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Home My WebLink AboutSEP1970-00102903 East Caroline Fort Angeles OLYMPIC HEA.T.E 3 DISTRICT Permit No. Fee Paid $ SEWAGE DISPOSAL Pl'MIT APPLICATION Submit in Duplicate LEGAL DESCRIPTION DIRECTIONS FOR LOCATING SITE. PHONE, APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM C i ( I I -OF BUILDING NO* OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER PERCOLATION TEST RESULTS Depth Time require to Of hole seep last 6 in.-. Pere, No. 1 Fere. No. 2 Pero, No. 3. Percolation rate (divide time 'by 6) e DRAINFIELD LENGTH_ WIDTH DEPTH NO. OF LINES. IT IS HEYMY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER' AS DESIGNED AND APPROVED ON THIS -APPLICATION, I Signature of Applicant -1kN APPROX. DATE OF INSTALLATION42 SANITARIAN' S COMMENTS: 1 ov THIS CONSTITUTE PE .IT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED - R� PLAN APPROVED DISAPPROVED DATE p v � y DATE INSPECTED NITARIAN Q RE14ARKS : 5-68 -- ---- –+--I -.nnvv kL Lz#xKj..UM.J ruu-x 1:'.LRA UIVIAU A:nyj rvusUWlau l:Yrvarirs—V 1• Property lines 7, Driveways., patios, carport, etc. Location of building 8, Streams or bodies of water nearby 3. 4. Location Location of septic tank 9. Location of percolation test holes of drainfield 10. Septic tank. size Sallow 5. 6. Slope of land j Water lines & wall(if Ile Length of proposed drainfield applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS Depth Time require to Of hole seep last 6 in.-. Pere, No. 1 Fere. No. 2 Pero, No. 3. Percolation rate (divide time 'by 6) e DRAINFIELD LENGTH_ WIDTH DEPTH NO. OF LINES. IT IS HEYMY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER' AS DESIGNED AND APPROVED ON THIS -APPLICATION, I Signature of Applicant -1kN APPROX. DATE OF INSTALLATION42 SANITARIAN' S COMMENTS: 1 ov THIS CONSTITUTE PE .IT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED - R� PLAN APPROVED DISAPPROVED DATE p v � y DATE INSPECTED NITARIAN Q RE14ARKS : 5-68 a K ,G. 903 East Caroline OLYMPIC HEALTH DISTRICT Court House Port Angeles Port Townsend BUILDING SITE INSPECTION APPLICATION Submit in Du, liar cafe �6 i OWNER `' f1 ( �° ✓ ADDRESS jseatW i0 e,f �/ 7 DATE ° o�,'q 7® LEGALg- ESCRIPTION401"A '1191 0 -e o Ale®f®R:S' 16r t /21t7&1-'We--kzP / qfA�'�� DIRECTIONS FOR , LOCATING SITE��'� 01 %ae AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A^ STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. RESIDENCE COMMERCIAL BUILDING� OTHER. Fr'�� 177 �`x ;ZAO NO. BEDROOMSASEMENT 4� SITE SIZEh^--re,WX3&' SOURCE OF WATER TYPE OF SOIL.54-4-d - �� f c- �� DEPTH TO WATER TABLE DgAW A SKETCH in the space below$ indicating location of building in relation A,to other buildings, property lines, well, streams or other bodies of water. Indicate proposed location of sewage disposal system. �o' a va c x p .� rp: ' Ulu `.. e. C. i x44 C to of '`Site Inspection_- -1 4t � API .2 ��Approved*4 Disapproved c '''oO ' See reverse side for remarks. efs THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT 0i'Q1I NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND 4v��' ,x IP. A "r'1 l5� E4."' e®+'oa/ �`>'i '�` "' " A SEPARATE PEPJ4IT IS DRAINFIELD. d s '• Cl s r ' a+ -+Y f F. t. S/zppe v Parcel Print Parcel Number: 975901202 07/26/2006 Owner Mailing Address: MARCIA A CAYfON 6712 35TH AVE NW SEATTLE WA 981176105 Site Address: 8533 FLAGLER RD NORDLAND 98358 Section: 29 School District: Chimacum (49) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1E Tax Code: 211 Planning area: Marrowstone (3) Sub Division: NOLTON'S E P T Land Use Code: 1100 - HOUSES (single units, non-farm) 55919 Property Description: NOLTON'S E P T I BLK Q 1 3& TAX 8 (S 50' OF I N 1/2 OF S 1/2) Page 1 of 1 http://www.co jefferson.wa.us/assessors/parcel/parcelprint.asp?PARCEL NO=975901202+... 1/5/2007 Map Output ArcIMS HTML Viewer Ma sll It . WVXTON — I W 4'+t197 1 97 I06 97� 963700411 Page 1 of 1 Legend grad Sp%fn Pa"" io?,66am,, I �7 Bain tiasies i, 0. 1 :OR INFORMATIONAL PURPOSES ONLY - Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respec ;orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection. Fri Jan C ?007 http://gisserverlservleticom.esri.esrimap.Esrimap?ServiceNarne=ovmap&ClientVersion=4.0... 1/5/2007 Jefferson County Department of Community Development 621 Sheridan St, Port Townsend WA 98368 (360) 379-4450 Evaluation of an Existing Onsite S 3 rs; emau_4 i�E Draw on the back of this sheet a current plot plan showing Q�9boonVoEt" Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a current plot] 1 identifying these items. ALL SPACES MUST BE FILLED IN. If information is not available enter (NV) or not applicable (NA). Type of Evaluation Evaluation of on-site sewage system 1� ❑ Evaluation of drinking water ❑ ❑ ❑ Evaluation of on-site sewage & drinking water ❑ Office Use Only Date - - 0 Fee la 6 Recpt�q� Check p b Case # '70 -lo Reason for Evaluation Routine Operation and Monitoring Inspection Real Estate transaction Complete a Permit # . Building Permit Review and/or no septic permit on file Other, explain Date of evaluation \ \ Q\o(Q Inspected by 08W WWSMIM (Emir+ UQ Tax Parcel # OCI54�(D\a c3';k Permitted System eyes no Permit/case # SEP �,)\j Subdivision, Division, Block and Lot(s) Lot Size „a3 cr or Dimensions �O14-1, �tao� f�^ Current Owner Ba&ti A &Sat -a Site Address 9 SEna 'a�fit. VM,_ 1.