HomeMy WebLinkAboutSEP1972-00021F J ,efferson County Health
802 Sheridan Ave.
Port Townsend, WA 98368
206 - 385 -0722
Department I
S�PrItk�00a.I
Receipt No.Q- 'T_
Fee :
Date: %�1. :2/9 l
'4� 17L
EVALUATION OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM AND /OR WATER SUPPLY
Information Regiested• x Individual Sewage Disposal Sys RECE����°
tm E
f3WENMOL'T,8. Water Supply Public Private SEP is y
JEFFERSON COUNT'c
Appliceints Name Russ & Cris Hay Mail Completed Report To: PERMIT CENTER
Owner.--. Name -iRussiA Cris Hay Windermere RE c/o Steve Slaven
Address 110 Churchill Lane P.O. Box 700
ark Ludlow, Wa Oui.lcene, WA 98376
Phone: 765 -3450 (Windermere) Number of bedrooms 2
Previous Owner (if Known) Mr.Bock Year Installed la 7
Legal Description: Section 33 Township T28N, Range WE
Street Address 11
f a,.c4 4- c6- Qt i 33'Vo 30 ,G -) iidsz on 5�- al 3�4 ® 3 <
Directions to proverty Beaver Vallev to Hwv 104. turn left ao to Shine road.
*** see map attached
Permitted system X 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 CR_ bedroom residence. This system is not considered
adequate for a bedroom residence unless it is sized per current
regulations. .
W
N
1
I
peptic tank should be ptAnped if not done within past 3 - 5 years. �j
40 WATER SUPPLY S -� /a& %i C4 (?2ca .4 cz�(_"CQ
Well casing 12" above ground yes no
Sanitary seal in place yes no
Well 100' from drainfield yes no
Water sample taken yes no
Sample results
comments :
OLAM'e:\ 1(\ ca l� icsr , 4\V4 ^-Q-Q- A5 ko be
\iA or, jr`-P-k VC, 1s& r e- f30-,f'eA l r"e g1e'C0Ci.
Date 0�- Tine
re'P ic�c�d q Ia4(��.
A "i
th Specialist
* This report does not constitute a guarantee, either written or implied, that
the system will contirrae to function properly. This report constitutes a
cnnnary of findings only.
EES FORM 11/88
co
O
t a
JEFFERSON COUNTY HEALTH DEPARTMENT
MULTI- SERVICE BLDG., 2ND FLOOR
802 SHERIDAN AVE., PORT TOWNSEND, WA 98368
(206)385 -0722
INSTRUCTIONS FOR EVALUATION OF EXISTING SYSTEM APPLICATION
1. Please complete the information on the top half of the application
form. Include a drawing of the plot plan and map to the property on
the back
2 Uncover the septic tank. Be sure the inspection ports are loose, so
inspection of the inside of the septic tank can be made. Provide copy
of pumping receipt if septic tank pumped within the last 5 years.
3 If a water sample is involved please allow one week from the time of
sampling until results are ready.
4. Unless otherwise noted on the form, all reports will be mailed back
to the applicant when completed.
S. Fee schedule: Sewage Disposal system $60.00
Sewage Disposal and Water $89.00
Water Sample $65.00
EESINS /91
SEP -28 -1994 14 :12 FROM Hood Canal Properties TO 3859401 P.02
GOOD14A114 SEPT i C DISPOSAL, INC.
P. 0. BDX 233
PORT TOWNSEND., WA. 99368
206-385-2557 18is a 974 -2557
[4r1VDZRMVIR f1FRL770RS arT:
P.C. Box goo
t�l1ILt:GlVE, W/a. 58376
RE=. 118 CHURCH HILL LN.
PORT LUDLOW, WA.
