HomeMy WebLinkAboutSEP2014-00129 1t
Jefferson County Department of Community Development s •e
t.,,,Sheridan St., Port Townsend WA 98368, (360)379-4450 '' t`
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SEPTIC PERMIT APPLICATION ` 'AvA 10/21/14,
PROPERTY OWNER Marcelle Berlin ��a+' \\
�'�'� Jess 0 Godsalve ��
MAILING ADDRESS 4960 Center Road ..�.�� ��� �+
Chimacum, WA 98325
PHONE ( 360 ) 509-7587
SYSTEM DESIGNER Jess Godsalve Designer Phone# 360-551-9973
LEGAL DESCRIPTION: Section 3 Township 28N Range 1W PARCEL# 801 033 005
Subdivision Name Division Block Lot(s)
Site address/Directions to site Center road near MP 5. Address posted. get d
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New Tank/s only Private X
Residential ADU Modification X Public
Commercial Expansion
Community Upgrade
Repair X SITE SIZE 5 Acres
SYSTEM TYPE Partial Repair-(tank) (drainfield) X Previous Evaluation
Conventional X Designate Reserve Area Yes# SEP 83-66
Alternative Redesign No
SYSTEM DETAILS
Number of Gallons/day 240 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day
Drainfield Length 180 ft. Trench Width 2 E'-ft. Trench/Bed Depth 24-36 sikin.
Septic Tank size 1000 Ex-gal. Pump Chamber size gal.
TYPE of system Repair of broken drainfield pipe, see narrative and design page.
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this
application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson
County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against
Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole
purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the
applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry
Appeal -A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in
writing within fifteen days after receiving written notice of the decision.
DISCLAIMER-This application is for an on-site sewage system that meets the state and county
standards in effect on the date of application. This application for an onsite sewage system DOES
NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that
you will later obtain permission to build a permanent residence or other structure on this parcel. Any
future application will be separately judged by the rules and laws in effect at that time.
,A/ �� ..4 .r/ /°/? /
Property Owner Signature I _ Date _'-
FOR OFFICE USE ONLY�i,/� 'y'Y� J�U �CQI '! •`I'/ [ ' '
PARTIAL t) IZ/2 ft 9 ASBU eT L ' • FIN /7//
y
APP'•V'D
INSP/PUMP TEST \A r( t\t'l\ 4L
2 ALL HOLD REQ. MET '' II rte, �j
Date 1 bb i ee t q Rec# `t I 1 Check# 21 17- Case#SEP t f ) Z-9
H:\WEB\PDFs\Septic\septic_permltapp_2008.DOC
J- JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublichealth.org
Phone MU-38b-9444 Fax :36U-3(9-448
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP14-00129 Date Received: 10/30/14
Date Issued: 12/11/14
SITE ADDRESS: 4960 CENTER RD Date Expires: 03/11/15
CHIMACUM, WA 98325
APPLICANT: MARCELL M BERLIN PHONE:
PO BOX 205
CHIMACUM WA 98325-0205
LEGAL DESCRIPTION: S3 T28 R1W TAX 37
PARCEL#: 801033005 Section: 3 Township: 28N Range: 1W
DESIGNER: JESS GODSALVE PHONE: (360) 598-3505
MILLER BAY WATER CO
PO BOX 1054
SUQUAMISH WA 98392
SYSTEM DESCRIPTION: CONVENTIONAL TRENCH
No. of Gallons per Day: Type of work: MOD
Drainfield Trench Septic Tank
Length: 180 feet Width: 2 feet Depth: 24 inches Size: 1,000 gallons
DISCLAIMER-This approval is for an on-site sewage system that meets the state and county standards in effect on the
date of application. This approval for an on-site sewage system DOES NOT assure you of any other County approvals. For
example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure
on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. All construction
and development activities must comply with all permit conditions, state and local codes, and Recommended Standards and
Guidance documents in effect when the permit is issued.
