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Home My WebLink AboutSEP1975-003991 903 E. Caroline Port Angeles Court House Port Toarasend s P, OLY1 PIC HEALTH DISTRIG"r SEWAGE bISPOSAL PERMIT APPLICATION Submit in Duplicate Permit No. Builder Date PiiONE� � - si�G�cG DIRECTIONS FOR / -ILO IL7O�e APPLICATION IS HEREBY MADE TO: INSTALL NNE SYSTEM, REPAIR EXISTING SYSTEM YP� OF BIIING� Nb. OF BEDROOMS BASEMENT ��0 X BS NAMEn a5P-L4 OF Ij �INSTALL�R� p _� DRAINFIELD LENGTH �'S� �!IDTH�iyu3t��DEPTH#LINES SEPTI TANK SIZE 9 DRAG. A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE l (A PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. DATE OF INSTALLATION SIGNATURE OF APPLICANT ROOTED DATE j INSPECTED BY SANITARIAN'S COTIMENTS: w I CERTIFY THAT THIS ': j INST kLED I THE MANNER APPROVED BY THE HEALTH DEAPRTMETIT INSTAL RS NAME Jefferson County Health DepartmeReceipt No. ��/tiiCi 8025 Sheridan Ave. F'tal. Pont Townsend, WA 98368 206-385-0722 bCT 0 4 1991 nate:— EVALUATION OF INDIVIDUAL SEWAGE DISPOSAL � w„ 4 M SUPPLY L,.�, P Information Re-iesr_Pd: ✓Individual Sewage Disposal Systan Water SuPublic Supply_ Plic Private Applicants Name r er Wl Completed Report To: Owners Name a -,e f Address pr rh n s E if Phone: J'�S- r2- NAmaer of bedrooms 2 - Previous Previous Owner (if Known) Year Instal led 1 17 S - Legal Description: Sect on _ e TownshipRange /E Street Address /2-n o a �, �, n h 'h,ppa, 0 Directions to property A11- FOR HEALTH DEPARTMENT USE ONLY - DO NOT MRM BEM THIS LINE SEWAGE DISPOSAL V f Permitted system yes n0 Installed prior to permit requirement yes no S�ge noted on ground at time of inspection* yew no LS_ Howse is unoccupied therefore an evaluation of drainfield performance ism not possible at this time. A review of our records indicate that this system was designed to service a bedroom residence. This system is not considered adequate for a bedroom residence unless it is sized per currA regulations. 6 CQ k t a Septic tank s ifpot d within past 3 5 tRbC1 13.0 7ft4Q•%cit k •C:�,r� WATER SUPPLY Well casing 12" above ground yes no Sanitary seal in place yes no WP -11 100' from drainfield yes no Water sample taken yes no Sample results Oo�ants: Air. aepd {,, A r•oc� s��►c,�d g .. � is '` 51'``�- 1wo�,5.. � sh L � • �a � 'ro;1 �-�•s� lam � b�.. c ',C4"" . [� I res o,,ti \ =Ital . luprn PkurTimealth Specialist "•This :report doht.nst3tute a guarantee, either written or implied, that x the systemI acon�tixnxe . to f�iillction properly: Thie report constitutes a s� `of ��xrlix aniy - Ona t n: rbc.K - -Vo _ I t �41409dab r s � a �M Mo)66. �--v3me Baan 4 an-�1,2id L I� i 11991 _T,:_w ww..moi'15;nw. C.C7T7W�r lam,Ti T T.T3 1=:,1=T.T' t: X%'rT n TINT JPffP.rsnn County Plannirita s�,d Rz�i ldin� nt�Vartmt-nt Cn13rIfTS uaP, 3rc7 v1—on-r PO Box 12.20 Pnrt Townsend, WA 993SR 206-3A5—q141 PF.RMTT #....:RT.n91-0706 nATF RE.CFTVFn.:10/04/91 STTF, AnnRF.SS : 120 REACH nR : NORT)T,ANn, WA 98358 ------------------------------------------------------------------------------- OWNER....... : RTT,T.TF. CARTER PHONE.: 386-1244 MATT,TNG AnnR : 1414 STTRRMAN :PORT TOWNsFNn WA 98368 ------------------------------------------------------------------------------- CONTRACTOR.::NO CONTRACTOR PHONF: MA T T.TNG AnnR : CONTR. T.TC #: F.XPTRATTON nATF.: ------------------------------------------------------------------------------- ARCHTTFCT/... PHONE: s " nFSTGNRR I a 0 �v% ..... MATT.TNG AnnR: lv�lhC� /9j� �� (b�C( I1-�� rN5 --------------------------------------------------------�w't PARCEL NO:9.92200-002 HF.AT,TH• T.F.GAT, T)RSC..: STIR 08 -*9.q-01 .WM, TAX # BV: (�tA nATF.: LOT 2 , BLOCK FTIT.T,F.R' S ACRES SHORET.TNRS : RV: nATF. : nESCRTPTTnN OF TMPROVFMENT: MORTT,F HOME TNSTAT.T.ATTON -aAk ------------------------------------------------------------------------------- RTITT.nTNG TYPF...... :MOB BEDROOMS--- BATHROOMS— MATN FT..