HomeMy WebLinkAboutSEP1973-00229s�P�3 aa9
903 E. Caroline OLYMPIC HEALTH DISTRI� 4�'. . Permit No. 397
Part Angeles SEWAGE DISPOSAL PERMIT APPLICATIQN,�
Submit in Duplicate �," ;i lder
Court House-0--
�� •`� '
Port Townsend Ya 5 <F a, T�<'I-Date S-10-73
011NER6er0/d (,,// s.:< ADDRESS PHONE
DIRECTIONS FOR LOCATING SITE_2^ /!y
APPLICATION IS HIM EBY MADE TO: INSTALL NEI%! SYSTEM x REPAIR EXISTING SYSTEM`
oa 40 c /7xbo
YPE OF'BUILDING N0, OF B ROOpS I BASEN;ENT SITE SI_Z_ NAME OF INSTALLER
i
DRAINFIELD LENGTH /�ifIDTH_ 7 DEF /d `r #LINES 22 SEPTIC TANK SIZE /c: o o
DRAB'' A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE d rZo
,r�./l 1,, jk; .-
14
/y
E-5 sYd<
�as� i7eld o•. At S.de
o., S 'ilk S. </e
e dbe5 n
.y4Yy� J.JV Vh11V1Y VR A]11 L'� y1.YHL1LH1l..Yi ♦nia
PERMIT UNLESS PRIOR APPROVAL 0DTAINID FROM THE HEALTH DEPARTM12iT W
c
DATE OF INSTALLATION b�/b _73 SIGNATURE OF APPLICANT
APPROVED
.2W_ DATE G -/c_>7 INSPECTED BY �� a , A, DATE -/6-»
SANITARIAN' S- COPiMENTS :
1 i Car/anrt , e fc, is S< (�.«� & 6e ee.f
l,® , M/A~"'-'-� kew, wr �a
jNLN �4 nJr EY y fern ent Q. [�, /iae( �� �°"" '
14
acres. /Ke -..a ..i�a .JQeo,C_�.a` Su.,.�
I CE� T FY THAT THIS SYSTEM OAS UrST iLED IN THE MAINNER APPROVED BY THE /oPY
HEALTH DEAPRTMENT DATE C/i
INSTALLERS NAW _O
$�„T..i /mox .t x 6 tten.�?: - aap� „ CwCeLn:Y' oQo . • �-� �.tn<.laa/ c.� .,erR ee.%y7f _ <.A.e..� �-G/.o-nA..+.
saw tB...A -.--./ •$`„+R fa`�'.ec-PG..tt''o 7GB.
JEFFERSON COUNTY PERMIT CENTER OTH # 9 - 0 r s1
621 SHERIDAN RECEIPT -Iv
PORT TOWNSEND WA 98368 CA CHEEX 0 5i5
206-379-4450 DATE— /,/ s/
EVALUATION OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM AND/OR WATER SUPPLY I
Information Requested: "ndividual Sewage Disposal System
_ Water Supply _ Public _ Private
Applicant's Name _ EA s L M U L f a fj V Mail Completed Report To:
Applicant's Address . j A/ / tq-%' /VS w V % T /% f'L C � i A Yi E -
Applicant's Phone 777- 7 o t f y
Owner's Name — S9 M f"_
Owner's Address
G(kAr G G�GGrfSi�iE-?
Owner's Phone
.M
Previous Owner (if known) I'll",
cai c�p05-1 ty>fG.a/� LC%�+reJ
ttv
ep AZe, d--f;o-Id
6F,k5 c
OccupiedlI(_�Vacant
YFS How long?
Number of Bedrooms 9
Year Installed '6 e
Site Address: 3 j f=:4
R /V Sy✓ a 117-F/ t'4-
SURJ f M
�y 3g i
Legal Description: Section
Township J
o N, Range
Plat Name: ��
/t i f=yf �v w Block/Division
Lot r X
r
w
Parcel No.d- Y
14rPermit tY
Directions to property.
Attach plot plan showing location of structures, drainfield & septic tank.
