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Home My WebLink AboutSEP1975-00106r r te 403 �. Cerol.�,ne , OLYMPIC HEALTH DIST'_2iCT. - W! iWe Dit Nob fait Angeles SEWAGE DISPOSAL PERMIT APPLICATIO Submit in Du l� Kate Builder Court House Poet, `%Oi► we Date SECTIONS -FO .. IOCATING`SITE" APPLICATION IS HEREBY MADE TO:'INSTALL NLV SYSTEM REPAIR EXISTING SYSTEM �' tc( YPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZ NAME OF STALL'M DRAINFIELD LENGTH,&n WIDTH --C D ®#LINffi, ,SEPTIC TANK SIZE & DRAW A DETAT7M PT.nfP iDT.Am Rr-TnW evr. emo7TrnTrn1KTe enrT mvnV �' .Y7.. n j., .c cCr v -S 4 ,, x t/Alk v_c_j 13,4 1-* 13,E Z3o WA ANY CHANGE IN BUILDIN OR SET:AGE ISP A S, CATION E OR SIVE, r L A AEIS S T PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. DATE OV INSTALLATION - SIGNATURE OF APPLICANT APPROVED DATE 2: Z 2 V /_; � INSPECTED BY G L� sus DATE 75 54NITARIAN'S COMMENTS:. �� S � f � I CERTIFY THAT THIS SYST tIAnLLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTKan nems NINE mmomis Emm limmillom 0 m MEMO limommmommmsimm :MEIN 0 MEN mmom "ME JEFFERSON COUNTY HEALTH DEPARTMENT Multi -Service Building - 2nd Floor 802 Sheridan Avenue A Port Townsend, Washington 98368 385-0722 Applicant: James A Rice ;7o.�-� Address: :� n.. n,,.. 08 quilGdaWA ' 6 1833 9 Phone: 732 - 4465 THIS DOES NOT CONSTITUTE APPROVAL OF A BUILDING OR SEWAGE DISPOSAL PERMIT. No.: 4'939 Feer 15.00 Date: 10-17-78 Sec. cz7- Twn. a-7-7 Rg. I W Lots 1, 2, 3, Block 9, Harrisberg Addition LEGAL DESCRIPTIONOV., 7C., LOT) Irondale on Montgomery DIRECTIONS FOR LOCATING SITE (DRAW MAP ON BACK) Site size 50 x 100 150 x 100 Seller Ron Olsen:_ Buyer James A. Rice request this site evaluation for single family residence o(Inspection for Farm Home Loan 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•) A site evaluation of the above property was made on 10-27-78 by this department and your request has been: ❑ 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: On 10-27-78 anon --site evaluation of the sewage disposal system serving the residence on lots 1, 2 -and 3, Block 9, Harrisburg Addition to Irondale was made. At the time this evaluation was made no problems were noted with the system. The system is constructed in a manner approved of by this office. Soil Log: Respectfully, l 1 D Larry Anderson SANITARIAN v.;01/1 I /�w ,its Jefferson County Department of Community Development 621 Sheridan St.., Port Townsend WA 98368 (360) 379-44(50 of an Existin OnRF!" S Evaluation g _ 20 g _}r ) Draw on the back of this sheet a current plot plan shoilviAj I9citX7f: Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a curr Ian identifying these items. 1.O ALL SPACES MUST BE FILLED IN. I�F�E�i, If information isnot available enter (NV) or not applicable (NA). Type of Evaluation M Evaluation of on-site sewage system ❑ Evaluation of drinking water ❑ Evaluation of on-site sewage & drinking water Office Use Only Date '&&..211i Fee 3 RecptMS r Check 2 Case # S" a 6 Reason for Evaluation ❑ Routine Operation and Monitoring Inspection D4 Real Estate transaction ❑ Complete a Permit # ❑ Building Permit Review and/or no septic permit on file ❑ Other, explain . Date of evaluation D31,Qb_Inspected by Tax Parcel # c 5(e-jool o I Permitted System Oyes no Permiticase # SEP `75-- I d(0 Subdivision, Division, Block and Lot(s) HARR�s B�ttC l..ti of Size Acres or Dimensions Current Owner Q.Au&Q-1a �iEA��tJse5t.1 Site Address DAR Owner Phone #_ Previous property owner name(s) - (NN if not known}_ N Directions to Site p''C , {sem, <111 )A,.x..11 'EJE kAs!