HomeMy WebLinkAboutSEP1989-00151 1 exo 1
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Include the following items on the site plan Case# S '5"9 ''--00/5/
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> Prope boundaries - Drainfield area if known Parcel# I /` v' f V
Name- of adjacent streets ➢ Septic tanks and/or Pump chamber Address ee 'r
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A Drive ays and parking areas ➢ Wells w/distance to OSS components Prepared by V-1144 Fuji leer~„
- Surfac- water(ponds,creeks,etc) A Buildings-residence,sheds,garages,etc Date • -. -/ /4
A North .rrow
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Plot plan submitted by � �1C)- � '-� o f g
as a part of a Monitoring inspection ii I
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I Not reviewed or approved by JCPH.
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14019` •�
°` JEFFERSCtIfirebliaY HEALTH DEPARTMENT • l5i
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802 SHERIDAN AVENUE _5E1°8"I--
INSTALLER ' E.".------,- :..��� PORT TOWNSEND,WASHINGTON 98368 RECEIPT NO. I ?7.1-,
jes>f.)w--: /KW. r rr,r s r:-es (206)385-0722 r..
BUILDERDATE SEWAGE DISPOSAL PERMIT J/' 3 /f 2
0 r.
' / \ 31r 3o`7/' -I
MI
t .. id — -�AGrr _ mI
it A
Owner
Address Phone 6 r.
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-9- � -. < >
Directions for locating site —
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0 RI
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INSTALL NEW SYSTEMS REPLACE,sYSTEMIi Et----"PARTIALREPAIR TANK/DRAINFIELD 0
Pi
O
_. — o, ct�- d z z
TYPE OF NO. OF .:- .-. SiT ..
BUILDIN�% /r'l/rh e- BEDROOMS 1 2- BASEMENT -SIZE 11, Uoa•Sr a
Healthupesite ev luation by 'SOIL TYPE- DESCRIPTION rn
1
Yes No • 1) 2
Depth tp maximum seasonal
water table
Source of potable water supply 2)
Public V/ Private
g
Source type: Drilled well
Dug well Z
Other 3) < z
EVERY APPLICANT HAS THE RIGHT OF Z
APPEAL PER JEFFERSON. COUNTY
ORD ' %/ 2-7 • 4)
1000„4
Aiiii ' .41.44k 33
SIGNA U' OF .+'P 4 i Z
ANY REMO ` OF ' MAJOR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DRAINFIELD wr in
Q
AREA MAY QFEATE SITE COfmITIONS THAT ARE UNACCEPTABLE FOR THE INSTALLATION OF A
SEWAGE DISPOSAL SYSTEM. ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING lc SL►
PLU'BING TUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS
PERMIT UN SS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept.
for final inspection). STug OUT PLUMBING ABOVE FOUNDATION FOOTING, O
Drainfield Length Et: Trench width,' Trench depth36 pexNo.lines ..Z Tank size 10(.064-L.,.4 j
Soil type and application rate used for design 1 GPD/ft22 - C r' 1
COMMENTS: f Oi 73
'1-J-)s%s+e,'- P£2 SA. 5'f2R7 aie4'1-.5-Ns Afv_a 10 d s. d+d. 3-i -bei 1.,,, Z.. ,
SEE A rrAc9it7 Gv m A S.-'TJ
/
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APPROVED DATE INSPECTED PARTIA !NAL DATE� �
I� t n
I cerlify that this system was installed in a manner approved by the Health Departmen w�w� ��_ '� rm'
44 0 73
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INSTALLER'S SIGNATURE DATE DATE INSTALLED Ort S3i 9® "Oo I 6
5tf '6,-i ntt,(01JG L---
JCHD 7-+54 C FJ(, 00 r;_.W��
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