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HomeMy WebLinkAboutSEP1970-00076cti d East Caroline OLYMPIC HEALTH DISTRICT P'I t No. � Yr 'r -Ange e$ F e Paid $ ► --r ° SEWAGF,DISPOSAL PERMIT APPLICATION Submit in Duplicate w M 1 I• Y Q "ADDRESS DATE SAL DESCRIPTION DIP=T_1ONS -FOR LOCATING �i -7, A,I PHONE�„,,�. APPLICATION IS HEREBY MADE T0: INST&U NEW SYSTEM REF R EXIST336 SYSTEM iiiiiiiiiiiiiiii Residence 3 E'OF BUILDING NO,'OF BEDROOMS BASEMENT :SITE ST?E NAME OF INSTALLER ON THE REVERS SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORNAZ'I0; 1. -Prager ty 13nes7, 2+ Location Driveways � pa 'lios t carport i etc ` . of building 3--_L0cati0n 8,,Streams or bodies of water nearby of septic tauk 4_Location 9; Location of p 'rcolation test holes �P of drainfield .. Slope 100 Septic tank size galla of land 6"ater Lines & well (if applicable) 11. Length of proPlosed drainfield 12., Depth to watery if encountered. PERCOLATION TEST RESULTS nv ePth Time required too Percolation rate i, Type of soil, Of .hole seep:,lazt 6 inl Pere. No. 1, (divide time by 6), Pere.. No. Nos DRAINFIELD WIDT$ IT -.IS- HEREBY AGREED THAT HE PROPOSED INSTALL AS—DESIGNED AND APPROVED ON THIS APPLICATION. 1 _ LN©. OF LINES„, , APPRO.Xw .. DATE OF INSTALLATION_', _ Signature of ppllcant SAIMARIAN S CON S THIiS_CONST TUTES A PERMIT =:; 5 ' IGNATURE' APPEARS AS APPROVE_ PLAX-_APPROVED DISAPPROVED DATE REMARKS: 5-68 0 1 T� R 11ung � � � � i.,. _ '"`i—. SI ET PLAN ON GRID 13hOW SCALE--10 I I'I I IEET B II WEN LINES INDICATE NORTH I I I i. I II i I i _ � FI I I II r e ti '• .41 I r I I I I "I' IE 1� II it I 11. 41 i 1. II I I I. II I I. � r I t I I 6 f II I I� I� 6 I I v.l 1 1 I I I I' I 1 i II i i I �k I III 1 J i I 6 i ISI I I I c II i I II III i iI }' i � d JEFFERSON COUNTY HEALTH DEPARTMENT Multi -Service Building - 2nd Floor 802 Sheridan Avenue Port Townsend, Washington 98368 385-0722 Applicant: Joseph & Linda Nutsford. Address: P.O. Box 34 Hadlock, WA 98339 Phone: 385-0521 THIS DOES NOT CONSTITUTE APPROVAL OF A BUILDING OR I ` . No.: - 4303 Fee: $15.00 Date: 5-16-79 Sec. 2 Twn. 29 N Rg. 1 W Garfield's Addition to Harrisburg LEGAL DESCRIPTION PV., BLK., LOT) Block 5, Lots 7 & 8 DIRECTIONS FOR LOCATING SITE (DRAW MAP ON BACK) Site size 100' x 100' ( A.) SEWAGE DISPOSAL PERMIT. Seller Joseph & Linda Nutsford Buyer Blaise & Marla Heck evaluate existing septic tank I request this site evaluation for single family residence or and drainfield operation 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. A site evaluation of the above property was made on May 179 1979 by this department and your request has been: 0 APPROVED — Pending submission of a completed sewage disposal permit application. ❑ CONDITIONALLY APPROVED — Providing conditions listed below are met and submission of a completed sewage disposal permit application. ❑ DENIED. COMMENTS: Soil Log: System is functioning in a proper manner on this date. Recommend pumping of septic tank if this has not been done since.the system was installed. Respectfully, SANITARIAN Randall M. Durant, R.S. t !'t }tSON COUi��ti `':LALIti ULt-i. 802 Sheridan