-2!y 11(m, N-13 Date System Installed Age of Dwelling -# Bedrooms House Occupiedyes_no, vacant how long? the Who installed system? <k\pLn Send completed report to: Owner Name MALL Qt) -% )C\et WeAQsos% Mailing Address _4oL- P' �T lVM Realtor or Other Representative Name mjQ i_ S � s• �� 'Tv Evo� i r � Mailing Address �V Phone/email1fax)-Rfnn _73a.— EES EvalLiation 1- orm 0?-30-04_pdf page 1 of 5 Include the following items on your plot plan: ❑ Property boundaries ❑ Names of adjacent streets ❑ Driveways and parking spaces ❑ Surface water (ponds,creeks, etc) ❑ Buildings(residence, sheds, garages, etc) PLOT PLAN -date prepared n3 XJ 0'7 Ow ❑' Wells I "I ❑ Septic tank \ f it ❑ Drainfield (enter N if unknown) _ ❑ North Arrow.>mtit� 1�� ,f �ov51E e �S Cvf�W1Ls1� �R�1+�6 U NOT TO SCALE A,I ENVIRWCHECK, L.L.C. . 1612 Hastings Ave. W. Port Townsend, WA 98368 Permit # or Parcel # Evaluation of an Existing 0isite Sewage System _07130104_idf page 2 of 5 Date of Inspection Inspected by Ode ww (Et>< dc' UP Water Supply (fill in only if water supply is being tested in this evaluation) Sample was taken Yes . No Sample Results Well casing 12" above ground Yes No Vd 2 ® 2007 Sanitary Seal in place Yes No Public: offsite onsite Name of System IUMI 111111191ful Individual: offsite onsite Is well more than 100' to drainfield/disposal component fires_ no, if not, distance Is well more than 50' to tanks and effluent transport line fires_ no, if not, distance ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept. records for this case 3, 3(flb #1 - Septic Tank Tank size \to e�in gal. _ ( single compartment two compartment dn6=8A %� material Riser to grade on inlet ves X no. Riser to grade on outlet yes X no Condition of tank K good needs repair, describe 1 st comp. Scum (top layer) 1 S in. sludge (bottom layer) in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? ves �_ no If yes, where was water observed? Condition of baffles: Inlet: good eeds repair material (PVC&) Outlet: good k- needs repair materialdfD,concrete) Screened Outlet _)!�_no des; condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b))Y, yes no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: Does system include a pump? yes If yes, complete the next section X no (if no skip to section 3) #2 - Pump Chamber Tank size gal. Material. Riser to grade? yes no Condition of tank 000d needs repair, describe Solids in Tank (see 8.15.150) yes no scum in. sludge in. Was Ground water observed leaking into tank ? ves no If yes, where was water observed? Screen around pump? no ves, condition clean dirty/clogged Shroud around pump? no ves Electrical Components Pump operating ves no, describe High water alarm functions ves no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured: ves no Permit # or Parcel # Evaluation of an Existing Wtsite Sewage System ._07/30/04 odf page 3 of 5 #3 - Drainfield Appropriate Vegetation in area S. es no. Describe vegetationC.-"6S Indications of surfacing sewage (check one) es, if yes, describe and diagram on plot plan �C no drainfield area is overgrown and not observable Signs of parking/driving in area -_yes no drainfield area unknown Ground settling or erosion __yes X o overgrown/not observable Monitoring Port Observations (if present): Residual Head ves, # of inches no Ponding in trench yes, # of inches of ponded effluent no Repair area is? Available as shown on permit X_None evaluated or shown on permit �— Addendum (page 5) is attached for evaluation of Treatment Unit or detailed evaluation e _yes�C no COMMENTS (attach additional sheet if necessary): 41-A. Risers are mandatory on next inspection. TNS SAS h %,L.0 lk"D cIJTLET 15 SL4ffim(,e'FF ?Willer- DoT. 