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JEFFERSON COUNTY HEALTH DEPARTMENT \ `�
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INSTALLER `-;r. A_ PORT TOWNSEND, WASHINGTON 98368 RCEIPTIRO. 11,
(206) 385-0722
BUILDER DATE Lt \ ; L G� 1Z-IC
SEWAGE DISPOSAL PERMIT 1
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Owner Address Phone m
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Directions for locating site v
I CQo cJ�• S .INSTALL NEW SYSTEM REPLACE SYSTEM ❑ PARTIAL REPAIR❑ TANK/DRAINFIELD❑
TYPE OF Exts►,"' C61 NO. OF SITE
BUILDING a� � BEDROOMS `-7 BASEMENT iND SIZE lcg5)C1 O� c DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING co
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Dig two holes per site. (min.) D 4-., M
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4' deep-2' dia. -50' apart & flag APPLICANT 0 \
ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT
LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDAT S THIS PERMIT UNLESS
PRIOR APPROVAL IS OBTAINED F'Iu . I '=' u , t7`- -- 0
Drainfield Length °, '''' Width Depth :304 # Lines -3 Tank Size /r?OO Gal. c
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COMMENTS:
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APPR ,VED - DATE INSPECTED `- RTIAL/FINAL / DATE ( --0
I certify t this sy was installed in a manner approved by the Health Department
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INS:FALLERIS SIGNATURE DATE DATE INSTALLED ,..C•
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.JEFFERSON COUNTY Ht'ALTH DEPARTMENT, 'hece±pt No: 2080
Multi-Service Building
802 Sheridan Avenue Fee: $35_00
Port Townsend, Washington 98368
385-0722 Date: 2-11-80
Applicant: Arnold L. & Marlene M Parker Sec__ 34 Twn. 30 R9 1W
Address: Rt. 1 Box 187 32-40,9 Take 7th Ave. to- Swaney Street
Legal Description (Div- ,Blk. , Lot)
Port Townsend, WA 98368 Irondale
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385-4268 Directions for Locating Site (Draw map on back)
THIS REPORT DOES NOT ( N TITUTE APPROVAL OF 10,000 sq ft. 15,000 sq ft.
A BUILDING OR SEWAGE DISPOSAL PERMIT. THOSE Site Size (100 X 100 ) (125 X 00 + 25 X 100)
PERMITS SHALL BE GRANTED ONLY UPON APPLICA-
TION AND WILL BE REVIEWED IN ACCORDANCE WITH Seller DeMots
CONDITIONS AND REGULATIONS EXISTING ON THE
DATE OF THE PERMIT APPLICATION. THIS REPORT Buyer Arnold L. & Marlene M. Parker
IS NOT A PERMIT APPLICATION.
(1 on 32-35, 1 on 36-40 + 9)
I request this site evaluation for 2. 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 February 14, 1980 by this department
and the property has been found:
1Xi ACCEPTABLE - Soil and _site conditions are .acceptable_for .installation of a sewage disposal
system, as requested above,. under existing conditions and regulations.
CONDITIONALLY ACCEPTABLE - Soil and site conditions are acceptable for installation
of a sewage disposal system, as requested abov.e, .under existing condi-
tions and. regulations, provided. THE CONDITIONS SET OUT BELOW ARE MET_
f ( UNACCEPTABLE - Soil and site conditions are unacceptable for installation of a septic
tank system.
COMMENTS: Soils acceptable for on-site sewage disposal .
Acquire city water tap.
SOIL LOGS:
1 ) 0-4' sand Respectfully,
lightly mottled at 28"
2) 0-4' sand
3) 0-53" sand (3, )
4) 0-34" sand Merilee L. Blaine
34-36" Clay sand ENVIRONMENTAL HEALTH SPECIALIST
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respec
correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Feb
11:46:41 2008
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