HomeMy WebLinkAboutSEP1975-00469EP
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No.`��
Port Angeles SLUAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House
Port Townsend Date 'Z
,67 11c4 n I Rd — 4S -a
OH'iR ADDRESS PHONE 3
DIRECTIONS FOR LOCATING SIT'E����-C_��
APPLICATION IS H'MMY MADE TO: INSTALL N3q SYSTEM REPT EXIISTING SYSTEM i-�
UG 1
NO. OF BEDROOMS, I BASEMENT 13'�ICA"-p,
I'GJ NAME OF tII STA]
DRAINFIEI,D LENGTH rVTIDTHH �DEPTA , �, #LINES_a .SEPTIC TIN SIZE `��, ,
W A DETAILED PLOT PLAN 'BELOW. SEE INSTRUCTIONS. SOIL TYPEAt
\C-
7�.� mac:
Q.
N
I CERTIFY THAT TH
HEALTH DEAPRTMENT
C``e,� _Z_ g' -i - ye, G . - .
?ST. ' SLED IN THE MANNER APPR
RS NAMEOVID BY THE
ATE
T"A
'216-30-'07
qate'.
Wnnm--a+' TWIV111M SffMKZ DISPOSAL SYMM ANDAIR W=
Information Requested: _Z -Individual S&qVe Disposal System
Water !applyPublic Private
Applicants Name f ke 'r. B Ia St. Mail Completed Report To:
(Miers Name v—
Ad&vw -T I R tf
Rd 1-t W4 -d /IF C
MMM: 3,fs-- G,-07 Nurber of bedrooms -t-
..Previous QW*r (if Known) Year Installed /-;L7 - 7t`
Legal Description: Section TbwnshiptgyA) Range/f/
Street Address ,I-! 2.4
Directions to_ properW 4- -4/ Z4w� A4-�
Tt�,c�o-j Co�e 3-;�LaAA
SEMM DISFOUL SVSMW
Permitted system�yes M
Installed prior to permit requirement yes _Z no
-SeMW noted on ground at time of inspection* _ yes ✓nn
House Is unoccupied therefore an evaluation of drainfield performnoe is
not possible at this time.
A review of our records Indicate that this system was designed to
service a -3 bedroom residence. This system is not considered
adequate for a bedroom residence unless it Is sized per current
regulations.
Septic tank should be pumped If not done within past 3 5 years. 'Ieck;r�
NMW SUPPLY
Well Casing 12" above ground _ yes no
Sanitary seal In place _ yes _ no
Well 100' from drainfield
yes — no
Wter sample talmn yes _ no
Sample results
Z-9-' 01"?
+-- AC- IS toxo 0-
so
Ro rwt h7 PIA C1 1--7 T4
Date K -J:1- h to Time Is cwt
Eavirommtel Health Specialist
s. This report d088 not constitute a guarantee, either written or implied, that
the system will Continue to function properly. This report constitutes a
summery of findings only.
EESFORM 11/88
l�
�,..-rte tit c�.,-��..,�
(�
�,,� old }� �t►-�..)
M
4_ x
s )
GO�DMAN SEPTIC DISPOSAL '
P.O. Box 233
PORT TOWNSEND, WA 98368
iv
(206) 388-2557 +
.inn claims ano recurnea goons Mus i oe
• accompanied by t)tts bill.
008 ` hank`You
PMV 6033.4 ees 1.—& mV. 01471.
. cii•�.nt'+�'si � : . � r :'^ .... c�� .'re>r.-.. s .....it Ys .....-.r r. ,:'yN :. s. �. c y _-., ....:-.. .='r-'a�ra'
M i UFAS,
AWA - '
.inn claims ano recurnea goons Mus i oe
• accompanied by t)tts bill.
008 ` hank`You
PMV 6033.4 ees 1.—& mV. 01471.
. cii•�.nt'+�'si � : . � r :'^ .... c�� .'re>r.-.. s .....it Ys .....-.r r. ,:'yN :. s. �. c y _-., ....:-.. .='r-'a�ra'
Awn-
� v!.fir
)
--
/
.l
L
(
JEFFER
's 1. Su
3. Food
4. Rest
runn
5. Hand
not
&A TH DEPARTMENT - BA
FOR
-. �� - "► j
ARY FOOD SERVICE, BOOTHS;
apolicatlion, fee, and attach specific plans at least ,ten (10)days prior, to
3 peng date. Be sure application form -is; complete.
Ep eml ary Food Service is required. See fee sch �dule for fee. Pie it
of ecce a period of two (2) consecutive weeks.
filer' �ards are required (seefee soheftle).
ns mus be conveniently located (no more than 200' away) with hot and cold'
dater vailable and permission obtained to use the restrooms.
hitg falilities are required, conveniently located in the booth, with hot
v ter,Ihandsoap and single -use or paper towels. The handwashing sinkshall
us d'fo food preparation or dishwashing. If hot water is not availabl ,
provode
pr
2.
