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Home My WebLink AboutSEP1974-00098v -4-- • -i, _va�'a � � t`•i i�( �d+��liia��i� Tr;t, ".t � t �.i/.-}"• F ). 1 f�.- ' i3��p; p��; • ..., ., .r`i 't�aF ; a.. r Nx, J'zf � % � .s . sat' . ��SOft�iWlty��1PI1�O�C.OIM1U111� Q@ve�OPn1� � 621 Sher S . T -"&WA 03 79 44511 p A -I . owsIT SEwAG� X G 1NSPEcnON VERIFICATION tia ThIS Cardgg SerVe.S asnc�ce�Few_ J ed and has nthe fi dpi Jefferson Cale '1�@QU 815150, fartheRa s�sbe qtr �G Kofi . $g8 't. OrflMUWIl Oii the SEE �OtiAlYl �Qti�1CA�1�iS TO THE ONSITE "SEWAt'E. CTION REPORT DATED itnsas isled on the report may - resultIn _ JC Code $.15 ragaNO art Ir spec on eviW. Year t�� _• "��° "" � 3 � � r � F The alcove intomia 5ased the fie and does not Imply or grant a W. Jefferson cwntf far d ielb urr� at re approvals by Jefferson County Department of Community Development -:621* Sheridan St., Port Townsend WA 98368 (360) 379-4450 Evaluation of an Existing Onsite Sewage System (EES) Draw on the back of this sheet a current plot plan showing Location of: Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a current plot plan identifying these items. ALL SPACES MUST BE FILLED IN. If information isnot available enter (NV) or not applicable (NA). Type of Evaluation Evaluation of on-site sewage system 151 ❑ Evaluation of drinking water ❑ ❑ Evaluation of on-site sewage & drinking water ❑ Office Use Only Date - L. 'Xt Fee D/ -1 Recpt_� Check, Case # 17 Y!Q Reason for Evaluation Routine Operation and Monitoring Inspection Real Estate transaction Complete a Permit # Building Permit Review and/or no septic permit on file Other, explain Tax Parcel Permitted System yes no Permit/case # SEP Subdivision, Division, Block and Lot(s) L..A-P $l,�c� _iJ� tiV 1 L.P'T_ 24 of Size Acres or Dimensions `-7 SJ X O' Current Owner _.o &h.. WE Site Address 2-! o�� Lbb� �12. ��R%►.sws�as.1 Owner Phone # Previous property owner name(s) - (NN if not known) t.-YA, Directions to Site. 'Pa, 4'C.. s j% .&:g�v Uzij!a ;No<E6_5dLUg6 16 Date System Installed \ o --"7 Age of Dwelling Mo' # Bedrooms_ House Occupied yes no, vacant how long? Who installed system?V2,bjg DE>J Send completed report to: L . Wa14 Owneris��;;:, rJil�'i VVcWPMENT Name _ Mailing Address �� .G�� oe1_ Qkihak�,, ;mak Ate' Phone%mail/fax 1.51 Realtor or Other Representative Name �.��.�.5,)�SZM12oo eAt r Mailing Address= yc • Include the following items on your plot plan: u Property boundaries u Wells u Names of adjacent streets u Septic tank u Driveways and parking spaces u Drainfield (enter NN if unknown) o Surface water (ponds,creeks, etc). c3 North Arrow a Buildings(residehce, sheds, garages, etc) PLOT PLAN 07 NOT TO SCALE va mac 6t; As 16 / PAP -461A40- 117 ?wff 11L 6*45 W1 N ENVIRWCHECK, L. LC. 1612 Hastings Ave. W. Port Townsend, WA 98368 4 Permit # or Parcel #!Z&'U Documentl 2 of 4 .. Ekraauation of an Existing Onsite Sewage System Upte of Inspection no X10 ! Inspected by 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 Sanitary Seal in place Yes No. Public: offsite onsite Name of System Individual:` offsite onsite Is well more than 100' to drainfield/disposal component _yes_ no, if not, distance Is well more than 50' to tanks and effluent transport line _ves no, if not, distance ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept records for this case #1 - Seotic Tank Tank size -n-- gal. ,single compartment two compartment C' e a C t CI -C material Riser to grade on inlet ves )S,__ no. Riser to grade on outlet yes X no Condition of tank X. gpod needs repair, describe 1st comp. Scum (top layer) _ 7 in. sludge (bottom layer) `"7 in. 2nd comp. scum in. sludge . in. Was ground water observed leaking into tank ? ves )& no If yes, where was i Condition of baffles: Inlet: Oi Sc uo'lueJ Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) yes _X no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: ( eg: ) 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? ves no Condition of tank good 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? ves no Shroud around pump? ves no 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 !pin/§ec. Timer. Settings min/sec on min/hrs off Floats securedS ves ` -no^ _ JH - 4 Permit # or Parcel # terI' `�'� Documentl 3 of 4 JE`ri=ERSON C01_ iMTY Evaluation of an Existing Onsite Sewage System #3 - Drainfield Appropriate Vegetation in area _�C Yes no. Describe vegetation =ASS Indications of surfacing sewage (check one) ves , if yes, describe and diagram on plot plan no drainfield area is overgrown and not observable Signs of parking/driving in area ves X. no drainfield area unknown Ground settling or erosion ves . no overgrown/not observable Monitoring Port Observations (if present): Residual Head as, # of inches no Ponding in trench ves, # of inches of ponded effluent no Repair area is? Available as shown on permit _• X None evaluated or shown on permit Addendum Is attached for evaluation of Treatment Unit or detailed evaluation of drainfield_yasc.c _no COMMENTS (attach additional sheet if necessary): � � -- }�. �;�S��S R� ��*a�►'te� ou 1.