'QVC ?,AWM LCV &--4 R65& -*E otter UffL£ . other W The house / dwelling was unoccupied so no assessment ofdreilnfleldc ouldbdmade. SEE ATTACHED ADDENDUM Was a System Problem Identified? Yes k if yes, what section #.,v .,%*) -No This report on the existing onsite sewage system is valid for the permitted or historic (if installed prior to permit requirements) use of the system only and does not constitute assurance of future County approvals (such as building permits) on this parcel. Any future application will be judged separately by the rules and laws in effect at that time. I certify that the information provided is based on a review of County records and my direct observations at the time of inspection. Name/Signature Date No guarantee of future onsite sewage system performance is implied or granted based on the information contained in this report. This report constitutes a summary of findings only. Permit # or Parcel #_SEA^�o(o Evaluation of an Existing g s e Sewage stem _0; /30/04_pdf page 4 of 5 ADDENDU,�M Enviro Check. L.L.C. Company Disclaimer • . ADDRESS OWNER Based on what we were able to observe and our experience with on-site wastewater technology, we submit this Sewage treatment Inspection/EvalimMo d Report based on the prem condition of the on-site sewage treatment system. Enviro Check, L.L.C. has not been retained to warrant, guarantee, or certify the proper fimctioning of the system for any period of time in the present or fixture. Because of the numerous factors (usage, soil charactenisticAs, previous failures, etc.) which may affect the proper function of a septic system. And the inability of our company to supervise or monitor the we of the system, or to inspect none visible areas of the system, this report shall not be construed as a warranty by our company that the system will function properly for any particular owner or buyer. Enviro Check, L.L.C. disclaims any warranty, expressed or implied, arising from the inspection/evaluation of the septic system or this report/evahntiwr. We we also not mining the impact the system is having on the groundwater table or environment. Enviro Check,L.L.C. does not make any claim, warranty or guarantee as to where property linestboundaries of properties are located. And does not warrant or guarantee any encroachments from on site sewage systems on to adjacent properties. AM indications of possible property 1meslboundaries are aPProxiunations and do not indicate legal property lines or boundaries. Enviro Check, LLC EES reports do not state where the exact location of drainfields are located. Only the general area is indicated, based on permit information that may or may not be correct, Enviro Check, L.L.C. will not be held responsible in any way for Mormation being undisclosed (intentionally or unintentionally) by property owner, representative or other parties of interest All reports, including E.E.S. inspection reports are subject to any change by Jefferson County Environmental Health Department Enviro Check, LLC is not liable for any such changes. .Q VAR �owa All parties are encourages to check county records for any information regarding properties Enviro Check, L.L.C. 1612 Hastings Ave. W Port Townsend, Wa. 98368 360-379-9400 I acknowledge that I have studied the information cantanaed herein and that my assessment is honest, done inacro c hi Tem �y Ordinances, and to the best of my ability, corre m Dale urtsmith Co. SAMPLING (Septic tank) Date - PH Result- DO esultDO Result Temp. Result MEASUREMENTS Counter Setting PC SF Hour Meter- PC SF Screen: 01 Parcel # 000956700901 Geo Cd 290102204211 HARRISBURG BLK 9 LOTS 1 & 2 Mode: INQUIRY Auto Roll* OFF Nbad Cd 4211 * Taxpayer Cd JOHN 2095 JOHNSON, JARROD K T/P Chg Dt 12/18/1996 * Title Owner T/P Chg Usr JODI Tax Code 0211 Status Tx TAXABLE Land Use 1100 RES -SINGLE Affidavit 80982 vol/Page / -C/U Code S/C Cd I 1 n 0%11n► A A Ie n 10% J% A 1 '7wr'1919 Ttln