FOR HEALTH DEPARTMENT USE ONLY - DO NOT WRITE BELOW THIS UNE
SEWAGE DISPOSAL SYSTEM" /
Permitted system yes ✓ no Installed prior to permit requirement? _ yes ✓ nc
Sewage noted on grointime of inspection* yes no
House is unoccupied therefore an evaluation 6f—drainfield pe ormance is not possible at this time.
Health Department records indicate that this system was designed to service a _ bedroom residence.
Septic tank should be pumped f not done within past 3 - 5 years.
Septic tank:? volume 1 compartment ? 2 compartment
Baffles: _.Zgood condition inlet missing — outlet missing
Repair area: _moi adequate _ limited _ none available
WATER SUPPLY
Well casing 12' above ground_ yes _ no Well 100 ft from drainfield _yes _ no
Sanitary seal in place _ yes no Water sample taken _ yes no
Sample results
Comments:
0,—'
g/f PF- 17ii sE'✓ry�
cai c�p05-1 ty>fG.a/� LC%�+reJ
ttv
ep AZe, d--f;o-Id
m,<1d �r
Date Ii -29-i3 Time 11 1s`l� Environmental Health Specialist ee)i e
This report does not constitute a guarantee, either written or implied, that the system will continue to function
properly. This report constitutes a summary of findings only.
M:Venv.�pl,cntlfumslr.hm
I
m
q
❑❑ 000110 ❑ 0000❑
W N JOO O7 V T O1 i, W NJ
J
noI T-0 fes- Z fJl0 q No KvZ'M 0)"7Z
^� N D y 0 m C< N N N d �• G 3 C .Z
3 n C 0 N •0 mI n d N d d =�• .� O p' < 3 d S
�o3F311:r °•Q ���o Fy�d
A O d g m t W c 0 7 .+ d ti. d O
O
< d 0 S y O N N 0 O N G O O y d 0
w m m_ o 0 ,: n � v F c , 3
O C. < f, o S m N� c O d F m Cdi 6
7 d 7 d Oat q X 1C Nqd >1D OJi• ti d y
m 0a
iD. Sn y C _
d
7aa d y aC q
d =�• s
DMnF CD
O 0 10da
. O
0 J 06 �, d q C.
��Oo� o of O.a 0 3
7 O d d 0 1D d q
'* 1 d g y 1D 0 r1D+ O d l< O
O
j y
0 y
m .r p 0 7 1
n N
,. d O
,
3
O
a
a
W
A
P4
1
9
v
g 1 ioe
a -
1
9
I
I
V
3
I
a ;�
500
u
3
I
I
I
Q
pQ
I
^
n
4 I
O
N
q W1
CL
2
ZW
ZW
O d
m
J D
-
6
6
W
r
W
J,
rr�
W
y
Z g
N
V4
1
o
Q i Y
s
Z a4
� I
i
Y
v
CL o «
J
I
_
O
CL
7
Q�
N o _�
3
L = S
j °�,� l
I
7
I
ti.
I
H
, I
K Z
I
K
w N
ai
� v
V
N
aui N
4e N
NIS'
LL sus
s
s
W
G S
S O I
N S
i9 S
O
a
a
W
A
P4
1
9
1
g 1 ioe
1
9
I
I
3
I
500
3
I
I
I
pQ
I
^
n
4 I
O
N
I
I
I
-
1
I
V4
I
a
o
s
� I
i
Y
v
J
I
_
•`
I
7
I
ti.
I
H
, I
K Z
I
K
w N
m
I
I
w
a
9
g 1 ioe
9
3
500
3
i
tF Jefferson County Health & Human Services
HILL CENTER • 615 SHERIDAN • PORT TOWNSEND, WA • 98368
February 24, 1994
MRS BASIL MULFORD
341 FARNSWORTH PL
SEQUIM WA 98382
RE: Evaluation of Existing Onsite Sewage System Report
Assessors Parcel Number 002-283-015
Dear Mrs. Mulford:
This letter is a follow up to our phone conversation earlier this
year. As you know, this office has no record of a permit for an onsite
sewage system on the above referenced property, which is not surprising
given the age of the system. The lack of a permit makes the
determination of system capacity difficult and a normal evaluation is
not designed to estimate size and capacity, but to establish how the
system has been performing under its past usage. In this respect, there
was no sign of a problem at the time of the inspection.