Ave. Receipt :Vo. ' Port Trnmsend, WA 98M Fee' 206- 385.0722 Date ' 11 V I ,.' MWIVMUlkL v• r. Water supply Phone:Appli ts Name It e, 10e- i i Mall Cxxnpleted Report To: . .. Previous • . . ', Legal DeTownship Range scription:Street i, Address. i Directions to prope 1 �,,_1 ►� _ —Cy ior• i•. [ i Note: If the Health Department has a record of the sewage disposal system, uncover the outlet inspection port of the septic tank. If there is no record of the system, uncover the entire septic tarok, D -Bax, and expose the ends of the drainlines. Be sure the i.rmqpection port(s) are loose, so inspection of the inside of the septic tank can be made. Provide copy of pumpiruj receipt if septic tank pumped within the last 5 years. - - Part HBAM EWARi M USE OMY - DO Mr MM EEMU TfIIS LIM SEWAGE DISCAL SYSTWO Permitted system yes no Installed prior to permit requirement yes Sewage noted on ground at time of inspection* ✓yes Howse is unoccupied therefore an evaluation of drainfield performance Is not possible at this time. A review of our records indicate that this system was designed to eervioe a bedroom residence. This system is not considered adeguate for a bedroom residence unless it is sized per current lotions. _✓ Septic tank should be pumped if not done within past 3 - 5 years. WMM SUFPLY Well using 12" above ground yes ro Sanitary seal in place yes no Well 1001 from drainfield yes no Water sample talmn yes no Sample results See over Date moo -13 g1 Time :OO'P.tt -12nviMMental Health Specialist « lhis repoe't does not constitute a guarantee, either written -or implied, that the system will conthm to fuection properly. This report constitutes a wry of firdl ps only. � Vie► yw �J r. � i �.. `ti nrvm- +4 i ykx. +.Ww'. n # .,£ ; Y __. ... fiyr. p.1L,� � ♦ {{.. „ .: i� ;.. fW6n x - :0411• ":; r � it � � e. # j- s o- ,6... - rt - ' - ,::. .. ._: ,may .•_...n . :. ....; .. '� «r �t x , .:mac• ..,.. .<:x•, �,,. . J4 i- r Y'- - 4 4 E k h k .% a ,Y n u _ F S' Jefferson /County Health DepartmentReceipt No. 802 Sheridan Ave. RECEIVED / ' Port Townsend, WA 98368 Fee:C�-- 206-385-0722 .JUN 2 91990 nate: — y JEFF. COUNTY MMM TON OF IMIVMUAAL SEE DTSPO AffbW* 10R HAM SWMY Information ReTpested: Individual Sewage Dis cal Sysre _ Water Supply Public _ Private Applicants Name , U i + SLt, ItE XL►- Ly u )�`� Mail C _ _ feted R _ rt To. T— 1 avrx�rs Adore n G ,�A ` ; ►J Pfione : ?>6 j-64) ?5S5 ' (-I( {LI bPr of hPcirooms Previous Dwner (if Kndzvnj c.�i'- Year Installed Legal Description: Section -52- Townshipa < Range J Street Address <?')F � , h ti. ;, if 1 n,L— rect ons to r , OT 10& nivMioc 16i5f Kelt ort t. � hh�� FSR HEALTH DEPARMW USE QWW- Do MOT WRITE HEiAw 1 LIIM SEWAGE DISPOSAL SY,'�L'EW Permitted system -' . yes no Installed prior to permit requirement yes no Sewage noted on ground at time of inspection* yes no House is unoccupied therefore an evaluation of drainfield performance is 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 current w regulations. Septic tank should be WgPed if not done within past 3 - 5 years. HMSUPPLY Well ding 12" above ground yes no Sanitary seal in place yes no Well loot frOM grainfield yes no Water ample Sem�pl results talo -an 7W no AC_7U�,1 i i� O U G L� 1 rk dY\ C- <—/1v� `.32 Qa �� w � d C- �c ,,,k v ryr P4 c" c-1 > > C'1ec.pfrr-1t�....c` JAC (.Q S 5 6704 r .