The URL can be used to link to this page

Home My WebLink AboutSEP1973-00043r ,Ir•.rludq the. following items on your plot Alam,-- i o Property boundaries b Names of adjacent streets c` Driveways and parking spaces o Surface water (ponds,creeks, etc) a/' Buildings(res'idence, sheds, garages, etc) A5 $ e e vP PLOT PLAN -date prepared ' 1J "(o' ,5. Permit # or Parcel # ` Evaluation of an Existing Q A/ Septic tank a/ Drainfield (enter NN if unknown) / o North Arrowc?67L trr 'To .S'cc,/G �Xcc: v� t 'Rex ► .0 . w/mol Nek Otis ll5 K..2 C�iA not LMCs VCr p rf; Ml t!� WaZd tia el e��no�►c - 10cut pol +o 4kt MA i caj�d 4 0- LA)0\,S -�c l �- po4 *kj- a 9 j jJ c, r rc> vv 14 I \ S� Milo L Sewage Bystem _01130/04_of 3- dntl� Jefferson County Department of Community Development MP, 9 �j 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 1((S11d ONSITE SEWAGE SYSTEM MONITORING INSPECTION CERTIFICATION The onsite sewage system serving —7 0ro on parcel # Q 3 5 (1 6000q , permit # 1 3 —� was most recently inspected. by. in Jefferson County Code 8.15.150. as specified The above referenced system is in compliance with the Monitoringrinspection schedule identified in Table 1 of Jefferson County Code 8.15. See report completed for information on the condition of the onsite sewage system. RECOMMENDED REPAIRS/MODIFICATIONS TO THE O (SITESEWAGE SYSTEM ARE LISTED ON THE INSPECTION REPORT DATED . 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 `&Q3 Table 1 of Jefferson County Code 8.15 requires that this onsite sewage 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 or future approvals for development of the property. re of Jefferson County Employee Date I- 1- o3_ �0(— c5y\,Q (^ c Corn -T1 L), \\Heahh mff\home\env heWth\linda\GD�RMS\EES fo=WlONTfORING INSPECTION CERIUICATIONI1-17-01.doe if . Jefferson County Department of Community Development office Use Only 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 Date Evaluation of an Existing Onsite Sewage System (EES) Fee Recpt Draw on the back of this sheet a current plot plan showing location of: Check Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a curre - o identifying these items. e ALL SPACES MUST BE FILLED IN. If information isnot available enter (NV) or not applicable (NA). OCT - 7i Type of Evaluation Rea on for E:MFififiah COUNTY ❑ Routine Operation A01"41NITY OEIIELOPMENT evaluation of on-site sewage system 1A Real Estate transaction ❑ Evaluation of drinking water O Complete a Permit # O Building Permit Review and/or no septic permit on file ❑ Evaluation of on-site sewage & drinking water ❑ Other, explain Tax Parcel # 0l35g00009 Permitted System )c yes no Permit/case # SEP — Subdivision, Division, Block and Lot(s) _'LRtL oC►E NAXEM Zk'4 $ 4A rwsr. Lot Size ea,� cre or Dimensions—X t7,,pao SVFi) Current Owner F,E,CCp,� Z-xr- 1.tJ Site Address '7 o CM Owner Phone #loo- 4.31- aa�a Previous property owner name(s) - (NN if not known) w3A Directions to Site �_� � R�cwv �� KR whK r�wwcs�vt�� w 1K ►�D1li,� � W� SV,E,RRew ET• Date System Installed_ S^1_ Age of Dwelling_ Igi3 —# Bedrooms House Occupied X yes no, vacant how long? Who installed system? �'oWw Sl\o1.,0 Send completed report to: Owner Name iz t= e ��c SaN V'LM Mailing Address_jj�,QAQR�,� c'Z. , �eRTLuDI..oW��A• �$ on /emaiVfax_ Realtor or Other Representative Name �l,a L. S�rat_'11►, �►t B�sttt�� L f • Include the following items on your plot plan: o Property boundaries v Wells U . Names of adjacent streets v Septic tank C3 Driveways and parking spaces o Drainfield (enter NN if unknown) SurFace water (ponds,creeks, etc) v North Arrow o Bu s(residence, sheds, garages, etc) �Fn) CPVEr 1 PLOT P .,,M Tt)i' O SCALE 9E;7 k' V Permit# or Parcel #gip —1S-43 Docurrentl 2 of 4 W 11NI OCT - 7 2003 l , S lv?1' P & JEFFERSON COUN ri DEPS". OF Cn,'&j11JN1TY DEVELO ENVIRWCHECK, L.L.C. 1612 Hastings Ave. W. Port Townsend, WA 98368 Evaluation of an Existing Onsite Sewage System Date of Inspection "n O S Inspected by �A� v�TSlt�"R �� .�V� Flo, Water Supply (fill in only if water supply'is being tested in this evaluati _ Sample was taken Yes No Sample Resultsn C E 9 V E Well casing 12" above ground Yes Not -11 Sanitary Seal in place Yes No OCT - 7 Public: offsite onsite Name of System - Individual: offsite onsite Is well more than 100' to drainfield/disposal component _yes nof TY „p�A��„ Is well more than 50' to tanks and effluent transport line ves .cn z a �- ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept records for this case120 #1 - Septic Tank Tank size :1 5�n gal, single compartment two compartment C o ha elf- material Riser to grade on inlet ves �K no. Riser to grade on outlet vest, no Condition of tank_ 'X good needs repair, describe 1 st comp. Scum (top layer) . L n. sludge (bottom layer) 12L in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? ves X_ no If yes, where was water Condition of baffles: Inlet Good) needs repair material (PVC,(o re e Outlet: _good needs repair X material (PVC o re Screened Outlet _ X no _yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)),k_ yes no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: (eg: 9) (D I Does system include a pump? yes If yes, complete the next section ---)i 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 ? ves no If yes, where was water observed? Screen around pump? ves no Shroud around pump? ves no Electrical Components Pump operating ves no, describe High water alarm functions ves 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: ves no Permit # or Parcel #'� E p 711--LV�% Documentl 3 of 4 Evaluation of an Existing Onsite Sewage System #3 — Drainfield Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage (check one) yes, if yes, describe and diagram on plot plan X no �^ drainfield area is overgrown and not observable Signs of parking/driving in area X yes no drainfield area unknown S" evAV1SAVS Ground settling or erosion ves �n0 overgrown/not observable Monitoring Port Observations (if present): Residual Head ves, # of inches no Ponding in trench ves, # of inches of ponded effluent �� _no. Repair area is? Available as shown on permit None evaluated or shoyvn-on-r pe^' -..mit _ — - Addendum Is attached for evaluation of Treatment Unit or detailed evaluation of, n alC CLI s . e COMMENTS (attach additional sheet if necessary): nOCT — 7 2003 ' A . �ISERS �a� 1V% lJ 1DxTo%7 d I,� �,s �.) C 4,3. �►frFL.iE �S 71�GRae►D'�1�� A� Jrrrrr�ER�ON COLI'MI uitiYLv -�iQPrEPTB.7WE 5% VLE' NBE 4?Lho-av -14� 3 - A. `VHF-?€ WAS ?M1J ISOME ou\310r " Vo tJ& am I mo& ?kg% of —Mir, 1Df lbw EJ L!,L D. 1Z>0 lM\31F OR- �AR k ow SEE ATTACHED ADDENDUM Was a System Problem Identified? Yes 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 Wormatio a review of County records and my direct observations at the time of inspection. 099 a3 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. 