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HomeMy WebLinkAboutSEP1975-00396Jefferson 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 plaFt; identifying these items. ALL SPACES MUST BE FILLED IN. If information is not available enter (NV) or not applicable (NA). Office Use only Cate Fee Recpt Check CaS4 # ., 1 Type of Evaluation Reason for Evaluation 0 Routine Operation and- Monitoring Inspection �. Evaluation of on-site sewage system Real Estate transaction D Evaluation of drinking water D Complete a Permit # 0 Building Permit Review and/or no septic permit on file Evaluation of on-site sewage & drinking water O Other, explain Tax Parcel #_CZ1 2jE3 ©\� Permitted System )Oyes no Permit/case # SEP11 Subdivision, Division, Block and Lot(s) �,,A Lot Size%LgAcre or Dimensions X Current Own Site Address Owner Phone # \CSS(,® . - Previous property owner name(s) - (NN if not known) Directions to Site 1,.; Date System Installed l-aAge of Dwelling Bedrooms House Occupied es no, vacant how long? Who installed system? �' a. p ey,,,jE Send completed report to: Owner Reaitor or Other Representative Name IVf icing AddressR 6o?n/ernail/fax .lI Include the following items on your plot plan: ❑ Property boundaries ❑ Wells ❑ Names of adjacent streets ❑ Septic tank ❑ Driveways and parking spaces %infield �{er tor /V,:if un,kribwn) ❑ Surface water (ponds,creeks, etc) North Arrow c38uildin s residence, sheds, garage , c ` APR — 1 2043 s' i PLOT PLAN- Q y 0 C1 % 2 f3 NOT TO SCALE o ass Permit # or Parcel 2 of 4 Mew ENVIROVNECY, LLC. 1612 Hastings Ave. W. Port Townsena, WA 9 168 �► i NOT TO SCALE o ass Permit # or Parcel 2 of 4 Mew ENVIROVNECY, LLC. 1612 Hastings Ave. W. Port Townsena, WA 9 168 • Evaluation of an Existing Onsite Sewage System Date of Inspection 63'-�t6?5 Inspected by Water Suppiy (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 APR - 1 2003 Sanitary Seal in place Yes No Public: offsite onsite Name of System I 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 _yes_ no, if not, distance ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept. records for this case #1 - Septic Tank Tank size gal. single compartment two-compartment material Riser to grade on inlet ves_ no. Riser to grade on outlet yes'5.- no Condition of tank good needs repair, describe 1st comp. Scum (top layer) - in. sludge (bottom layer) in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? ves `X no If yes, where was water observed? Condition of baffles: Inlet k oo needs repair material (PVC oncret ) Outlet: _good needs repair C material (PV co ret ) Screened Outlet __�S­no _yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) X _. yes 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 no (if no skip to section 3) #2 - Pump 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? Screen around pump? ves no Shroud around pump? yes no Electrical Components Pump operating ves 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 min/sec. Timer Settings min/sec on min/hrs off Floats secured: yes nc Permit # or Parcel # fJ l Documentl 3 of 4 Evaluation _of an Existing Onsite Sewage System #3 — Drainfield Appropriate Vegetation in area_ G�yes no. Describe vegetation Indications of surfacing sewage (check one) es, if yes, describe and diagram on plotfplah', Y-1 no drainfield area is overgrown and not observable APO — j 2003 Signs of parking/driving in area yes 'X no drainfield area unknown_ Ground settling or erosion yes no overgrown/not observable Monitoring Port Observations (if present): Residual Head yes, # of inches no Ponding in trench yes, # of inches of ponded effluent no Repair area is? Available as shown on permit ._None evaluated or shown on permit Addendum is attached for evaluation of Treatment Unit or detailed evaluation of drainfield _yes—)!�—_no COMMENTS (attach additional sheet if necessary): 1g. c oo-T t,F-T Zt- q i 'B.