HomeMy WebLinkAboutSEP1993-00541 06.JEFFeRSOU COUNTY HEALTH DEPT. jv f C l p L No. i1c311 ..
CASTLE HILL DENTE/ eApr-�5 FCe: Q
845 SHERIDAN Tom' /
PORT TOWNSEND,WA 98388-2439 L,
208-385-9400 D L'� , 1.20'193
EVALUATION OF INDIVIDUAL SESACM:DISPOSAL. SYSTEM AND/OR WATER SUPT Y r (_
Information Requested: 1/Individuai, "' ":
{ equ $ec�ia�e Disposal System �.
{ — Water Supply ` Public ivate : k,.-. .._,-..,
Applicants Name ta..r.,'Ne LS 0.-is) r o. MiR11 Completed Repo Rn °- �d _ -- ------.:
( ners Name Le,.•.1 e: C. a-.�N o Pi Law,,c._. C, T, eons I s a,
Address ''0 k6 ox t b e‘ e t C 1 681
p
7 o \.s t- L ct ciEn7O eQJt,S O LD 6.,._ ct.g3?? '
Phone: I- 20(, - 5-1 8--L(7 7 4 Number of bedrooms t r`w""�
Previous CAvner (if Known) IkU<y e Year Installed 2
Legal Description: Section 19, Township 7 q Range 1 W PARCEL # q 0 1 - 1 -Q-a3C\
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Street Address `ASS- era., V 11cy R-d.
Ct.1 �ix. LJ ^'ti
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Directions to property g 4 ' -' 1' 9.. W ( y ct S S.�r o N ° P
D N `t e '�c- � 4r o w o_`.ki (.1 4 -- \ k--,..,. 4\--Orly! in-,--coC��.a(h-d o-.a/n p
Yom.!.) ,��S �Q..- s w,-o.i` V c-A- \O il1`L. G e_.:.N WL O. Ii.o 0 se_ L'.---'-e-- 1�
4- g o-y G. (p c-V-::N 4-t-e-- -&.�U7 + l,
FOR HEALTH DEPAR mart USE ONLY DO NOT FRITE BELOW THIS LINE
SEWAGE DISPOSAL SYSTEM* C
Permitted system yes A no
Installed'prior to permit requirement yes _ no L ri k-n0 wY'\
Sewage noted on ground at time of inspection* — _ no
House is unoccupied therefore an evaluation of drainfield performance is O
not possible at this time. )( N.
A review of our records indicate that this system was designed to n
service a bedroan residence. This system is not considered
adequate for a bedroom residence unless it is sized per current
regulations. 41 C
Septic tank should be pumped if not done within past 3 - 5 years.
�,t p-1; t' c � cock, el S ;
ll
WATER SUPPLY ctC � I Atia t n C Id}'1,
Well casing 12" above ground yes - no J
Sanitary seal in place yes no
•
Well 100' from drainfield _ yes _ no
Water sample taken yes _ no It
Sample results
Ca rents:
— A, k*.V,.,k ka6c,._-*\0,-, .- �4r— -F't tQ
— c�;1 Co ri.Q c (AxtT (L C- S2. IC � AO o,c f k`e. 6 r3`�Gil S� G -i
d �
�D e� 5 o'r\ ;�,} �v �� e4 E dam- nE i sA ..0 ► ,
Date S - 1 _C( Time 1.It C f ��T
c .
tal Health Specialist
* This report does not; constitute,a guarantee, either written or implied, that
the system will continue to function properly. This report constitutes a
summary of findings only.
rrevnrom
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JEFFERSON COUNTY HEALTH DEPARTMENT - �•;k',t maf M
MULTI SERVICE BLDG., R z
LDG. FLt�
802 SHERIDAN AVE. RND, ,WA
9836
,0fr).38
INSTRUCTIt?NS F+OR EVAL13XiffoN,OF EXISTING SYSTEM APPLICATION:
1. Please complejte the information on the top half =of the, application
form. Include a drawing of the plot plan.and .tnap°to the property on
this form.
2. Uncover the Septic tank. Uncover the inlet-,and outlet inspection
4110:16 ports and be cure the inspection ports are loose, so. inspection ofd the
inside of the septic tank can be made. Provide copy of pumping
receipt if septic tank pumped within the la t�;,5 years. _°k
1 10 1 evmPe b.- ".ra,..r s- r.l , \ , ry \�t8b,. �- , �s 6
I 3. If a ample is involved, please allow one week from:the time of S ea`�`4i"c'
pling until results are ready.
4. Unless otherwise noted on the form, all reports will be mailed back
to the applicant when completed.
5. Fee schedule: Sewage Disposal system `. $60.b0 -,_\
Sewage Disposal and Water $80.00
Water Sample $65,00
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ACTIVIjY REPOAT •
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LETTER TO FOLLO t(E: ( ) OTHER RECD! ZI MTIONS
OMINIIIVINIIIMIIMINIM
°Al' • 19", • REPRESZNTATIVL: