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COMMUNICABLE PUBLIC HEALTH HOME VITAL ENVIRONMENTAL HEALTH
DISEASE CONTROL NURSING NURSING STATISTICS HEALTH EDUCATION
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JEFFERSON COUNTY HEALTH DEPARTMENT
SO2SHERIDAN PORT TOWNSEND,WASH:f138E QOh M15-072J
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MINUTES OF E
BOARD OF HEALTH MEETINGS,
HEALTH DEPARTMENT CONFERENCE ROOM
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BOARD MEMBERS: STAFF MEMBERS:
B. G. Brown, Member Randall M. Durant, R.S.
A. M. O'Meara, Member Phyllis Bee, P.H.N.
Carroll M. Mercer, Chairman Joseph Fischnailer,, M.D.
Gael Stuart, Admin.
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COsneuNn.ABLE PUBLIC HEALTHVITALENVIRONMENTAL " HEALTH- {DISEASE CONTROL NURSING NURSING STATISTICS HEALTH EDUCATION y
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�' JEFFERSON COUNTY HEALTH DEPARTMENT
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$02 SNEIIIDAN PORT TOWNSEND,WASH.9f30i (200)308,0722 •
JEFFERSON COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH MEETING .
9:30 November 1, I978
CORRESPONDENCE
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OLD BUSINESS
I. Insurance. Homer Smith Agency'has indicated an interest
in submitting a bid for Health Department insurance. As
a department of county government, it should be included
in the total county policy. Insurance renewal is May, 1979.
2. Other old business. , •
NEW BUSINESS
1. Equipment for the Home Health Program will be included in the
cost per visit fees. Transcribing and dictating equipment is •
needed for client charting and costs are being investigated.
A request fer equipment will be submitted soon. i
2. In the geriatric health screening program, there is a need for
foot care. Mrs. Catherine Merrill is providing the care and 3
fees for service are collected. Because of the need for financial
and payroll accounting, the administrator authorized the channeling
of these funds through the department. Board authorization is
requested.
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REPORTS I
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1. Public Health Nurse f
2. Environmental Health
3. Public Health Officer
4. Administrator
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Next meeting will be December 6, 1978
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COMMUNICABLE PUBLIC HEALTH HOME VITAL ENVIRONMENTAL HEALTH
'SEASE CONTROL NURSING NURSING STATISTICS HEALTH • EDUCATION
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JEFFERSON COUNTY HEALTH DEPARTMENT
� t 802 SHERIDAN PORT TOWNSEND•WASH.66366 GOP365.0722
4411441010
�• BOARD OF HEALTH MEETING
:11" HEALTH DEPARTMENT CONFERENCE ROOM I
BOARD MEMBERS: STAFF MEMBERS: 1
B. G. Brown, Member Randall M. Durant,, R.S.
A. M. O'Meara, Member Phyllis Bee, P.H.N.
Carroll M. Mercer, Chairman Joseph Fischnaller, M.D.
Gael Stuart, Administrator
November 1, 1978
MINUTES
9:30 a.m. Meeting called to order by Chairman Carroll M. Mercer with
all members present. 44
MINUTES:
The minutes of October 4, 1978, were approved by motion of Commissioner
O'Meara and seconded by Commissioner Brown. Unanimous.
CORRESPONDENCE:
1) Letter from Insurance Company of North America regarding the Loss
Control Survey conducted September 19 & 20, 1978. The letter contained
suggestions resulting from the Survey and also a section on Evaluation
Data (see attachment #1).. The Staff discussed the suggestions that were
made. Mr. Stuart stated that he felt the suggestions should be looked
into and corrected or updated as necessary but the Evaluation Data section
isn't really necessary.
OLD BUSINESS:
1) Insurance. The County's insurance is through the Homer Smith Agency.
Mr. Stuart expressed his wish to consolidate the Department of Health's
Insurance with the rest of the County's making one policy. This will
provide a common due date and perhaps be cheaper. Mr. Stuart went on to
talk about error and ommissions being included in the policy. After dis-
,cussing the pros and cons of the matter, the Board told Gael to have
Homer Smith consolidate the insurances if the cost is acceptable. Also
.check Out the error and omissions in the policy.
2) Shine Plat 91. Randy Durant reported that he had met with the Realtor
from Seattle and explained to him why the permit couldn't be approved.
Randy said the Realtor understood fully and was going to talk to the owner.
3) Building Permit; Dick Christiansen. The Building Permit was approved
and an application has been sent out for a sewage disposal permit. Randy
reported that he hasn't heard from him but will contact him.
4) Gardiner Community Center. Randy Durant reported that since the last
meeting he has received some sewage flow rates from Architect Dave Johnston
and now knows the location of the property lines. He reported the soils
to be at the border line and added that in the area provided there wasn't
enough._room for the initial drainfield let alone a replacement area. a
It is expected that the building will have from 124 to 170 people -
per 24 hours.
Randy told the Board that the soil perforates, based on soil conser-
vation maps and some logs down toward the lower County Road, at less than
30 minutes per inch•which is the cut off point. He suggests finding other a
options such as a different type of usage along with •more soil tests on
both the County's property and'the church's property. He added that the
best log has been from the churches property. Dr. Fischnaller suggested
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' Board of Health Meeting
November 1, 1978
Page 2,
perhaps an easement could be obtained from the church to put the drainfield.
on their property.
Commissioner Brown said he felt the water table will change after
the spring is diverted and no longer comes across the road. Randy said
that the design would have to be a curtain drain on the property.uphill
from the drainfield to pick up any seasonal water table.
After further discussion onshe various possibilities it was decided
to turn the problem over to Archetict Dave Johnston and have him and his
engineer solve the matter inthe best way. - .
NEW BUSINESS:
1) Equipment for the Home Health Program. Transcribing and dictating
equipment is needed for client charting. Mr. Stuart reported that the
cost for the equipment for the Home Health Program will be included in
the "cost per visit fees". The advantages of the equipment was discussed
further.
2) Gael Stuart expressed the need for a foot care program in the geriatric
health screening program. At present Mrs. Catherine Merrill, LPN, is
providing the care. The fees for the services are collected and put in a
foot care fund which in turn are paid to Mrs. Merrill for her services.
Because of the need for payroll accounting , Gael said he had authorized
the channeling of these funds in this way. Mr. Stuart requests the Boards
approval of this action. Commissioner O'Meara moved to approve the auth-,
orization, Commissioner Brown seconded the motion. Unanimous. They dis-
cussed further with Dr. Fischnaller, the program and its liability. Com-
missioner Brown moved to approve the program and if the need is apparent
to expand, Dr. Fischnaller and Phyllis Bee may do so within reason. Com-
missioner O'Meara seconded the motion. Unanimous.
REPORTS:
1) Public Health Nurse: Phyllis Bee
A. Report of Nursing Service: (attachment #2)
Home visits had to be cut down because the forms for transfering
patients over to Medicare has been taking up much of the time.
School Health numbers are up due to hearing and vision tests.
Home Health Aid is down because the aid has been ill. They are
in the process of interviewing for a person to substitute.
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B. The people from Maternal Child Health are coming to Port Townsend
to have a workshop on Postpartum Mothers. The Health Education
will then teach the nurses the classes so that in January they
may begin classes on infant care.
2. Environmental Health: Randy Durant
A. Activities Report: (attachment #3)
B. Lazy C. Division 2. Randy reported he has received a list from
the Prosecuting Attorney's office of names of people having lots
in Lazy C Divison 2. He will research to see how many permits
have been issued since 1970.
C. Letter re: Triton Cove Estates Water System, Williams Addition,
Jefferson County, from John Maxwell to Fred Williams. (attachment#4)
D. Discovery Bay Cafe has been closed by Health Department due to a
failing drainfield. It has been fixed twice before and has now
', been failing again for the last=8-znontha without anything being
done to resolve the problem. The store and gas station are still
open at this time.
E. Shell Fish Program concerning problems with toxins. A news release i
was published October 17, 1978 about the problem. The test results
come from the State Lab via commercial testing areas. Based on ='.
those results, the total County remains closed with the exceptions
of Dabob, Quilcene Bay, and South.
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Meeting adjourned
Next meeting December 6, 1978
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-Art attachment 11
Otberillt
Insurance Company of North America
4050 Wilshire Boulevard Terminal Annex Box 4092 Los Angeles CA 90051
2134924600
October 25, 1978
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Mr. Gael Stuart
Jefferson County Health District
802 Sheridan Street
Port Townsend, Washington 98368
RE: Loss Control Survey
HMI-DO-191240-9 f A
Dear Mr. Stuart:
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On September 19th and 20th, 1978, I visited your facility for the
purpose of conducting a Loss Control Survey. The purpose of
this survey was to evaluate the system of control within the clinics
that impact on the quality of patient care and to compare these with
national standards.
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Information regarding your operations were obtained and interviews
with you, Mr. Randall Durant, Ms. Marla Weed, RN; Ms. Joyce
Guptill, RN; and Ms. Sylvia Adams. Additional information was
obtained by a review of selected policies and procedures, medical
records and by a tour of key areas. I regret that I was unable to
meet your Nursing Supervisor due to her attendance at an out of
town meeting.
Variations in practice that were identified and that may detract
from the quality of care and lead to potential losses were discussed
at our summary conference held on September 20th. The resulting
suggestions are attached.
It is realized that further review of the suggestions may be necessary
by yourself, your professional staff, and the Board of County
Commissioners. After considering the impact of these suggestions
on the quality of care and the Health District's potential liability,
please submit a statement indicating the plan of action to be taken
or the status of the suggestions.
Very truly yours
.mot A.
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Arlette D. Figdore
Health Care Loss Control Specialist
ADF:ah
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Mr. Gael Stuart
Jefferion County Health District
October 25, 1978
Page 2
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cc: Bill Gellor, Sr. ,w
Gellor Insurance
Bud Hannon
Special Risk Facility •
File
Numa Laiche, Sr.
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• JEFFERSON COUNTY HEALTH DISTRICT `E
Port Townsend, Washington
SUGGESTIONS
78-1 No personnel files could be located during the survey.
Personnel files should be maintained, and it is suggested
that they contain the following to be complete:
1. Employment application. •
2. Results of references contacted.
3. Validation of current licensure, if any. (This
item should also be up dated upon expiration.) 4
4. An orientation checklist indicating those items
-covered with employee by his or her supervisor.
(Such a checklist should be developed for each
position to assure all significant policy and
procedures relative to the position, including
technical as well as administrative information,
have discussed. The checklist should be dated
and signed by the employee and the supervisor
when complete. This system is especially
warranted in the case of the home health aides
due to the on-the-job training they receive.)
5. Performance evaluations; counselling and
disciplinary actions.
6. Attendance at special seminars and continuing
education activities.
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Such personnel records will serve to document the pre •
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cautions taken by the Health District on behalf of the •
patient to assure than an individual is qualified by train-
ing and experience to perform the tasks they undertake
and that their performance is regularly evaluated.
78-2 In a review of current manuals, the following procedures
were found not to be documented:
1. Emergency procedures to be followed in the case
of fire, cardiac arrest, etc. for Port Angeles and
outlying clinics. l %r
2. Procedure for reporting adverse reactions to •
drugslmedications.
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Suggestions, continued Page Z.
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3. Procedure for reviewing drug/medication
supplies for out dated and recalled stock.
4. Procedure for completing consent for treatment
and take-home instruction forms.
To assure the highest degree of care, written procedures
should be developed to reflect the clinic's current
practices in these areas and be made available for all
personnel for ready-reference.
78-3 The County Health Officer should assume primary
responsibility for providing medical direction and
strengthening the clinical aspects of all Health District
programs. No documentation could be found that in-
dicated the Health Officer's regular review and monitoring
of nursing activities.
It is suggested that the Health Officer rountinely review
patient care records and periodically accompany nursing
personnel, including the Pediatric Nurse Practioner,
during clinic appointments and/or home visits for the
purpose of evaluating the appropriateness of the care
being rendered. Such audit activities should be documented
and the findings shared with the Administrator, the
Director of Nursing and the Governing Body in writing.
This suggestion is not only consistent with guidelines for
an approved Home Health program, but should be extended
to all nursing activities to assure that the highest quality
of patient services are being offered
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JEFFERSON COUNTY HEALTH DISTRICT
Port Townsend, Washington
HMI-DO-191239-2
EVALUATION DATA
GOVERNING BODY
The governing body of Jefferson County Health District is comprised
of three members of the elected Board of County Commissioners.
Board of Health meetings are held at least monthly. Based on the
information obtained during the survey and a review of Board minutes,
the governing body is effectively addressing issues, establishing
policies and objectives, and delegating the authority to implement such
policies and objectives.
ADMINISTRATION •
The Health District is administered by Gael Stuart. Mr. Stuart has
extensive experience as a Public Administrator. He attends all
meetings of the Health District's governing body. Since the split of
the Olympia Health District into Clallam and Jefferson County Health
Districts in January 1978, Mr. Stuart has been actively involved in
the administrative aspects of disaccociation and establishing the in-
dependence of the Jefferson unit. .
MEDICAL STAFF
Direction for medical aspects of the Health District's programs is
provided by the County Health Office:, as prescribed by County statute.
Joseph E. Fischnalle r, M.D., holds the current appointment by the
Board of County Commissioners.
Dr. Fischnaller's training and experience make him well qualified
for the position. An internist, he had a private practice for over
20 years and previous experience serving as medical director for a
currectional system and,, later, another County Health District.
Dr. Fischnaller's appointment is part-time; he holds the same position
with the adjacent Clallam County, rotating time spent between locations.
He attends all meetings of the Health District's governing body.
A suggestion is submitted to increase the Health Officer's involvement
in monitoring/audit activities.
NURSING SERVICES
Nursing services are directed by Phyllis B., who has extensive
experience as a Public Health Nurse. In addition a complement of
three full time registered nurses and two home health aides assist
in providing services.
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Evaluation Data, continued Page 2.
A suggestion was offered to establish complete personnel files which
reflect the training, credentialing and continued evaluation of these
individuals.
There is a system of new employee orientation; it was suggested Y that
the system be formalized by way of a checklist indicating items
covered and completed in the orientation of individuals for the various
positions. The checklist should be included in the individual's personnel
record.
Staff meetings for R.N.s and aides are held at least monthly. 4
Administrative policy and procedural matters, case reviews and in •
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service topics are discussed.
Policy and procedure manuals are available describing the standards
and guidelines for the various services, particularly those federal
and state funded programs. However, the need was noted and a
suggestion offered for establishing a general administrative manual
which will include those policies and procedures which relate to $ j
operations but may not apply to a specific clinic or program.
CLINICS AND SPECIAL SERVICES
The following health services are provided in approximately 14,000
out patient visits (including school system children):
1. School Health Services- perform vision and hearing screening,
student/parent/teacher health conferences, general first aid as
needed.
2. Maternal/Well Child Health Program - conduct post-partum,
home follow-ups and new baby care instruction. Well-health
screening exams for children through age 6 are conducted.
Physical evaluations are made by the Pediatric Nurse
Practitioner(the same individual conducting services in the
Port Angeles area) with medical back-up provided by the County i s
Health Officer.
3. Home Health Agency - provides skilled nursing service and
assessment for the homebound by public health nurses and
personal care by home health aides. All services are
coordinated with the individual's private physician.
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NOTE: Program is currently seeking certification under State
Medicaid/Federal Medicare guidelines. Plans to satisfy
governmental regulations and standards will greatly improve
communication with private physicians and documentation of
the care provided in this program, two areas which present
potential malpractice exposure. Coordination of this effort
is being conducted by Claudia Davis, RN, in a thorough manner.
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Evaluation Data, continued • Page 3.
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4. WIC Clinics - providea supplemental food vouchers to eligible
milies to improve nutrition.
5. Tuberculosis and Venereal Disease Clinics - provides diagnosis,
treatment, consultation and follow-up.