The property owner is responsible for the accurate location of all property lines.Any removal of or major disturbance of soil in the
primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system.
Any change in drainfield or tank location may invalidate this permit unless prior approval is obtained from the Jefferson County
Environmental Health Division. If during excavation or development of the site an area of potential archeological significance is
uncovered,all activity in the immediate area shall be halted, and the UDC Administrator shall be notified at once.
Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL
SYSTEM IN JEFFERSON COUNTY, WASHINGTON
This permit is issued for a period of three years (unless otherwise stated above) in accordance with
Jefferson County Rules and Regulations for On-Site Sewage Systems, codified in JCC 8.15 as amended.
This permit may not be renewed.
Jefferson County Envy nmental Health Specialist
This permit with conditions must be onsite during all phases of construction
HEALTH DEPARTMENT MUST BE CONTACTED FOR FINAL INSPECTION.
SPECIAL CONDITIONS APPLY - SEE ADDITIONAL PAGES
CONDITIONS OF APPROVAL- PERMIT NO.: SEP14-00129
1.) This permit was issued to correct a violation of WAC 246-272A for an exposed drainfield lateral and
ponded sewage. The permit must be completed within 90 days of the date of issuance.
2.) This is a permit to: 1) Remove the sections of PVC piping that tie the lateral ends together. 2) Cap
and glue each lateral end. 3) REPAIR "D" box and install risser. 4) Install risers on septic tank to
meet current requirements. 5) Provide vehicular barrier to protect the drainfield.
3.) H - Permanent barriers are required along/around primary and reserve drainfield areas to protect
from parking, driving, and other land disturbing activities prior to final.
4.) H - AS PER WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE
SYSTEMS REQUIRE THAT A RESTRICTIVE COVENANT REGARDING THE MONITORING OF
THE ONSITE SEPTIC SYSTEM BE RECORDED TO THE PROPERTY TITLE. THE PROPERTY
OWNER SHALL ASSURE THAT MONITORING IS PROVIDED BY AN APPROVED ENTITY AT
THE FREQUENCY DEFINED PER STATE WAC 246-272A AND JEFFERSON COUNTY CODE
8.15 AS ADOPTED OR AMENDED.
A COPY OF THE RECORDED OPERATIONS AND MONITORING AGREEMENT IS REQUIRED
PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL PERMIT
5.) Designer must be contacted prior to start of construction and for inspections during installation.
DESIGNER IS REQUIRED TO DO A PRECOVER INSPECTION ON ALL TYPES OF SYSTEMS.
6.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
7.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
8.) All construction and development activities must comply with all permit conditions, Washington
State and Jefferson County Codes and Recommended Standards and Guidance documents in
effect when the permit is issued.
9.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
10.) Approval of this sewage disposal permit does not preclude the permit holder from complying with
the Unified Development Code for other/future development on the site.
11.) Approval/issuance of a sewage disposal permit or installation of a septic system does not
guarantee the approval of other development or a building permit on this site. Future buildings that
require connection to an on-site sewage system (OSS) shall only be approved if the OSS meets
the current standards and codes in effect at the time of the building application.
12.) This system as designed and approved is sized for only one single family residence. It is not sized
for an Accessory Dwelling Unit (ADU). The minimum daily design flow per residence is 240 GPD.
13.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion
and sediment during construction. BMPs shall address permanent measures to stabilize soil
exposed during construction, and in the design and operation of stormwater and drainage control
systems.
SEP14-00129 Page 2 of 2
\\tidemark\data\forms\FSEP_Permitmod.rpt 12/11/2014
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tb CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT S0 ®1S
1)2eti/ /714,
Installer: Owner Parcel # 801 033 005 0,/th
Permit Owner: Marcell Berlin Permit# SEP 14-129
Designer: Jess Godsalve-MBH2O Design Flow: 240 GPD Peak
Site Address: 4960 Center Road-Chimacum
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAL/DAY
LENGTH 150 36" varies 1000 2 180
IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen
Tank Size:
Float Arrangement
High water float—distance to top of tank/emergency storage
Dose drawdown (#of inches) #Gallons/Dose
Timer/Dose Counter info Pump Size/ Manufacturer
COMMENTS (inspection notes, changes from design or deficiencies installation)Attach additional sheet(s)if necessary
-system repair only. Refer to record of construction(attached).
