HomeMy WebLinkAboutSEP1974-00118A 4.1
"3 E, Caroline OLYMPIC HEALTH DISTRICT Permit Novi"i
Port Angeles .SEWAGE DISPOSAL PERMIT APPLICATION
Submit in,Duplicate Builder
Court House
Port Townsend Date -
5— 13 ZZ
�ADDRESS HONE
DIRECTIONS FOR LOCATING S ITE
APPLICATION IS HEREBY MADE TO: INSTALL N.34 SYSTEM L, -116 -AIR EXISTING SYSTEM
"0
DRAINFIEM IM4GTHJ
'JIDTH DEPTH #LINES SEPTIC7a e 3^ TANK SIZE
DRAW A_aE SEE INST', CTIONS.
DETAILED_ PLAN BELOVY. RU SOIL TIPS
JQ-'- 2 3
,-, ted', 41, .,, \ ,
N
- --- ----- u -L
PEIDUT UNLESS PRIOR APPROVAL OBTAINED FROM THE7 HEALTH DEPARTMENT.1 -"'6v'K4j.L-wA LxjQ Lnj.Q
DATE OF INSTALLATION
SIGNATURE OF APPLICANT
APPROVED DATE,
SANITARIAN'S COIRAMTs' JeINSPECTED Bki���� DATE
I CERTIFY THAT THIS SYS '+AS
IRT
-QTUf,1ZD IN THE, MANNER APPROVED BY THE
HEALTH DEAPRTMUENT_�N
% DAM
INSTALLERS NAME-
Phone:rt
Prevlc�s,,,Owner (if MicWn),
Legal Ion: * Sect'16n
Street
FOR AF.AL2ii WAFM*W WE ONLY - DO NOT MM BELOW TffrS -1 LIIM
SEM3E DISPOSAL- SysTRw
Permitted system _'yes r . 10
Installed prior to PF-brMit,..requirvmentan evaluationyes ho
Sewage noted on gm- -ind at .-time of insp;-;�Fjon* yes
House is . no
unoccupied therefore of drainfield performance is
not possible at this time.
A review of our records Indicate that this 'It was designed to
servir,e a - bedroan residence. This system is not considered
adequate fora — bedrocm residence unle-,s- it is siz
regulations. ed per current
Septic tank should be pumped if not done within past 3 5 years.
WRM SUPPLY
iwi�CZW�12" above ground yes no
SanitarY seal in place — yes — no
Well 100' from ch'Rinfield — yes no
water sample taken Yes no
Sample results
CCBMmts.-
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cock
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Phone:rt
Prevlc�s,,,Owner (if MicWn),
Legal Ion: * Sect'16n
Street
FOR AF.AL2ii WAFM*W WE ONLY - DO NOT MM BELOW TffrS -1 LIIM
SEM3E DISPOSAL- SysTRw
Permitted system _'yes r . 10
Installed prior to PF-brMit,..requirvmentan evaluationyes ho
Sewage noted on gm- -ind at .-time of insp;-;�Fjon* yes
House is . no
unoccupied therefore of drainfield performance is
not possible at this time.
A review of our records Indicate that this 'It was designed to
servir,e a - bedroan residence. This system is not considered
adequate fora — bedrocm residence unle-,s- it is siz
regulations. ed per current
Septic tank should be pumped if not done within past 3 5 years.
WRM SUPPLY
iwi�CZW�12" above ground yes no
SanitarY seal in place — yes — no
Well 100' from ch'Rinfield — yes no
water sample taken Yes no
Sample results
CCBMmts.-
LAII
cock
1) SP
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It 3*85
CAT%
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Off':
r EXISTING; ON -it *
-oil
ap
:,614S t"'VOR f, theft". on
I'-' to he
on the top'
P
of t- I
pr�l r-7
�0*plate information. -p- an. and ma
P
..
plot.
please Q
inspection
eCt on
this f
the
gorier. and -
inlet ectioTt-P.
ncover thO.: oso
so iisp,
+aqutiet
copy of
se•Ptic L rk s are c ping
this ,inspection Poovide
P- juade -
ports5 yiars•
2. Uncover. �
,,- and., 1*6 :,,,,can last-
- 5iiii- �.�6100 within
inside -tank p=Pdd W1 the time Of
eptic. f rolu
receipt one week r6cd P-:
allow 0
..w s inV614ed.1 please
:.water --j�x
'a r,,,saz w,
3. If ;,results are�readY-
- .led �back
s 'until,. --re s.Vill be mailed sampling all report
form, ted on. the ,
th IrVis8' no id.
4. Unless otherwise
' ,when,compld SYSTEM
to thia appliz ON OF EXISTING 01
EVALUAT
$60--00
5. Fee schedule:`Without water sample water only
$'8'5.00
Water and septic
-,
4 And
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EESIN
V
INSTALLER `71 Wn'P
BUILDER
Owner
JEFFERSON COUNTY HEALTH DEPARTMENT
802 SHERIDAN AVENUE
PORT TOWNSEND, WASHINGTON 98368
(206) 385.0722
SEWAGE DISPOSAL PERMIT
Submit in ,Du licate
Z jir 11 `' W )QIP r i A ae t �`I✓'
Address
' n
RECEIPTNO.J
DATE.-_
Phone
Directions for locating site
t�:(�,,Gwr Ro . ziaw �EN w vAu.s--y ?\D AN 0 lel T
INSTALL NEW SYSTEM 0 REPLACE SYSTEM ❑ PARTIAL REPAIR 0 ANK/DRAINFIELD U
TYPE OF
NO. OF
SITE
BUILDING BEDROOMS Fns BASEMENT S
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDA
SOIL LOGS
Dig two holes per site. min.}
4' deep - 2' dia. - 50' ap rt & flag APPLICANT L ^•.��a��Y ��'
ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT
LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES T ESS
PRIOR APPROVAL IS OBTAINED .F ,n —
Drainfield Lennthtad idth n ,,thud" it Line -4%%N- a GSI.
m
c
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11
Dig two holes per site. min.}
4' deep - 2' dia. - 50' ap rt & flag APPLICANT L ^•.��a��Y ��'
ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT
LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES T ESS
PRIOR APPROVAL IS OBTAINED .F ,n —
Drainfield Lennthtad idth n ,,thud" it Line -4%%N- a GSI.