__: 0 sf TYPF. OF TMPROVFMFNT:NF.W FXTST.: 0 FXTST.: 0 2Nn FT,....: 0 sf GARAGE/CARPORT.....: PROP..: 2 PROP..: 0 3RT) FT.. ...z O sf WOnnSTOVF:........ :.: TOTAL.: 2 TOTAT..: 0 BASEMENT..: 0 sf TTRC Orr.TTPANCY GROIIP:R3 SEWAGE nTSP..:SF.PTTC CARPORT_: : 0 sf TYPF OF CONST ......: WATER STIPPT.V .: PWRT,T. GARAGE ....: 0 .f. TTNTTS.: 0 STORTF.S:O HEAT TYPES.: nF.CKs..... : 0 sf TiTMFNSTONS : -------MORTT.F. T-TOMF.------ COMMF.RCTAT.: O sf FRAME TYPE: MAKF : RRF.AM VR : 72 TNT)TISTRTAT.: 0 sf EST COST.$: 3000 ST7.F:12 X 60 RANK HT ... :0 ft PROD GRP..: 2042 SH SFTRACK:O ft -------------------------------------------------------------------------------- Owner/argent ---------------- FEES-------------- Signat-urP: type ammint by date rec:pt PRMT S 75.00 AN 1 0,/04/9 i AgSg9 nate: B. c. $ 4.50 AN 10/04/91 59699 TsS"ned By: na t P. : ------------------------------------ $ ----------------------------------- 79.50 TOTAT. Jef f erson- Cou Environmental "Heal, h ` partment Application Fo3 et rm.na iok, P Adequate Potable, at Jefferson County Resolution 199-90 requires building permit to rovide elidence of an adequate potable water supply. y ••• • •�� rte•Wk Assessor's Parcel°�P# Legal Description .df Pr erty Site Address applicants Type of Evidence* (check one) y Valid Water Right Permit (attach copy) Approved Public Water (attach letter from purveyor that the system is capable of and will supply water. Include State ID number. Environmental Health will determine if system is in compliance with State Drinking Water Regulations). N,/ Individual Well (attach copy of well logs including production test results and lab analysis for water quality parameters - total coliform, Nitrate -N, primary inorganics - and plot plan showing location of well with respect to proposed sewage system, buildings, driveways and surrounding properties). Office Use: ' a) Waller Right Permit# b) Public Water Supply Name of Supply Washington State ID# In compliance yes_ no. c) Individual Well Driller Name Date Drilled Depth Production Meets Water Quality Standards yes rx' :,Z��_ Application Approved Denied** Not required I'm_ (At7r�K_�M - Date * A temporary Moratorium shall be placed on approval of alternative -water supply systemsuntil appropriate design and construction guidelines have been established. ** Appeals shall be filed in writing within 15 days pursuant to Jefferson County Health Department Policy Stat ement#2-88.;. Screen: 01 Parcel # 000952200002 Geo Cd 292108403211 FULLER'S ACRES LOT 2 & TL TAX 0 * Taxpayer Cd CART 0100 CARTER, BILLIE J * Title Owner Tax Code 0211 Status TX TAXABLE Affidavit 54574 Vol/Page / Legal Doc QCD 5/21/87 -0- Taxpayer CART0100 Search Keu BILLIE J CARTER 1414 SHERMAN ST PORT TOWNSEND Mode INQUIRI Auto Roll' OFF Nbad Cd 3235 T/P Chg Dt 7/27/1987 T/P Chg Usr KG Land Use 1104 CIU Code Amount WA 98368-8511 MH SITE RP S/C Cd 0� Of FEB ,4 2000 FFFn.._