� ociD1-Ar.�o Owner Phone # '2toL, --184 - 99 41 Previous property owner name(s) - (NN if not known) njlnRcAa� �6Rfs�' 'C n�ToN �o`�NAt�1. Directions to Site�h.'4. �: C\$ _-ItN IS IR WL -M., V9 . E\ 9% 1\ LN,, XkL VIU &L4EIL Qo`) Date System Installed�9�� Age of Dwelling \�"-(_h # Bedrooms House Occupiedyes_ no, vacant how long? L vAL� Who installed system? isi, Send completed report to: Owner Name_ Mailing Address Phon email/fax n^t,_--r�q_-89tkl Realtor or Other Representative Name Mailing Address _3YS- EEE Evaluation Form_07-30-04_pclf f &O& 1 of 5 Include the following items on your plot plan: ❑ Property boundaries ❑ Names of adjacent streets ❑ Driveways and parking spaces ❑ Surface water (ponds,creeks, etc) ❑ Buildings(residence, sheds, garages, etc) PLOT PLAN -date prepared u A` bye ILI I< I NOT TO SCALE rpm` % 0 U.10 (7.*- Atc ass >s� � t>e ❑ ` Wells ❑ Septic tank Env o, •i^r ❑ Drainfield (enter NN if unknown) �Vu�4x ❑ North Arrow JELF�USLU�IY UCU ,� •� 6kPk�E e.pAmEL cls U!/00 // �- r 70 •+l— ENVIRWCHECK, LLC. . 1612 Hastings Ave. W. Port Townsend, WA 98368 Permit # Parce #!a-I'J `) O k D' o -A Evaluation of an Existing Onsite Sewage ystem _07/30/04_idf page 2 of 5 Dde Date of Inspection \ \ koio Inspected by I (Eft*0dxCk, Water Supply (fill in only if water supply is being tested in this evaluation) i 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 LUL' Individual: offsite onsite Is well more than 100' to drainfield/disposal component des_ 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 1150 1 gal. ,single compartment two compartment &3,,sc Q.fME material Riser to grade on inlet ves X no. Riser to grade on outlet es____k no Condition of tank good needs repair, describe 1st comp. Scum (top layer) 0 in. sludge (bottom layer) -A 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:good a ds repa�' material (PVC, cre ) Outlet: -4g` 0 ---needs repair material(o,concrete) Screened Outlet -)�,_no _yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) yes k_no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: (e9 9 0 1) Does system include a pump? yes If yes, complete the next section X no (if no skip to section 3) #2 - Pump Chamber Tank size gal. Material. Riser to grade? ves 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? no ves, condition clean dirty/clogged Shroud around pump? no , ves 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 min/sec. Timer Settings min/sec on min/hrs off Floats secured: yes no Permit # oPar # 1111,5!2 Q � Qna Evaluation n Existing Onsite Sewage System ._0 7 /30/0,4.�, age I of 5 #3 - Drainfield Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage (check one) ves , if yes, describe and diagram on plot plan no drainfield area is overgrown and not observable Signs of parking/driving in area ___yes no drainfield area unknown Ground settling or erosion yes 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 None evaluated or shown on permit Addendum (page 5) is attached for evaluation of Treatment Unit or detailed evaluation of drainfield{� _yes--)S_no COMMENTS (attach additional sheet if necessary): t J v t., #1-A. Riser's are mandatory on next inspection. 11II00 10 other (N No permit is on file as to size, location or adequacy and it could not be determined p�.�.u�iL'T"�k �, � PST iw+Ca-'7o� e.sc--T'N�'�►s'Nb A�t>`�sp�N BEcs�s� i'T'wi�Z AL�A4y �VR'��. aoC��+SC3 A't`3'1►�,W�v � �t.�}�C.rr. SEE ATTACHED ADDENDUM Was a System Problem Identified? Yes x if yes, what section #. A!(,IL .... 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 in ormation provided is based on a review of County records and my direct observations at the time of inspection. `vnAL o 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 # o Pare oEvaluation _ paste 4 of 5 VAkeL S -7s901202 ADDENDUM ADDRESS 6V63 is � -0¢otA OWNER--- �� Enviro Check, L.L.C. Company Disclaimer Based on what we were able to observe and our experience with on-site wastewater technology, w e UIV 9,��9�� this Sewage treatment Inspection/Evaluation Report based on the present condition of the on -sitI� I 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. Enviro Check, L.L.C. will not be held responsible in any way for information being undisclosed (intentionally or unintentionally) by property owner, representative or other parties of interest. All reports, including E.E.S. inspection reports are subject to any change by Jefferson County Environmental Health Department. Enviro Check, LLC is not liable for any such changes. All parties are encourages to check county records for any information regarding properties. 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. Dale R Wurtsmith Co -Manager SAMPLING (Septic tank) Date - PH Result - DO Result - Temp. Result MEASUREMENTS Counter Settina- Hour Meter-