Lack of knowledge of system capacity makes it difficult to say
exactly what kind of structure can be permitted. Generally, existing
older unpermitted systems are viewed as existing nonconforming systems
and continued use is permitted provided the system functions properly
and usage is not significantly changed. When a mobile home is being
replaced, it would need to be similar, in terms of potential occupancy,
to the existing mobile home and there would need to be adequate reserve
area for a replacement drainfield.
Since there is adequate reserve area and the sewage system showed
no signs of failure, this office would approve the installation of a
replacement mobile home on the property. This opinion is based on
rules, regulations and policies in effect at this time. Changes to
state or county rules and policies could alter this opinion.
If you have any questions concerning this matter, please feel
free to contact this office.
LDF/wg
Sincerely,
0cq-Z,4� n-�LLawrence D. Far.
4
Environmental Health Director
HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG
DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX
206/385-9400 206/385-9444 206/385-9400 206/385-9435 206/385-9401
JEFFERSON COUNTY HEALTH DEPARTMENT Permit #
INDIVIDUAL SEWAGE DISPOSAL INSPECTION FORM Date
APPROVED YES NO ENVIRONMENTALIST
Address Owner
Legal Description
Residence Commercial # of Bedrooms System Installer
System Designer
SEPTIC TANK
Commercial Non commercial Measurements: L W WD
Construction Material Lig. Cap.
DISPOSAL FIELD
Exc. Depth Width Total Length Sq. Ft.
Rock Type Depth Under Over
Engineer Design Yes Type Engineer Aoara:•al Letter Yes
Well 50 feet from tank 100 feet from leach field
Well installed at time of septic system inspection Yes No Public Water
Comments
S
Sta��
Dry ry f Jd
��in5w�� �1•
Dr.,,a��) ��}•fDS�.le.
2lA rn
Jefferson County Departmeo 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 is not available enter (NV) or not applicable (NA).
Type of Evaluation Reason for Evaluation
0 oP �n and Mariliming Inspection
Evaluation of on-site sewage system {p Real Estate transaction
❑ Evaluation of drinking water Q con4dete a Permit #
0 Buiding Permit Review a calor no septic permit on file
❑ Evaluation of on-site sewage & drinking water 0 00w, eviam
Date of evaluation
Inspected by _/1 h6iP Y
Tax Parcel #--LL2--21j-0L6 Permitted System fires __J�/no Permit/case # SEP
Subdivision, Division, Block and Lot(s) 5 I if' /;z w if l(/ t✓% 1'tV&AS';1ei rrs _
Lot Size Acres or Dimensions X
Current owner v? 00
i
Site Addressd'L(x'i 3>��
Owner Phone# SC C7 - 7 i?7- -7 1'? -7
Previous property owner name(s) - (NN if
Directions w Site H Y /6°f r C >/,
Date System installed tit "HOC S >>'. Age of Dwelling
Bedrooms_,Z_
House Occupied—_jesi—no. vacant how Iong?
