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HomeMy WebLinkAboutSEP1973-00035e �E Prl -7- 86336 903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No- :55r,, ,1. Point Angeles SMIAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House PqTA Towns ay w �:� s�"ruG?i®� �g4® �ir'geo ��r Date ! ! I 3 ADORES PaY T � 1.1-C E�h PHONE DIRECTIONS FOR LOCATING SITE APPLICATION IS HEREBY MADE TO: INSTALL NLI•T SYSTEM AIR EXISTING SYSTEM DRAINFIELD LENGTH'it !IDTH D` DEPTH ,#.LINES -Z SEPTIC TANK SIZE -v&c is DRAW A DETAILED -PLOT PLAN BE10%4. SFE INSTRUCTIONS. SOIL TYPE • k J Sv � � �► S��c�e. O\��.. � � 9 ° ® ttc a ANY CHANGE IN BUILDING OR SE'AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS Q PERMIT UNLESS PRIOR APPROVAL OBT'AINED-FROM THE HEALTH DEPARTMENT. C 1 DATE OF INSTALLATION 1 A4 - 111,1%, 'SIGNATURE OF CANTS !! '� �' W A RS DATE , , INSPECTED OF DATE l! `l SANITARIAN'S COkR,,IEVTS : 9J ®� a/s �� r _ �Ao.�G,�c�e Sia . • ���..• �����.�• �;.» ��e � � � ��� --cam � I CERTIFY THAT THIS SYSTEM YAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTM�i�TT DATE INSTALLERS NA1tiIE YPE OF .BUILD TG N0. 0 BROOMS BASEFIENT •SITE S IZ NAME 0 I STALLER DRAINFIELD LENGTH'it !IDTH D` DEPTH ,#.LINES -Z SEPTIC TANK SIZE -v&c is DRAW A DETAILED -PLOT PLAN BE10%4. SFE INSTRUCTIONS. SOIL TYPE • k J Sv � � �► S��c�e. O\��.. � � 9 ° ® ttc a ANY CHANGE IN BUILDING OR SE'AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS Q PERMIT UNLESS PRIOR APPROVAL OBT'AINED-FROM THE HEALTH DEPARTMENT. C 1 DATE OF INSTALLATION 1 A4 - 111,1%, 'SIGNATURE OF CANTS !! '� �' W A RS DATE , , INSPECTED OF DATE l! `l SANITARIAN'S COkR,,IEVTS : 9J ®� a/s �� r _ �Ao.�G,�c�e Sia . • ���..• �����.�• �;.» ��e � � � ��� --cam � I CERTIFY THAT THIS SYSTEM YAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTM�i�TT DATE INSTALLERS NA1tiIE 711 - ', ILII' - III • I - '•�1 � II .�1 �� '. L I I �I r r I� I I {_ 1 � I I •III _ .III I ��..� I III-• '. II I III �'�i. • �I p 6 � u � 1 1� I I` I I IIID I 1 1 I ' II 3- 4 'I II I I I n fN - -t r I _ II } C X11 441III I 'I I r SII IR: t j -•I h r I _ Il I III t Ili. i I - , I II J . VIII © pp I I Ia' r I I I, II e •I � I I (.. I I I' �• � � �I c I` Y 14 Ili, I, I I I - II I It •I ' EVALUATION OF EXISTING SYSTEM REPORT JEFFERSON COUNTY HEALTH DEPT. Multi -Service Building 802 Sheridan Avenue Port Townsend, -Washington 98368 Applicant Name -r 7CAJ (77;:17- AddressV ifI? vw. sE� o lv 9ff?, Phone 3SI.5"— O 2-13 r Receipt No: Fee: Date: Mail Completed Report To: e 7-0 (�'­ONs> SITE LOCATION OF SEPTIC SYSTEM Section 3 Z Township -30 A Range / Date System Installed // - ZL- - 7 j Installer S-_f70,1J Sewage Disposal Permit on File: Yes _� No SEPTIC TANK: Capacity f eAr LEACHFIELD: No. Compartments Z Size � Q Sq. Ft. Baffles/Tees -64 REPORT OF INSPECTION ' Assume system to be functioning properly as this department has not received notification of a malfunctioning system as required by law. --1--- System appeared to be functioning properly on the date of inspection. House is unoccupied therefore an evaluation of system performance is not possible at this time. A review of our records indicate that this system was designed to service a bedroom residence. This system is not considered adequate for a bedroom residence unless it is sized per current regulations. Effluent was observed surfacing on the day of inspection. The system is malfunctioning and the owner must apply for a repair permit within 3 days. No pumping receipt has been received by this department. Owner should verify date septic tank was last pumped. Tank should be pumped if not done within the past 3 years. This department has no records on file concerning this system. We are unable to verify type, size, location or adequacy of the system. COMMENTS: '41'r mm e W1/_rf71_y Environmental Health Specialist * 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. APPLICATION FOR EVALUATION OF EXISTING SYSTEM JEFFERSON COUNTY HEALTH DEPT. Multi -Service Building 802 Sheridan Avenue Port Townsend, WA 98368 (206) 385-0722 o�v Applicant Name :5E?'O AJOitIST/�ilGT/ ' Tvc . Address '416 410 �/Scovxw!x t R® . fo2i /f�1nl/�S�M�. G�✓✓� �y�� Phone OZ13 Receipt No. 3g14 Fee: , �s.119V Date: Owner, of Septic System. // ff Owner's Address 4(770 Q%SCnt1eA!j �b., Aw rvw1/56rll.�AA 1 f -366 Owner's Phone 305-.2159 Previous Owner of Septic System Previous Owner's Address Previous Owner's Phone SITE LOCATION OF SEPTIC SYSTEM . Section 3a. Township 30,./ Range 11� -t 114E Jo ,s'4wcZT l/v.< pif THE I Ate,&rHkJ,6sIf r1k A/Qotr//4l4s? /'y UfA ?HE 511rNW?l /t OfSEcrl i. Installer of Septic System j/,S X7196 CAOAJ &t,-A;1,e 67,-0 t/ &o Date System Installed PFS 1T 5(4 a9 -3 Do you have a copy of the septic permit Yes` No r Da/t Number of bedrooms in r ewer a?, -Number of persons ' y _ Do you utilize a garbage disposal unit Yes Septic Tank: Capacity D ©ems gallons Leachfield: Size Sq. Ft. No X Date last pumped /2//�< (Please provide receipt to this dep rtment) (s4r1'A6*6P Ifec-5193 * If there is no record of permit at health department, uncover total top of septic tank. If there is a record, uncover outlet of septic tank only. tAlol-4 - -r14/5 / PPL/C4T/PA1 /1 r e6PAA66 661-lraley Aleut Make . 4 1114'elAIVC4 A1As Cr&Wr4 � A ort 405/fa ra ;20` s,eTa4&e_ . _ _.=jjA4e AlVkt,9�54 4VIA . U5� 4 ffiC . a em/r K:141:!9V19A0161e5T