-TWE:9.6 `%S ?.00T 131Ee-�Os -VO W Wbhb%F-0 WWEPQF-D, SEE ATTACHED ADDENDUM Was a System Problem Identified? Yes C 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 informatia is b sea o3 �an 'Tev�iea�c of County records and my direct observations at the time of inspection. \ Z) ss N - 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# Documend 4 of 4 ADDENDUM Enviro Check, L.L.C. Company Disclaimer DATE ADDRESS !a ja1& D, P,V OWNER 1 &,sem 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 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. I ' Company o ; a Enviro Check, L.L.C. { APR 1612 Hastings Ave. W I Port Townsend, Wa. 98368 I- 360-379-9400 I acknowledge that I have studied the information contained herein and that my assessment is honest, done in 4ace with Jefferson County Ordinances, and to the best of my ability, correct. rts nth Co_ Weather Conditions SAMPLING (Septic tank) EASUREMENTS Date - PH Result - DO Result - Temp. Result - Counter Setting - Hour Meter - Water Usage (Ave.GPD) Meter - Squirt Height (In feet) go 1 Q Oessea, 14iW e`(j 903 E. Caroline Port Angeles, Wash. OLYMPIC HEALTH DISTRICT SEWAGE DISPOSAL PERMIT APPLICATION Sv�md,t inbupf icate Permit No. Builder Courthouse Port Townsend, Wash. ate ADDRESS�a9PHONE DIRECTIONS FOR LOCATING SITE APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM 2_S OF NO. OF -� "1Z NAME .SENENT SITTE�SIZE NAME OF INSTALLER DRAIlVFIELD LENGTH,Q: WIM DEPTH,- #LINES SEPTIC TANK SIZE DRAW A DETAILED PLOT PLAN BELOW. SNE INSTRUCTION& SOIL TYPE a 1c°oI ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PIANS, LOCATION OR SITE, INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. E INSTALLATION SIGNATURE OF APPLICANT,� APPROVED DATE I Oa 7 ' INSPECTED BY °' �i;°�-��- � / N Q< tj C G C�. SANITARIAN IS CONTENTS: I CERTIFY THAS � ' AS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEPARTMENT ( fl, < ,L � �_ _ DATE /Z 7S— INSTALLERS NAME OHD 6-75 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 MONITORING INSPECTION CERTIFICATION The system serving _ � 1 kQ parcel # CO t Qc6a C'W 1k . permit # 1�5e 9 ff was most recently inspected on ��� - by xA T<vAg+ , as specified in Jefferson County Code 8.15.150. The above referenced system is in compliance with the Monitoring/inspection schedule identified in Table 1 of Jefferson County Code 8.15. See report completed for information on the condition of the onsite sewage system. 21 REQUIRED OR RECOMMENDED REPAIRS/MODIFICATIONS TO THE SYSTEM ARE LISTED ON THE INSPECTION REPORT DATED ':�- I-� Failure to complete repairs or modifications to the system as listed on the report may result in premature failure of the system. The next inspection required for this system is in 21 Table 1 requires that this system receive an inspection: Annually Every 3 years Every 6 years 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. Sodatu?e of Jefferson County Employee I r:;: L•ralth hl"Ll t d t I ORMS MONITORING INSPECTION CERTIPICA rION ilio +61-Q� Date Parcel Details Page 1 of 2 Parcel Number: 001282019 ! SEARCH Parcel Number: 001282019 Owner Mailing Address: LINDA LA COSSE 430 THEATRE RD PORT TOWNSEND WA983689789 Site Address: 430 THEATRE RD PORT TOWNSEND 98368 Section: 28 School District: Port Townsend (50) Qtr Section: NW1/4 Fine Dist: Cape George (6) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 161 Planning area: Quimper (2) Sub Division: Assessor's Land Use Code: 1100 - HOUSES (single units, non-farm) RESIDUAL ACREAGE #001282029 Property Description: Printer Friendly S28 T30 R1W ONE ACRE HOMESITE I N1/2 SE NW(PTN W CO RD) LS I PTN TAX 14 1 1 Click on photo for larger image. Perml a As sor Data ax History 6,-j" JPlats & Surveys 1+#n•//r<mmrnn ir+fF-"f%n xim rno /nornal aanIPAV rPT AT(L—(1M7Q7MO I/74/nq Map Output Page 1 of 1 ArcIMS HTML Viewer Ma ^i +, Wghrghted Feature �Q1232Gtit 5e3aded Features $91omEne Fhotbs-H ==W7 OQifiB?L4,* . ','° (� 007291001 T owTm Rmi CgrtLrs Pbad 5'ystain �601292ti06 FD Pam�e95-�B Ci07292006 OM26=7 �OOOOOd224 ddt292?1�9 5�', ti41292�A13 � '''"a� W1 '4 W12=4 APR - 1 20 0012920ts a 0012e _ *+^ 00129'26 IAapskl P�wiclad bYJeRamsn Count] _G ftQ12W016 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 collection. oning information is based on the 1998 Comprehensive Plan Map and does not include changes made unng the 1999 Comprehensive Plan amendment process. Zoning designations must be confirmed with the De artment of Community Development. Page 1 of 1 Randy Marx From: Chuk Trisko [chuk t@yahoo.com] Sent: Monday, June 26, 2006 7:16 AM To: Randy Marx Subject: drainfield location re:fleamarket app. Dear Randy, I have located the ends of the drainfield, and the holes are currently open. Please call me a 301-2725 and let me know when you will be able to have a look at them. sincerely, 006 Chuk Trisko 430 Theatre Road Port Townsend, WA 98368 �1J a 360-301-2725 V� l' 6/26/2006