of Drinking W T. OF COMMUNITY DEVELOPMENTO Complete a Permit # Pe Building Permit Review and/or no septic permit on file D Evaluation of on-site sewage & Drinking Water IK Other Date of this inspection 5 - Z.3 -0 1 Inspected by J 11 L.. c_Lqc--03S Owner or representative, report to: Name/Address/Phone C7 ik.4L1 L.9-r-te- / 4C.Lw Lo G GIW 6 Co , f1GF6L 11I41i'l < [ Ol , -e(-)NKs , wq. (?1:13n Current owner 4-C,LtEM ( o G G i PG C-0 . Site Address 17 6 46 Z t-iwv1 101 Owner Phone# 3G0 - 3-7q- (>000 Previous property owner name (S) if known 0/g Parcel # 71 Z- 339- - 00(5 Subdivision, division, block and lot(s) Permitted System r yes ). no Permit/case# Date system installed I 70 s Age of dwelling '30 \i r Kt-i-0 t- # bedrooms N//- House occupied X yes no, vacant how long? Designer — Installer ,4c -N we 674.)6 Water supply Sample was taken Yes No Sample Results Well casing 12" above ground Yes No Sanitary Seal in place Yes No Public: offsite onsite. Name of System Individual: offsite onsite Is well more than 100' to drainfield/disposal component yes no, if not, distance Is well more than 50' to tanks and effluent transport line yes no, if not, distance ONSITE SEWAGE SYSTEM <" #1 - Septic Tank J Tank size [000 gal. Y single compartment two compartment C0t4 car-_,:_n material Riser to grade on inlet 'X yes no. Riser to grade on outlet k yes no Condition of tank k good needs repair, describe 1st comp. Scum (top layer) G " in. sludge (bottom layer) 7 I g�i in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? yes X no • If yes, where was water observed? Condition of baffles: Inlet X good needs repair Ci c∎-i —f material (PVC,Concrete) Outlet: \i, good needs repair 1 y L material (PVC,concrete) Screened Outlet /. no yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) X yes no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: ( eg• © ) ED___ Onsite Sewage System Inspection Report Page 1 of 3 Parcel # 7 / Z -33 - 000 Owner Name C.4-) 6 i r• Does'system include a pump? yes X no If yes, complete the next section. #2 - Pump Chamber Tank size gal. Material. Riser to grade? yes no Condition of tank good needs repair, describe Solids in Tank (see 8.15.150) . yes no scum in. sludge in. Was Ground water observed leaking into tank ? yes no If yes, where was water observed? Electrical Components Pump operating yes no, describe High water alarm functions yes no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured yes no #3 — Drainfield • Appropriate Vegetation in area 7, yes no. Describe vegetation GP.t1�b_ ( •.) ,y.,, ;< Indications of surfacing sewage yes , if yes, describe and diagragm on plot plan no overgrown/ not observable Signs of parking/driving in area x yes no Ground settling or erosion yes X no overgrown/not observable Monitoring Port Observations: Residual Head yes, #of inches X no Ponding in trench yes, #of inches of ponded effluent >( no Repair area is X adequate limited none available, describe Complete this section if system is permitted but did not receive an OK to cover or final approval OR there was no septic permit on file. Describe materials observed in drainfield construction: D-box present yes if yes, material X no Drainlines >( rigid PVC corrugated flex pipe clay tile concrete tile seepage pit or cesspool other Drainfield dimensions '0 -SO length width 2- #of drain lines ? oNL L‘oe S�rnt Do observations coincide with permitted system requirements/conditions? X yes no Comments: ECIEGYIE JUL 1 1 2001 i DEPT. OF COMMUNITY DEVELOPMENT Onsite Sewage System Inspection Report Page 2 of 3 Document8 • ` Parcel # -] 12 -,33 f - O0 Owner Name (.0 6 6 f aJ #4 - Treatment Unit (Sandfilter, Proprietary Device, etc) Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage yes , if yes, describe and diagram on plot plan no overgrown/not observable Riser to grade? yes no Signs of parking/driving in area yes no Ground settling or erosion yes no overgrown/not observable Monitoring ports in good condition yes no none present/no port found Monitoring Port Observations Residual Head yes, if yes, #of inches no. If no, notify Owner immediately Ponding in trench yes, if yes, #of inches of ponded effluent no Electrical Components Pump operating yes no, if no, describe High water alarm functions yes no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured yes no COMMENTS Was a System Problem Identified? Yes if yes, what section #. No X I certify that the information provideps,based on a review of County records and my direct observations at t 6 ti e of-inspect'on. / 7 - 6( Nam- igne ✓ Date No guarantee of future performance is implied or granted based i) efrrtirrri n this report. This report constitutes a summary of findings only. , 1L-7 • JUL 1 1 2001 Onsite Sewage System Inspection Report RA TYOUNTY Document8 DEPT. OF i DEVELOPMENT I , '4 i ,t (4.- . / N' - - i 2_. .•-; 1 ,'!/ /I/ -----------. ...._ ..-. ----1--: I , 9) ' - '■ il-n-il a r-1 \ r I 0 8 Sg'I / 0 \ , N ,l 1 ....-- ( ‘ .=, , PU1 ---. ,,, cc I .___I ...Li 1 0 ..z.co , . c:-.) • & ' t:o • ■ — u-ic..1 ■ , cA rul ■• -1 a. ,• r (A C:11 w / , 0 t -11 , ' : ■..-....6..." I ,r;1 1 -------,--- . 1 "I • : . • , , I-- / . r . ..t..) ...., , „ t i . . / , a , / 1 ; El I i , ___ _ _ _ j / . --) , G / / A) • 0 / • // . . , .. . , .... . , g • / i . 1 r . . 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