Pear Steve,
i hm Septic r: Tank At the all .. ve add. was Cleaned and
Pumped ran 9/x&/94. Thca inlet Baffle tme,,s irm noad of rapair
at that time. Uvwi yzwur+ "equp --t wo ropair wd Lhe 1,11M x riifat
Raffle at Ehe tiftle w. t° Pumping.
lie Tank is now in Good Wcrkinq Cored i t i on all
Baffles arm now in placo and the Drairt F"i.ald Oppaarr. to bL+
draining properly.
Thank. ;►;;•„t f•zr you" guginera and if we man ba any
ather,%ervir_c► to you or you" fIrlm r)10PaG49 ricitify ud at the
above Ladd. cir phone.
Gi nce, ^eat y,.
Raebar,a Qnn Raka. -I � ►rMr7�N
.i d �.- - a... -
SEP -28 -1994 114:12 FROM Hood Canal-Properties TO 3959401 P.03
GOOD MAN SIEPTM DISPOSAL
P.C. sox =
Part Townwd,�ri A M%
r
order No L02 /J 9 Date 19
r
Name �! P /��' ��S 17t1I —A
Address rd . 1,60 r179 w 11
SOLD BY
CASH r, Q. D MARE ACCT, RETp. PAID OUT
•
•
x,ell
f-
4 Zf
1� t� ,
r
1 TAX
Porn
t i ,+ i
� t
. .1
.I
d
remarks :WONDERFUL VIEW OF S9UAMISH HARBOR & HOOD CANAL FROM
THIS IMMACULATE MOBILE.FULL CONCRETE BLOCK FOUNDATION WITH
1/2 BASEMENT (30X24).ADD AN OFFICE /STUDIO W /VIEW,2 CARPORTS,
STORAGE SHED,BEAUTIFUL LANDSCAPING,AND COMM.BEACH -- -WHAT
MORE COULD YOU WANT?
** *PROPERTY IS IN 2 TAX PARCELS AND HAS 2 SHARES IN A 3
PARTY WELL. * **
Directions:
Per Prop -Incl.WASHER,DRYER,REFRIGERATOR
Poss Date: Occupant:OWNER Ph :000000
Own :HAY Add :ON FILE Ph :00000
Showing Inst:CALL LISTING OFFICE Sign :Y Box:N CSO :3.5 & 2.5
Off :WINDERMERE RE HOOD CANAL Ph:765 -3450 Agt :S. SLAVEN Ph:765 -4826
LISTING NUMBER
:
94 -00487 BEGINNING DATE: 04/07/94 ACTIVE
LISTING
DT OF LAST
BOOK:
00 /00 /00
PICTURE NBR: 0
LIST PRICE:
149,000
PROPERTY TYPE: RS
AREA: 600
Address:
110 CHURCHILL
LN.
City:PORT LUDLOW
Area :600
Map:I
GRD :6 -L Lot Size: ACR :.79 Asz:.5
- 1.5 AC
Style :MOBILE
Yr1979/ View:WATER Wf Lnd
Typ:FLAT
Sq Ft T1;
B
; 1 ; 2
;Plat
Div 61
Lot:
14404
;
;S33 T28N R1E
Tx 24 Apn
:821334030
FEATURES;
B ; 1
; 2 ;OUTBUILDINGS: OFFICE /STUDIO,2 CARPORTS /STORAGE
Living ;
;1
; ;Utility ;
;Gar Size:
,Heat:ELECT FA
11LB1:
Kitchen
;1
;Dishwash;
Roof :COMP
;Water :WELL
;Int%
Dining
;1
; ;Range ;X
;Foundation :CONC
;Sewer:NONE
;Pmt:
Fmly Rm ;
;
; ;Refrig ;X
;Survey:Y /ST:
;Septic :CONY #2
;Type:
Den
;Washer ;X
;Zoning :SUBURBAN
;Wf Ft
;A1:
Bedroom
;2
; ;Dryer ';X
;Taxes $ 88894;Bank:
;Hldr:
Full Bth;
;2
; ;Micro Wv;
;CC &R:
;Moorage:'
;Prim:
.75 Bath;
;
; ;Cab Rdy ;
;HOAR Per
;Tidelands:
;Rnt$
.5 Bath ;
;
; ;Wnd Trea;
;Others Per
;Beach Rt:
;[P ] [I ]
Firealce;
:Garb Dsp; X
:Time Shr %
!Mobile:
'.CT ] [I ]
Woodstov;
;1
; ;Deck
;Lse Lnd$ Per
;Condo:
;
Terms "SE -
REMARKS
T Rmks :CASHOUT / REFINANCE
remarks :WONDERFUL VIEW OF S9UAMISH HARBOR & HOOD CANAL FROM
THIS IMMACULATE MOBILE.FULL CONCRETE BLOCK FOUNDATION WITH
1/2 BASEMENT (30X24).ADD AN OFFICE /STUDIO W /VIEW,2 CARPORTS,
STORAGE SHED,BEAUTIFUL LANDSCAPING,AND COMM.BEACH -- -WHAT
MORE COULD YOU WANT?