Users Manual Provided to Homeowner N/A Date
ATTACH ASBUILT DRAWING signed by Designer or stamped/signed by a Licensed Professional Engineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS
VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED
AS DESIGNED AND APPROVED by JEFFERSON COUNTY
12-4-14 (DATE)OR THAT CHANGES HAVE BEEN
NOTED AND THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272
s. 9/17/15 5100341
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Repair Narrative 10/21/14
4960 Center Road - Chimacum
Parcel # 801 033 005
SEP 83-66
Overview:
A site inspection was made in October 2014 to determine the feasibility of a repair to the septic
system on this property. The septic tank, distribution box, and drainfield laterals were inspected to
evaluate condition and suitability for continued use. Results of this inspection and repair justification
are outlined below.
Inspection notes:
The septic tank was found to be in good general condition with lids, baffles, and connections intact.
The tank was pumped early this year according to the homeowner. No signs of groundwater intrusion
or leaking were observed. The distribution box was exposed for inspected and found to be intact and
level. The lid was broken during excavation and will be replaced as part of the repair. The drainfield
is mostly intact with the exception of the broken connecting pipe at the north end. The drain gravel
shows some siltation which can be expected in a system of this age. No signs of bio-mat or extended
ponding are present. The general drainfield area has been used for various activities throughout the
life of the system, which can potentially effect system operation long term, however the depth of cover
and soil type have protected the drain field trenches from damage. Remediation steps and customer
education of acceptable use are included as part of the repair plan.
Design overview and justification:
The condition of the site and drainfield indicates that a repair of the broken section along with some
other minor remediation steps should restore the system to acceptable standards. The repair plan
consists of the following:
-Removal of the building in the drainfield area. (completed)
I; -Removal of the broken pipe connecting the three laterals at the North end of the drainfield. This
connection is redundant as equal distribution is achieved with the distribution box. This type of grid
system is no longer considered in drainfield designs, and may be contributing to the concentration of
effluent in this area. I propose removing it altogether, and capping the ends of the laterals. This will
allow for a better use of the entire drainfield area.
-Clean up of drainfield area, and establishing vegetation. Provide a visual barrier to prevent driving or
parking on the drainfield. The owner and occupants have also been educated on acceptable use of
the drainfield area.
-Install risers on the septic tank and distribution box to facilitate inspection and future maintenance.
Conclusion:
Given the relatively small amount of effluent in the excavated area, and continued rapid absorption, I
believe that the repair steps proposed will provide an acceptable solution to the current problem at
this site.
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' JEFFERSON COUNTY HEALTH DEPARTMENT 5 v
802 SHERIDAN AVENUE, ',
INSTALLER I�rk,s- 1w..i�4k'r PORT TOWNSEND,WASHINGTON 9868' `�r L' L`RECEIPT NO. .` ` -
BUILDER Q'ru t �.:v.: 0
(206)385-0722 . �1
. SEWAGE DISPOSAL PERMIT L DATE `�
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• • Submit In Duplicate .lCFi.= COUNTY
l fl..It3 kc- 732., WIC,
Owner Address Phone r-
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Directions for loca ing site r
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INSTALL NEW SYSTEM El REPLACE SYSTEM❑ PARTIAL REPAIR❑ TANK/DRAINFIELD❑. 4
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TYPE OF V NO. OF Plif-s3;6 SITES ac rte-r
BUILDING V •, . BEDROOMS BASEMENT ' ' 0 .SIZE Ili' X Al- Kor.,; y N
DRAW DETAILED PLOT PLAN BELOW. ST : •UT PLUMBING ABOVE FOUNDATION FOOTING C m
(or draw on attached sheet) SOIL LOGS ' 2 9
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Dig two holes per site. Minimum
4' deep-2' diam.-50' apart & flag location APPLICANT (Jsh.'-..(-. c, 1 D
ANY REMOVAL OF OR MAJOR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DRA FIELD ' to C)
AREA MAY CREATE SITE CONDITIONS THAT ARE UNACCEPTABLE FOR THE INSTALLATION OF A r
SEWAGE DISPOSAL SYSTEM. ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING
PLUMBING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS 2.
PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept.
for final inspection) .
Oralnf,eld Length Width Depth M Lings Tank Size Gal. O
C
COMMENTS: (TWO C MPART ENTS) >
Evaluate existing system 2/17/83.
t1 ( EI��1ADyt
stpitAciA
See 2/2/83 and 2/22/83 letters. or\tt,‘, Aupyvv, (2,2 aAaG,, ,.6,4+4
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APPROVED DATE INSPECTED PARTIA FINAL DATE 3 q01
certify that this system was installed in a manner approved by the Health De..rtment. t
INSTALLER'S SIGNATURE DATE DATE INSTALLED i
/
JCHD/1-82 cc: B. Knight 2/22/83
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ACTIVITY REPORT
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FILE NAME/NUMBER PARCEL # S°1 033
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NAME .8 �
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Health Department Staff: ' \`'- Rag,/ ��� `c9
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JEFFERSON COUNTY HEALTH DEPARTMENT
, c ` 832 SHERIDAN PORT TOWNSEND.WASH.98388 QO6)3854722
February 22, 1983
Bruce L. Knight
Rt. 1, Box 645
Port Ludlow, WA 98365
Dear Y!'. Knight:
Oa February 17, 1983, an evaluation was done on coca existing
drainfield. As of this date the system was functioning in a sat-
isfactory manner. Some construction problems were noted:
1. d-box needs releveling so water flows evenly out to all lines
2. Additional fill is needed off the north and northwest corners
of the drainfield.
3. Curtain drain south of the drainfield should be deepened to
4 feet.
This is not an approval of the system. This is merely a statement
or existing conditions on the site as of this date.
Should you have any questions, please contact this office.
Respectfully,
Jo :. Hayes, R. .
Environmental Health Specialist
JE:fs . . .
cc: Dr. J. E. Fischnaller, Health Officer
John Raymond, Prosec. Attorney
COMMUNICABLE PUBLIC HEALTH VITAL ENVIRONMENTAL *HEALTH r
DISEASE CONTROL NURSING STATISTICS HEALTH EDUCATION
• - 1
_'. ' JEFFERSON COUNTY HEALTH DEPARTMENT•l, c t 802 SHERIDAN PORT TOWNSEND,WASH.98368
_ .
,/�i . dr (206)ass-0�22
•• ' February 2, 1983
Bruce Knight
Rt 1, Box 645
Port Ludlow, WA 98365
Dear Mr. Knight:
In our discussion regarding your recent building permit application, which
noted that a septic tank and drainfield was installed during 1982, it was
found no sewage disposal permit had been applied for or issued. It appears
from our discussion, the "site evaluation" you had received via the realtor
selling property in 1980 was mistaken to be a "sewage disposal permit". For
your information a copy of Jefferson County Ordinance No. 2-77 is enclosed
regarding sewage disposal permit requirements.
Please complete the enclosed sewage disposal permit application form and attach
an accurate to scale as-built of the septic tank and drainfield you installed.
Describe how it was installed, when, and by whom. The information should in-
clude the amount of gravel used, pipe specifications, tank size, etc. Include
copies of your receipts from Fred Hill and Thurmans. Send this information,
along with a copy of your 1980 site evaluation, to me as soon as possible.
Our next scheduled trip to the area will be on February 17, 1983. The day
prior please uncover the top of the septic tank and the D-Box for our inspec-
tion. Also stake the location of the drainfield. Your co-operation will be
appreciated.
If you have any questions please call me.
ely
Randall M. Durant, R.S
Director of Environmental Health
RMD/cp
cc: J.E. Fischnaller, M.D. , Health Officer
John Raymond, Prosecuting Attorney
SITE EVALUATION REPORI
JEFFERSON COUNTY HEALTH DEPARTMENT Receipt No: 016Z
Multi-Service Building
802 Sheridan Avenue Fee:
$25.00
Port Townsend, Washington 98368
385-0722 Date: May 7, 1980
Applicant: Joe Clarkson Sec. 3 Twn. 28N Rg. 1W
Address: c/o P.O. Box 88
Legal Description (Div. ,Blk. , Lot)
Brinnon, WA 98320
THIS REPORT DOES NOT CONSTITUTE APPROVAL OF Directions for Locating Site (Draw map on back)
A BUILDING OR SEWAGE DISPOSAL PERMIT. THOSE Site Size 5 acres
PERMITS SHALL BE GRANTED.ONLY UPON APPLICA-
TION AND WILL BE REVIEWED IN ACCORDANCE WITH Seller Clarkson
CONDITIONS AND REGULATIONS EXISTING ON THE
DATE OF THE PERMIT APPLICATION. THIS REPORT Buyer Knight
IS NOT A PERMIT APPLICATION.
I request this site evaluation for 1 single family residence or
INSTRUCTIONS: A minimum of two soil log holes at least 4 feet deep, 2 feet diameter, and 50
feet apart must be dug in the proposed drainfield area and flagged before the evaluation is
made. See attached instruction sheet.
A site evaluation of the above property was made on May 1, 1980 by this department
and the property has been found:
i ACCEPTABLE - Soil and -site .conditions are .acceptable. for .installation of a sewage disposal
system, as requested above, under existing conditions and regulations.
IXI CONDITIONALLY ACCEPTABLE - Soil and site- conditions are acceptable for installation
of a sewage disposal system, as requested above, under existing condi-
tions and regulations, provided THE CONDITIONS SET OUT BELOW ARE MET.
I UNACCEPTABLE - Soil and site conditions are unacceptable for installation of a septic
tank system.
COMMENTS: 1) Maximum drainfield
2) Partial fill
3) Curtain drain required (4'-5' deep)
4) Further subdivision of parcel unlikely due to soil conditions.
5) Great care should be taken in clearing lot so top soil is not
removed making the drainfield site unacceptable
•
SOIL LOGS:
1) 0-24" sand gravel silt loam Respectfully, •
24-48" compact sand gravel clay mottled
2) Same
Jo h' Hayes, R.S.
ENVIRON . NTAL HEALTH SPECIALIST
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. RECEIVED
Jefferson County Permit Center FOR OFFICE USE
621 Sheridan St /M( 3 0 1999 I Date 3/ '° / i1
Port Townsend WA 98368 Fee 96 . D,
360-379-4450 I.C. ec # ,/
l► PERMIT Tv •R Check # i
0TH #
(EES) EVA I ` • • : ''l'' EM /
INDIVIDUAL SEWAGE DISPOSAL AND/OR WATER SUPPLY SYSTEM C /J 3 -�C
Information Requested: X. Individual Sewage Disposal System �J
Water Supply _ Public Private
APPLICANT NAME C ff' 13e/rJ i pi Mail Completed Report To:
Mailing Address eL c G - '' pd,
Phone C 414e x/,11, “1/4
OWNER Name C-
Mailing Address 't S � e -
Phone 7 3Z - 7 3 9 g Previous Owner rV-ce- k pi i 4
Occupied101 No If Vacant, How long? Number of Bedrooms 13 Year Installed
Septic Permit Number A e-C d I p C ' ' /67
6
SiteAddress: 476, 0 Zvi 1-'e-k- ie.d
Legal Description: Parcel Number 601 .033 ®EIS S .3 T oe N N, R I Lk)
Plat Name: /Division Block Lot(s)
Directions to property t�- ._/-ef led 77 P f 6 ,tc4,iee,/1 1a4,50„ 104e-c c'.e.--t ,s—
Attach plot plan showing location of structures, drainfield & septic tank.
FOR HEALTH DEPARTMENT USE ONLY- DO NOT WRITE BELOW THIS LINE
SEWAGE DISPOSAL SYSTEM*
Permitted system yes no Installed prior to per i requirement? yes Kno
S age noted on ground time of ins c 'on" yes no
House is unoccupied therefore an evaluation of drainfield perfo mance is not possible at this time.
Health Department records indicate that this system was designed to service a bedroom residence.
Septic tank should be pumped if not done within past 3 - 5 years.
Septic tanl�: volume 1 compartment 9L._2 compartment
Baffles: d condition inlet missing outlet missing
Repair area: -adequate limited none available
WATER SUPPLY
Well casing 12" above ground yes no Well 100 ft from drainfield no
Sanitary seal in place yes no Water sample taken yes no
Sample results
Comments: '^ �, C� C.-a.7 ‹, �,-, Zh`l C IO_
- 4* .. .(-)AA flAI: f 1).A1/\ . 443--cCA CeCit"i/Lkl' Aajelcdr NjjyvVicL .
1\\f5A-CIC1611°--111).rhiV\ 2- Igo
Date 41- Time Environmental Health Specialist Pigot
" This report does not constitute a guarantee, either written or implied, that the system("67
ill continue to function
properly. This report constitutes a summary of findings only.
.
H:\home\pincntr\infohlth\ee..frm 2195 :c .r
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tEN
* °C).b V MOBILE HOME INSTALLATION APPLICATION , 10
Jefferson County Permit Center
Castle Hill Mall /
621 Sheridan St .
��l:��
Port Townsend, WA 98368 Q4c-
360-379-4450 //_ 9
PERMIT # •BLD99-0174 DATE RECEIVED. : 03/30/9`9
SITE ADDRESS :4960 CENTER RD
:CHIMACUM, WA 98325
APPLICANT. . . :CLIFF BERLIN PHONE : (360) 732-7398
MAILING ADDR:MARCELL BERLIN
:4960 CENTER ROAD
:CHIMACUM WA 98325
INSTALLER. . . : HUNT HOMES PHONE: (360) 683-2811
LICENSE # : EXPIRATION D TE : / /
CONTRACTOR. . :
t •� �' � PHONE:aisV
l ,i .. .1
MAILING ADDR: 4 \Y\ ` 1 • ,N
.: 44 h, 64\ 1p . .
c)
CONTR. L I C # : 11 • EX v 7A T I ON DATE: / /
Itie)
PARCEL NO. : 801033005 Landslide Plat Cond _ Wetland Flooding _
LEGAL DESC:STR03-28-01 W Seismic _ Streams Erosion _ F & W
LOT , BLOCK , TAX #37 Shoreline Aquifer
Area Com. Forest : Adj . 300"
DESCRIPTION OF IMPROVEMENT: mobile home installation
BUILDING TYPE -MOB BEDROOMS--- BATHROOMS-- CRPT/GAR. . : 0 sf
TYPE OF IMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 DECKS 0 sf
GARAGE/CARPORT PROP. . : 2 PROP. . : 2 COMMERCIAL: 0 sf
UBC OCCUPANCY GROUP: TOTAL. : 2 TOTAL. : 2 INDUSTRIAL: 0 sf
EST COST.$ : 34000 SEWAGE DISP. . :CON BANK HT. . . : 0 ft
PROJ GRP. . : 11043 WATER SUPPLY. :PWELL SH SETBACK: 0 ft
MOBILE HOME
MAKE :SILVERCREST YR: 78
SIZE:24 X 60
Owner/agent FEES
Signature : type amount by date recpt
PRMT $ 137 . 00 MTM 03/30/99 11956
Date:
Issued By:
Date:
(bld_apmo.txt)
$ 137 .00 TOTAL
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