COMMENTS:C 'rte ' ��� (TWO COMPARTMENT5) Ip
U'i`ILIZr= LOW WATER USE 1=1XTU%6 O m
.DO NOT )PKIVUL Ot "'Piq Kr, ON
Nth \t�9 ice+ 10 1V -K1{ N ti'N 'cS
'DIV T .56v 5 G SA(Z�fl v�; CI 1z lomF M1ii1��AUJt'1�f c�RQW` Y�iI�GVI�
1
M3 6--154R1
APPROVED DATE INSPECTED PARTIALIFINAL DATE
certify that this system was Installed in a manner approved by the Health Department.
INSTALLER'S SIGNATURE DATE DATE INSTALLED
5^t 1'14s1
JCHDlt-78 �'-i an
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COMMENTS:C 'rte ' ��� (TWO COMPARTMENT5) Ip
U'i`ILIZr= LOW WATER USE 1=1XTU%6 O m
.DO NOT )PKIVUL Ot "'Piq Kr, ON
Nth \t�9 ice+ 10 1V -K1{ N ti'N 'cS
'DIV T .56v 5 G SA(Z�fl v�; CI 1z lomF M1ii1��AUJt'1�f c�RQW` Y�iI�GVI�
1
M3 6--154R1
APPROVED DATE INSPECTED PARTIALIFINAL DATE
certify that this system was Installed in a manner approved by the Health Department.
INSTALLER'S SIGNATURE DATE DATE INSTALLED
5^t 1'14s1
JCHDlt-78 �'-i an
JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
206-379-4450
PERMIT #....:BLD94-0574
DATE RECEIVED.:08/18/94
SITE ADDRESS:5521 WEST VALLEY RD
:CHIMACUM, WA 98325
-------------------------------------------------------------------------------
OWNER.......:JANETTE BARNHOUSE
PHONE:732-4393
MAILING ADDR:5521 W VALLEY
RD
:CHIMACUM WA 98325
-----------------------------------------------------------------------------
CONTRACTOR..:
PHONE:
MAILING ADDR:
CONTR. LIC ,:
---------------------------------------------------------------------------
EXPIRATION DATE:
ARCHITECT/..:
PHONE:
DESIGNER....:
MAILING ADDR:
-------------------------------------------------------------------------------
PARCEL NO ... :801033009
ALT: CON:
NA:_
LEGAL DESC..:STR
WWM, TAX # 211
WATER* DATE:LOT
BLOCK
, ,
SHO
S.
DESCRIPTION
BY : DATE :
OF IMPROVEMENT:
Garage
BUILDING TYPE ...... :GAR
---------------------------------------------------
BEDROOMS---
BATHROOMS-- MAIN FL...:
0 sf
TYPE OF IMPROVEMENT:NEW
EXIST.: 0
EXIST.:
0 ADD`L FL..:
0 sf
GARAGE/CARPORT ..... :D
PROP..: 0
PROP..:
0 HTED BSMT.:
0 sf
WOODSTOVE.......... :
TOTAL.: 0
TOTAL.:
0 UNHT BSMT.:
0 sf
UBC OCCUPANCY GROUP:
SEWAGE DISP..:SEPTIC
OTHER.....:
0 sf
TYPE OF CONST......:
WATER SUPPLY.:PWELL
CRPT/GAR..:
660 sf
UNITS.: 0 STORIES:O
HEAT TYPES.:
DECKS.....:
0 sf
DIMENSIONS:22X30
-------MOBILE HOME------ COMMERCIAL:
O sf
FRAME TYPE:WOOD
MAKE:
YR:
INDUSTRIAL:
0 sf
EST COST.$: 6600
SIZE:
BANK HT... :0
ft
PROJ GRP..: 5948
-----------------------------------------------------------------------
SH SETBACK:O
ft
Owner/agent
--------------=-
FEES --------------
Signature:
type
amount by date
recpt
Date:
PRMT $
90.00 AMW 08/18/94
96046
PLCK $
27.00 AMW 08/18/94
96046
Issued By:
B.C. $
4.50 AMW 08/18/94
96046
Date:
------------------------------------
$ 121.50 TOTAL
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094 bib
Parcel # 000801033009
Geo Cd 280103306210
53 T28 R1W
TAX W LESS TAX 18)
Mode: INQUIRI
Nbad Cd 4320
* Taxpayer Cd BARN 6350 BARNHOUSE, JANETTE E T/P Chg Dt 6/07/1993
* Title Owner UP Chg Usr KELL
Tax Code 0211 Status TX TAXABLE Land Use 1101 MH-REALW/LND
Affidavit 71217 vol/Page / C/U Code S/C Cd
1 1 16 0%11FL r 1A/! 10% 0% -JA AA A A 1 -1A r PI r% T►A PI