Who installed system? id >1 Kfj0�
Send completed report to:
Owner
Name
J C /6 11
Mailing
Address J °3t /
/ f).ti 6 7 S ►��'i?T
/'� j 61113/ tv r �.s
Realtor or Other Representative
_h Sound Septic SfnviCe
Name W�i7DEiSlt) JiE 7EG7tf!»i t its l ;t' NF1 /3Df717j FartLudlowW
Mailing Address_ ,L Y-. tv f)Stt/1'Ef��N Qti111 r1 Irv`/} 36385 VW
Phone%mailffax3 604 -8 i -y ff�t/,{X r , � - 11
EES Evaluation Form_07-30-04 udf
0.""1 -'� s- --('716 S 'p 9J�dS6
Include the following ite>* YOUF'PWt PIM:
2 -property hamdaries
Vra' aures of adjacent streets
y/ Dmteways and parking spaces
cY Surface water (pands,creeks,etc) j,) Yi
Buitdirgs(residence, sheds, garages, etc)
PLOT
J
Permit#or Parcel#
Evaluafion of an EwSUng Orrsi6e Sewage System _07:30
M/ Wells •
;/Septic tank
at Drainfield (enter WV if unknown)
Pf NOM grow fi /
`,, ' 4
i lrki — 2 200
FhKf'"15ds/CKT'14 ft
3
Date of Inspection Inspected by MIIPG (A X J 1 U_
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
nsiteIs well more than 100' to drainfietd/disposal component --yes— no, if not, distance
Is well more than 50' to tanks and effluent transport Hne,_yes no, If not. distance
ONSITE SEWAGE SYSTEM
# Bedroor"allons per day indicated in County Huh Dept, rem -ds for this lase yi / t
#1 - Septic Tank
Riser to 0(7 C" twonbmparhr>ent GOG1Ci?�� material
grade on inlet yes Riser to Bade on outlet
Condition of tank �` �h needs repair, describe
1st comp. Scum (top 1811w)— ! in. Mudge (botiorn layer) _ ` ar-
2nd comp "scum �"� m. Sedge kir.j`[r'�iIR 4i C'v
Was ground water observed leaking WO tank ? ;yes `
If yes, where was water observed?
Condition of baffles: Inlet n material Canweie
outlet good
_Cneeasreuam% malerial mncret
Screened outlet--- ^9n— —Y , carrdtiori dealdogge,,,V7!
Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b))�l.�/yes no
Effluent level at outlet (mark level on ck de)
if effluent is below the outlet indicate
when tank was last pumped:
Does system irrdide a pimp?no
yes if yes, axnplelle the nerd section roskip to section 3)
#2 - Pump Chamber 1,1
Tank size gaL Material. Fuser to grade? ves no
Condition of tank goodneet� desaine
Solids in Tank (see 8.15.150) yes no spbn
Was Ground water observed n. � m.
leaking into tank ? ves no
It yes, whore was water observed?
Sween around pump? no ves, ooiddion dean dirlytdogged
Stroud around PUMP? no vws
Pump operating vOS no describe
High water alarm functions ves nor, If no. describe
Elec Panel condition good needs repaW. die
Pump cycle drawdown inches. Time for pump cycle msdsc.
Timer Settings miNsec on miruhm off Floats sealed:_ ves no
Penn* # or Parcel
Evaluation of an
#k3 — Drainfield • r
APPropnate Vegetation in area yes no. Describe yegefation
Indications of surfacing sewage (check one) ff yes, describe and diagram on plot plan
dramfield area isovergOwn and not observable
Signs of Parking/driving in area Yes draiMeld area unknown
Ground settling or erosion overgroHmfiot observable
Monitoring Port Observations (if present)
Residual Head _yes, Jnq of inches no
Ponding in trench # of of ponded effluent no
Repair area is? Available as shown on permit Atone evaluated or stroym on permit
Addendum is attached for evaluation of Treabnent Unit or detailed evaluation of drainfield
_ es no
COMMENTS (attach additional sheet if necessary):
otl /17c ur fop G)i4rcV-r wiU
13Y rIFX7-1i. 1 --FC 1010
5 'Yf T-EfI') l c1 S i 14i:.&P
Was a System Problem Yes if Yes, what section S. No
- 4
Phis report on the existing onsite sewage system is valid for ft pema"tted or tbaric (d instailled prlor to permit
req+aremieft) use of the syslem ordy and does riot kite assurance of future County approvers (such as lwilain9
permits) on this parcel. Any future application w� be judged separat * by the rules and �
in stied at that time.
I certify that the ertormation provided is be on a review of County records and my d' rt o ervafirxrs at the time of
inspection.
Name/Sigrfdture
Date
No guarantee i trace onsite sewage system
mmar of
n dings, is im pied or granted based on the irr iormation contained in
this report Yids report constitutes a summary of 9s is
Penntt # or Parcel # f/[I .-Z 1l &� i' 0116
Evaluation of an Existing Onsite Sewage systam