6. Immunization Clinics - for children, adults, overseas travel.
7.- Crippled Children's Services - provides case management
and financial assistance for eligible children with certain
handicapping conditions.
8. Health Education - provides speakers and materials for
conferences and meetings on topics related to preventative
health.
AU services are offered appropriately within the skill level of the
particular professional. No treatment, no medications are given
without written orders by the private physician or Dr. Fischnaller.
With the exception of Home Health, documentation of care plans and
visits are adequate, and it is anticipated that Home Health records
will improve with the implementation of newly developed forms.
Forms for consent for treatment, take-home instructions, and release
of information are satisfactory. It was suggested that administrative
policies and procedures describing the use of these forms be developed.
The District has no formal laboratory or x-ray facility. The limited
number and type of drugs used for immunization and take-home treat-
ment purposes are procured through the state system. A policy and
procedure to check for outdated and recalled drugs was suggested; a
policy describing the actions to be taken in the event of adverse drug
effects, as was recently experienced, should also be developed.
ENVIRONMENTAL HEALTH SERVICES
The following environmental health services are provided by two
environmental health specialists:
1. Waste disposal - design and review of all sewage disposal
installations; site and soil evaluations; subdivision review
and consultation.
2. Food and drug establishment inspections.
3. Water supply inspection.
4. Solid waste disposal - landfill checks, etc.
5. Vector control -vermin, mosquitoes, rabies.
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Evaluation Data, continued Page 4.
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Activities in this area have been increasing rapidly due to population
growth in the area and the Health District has been experiencing more
appeals of Environmental Services judgments.
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attachment #2
REPORT OF NURSING SERVICE
.0etobWr 1978
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Sept. Oct.
HOME VISITS 236 .261 ' 76
OFFICE VISITS at qn 17
NEWBORN 14 5 7
A UNDER 1-YEAR 30 36_ 8
G 1 - 5 36 46 7
g 5 - 21 14 4 9
S 21 - 60 28 31 25
60+ 175 229 90
M.C.H. . 29 84 0
G.C.S. 12 • 4 13
ADULT HEALTH 41 26 28
p ACUTE COMMUNICABLE DISEASE nu 197
H CONTROL Immun 16 238 151
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G- V.D. 3 4 4
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SCHOOL HEALTH 1130 114 701
V.I.C. - 20 16 n-
DENTAL • 0 0 0
HOME HEALTH (AIDE) 108 iv Ana
HOME HEALTH (P.H.N.) 59 103 90
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JEFFrcwSOU C)UNTY HEALTH DEPT.
802 Sheridan Ave. attachment #3
Port Townsend,Wash. 98368
To: Board of Health
From: Randall M. Durant, R.S.
Director of Environmental Health
Date: November 1, 1978
Subject: Activities - Environmental Health for October, 1978
Field Work: Increase in permits and site evaluations over the same month last
year. Average per month is 43 sewage disposal permits (this month-
46) and 66 site evaluations (71 this month). Approximately 85 -
90Z of our time has been in sewage and subdivisions and site
evaluations.
Other Field Work:
Food Complaints Water Other Finals Followup Total
6 10 2 16 7 31 72
Contacta: Office calls, telephone calls, plan review
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Sanitarians: 354
Secretaries: 267 telephone
127 office calls
394 total for secretaries
748 total for both
Total contacts of sanitarians and secretaries for year to date (does
not include field contacts): 5,707
Food Handler's Permits: October - 23
Year to date - 419
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STATE OF DEPARTMENT OF SOCIAL AND HEALTH SERVICES
t'«/ WASHINGTON
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n.+ .. Dixy Lee Ray
Gourmor a achment j4
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October 26, 1978
RECEIVED
Mr. Fred Williams pC 3018
Star Route #1
- Post Office Box 145 X JEFF. COUNTY
Lilliwaup, Washington 98555 HEALTH DEPT.
