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Home My WebLink AboutSEP1971-000029 7 � 1� Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-4460 Evaluation of an Existing Onsite Sewage System (EES) Draw on the back of this sheet a current plot pian 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 is not available enter (NV) or not applicable (NA): Type of Evaluation X Evaluation of on-site sewage system ❑ Evaluation of drinking water ❑ Evaluation of on-site sewage & drinking water Cf;ice Use Only rate Fee Recot C ~ ec!c_�_ Case # Reason for Evaluation ❑ Routine Operation and Monitoring Inspection 'i,Z Real Estate transaction ❑ Complete a Permit ❑ Building Permit Review and/or no septic permit on file 0 Other, explain Tax Parcel Permitted System dyes no Permit/case #SEP Subdivision, Division, Block and Lct(s) _(- � iebRi �� j, V 1. LPT 20 QL=otSize) Acre or Dimensions X Current Owner Site Address1e1 Owner Phone #_ \J� Previous property owner name(s) - (NN if not known) �, A Directions to Site Fi_ 1 D r,v& — - y " u\.vIVV111v7 q( House Occupied_ / yes______no, vacant how long? Who installed system? Q. Send completed report to: ; Owner MAY -6 200 Mailing Address 41at �E,.,S Q X10. �aRCToyb,,pl��•`��'$ Phone%mail/fax 1��1 @eDaftoor Other Representative_ Name Mailing Add z 1:��DA�►L1..r�� W4 919"" Evaluation of an Existing Onsite Sewage System Date of Inspection 0S05f;3 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 drainfleid/disposal component _yes_ no, if not, distance Is well more than 50' to tanks and effluent transport line _yes_ no, if not, distance ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept records for this case �*;az #1 - Septic Tank Tank size SO _ gal.C�single compartment two compartment -material Riser to grade on inlet ves >& no. Riser to grade on outlet yes k no Condition of tank yC good needs repair, describe 1st comp. Scum (top layer) �_in. sludge (bottom layer) 4- in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? ves '— no If yes, where was water Condition of baffles: Inlet: repair material Outlet:/ oo�7c, needs repair material (PV concre ) Screened Outlet X no _yes, condition clean clogged/dirty C C^J co Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) yes X _no Effluent level of outlet (mark level on circle) If effluent is below the outlet,. indicate when tank was last pumped: ( e9= 9 ) . (D Does system include a. pump? yes If yes, complete the next section no (if no skip to section 3) #2 - Pumo Chamber Tank size gal. Material. Riser to grade? yes 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 ? yes no If yes, where was water observed? j Screen around pump? ves no Shroud around pump? yes no Electrical Components Pump operating Yes no, describe High water alarm functions Yes no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle minisec. Timer Settings min/sec on min/hrs off Floats secured: ves nc Permit # or Parcel # - Evaluation .& an Existing Onsite Sewage System #3 — Drainfield Appropriate Vegetation in areaes_no. Describe vegetation= �md+�.M Indications of surfacing sewage (check one) yes , if yes, describe and diagram on plot plan X no drainfield area is overgrown and not observable Signs of parking/driving in area X _yes no drainfield area unkncwnCSda-C'nlhAnE �> Ground settling or erosion ves 'k no 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 is attached for evaluation of Treatment Unit or detailed evaluation of drainfield _yes,14 no COMMENTS (attach additional sheet if necessary): A ��s t;wR'>- li-s�a�-a�Y o� ►�€ C ids is r -9c' L'*MaT t %,z AT C'Ihi �.w ��v A �AiLK,a '� V B� oEV- PAS SEE ATTACHED ADDENDUM Was a System Problem Identified? Yes if yes, what section 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 ' formatio `' on a review of County records and my direct observations at the time of inspection. QSL�o3 N e/Signatur Date No guarantee of future onsite sewage system performance is implied or granted based on the information contained in this repos. This report constitutes a summary of findings only. Permit;* or Parcei # 0=mentl 4 cf d Include the following items on your plot plan: ❑ Property boundaries ci Wells • Names of adjacent streets ❑ Septic tank • Driveways and parking spaces u Drainneld (enter NN if ;;nknown) • Surface water (ponds,creeks, etc) c2 North Arrow a Buildings(residence, sheds, garages, etc) 'LOT PLAN t ro N 2 NOT TO SCALE MAY ® 6 2003 ENVIROvICHECX LLC. 1612 Hastings Ave. W. Port Tcwnsena, WA OM3 Permit --"p or Qarc4i # �T I" — n 2 of 4 #=q -, k --a DATE 2a-5 di � ADDENDUM ADDRESS qk flt w,:,;s B�.va �QT• OWNER V., ,N wAnwp Enviro Check, L.L.C. Company Disclaimer Based 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 future. 