1�a' Permit # or Parcel # ® T � Documend 4 of 4 ADDENDUM Enviro Cheek, L.L.C. Company Disclaimer DATE e3g oS .ADDRESS na SQ&M�1r:,Q,L, : pVINER k.LLo 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 and do not indicate legal property lines or boundaries. Company Enviro Check, L.L.C. 1612 Hastings Ave. W Port Townsend, Wa. 98368 360-379-9400 roCm ,a tp FOCT - 7 203 JEFFERSON COUNTY DEPT. OF COMWAUNITY DEVELOPMENT 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. D e R, urtsmith Co- r Weather Conditions C t SAMPLING (Septic tank) Date - PH Result - DO Result - Temp. Result - Counter Setting - Hour Meter - Water Usage (Ave.GPD) Met Squirt Height (In feet)- 903 E. Caroline OLYMPIC HEALTH DISTRICTS � mi No. Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Submit inDu$�cate Builder Court House Port Townsend �`!04 W, Date 62 OWNER ADDRES PRME DIRECTIONS FOR LOCATING APPLICATION IS H=Y MADE -TO: INSTALL N31 SYSTEM REPAIR EXISTING SYSTEM E OF BUILDING I NO. OF BROOMS BASEMENT SITE 9� NAME OF -INSTALLER .CKD— DRAINFIELD LENGTH /� TIDTH ;Z- DEPTH /ff ��. #LINES 2 SEPTIC TANK ;SIZE - DRAVI A DETAILED PLOT PLAN BELOV1. SEE INSTRUCTIONS. SOIL TYPE �✓�'�V.vtA3 � s �,� tis � � " � � v �.�,. ��. s `� 'it��."' ° OCT � 7 2003 =� : vi or b/X5/74 C:\.e &-o 1 RTTf /1Tf� .+ i _.._u I .uywy11V19 Vll l21..L.U' 9 PERMIT S PRIOR APPROVAL OBTAINED FRONT THE HR-ALTH DEPARTMENT. Lr�y u9aat►y1,Hl �yld SIGUkTURE OF APPLICANT APP( VED' ✓// DATE to INS rip BY <; ` SANITARIAN'S C01114MS: � � - O•aaY` `�'�� DATE C s' �� , .. a �� i �+ N� vT�E MANNER APPROVED BY THE LTH DATE N%1 56 mm r Parcel Details Page 1 of 2 Parcel Number: 935900009 SEARCH Parcel Number: 935900009 Owner Mailing Address: REBECCA KOLLN JASON KOLLN 70 SPARROW LN PORT LUDLOW WA983659528 Site Address: 70 SPARROW CT PORT LUDLOW 98365 Section: 9 Qtr Section: SWI/4 Township: 27N Range: 1E School District: Chimacum (49) Fre Dist: Port Ludlow (3) Tax Status: Taxable Tax Code: 231 Planning area: Paradise Bay (8) Sub Division: BRIDGEHAVEN DIV 8 Assessor's Land Use Code: 1100 - HOUSES (single units, non-farm) 58/205, 18/230 Property Description: BRIDGEHAVEN DIV 8 1 9 1 1 1 Click on photo for larger image. Printer Friendly D E C E 11 OCT - 7 2003 JEFFERSON "'1UN T,r i ijEK OF DEVELOPMENT Permit Data Assessor Bldg Data x ales Info [Map Parcel Plats & SunLeo Map Output Page 1 of 1 ArcIMS HTML Viewer Ma 93MM12 ti owusomt� Legend M MOM � MOW= l• seoacWa Feat,ms i TfQ '3tiT?II00M 11 ' pqp q �LA�Y a 1} r ' OCT - 7 2003 Adr s; mA iall y J -I R nCardrCerdrd8er i G5 I I p I 1077 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 (lection. Tue Sep 3016:05:30 2003 SEP3 oay3 903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No. Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House Port Townsend .1_6 y W Date OG�NER ADDRES" : r' ` /%� PHONE DIRECTIONS FOR LOCATING SITE A'iN, / L41. 9 M - �,Ir APPLICATION IS HI -MY MADE TO: INSTALL N 1 SYSTEM "REPAIR EXISTING SYSTEM YPE �ADR8;9 I I OF BUILDING NO. OF BASEMENT SITE NAME OF INSTALLER DRA.INFIELD LENGTH %bV . '. WIDTH y DEPTH le " #LINES 2- SEPTIC TANK SIZE DRAW A DETAILED PLOT PT.AT\T RFTnW- fiF'F. TNfirr1THt'.rPTCINC-Q()TT. TVDr. V�� p1, 5 � a � `<S 1 � •— � '� v wSl. c �4 �J� S C�`a `�� "' i z01` n 0,N \ a,SC'-, z5 17; c, NQ GILDING OR SE --'AGE DISPOSAL PLANS, LOCATION OR SITE, .IOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. A DATE OFINSTALLATIN SIGNATURE OF APPLICANT APPROVED' DATE < INSPECTED-. BY 0—,W.S� DATE SANITARIAN'S COMMENTS I CERTIFY THAT HIS SYS E �, 5 Il\ T;LL /T� MANNER APPROVED BY THE HEALTH DEAPRTM , \ DATE 1 � lv,E �k4v 1 a D 1 �I I yy i� 9 yr 1 L y I I Iir I 2 5 X I I, � f II;, III 1 a, i I r I I ow, ,-