�Ek�"Si��rGQiol�• teens -�-� lae tZieQtAcXV wIm ' Vic \V E- 3aFf -LE. C>7-%\ -%-k\ IE V was ki � occv Rl G0 So &� IE% MELN'r % �,ta�T� (1,Et.ck.PS Skttow 1 g9Q.h, ��v5� �w�0 R {�01�IR• SEE ATTACHED ADDENDUM Was a System Problem identified? Yes i- if yes, what section #. 1 % 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 informal is I i n a review of County records and my direct observations at the time of inspection. o CQot o4 e/Signature Date No guarantee of future onsite sewage system performance is implied or granted baged on the information contained in this report This report constitutes a summary of findings only. Permit # or Parcel # SE. "1 L+- —� — -�— - Documentl 4 of • 4 s} r' ADDENDUM Enviro Check, L.L.C. Company Disclaimer DATE o CocAo4 ADDRESS aq* a�,�r.�st►�R,�w�ta�� OWNER L. Based on on what we were able to observe and our experience with on-site wastewater technology, we submit this Sewage treatment Inspection/Evaluation Report based on the present condition of the on-site sewage treatment system. Enviro Check, L.L.C. has not been retained to warrant, guarantee, or certify the proper functioning of the system for any period of time in the present or firture. Because of the numerous factors (usage, soil characteristics, previous failures, etc.) which may affect the proper operation of a septic system, as well as the inability of our company to supervise or monitor the use or 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 buyer or owner. Enviro Check, L.L.C. disclaims any warranty, either expressed or implied, arising from the inspection/evaluation of the septic system or this report/evaluation. We are also not ascertaining the impact the system is having on the groundwater or.environment. Enviro Check,L.L.C. does not make any claim, warranty or guarantee as to where property lines/boundaries of properties are located. And does not warrant or guarantee any encroachments from on site sewage systems on to adjacent properties. Any indications of possible property lines/boundaries are approximations and do not indicate legal property lines or boundaries. Enviro Check, L.L.C. will not be held responsible in any way for information being undisclosed (intentionally or unintentionally) by property owner, representative or other parties of interest. All parties are encourages to check county records for any information regarding properties. Company Enviro Check, L.L.c. 1612 Hastings Ave. W Port Townsend, Wa, 98368 360-379-9400 I acknowledge that I have studied the information contained herein and that my assessment is honest, done in accordance with Jefferson County Ordinances, and to the best of my ability, correm e R Wurtsmith Co -Manager or Steve Bell Co -Manager Weather Conditions SAMPLING (Septic tank) Date - PH Result - DO Result - Temp. Result - MEASUREMENTS Counter Setting - Hour Meter - Water Usage (Ave.GPD) Meter - Squirt Height (In feet�- Map Output Page 1 of 1 ArctMS HTML Viewer Ma 4 q 4 Lend SabdedFeahms TGWM cwty3ae a3� , Road System PamalrM Flo s ti Y II -by jeffamm COAMY calf N swom VNI 4 56i1 •5•"y FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with espect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its Ilection. Thu May 27 11:41:05 2004 Litlt.� 70hu-t u) Sc- to 903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No. �9 Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House Port Townsend Date_,,[ _)� p-e+3t I z4W0 QKc ?;7;z47 tv A ADDRESS A) & 4.4, 170i"Op Ee, m_( eH5ONE / DIRECTIONS FOR LOCATING SITE APPLICATION IS HEREBY MADE TO: INSTALL Nal SYSTEM REPAIR EXISTING SYSTEMN YYPPE 0 OF BUILDINGe NO. OF BMROOMS BASEMENT Siz INSTAl'ALLER DRAINFIELD LENGTH,• rIDTH t -f DEPTH 3�#LINES 3j .INEPT C TANK SIZE /n w . DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE_ y+--C-N�'kn W Al e14 ANY CHANGE IN BUILDING OR SLS=AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. m DATE OF INSTALLATION SIGNATURE OF APPLICANT/ ,kp ` DATE C® j ? NSPECTED BY CjNz-,�z SANITARIAN'S CONMLNTS : I CERTIFY THAT THIS SYSTEM I.r aTST!. . IN THE P1ANNER APPROVED BY THE HEALTH DEAPRTMEVTDATE INS ALLERS UE DATE !-O /17 h L -I