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 irispection/evaluation of the septic system or this reportlevaluation. 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. 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, correct. e R Wurtsm, Co -Man Ali MAY - 6 2003 Weather Conditions SAMPLING (Septic tank) Date - PH Result - DO Result - Temp. Result - MEASUREMENTS Counter Settine- Hour Meter - Water Usage (Ave.GPD) Mete Squirt Height (In feet)- -SEP 71 - 0(30 �k (J) -90 X. Caroline -LL OLYMPIC HEALTH DISTRICT Receipt No. ?&V, V- to -it Angeles, Wa, SEWAGE DISPOSAL PERMIT 457-8583Submit in Duplicate Builder .* (� a,&_ I v ' .1'@A" ni 802 Sheridan Date Port Townsend, Wao 385-0722 1, 1", � �IkC) 6 1g, lnstal�erA� AL: E. RAI W Ov- ADDRESS VIA DIRECTIONS FOR Ur-ATING SITE 1a76 .2p,0,1V '-F (""Ogg'-oze INSTALL NEW SYSTEM [:I REPLACE SYSTEM PARTIAL REPAIR fZ TANK/DRAINFIELD TYPE OF 0. Or �BEDROOMS r LSEMENT SITE 18I2E PUTLDINGz' a_IaVe, e A Lt DRADM-,ELD LENGTH.30 WIDTH -Lb DEPTH J&_j_ #M=j TANK SIZE GAI n10 COMPARTMENT. DRAW DETAILED PLOT PLAN BELOW, STUB PLUMING OUT ABOVE FOUNDATION FOOTING SOIL LOG: X, 0A " iR 0 z ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, OR LOCATION INVALIDATES THIS PEWIT UNLESS PRIOR APPROVAL IS.OBTA.INED FROM THE HEALTH DEPARTMENT, 7t IS COMMENTS: J SEE REVERSE SIDE FOR A DATE + ON-SITE SEWAGE DISPOSAL SURVEY OF Street Or I. Location, Lot Size I I . System OwnerjZsr� Address Telephone' Number (o Permit M (Previous Owner) Date Issued ITZ III. Installer ) y Average Number `of -People Served Date 'Installed 19(0"5—uNumber of Bedrooms Time In-Service°.(years) is'7�_ Clothes Washer YES N--, NO -- Septic Tank Pumped YES NO HOW Dishwasher OFTEN YES NO # of,Months/Years Residence Occupied? Garbage Disposal YES NO IV. Type of cover over drainfield. (i.e. grass, landscaping, etc.) V. Repairs (when, what, who) Cause of Failure 197 Ili' 'Parcel Details Parcel Number: 939900021 SEARCW Parcel Number: 93990002. Owner Mailing Address: PASCHAL RAINWATER 461 DENNIS BLVD PORT TOWNSEND WA983689412 Site Address: 461 DENNIS BLVD PORT TOWNSEND 98368 Section: 13 School District: Port Townsend (50) Qtr Section: SW1/4 Fre Dist: Cape George (6) Township: 30N Tax Status: Taxable Range: 2W Tax Code: 161 Planning area: Quimper (2) Printer Friendly Sub Division: CAPE GEORGE VILLAGE DIV 1 Assessor's Land Use Code: 1101 - MOBILE HOMES (owns mobile & land) Property Description: CAPE GEORGE VILLAGE DIV 1 1 LOT 20 1 1 1 Click on photo for larger image. Page 1 of 2 Permit Data Assessor Qata kax History Map Parcel IPlats & Sumo s Nap output Page 1 of 1 ArcIMS HTML Viewer Ma --_ e3W= faeaaaQM Legend GaaGe= -_ - -- - y selected �sa'Wm 13 �39A�GISG7 shaf'e6ne P37akm- l DEWS BJ,vD Tome ail Road SSydam 4 FamalrM 98Qat=0 -"- e mm ffigoom d;' r 8Q19r' M9flfSi't12 I A3W=8 If Id3�Q R1_OIP�QJ I.FIOO{y'j l�I _ -". FOR INFORMATIONAL PURPOSES ONLY - Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its Ilection. Zoning information is based on the 1998 Comprehensive Plan Map and does not include changes made during the 1999 Comprehensive Plan amendment process. Zoning designations must be confirmed with the IDepartment of Community Development. Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 alt � MONITORING INSPECTION CERTIFICATION The system serving 4 ( on parcel # _ 39 � CO 024 , permit # -71-2- was most recently inspected on 5151- - o by, b - , as specified in Jefferson County Code 8.15.150. The above referenced system is in compliance with the Monitoringrnspection schedule identified in Table 1 of Jefferson County Code 8.15. MSee report completed for information on the condition of the onsite sewage system. REQUIRED OR RECOMMENDED REPAIRS/MODIFICATIONS TO THE SYSTEM ARE LISTED ON THE INSPECTION REPORT DATED . Failure to complete repairs or modifications to the system as listed on th report may result in premature failure of the system. P P"tom. INF - The next inspection required for this system is in ZZO& Table 1 requires that this system receive an inspection: Annually Every 3 years Every 6 years LJ Other as specified in the sewage disposal permit conditions - An inspection will be required at the time of sale if the system does not comply with the schedule set by Table 1 as described above. The above information is based on review of the file and does not imply or grant a guarantee of current or future system performance. Signature of Jeff osre n Employee If: em•_health\linda\C,D\FOPMS\MONITORING INSPECTION CERTIFICATION.doc 6�1,1 .603 Date