** *PROPERTY IS IN 2 TAX PARCELS AND HAS 2 SHARES IN A 3
PARTY WELL. * **
Directions:
Per Prop -Incl.WASHER,DRYER,REFRIGERATOR
Poss Date: Occupant:OWNER Ph :000000
Own :HAY Add :ON FILE Ph :00000
Showing Inst:CALL LISTING OFFICE Sign :Y Box:N CSO :3.5 & 2.5
Off :WINDERMERE RE HOOD CANAL Ph:765 -3450 Agt :S. SLAVEN Ph:765 -4826
DISTRIBUTION DATE:
Windermere
Real Estate
blood Canal
NAME jay—
Wlndemfero peal Estate/Hpod 1 aukmm 8 , Cent P.O. Box 700 0WIMM. WA M76 MM7653450 14800476.3450 Fax MM765.3122
I -.b.. �& Q+w view sq. rt. :�oa�r Price
2 2 - 15 t .79 acres water /mats 11440 $%9-1M )fig fit) AAA
-- 110 Churchill Lane I- 6-L' c.oae
Foundation conc
Ext. Const. metal
Dishwasher yes
Disposal yes
TERMS
CASWMI REFINANCE
Roof comp
Range yes
I
Sewer SepticX
Wood Stoveyes
Sign Zoning
Possession Date
Watershared well
Fireplace no
Yes
Heat EFA
Patio/Deck yes
Listing Agent ph.
Wired for 220 yes
Refrigerator yes
Steve SLaven 765 -4826
Floors W/W vinyl
Garage
Taxes 888 --94'
LEGAL DESCRIPTION Tax 24 (W110' of E 2201) &Tax 24
(less E 2201), S33,T28N,R1E, W.M., aka: 821 - 334 -030
Carport 2 detached
Fenceyes, cyclone
Spec. Ass.
a" _ '21 A A "I
Wonderful views of Squamish ilaibor : & Ii- Canal. - froirt t its DDIAC ULATE,6 MaT -concrete
block foundation with half basement (30x24). Adel an office /studio with view, 2 carports,
storage shed, beautiful landscaping, and CMMM BEACH - -- What more could you want?
** Property is in 2 tax parcels and has 2 shares in a 3 party well.
"he following personal property is NOT included:
'he following contained herein is from sources considered reliable. Offering is subject to emrs, omissions, withdrawal and/or prior sale.
a . 6
ACTIVITY REPORT zst-o,3�
FILE NAME/NUMBER r5T PARCEL 33q oM
NAME
ADDRESS IM C-V\kLC k - A-
Health Department Staff: GrAc, A+kj't\!s —Date: _ci
NARRATIVE:
[E�
b eAro\
ho�
Actions:
C c,,r
IPA I+— � i f\k
1%
Permit toy
OL M VALTH DISTRICT
Fee Paid-sr
SiAU. DISPOSAL PERMIT- APPLIGATION
Sciit in Duplicate
ADDRESS
SAL.. DESCRaPT ION.�
DmummONS'FOR LOCATING SITE
,..Z A:Y�,. RSYTN, ,; HERL Y MDE _ T I LF4�IT
1 -prov rty lines 7 •
2. Location, of 'building 80
3., Loeatian of
septic. tank 99
4.- �"on of drathf ie ld 10.