Pe
gird
sb
3. Food
4. Rest
runn
5. Hand
not
&A TH DEPARTMENT - BA
FOR
-. �� - "► j
ARY FOOD SERVICE, BOOTHS;
apolicatlion, fee, and attach specific plans at least ,ten (10)days prior, to
3 peng date. Be sure application form -is; complete.
Ep eml ary Food Service is required. See fee sch �dule for fee. Pie it
of ecce a period of two (2) consecutive weeks.
filer' �ards are required (seefee soheftle).
ns mus be conveniently located (no more than 200' away) with hot and cold'
dater vailable and permission obtained to use the restrooms.
hitg falilities are required, conveniently located in the booth, with hot
v ter,Ihandsoap and single -use or paper towels. The handwashing sinkshall
us d'fo food preparation or dishwashing. If hot water is not availabl ,
provode
t ree
lastic buckets, one with soap and water, the','second with rinse water
and1he
gird
ith chlorine bleach in water for sanitizing hands (1 cap bleach',',per
gall
ofiwate
), A bulk potable water container with spout set above a wastewater
I
cont)
finer, with
n.dsoap and paper towels nearby may also be1,',used as an Alterna'i{tive',,
tempi
arkh d
ash facility. The handwash solutions shall be properly disposed
(int
a slewage(system)
and replenished as needed.
6. Potential
y ha
lardous food, consisting of meat, eggs, fish, !,dairy products or 'cream-
fill.d
pp t ie
and custards shall be prohibited. This does not apply to any Poten
tial
ha ado'ls,food
that has been prepared, packagedandserved under conditions
meet
g t' el're
uirements of the Rules and Regulations of the Washington State
Boar,(
of Realti
for Food Service Sanitation WAC 248-84 (i.e. prepared in an approved
comm
.rcial kit
hon).
J400
7. Peri
habil oo�s!,must
be kept at 45° F or below, or hot at F. Dairy products.
may
�e usid'if'stored
in refrigerators. All refrigerators must have thermometers
(ices,
of p.pproled
for refrigeration). All produce and other foods shall be rinsed,
and 'diced
sndl�lthen
brought to the booth in covered containers.(
8. If p
pend shla0hing
facilities with'hot water are not available in the booth
then
4 fo d-
o>itact equipment shall be washed, rinsed and'sanitized after use at
an a
provIed'es
ablishment with such facilities. The booth shall be provided with.
one
uckechlorine
sanitizing solution (prepared as in item 5) exclusively for
sari
izin, food
-contact equipment as necessary and extra food -contact utensilsll shall
'shall
be pI
viii d+
�'IIaddition,'any booth serving foods that arenot pre-packaged
prov
a al b ck't'!of
chlorine sanitizing solution for rinsing and storing wiping cloths.
9. All
Items on minu,
including ice drinks, must come from an "approved source". ',No
food
re ar ti
n,or storage may be done in the private home'
10. Food
on � s�►1al
l
�ust be protected from'contamination; i.ez gain, overhead du'6tlb inserts,
snee
ing,, or handling
by customers. Where necessary, effective shields shall be pro-
vide
; i.e. wrapping,
covering, or sneeze guard. Provide protected pour or squeeze
cont'Ineir.
f or'Ilcondiments.
11. Prov
.de v�re
garbage cans.
12. Provide
#smooth,
cleanable, non-absorbent surfaces on counters, floors, walls, and
othe
l sur aces a
l
13. Sing
-se ice
��alA!
articles shall be used unless there are facilities for cleaning and
sari
-izin
14. Bootl
skull n
t be located_ in an area wheregmay round surface ' contaminate food vial
dust's
etc,.
15. Inspi
_tioil f Ja
ilities on location prior to operation, before issuance of permit,
will
e d n b
the health department. Dispense only foods'Ilisted on the apprpved
appl
calln1
16. Fail
're to doml�lly
with all regulations can be cause for revocation of permit. '
JCHD/9-8
ir
�
F
it
Parcel Print
Parcel Number. 942903501 05/14/2007
Owner Mailing
HEIDI J DODD
6225 JODY CT SW
OLYMPIA WA 985127930
Site Add
51 HUNT RD
PORT HADLOCK 98339
Section: 3 School District: Chimacum (49)
Qtr Section: SEI/4 Fre Dist: Chimacum (1)
Township: 29N Tax Status: Taxable
Range: 1W Tax Code: 211
Planning area: Tri -Area (4)
Sub Division: CHALMER'S 2ND ADDITION
Land Use Code: 1100 - HOUSES (single units, non-farm)
92847 CLEARING TITLE 8/01
Page 1 of 1
Property Description:
CHALMER'S 2ND ADDITION I BLK 35 LOTS 1 THRU 4 ( W/10'PTN VAC TWIGGS ST ADJ I & PTN VAC
ALLEY ADJ I
http://www.co jefferson.wa.uslassessors1parcellparcelprint.asp?PARCEL NO=942903501... 1/22/2009