�2 ' JIT Vw� �� c�sCk �p r ns�-c,� 6� 6 Date _ L9 Time tal Health Specialist o}..,does.not.00nstitute a guarantee, either written or implied, that WAM theavatm :will . -continue .. to function properly. pie - Mary report constitutes a as ally. MA Jeff erson /6unty Health Department RECEIVED 802 Sheridan Ave. Port Townsend, WA 98368 Receipt No. Fee: �G'• �-- �jj 206-385-0722 J1lN 2 91990 Date: JEFF. COUNTY E�AIAATIQi1T (F MIVIDUAL SMM DiSPO O&MM/ R MMM SUPPLY -J Information Rec_g:ested : _7X- Individual' Sewage Disposal System _ water Supply Public: _ Private Applicants Name.� �L�-�1 12,�j L�7UlU l� +� �t � Q,(i-)lL,`� Mail C_ leted R rt To: Owners 1 cX Address ') G lk LX Phone: 5`3S (; jli-�� �v�5 '��(IL( �' tuber of bedroc--irns Previous Owner (if Known) L�`E� '- Year Installed Legal Description: Section -,7, Township a y Rarx�e Street Address 9 ) 1= Int rect ' ons tooperry o't FOR REACTS I PAR ENP USE OILY - DO NOT WRITE BFM— fromLINE SEWAGE DISPOSAL SYSTEM* Permitted system -�L yes no Installed prior to Permit requirement yes no Sewage noted. on ground at time of inspection* yes no House is unoccupied therefore an evaluation of drainfield performance is not possible at this time. 1y A review of our records indicate that this system was designed to service a - b residence. This system is not considered adequate fora bedroom residence unless it is sized per current regulations. Septic tank should be pumped if not dome within pact 3 - 5 years. MMM SMETY Well casing 12" above grand yes no Sanitezy seal in place yes no Well 1001 from drainfield yes no Water sample- take, yes no Sample results OLA\4 A, �i O"r\ C_ s SP -0 ,i L vw• Date Time I oi'. 7S Ij rornental Health Specialist *.7his, report.:doss 'jot.constitute a guarantee. either written or Implied, that Min.'. -continue to functian properly. Ws report oa�stitutes a 'Y of ,f1minis ally, wj= an z "t `. Y'x a i"a �, s t-•'�'-3�e to 4 �" `�' -'�-x i� . 'E "'-,'�*"Z" c. +fie rix #�^£Zai k ii' (' 9 aE' 'ts 14hEnv `�n'"'y+ - 'Y'' "NOR, N '.rli-MN4+ `y �s ,4»'^ '�-x` y � s f 410 y ,.:-My WMA - ' 'o F a� Al ff- 4 y; 5 r 3 -� 3, j L'x4%W n 4 R y 145 77 i i MI?1'� � a � ��2�OQDNUIN��SEPTIC DlSPOSAL,�INC ��'�� oo too s+b oil t.�,p, yri'c7rs -r ' v MAIMS" `4_�y t �"4�' tow-', ,.v 5A.r4''�mty rki i ax � Rollo STS`- ,. ILI a Y x � 3 }' . *z.�- Y` ,,;..z, Z3,ce- R�Lfi�.`-�My IMM C N to''Q."^t a.�`s., F ,_ '�''? !fat ` WAS - UM �� � �e i t� ��;`sSFf�'t•� � �.5: -� r?- `� ,+ �,`.a�`�'�,�k�*��.y�`S`'� `�4 � - �` s �r i" '.l OXTs VAN too -to ON nq Lot r -... S r` t is No: Got 009 0Z MIT t R x r, } �s Screen' 01 Parcel # 000952800505 Geo Cd 290102204211 GARFIELD'S ADDITION BLK 5 LOTS 7 & 8 Mode' INQUIRY Auto Roll: OFF Nbad Cd 4211 * Taxpayer Cd MUCK 0500 MUCK, BRIAN G T/P Chg Dt 5/22/1996 * Title Owner T/P Chg Usr JODI Tax Code 0211 - Status Tx TAXABLE Land Use 1100 RES -SINGLE Affidavit 79463 Vol/Page / C/U Code S/C Cd 1 1I rk Al IA r /A r /AA A 1 AAr,19M TLAn