- �lolme of ,land ;, .._ _ , 11..
�- Wa't-.er dines & well(if applicable) 12.
Dr?- veways, patios, carport g etc.
U x� eY:as or bodies of water nearb$
L� -, atlon of percolation to t boles
S � f- 'i:ic tank size( 7- C. J $a
Lent ;th of proposed drainfield
Dept-- to water if encountered.
..G t" PERCOLATION TEST RESULTS
meptn 'lime required to Percolation rate
of hole seep last 6 in. (divide time by
Percy No *'l
Perc... No.
L Plerc . No, ,3•
'hype oaf soil.t
3 XI
DRAINFIELD LENGTH 6¢ WIDTH_ DEPTH `? 4" NO. OF LINES
- n n.R�+ = Aliitl'itSU TnAT '.l',tW PROPOSED INSTALLA Sp]� WI L E , MAUE Y rn� .,�...• -r
AS -IGNED AND APPROVED ON THIS APPLICATION.
Signature of Applicant
APFRO.- .:.,DAT,E OF INS'1'AI T B;TI(1N: , e j ,
SANITARIAN 111": COMMENTS: ° V-4 ���` �� �,��. � �� ��e �.� � N,
c- �. -���°
DISAPPROVED DATE.Eli&
REMARKS:
I C%RTIFY THAT TH� S �,ST i�'vJ�.S N ITKI�LED IN THE MANNE -1i APPROVED BY T9 �`�1
DEPART1�WiT . a Y � ref _ Ve .
INSTAILjM S NAME r" D.&TE
0
V"
r
'
E OF BUILDING
NO. OF BEDROOMS
BASENENTT SJTE SIZE
NAME OF INSTALLER
ON T, VERS `S.
►) DRAW A DETAILED
FLOT P LAN to EVING THE
FOLLOWING INFO TIC
1 -prov rty lines 7 •
2. Location, of 'building 80
3., Loeatian of
septic. tank 99
4.- �"on of drathf ie ld 10.
- �lolme of ,land ;, .._ _ , 11..
�- Wa't-.er dines & well(if applicable) 12.
Dr?- veways, patios, carport g etc.
U x� eY:as or bodies of water nearb$
L� -, atlon of percolation to t boles
S � f- 'i:ic tank size( 7- C. J $a
Lent ;th of proposed drainfield
Dept-- to water if encountered.
..G t" PERCOLATION TEST RESULTS
meptn 'lime required to Percolation rate
of hole seep last 6 in. (divide time by
Percy No *'l
Perc... No.
L Plerc . No, ,3•
'hype oaf soil.t
3 XI
DRAINFIELD LENGTH 6¢ WIDTH_ DEPTH `? 4" NO. OF LINES
- n n.R�+ = Aliitl'itSU TnAT '.l',tW PROPOSED INSTALLA Sp]� WI L E , MAUE Y rn� .,�...• -r
AS -IGNED AND APPROVED ON THIS APPLICATION.
Signature of Applicant
APFRO.- .:.,DAT,E OF INS'1'AI T B;TI(1N: , e j ,
SANITARIAN 111": COMMENTS: ° V-4 ���` �� �,��. � �� ��e �.� � N,
c- �. -���°
DISAPPROVED DATE.Eli&
REMARKS:
I C%RTIFY THAT TH� S �,ST i�'vJ�.S N ITKI�LED IN THE MANNE -1i APPROVED BY T9 �`�1
DEPART1�WiT . a Y � ref _ Ve .
INSTAILjM S NAME r" D.&TE
0
V"
r
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