Re: Triton Cove Estates Water System,
Williams Addition, Jefferson County
Dear Mr. Williams: -
I have received recent complaints from customers on your water system con-
cerning interrupted water service. Emergency outages or even mechanical
repairs are not always predictable events. However, they should be corrected
within a reasonable time period. My understanding is that the current outage
has persisted for one week which is an exceptionally long time to make needed
repairs, if in fact this is the reason for the outage. Therefore, I request
that you provide me with a status update concerning the reason for the recent
outage and what efforts have been made to reinstate water service. I should
also formally notify you that the Rules and Regulations of the State Board
of Health Regarding Public Water Systems provide for reliable continually
operating water systems that can not be arbitrarily terminated without proper
notification to customers.
In checking our file I do not find any response to Mark Spahr's letter of
June 30, 1976 to you nor do I find any information verifying the chemical
or bacteriological acceptance of your well. This information regarding
water quality is as important as that regarding water quantity and well con-
struction which is listed in paragraph four of Mr. Spahr's letter.
I feel that the uncertainties associated with your water system do not warrant
further expansion and am asking the local health department to deny further
septic tank permits until you have answered the above questions.
Peel free to contact me at (206) 753-4152 if you have any questions.
Sincerely,
John M. Maxwell
District Engineer
Water Supply and Waste Section
MS LD-11
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cc: fferson County Health Department
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October 4, 1978
Carl F. Ackerman
Box 353
Quilcene, Washington 98376
Dear Carl:
Your problem was thoroughly considered this morning by the Board of Health
and they have permitted me to suspend any further action at this time.
In other words, we all realize that you have ignored the law requiring
building and septic system permits, but at this moment there is no danger
to your family or to the health of the community. Therefore, the Board
has directed that Health Department personnel make frequent checks of
this syptdc system to determine that it 1s still operating safely.
We must ask you to permit visits by our sanitarians for this purpose
and we expect you to advise us of any evidence of sewage surfacing.
IfIf the t tsystem fails, and I think you know there is a pretty good chance
in ordertoto eliminatenall health will ave to figure out some hazards. We all hope way
will repair it
Sincerely,
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4. E. ilachnaller, M.D.
Health Officer
JE/sa
CC: Board of County Commissioners
William E. Howard, Pros. Attny
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• PUBLIC NOTICE
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NOTICE IS HEREBY GIVEN THAT THE NEXT SCHEDULED MEETING OF THE
—JEFFERSON COUNTY BOARD OF HEALTH WILL BE HELD TUESDAY,DEGEM,BER12, 1978,
AT 9:30 A.M., IN THE HEALTH DEPARTMENT CONFERENCE ROOM.
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Please publish November 23rd. and 30th.
Thank you
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111MOMMINNIma •
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Affidavit of Publication
STATE OP WASHINGTON)
COUNTY or JEPFERsote
SRAN K W. CARPED, being sworn. says he la Pro
bvbbsltw of Ms Port Townsend Lawler, a weekly
awrsplper which has been established.published It.ne
• mash terabuade and nircutatsd continvwsty as a weak*
and�paPa�in the town of Port Townsend,in said County
Eg1a,and for sensual circulation to said county her
geed than*hi(I)months prior to in.date at the tint
pobllcatian of ifs Notice hereto attached,and that tee
Mid Pod Townsend Leader was on if.27th day of June.
V - lift,annoyed ass legal newspaper by Ma Supsler Court
of weed lagwaort County.and that wmadd te a mammy
et the
Public notice —meeting of
Jefferson County Board of Health.
M winkMd owinkwill bekaldt -
sm.id,ten.et OW ;
top ilipshh Dep/MMAM
as It appeared Was mauler and eatas Maur of sue peps+
Itself and not In a supplement usenet ter a psbd of
2 mlosetl&Ws wanks.badhnlesan the
23 day pe Nove'iber e,Z - -
and y ending on Me_.3�day of l:oYunber
ts�rt.sad that said newspaper was apvimfy distributed
I t ta Its eulccdbse during all of this pans.That Ma flip
roust of 11J1•76 bag ben—in bill.et the
WNW Waver sole for seat
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Subadlbed and sworn before sae Wile 1- day
Rnof
suesher ts�µ.
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--" Notary Pubes in and far Ma Sato of
WadMuSlon.resides at pat Townsend
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