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Home My WebLink AboutBLD2015-00108 - 01 PERMIT APPLICATION • a BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD15-00108 Received Date: 4/3/2015 SITE ADDRESS: 1890 IRONDALE RD Issue Date 4/14/2015 PORT HADLOCK, 98339 Expiration Date 4/14/2016 OWNER: GAIL E REED FMLY TR B PHONE: NICKEL & COMPANY, LLC 1014 VINE ST CINCINNATI OH 45202-1141 SUBDIVISION: Block: Lot: 38+ PARCEL NUMBER: 901024063 Section: 2 Township: 29 N Range: 1V1 CONTRACTOR: DEVIN JOHNSON PHONE: 206-842-9993 595 MADISON AVE N BAINBRIDGE IS. WA 98110 Contractor's License 602-221-948 Expires 4/5/2016 PROJECT DESCRIPTION: CONSTRUCT NEW PERMANENT ROOF ACCESS LADDER ATTACHED TO SIDE OF EXISTING BLDG. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 5,000.00 ADD'L: HEAT TYPE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $102.00 SRE 04/02/15 154275 Exist: Permit $66.30 SRE 04/02/15 154275 Prop: State Building Code $4.50 SRE 04/02/15 154275 Total: Total: $172.80 NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY • a Jefferson County Building Division Permit Number: BLD15-00108 Applicant: REED FMLY TR B BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous nclosed,fixed ladder. installed per plans A final inspection will not be scheduled until the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION $115 FINAL INSPECTION UST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR Sally Ellis From: Devin Johnson <devin @johnsonsquared.com> Sent: Tuesday, April 14, 2015 9:02 AM To: Sally Ellis Subject: RE: bld15-00108 building permit for ladder at QFC in Port Hadlock Hi Sally, Thank you for reviewing the project. Would it be possible for you to mail the permit to the Contractor? Elite Commercial Contracting Rob Larson 804 W Meeker Suite 201 Kent,WA 98032 251893.3122 Direct 253.893.3100 Office Thank you, Devin From: Sally Ellis [mailto:SEllis @co.jefferson.wa.us] Sent:Tuesday,April 14, 2015 8:34 AM To: Devin Johnson Subject: bId15-00108 building permit for ladder at QFC in Port Hadlock Good morning Devin Your building permit BLD15-00108 for QFC in Port Hadlock has been approved and issued. Please advise if you would like to pick this permit up at our office or if you wish for me to mail this permit to your office. If you have any questions and or need more information please don't hesitate to contact me. Thank you Sally L Ellis Jefferson County Community Development Permit"Technician 621 Sheridan St. Port Townsend,WA 98368 360-379-4452 sellis @co.jcllerson.wa.us 1 BUILDING PERMIT APPLICON BLDview Type: Re Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: SITE ADDRESS: BLD15-00108 1890 IRONDALE RD Received Date: 4/3/2015 PORT HADLOCK, 98339 OWNER: GAIL E REED FMLY TR B PHONE: % NICKEL& COMPANY, LLC 1014 VINE ST CINCINNATI OH 45202-1141 SUBDIVISION: Block: Lot: 38+ PARCEL NUMBER: 901024063 Section: 2 Township: 29 N Range: 1V1 CONTRACTOR: DEVIN JOHNSON PHONE: 206-842-9993 595 MADISON AVE N BAINBRIDGE IS. WA 98110 Contractor's License 602-221-948 Expires 4/5/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CONSTRUCT NEW PERMANENT ROOF ACCESS LADDER ATTACHED TO SIDE OF EXISTING BLDG. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 5,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $102.00 SRE 04/02/15 154275 ��®!/ ® Permit $66.30 SRE 04/02/15 154275 d State Building Code $4.50 SRE 04/02/15 154275 APR 14 2015 Total: $172.80 Jefter:on County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 4/3/2015 • • i'' S°N co DEPARTMENT OF COMMUNITY DEVELOPMENT �%L 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.ieffer son.wa.us/communitydevelopmcnt is-mail:dcd@ico.jetTerson.wa.us �yS/i j N CC• 0 PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application Us: MLA# Site Information Assessor Tax Parcel Number: 901024063 Site Address and/or Directions to Property:1890 IRONDALE ROAD, PORT HADLOCK,WA 98339 Access(name of street(s)) from which access will be gained: IRONDALE ROAD / NESS' CORNER RD. Present use of property: COMMERCIAL/RETAIL Description of Work(include proposed uses): CONSTRUCT NEW PERMANENT ROOF ACCESSIAJDER L T, , I } : . :_ IDE OF EXISTING BLDG. Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES _ NO _ 1 If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: I Septic Septic Permit#: SEP97-272 Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _1 _ Partial Has a reserve drainfield been designated? Yes _✓ — No — — Date of Last Operations& Maintenance check: 11/20/2014 _ • • •• Describe or attach any drainfield easements, covenants or not,ces or;title, w,;icn may : - ��! ro•env,, • �' r .-. ------� ( j r" ; APR - 2 2015 +i ill '6 j;I /, �� W 1 �/(J ... J n�n�f;;:CLUIVTY �7 or rOrgplinn'DEVELOPMENT • • The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/e-mail requests and information about the application to the authorized agent/representative and will copy(cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e., County email is not blocked or sent to`junk mail"). Applicant/Property Owner Information Property Owner: Name: QFC / GAIL E REED FAMILY TR B, NICKEL & CO LLC Address: PROPERTY TAX, 7TH FLOOR, 1014 VINE ST, CINCINNATI, OH 45202 Phone#: _ E-mail Address: Please co ct Authoriz •__,:ent/Representative with project info. (select only one). Property Owner Signature; ; �� - Date: 4/0„/`g" Note: For projects with multiple owners,attach a sepa - • sheet w eac owner(s)information and signatures. Applicant: Authorized Agent/Representative(If other than owner) Name: DEVIN JOHNSON / JOHNSON SQUARED Address: 595 MADISON AVE N, BAINBRIDGE ISLAND, WA 98110 Phone#: 206-842-9993 E-mail Address: DEVIN @JOHNSONSQUARED.COM Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer f Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement ! V. The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not ken'.-d contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. ,j Signature: Print Name: Date: I'tnn, 'q�h 6c�u��n P.n��2. 2 • • v_sON c,O DEPARTMENT OF COMMUNITY DEVELOPMENT 4 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.3794450 I Fax:360.379.4451 ti • Web:www.co.jeffcrson.wa.us/communitydcvclopment E-mail:dal@ko.jefferson.wa.us N``�O� SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt tt: Date: Related Application Us: Payment tt: Site Information Owner Name: tom' _ Assessor Tax Parcel#: 9o1 0 Z'-O(p', Type of Building New Replacement Relocated Addition s Repair Demolition " 'A separate permit is required Select One: Single Family Residence Modular Other X iist CO MtKEg.CtAL Proposed Building/Project Number of floors 1.1/A U new bedrooms existing total bed U new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane X Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor 311 OBIS 140 0-10.Z:6' Residential/Commercial Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated Attached Garage- heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less �7 Deck-uncovered I FE Covered porch Other(shed, barn, pole bldg,etc.) GAS s7A-tno8 2 I$l05 I Na Cli PC∎p Estimated Cost of Project (Required): $ rj o°o APR 2 O1rj ;l 'upp1rmrc:1 1'l,12 I it ■ • • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use d f,oCE 4 S'►bSZE C.on4 01 EftCIAL cite, S?A11O4 COW. tERCtAL By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his, her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any re. ed l- -r inspections. Applicant may request notice of the County's intent to enter upon the property for vi ICI,. : tot Ofriplication and subsequent permit issuance. Signature: „ a'! Print Name:711((S 0 44 1,,ISO/J Date: Mir,/ Estimated Cost of Project $ S ,bop For Department Use Only Building Base Fees Building Base Plan Check Review Land Use Review Septic Review Iffali Potable Water $ Technology/Scan OM* State Fee . Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach 7 Total Fees J rE — Receipt# Date: Cash/Check/CC: !lb; I j • • 4-5 ON eo DEPARTMENT OF COMMUNITY DEVELOPMENT 6, 621 Sheridan Street,Port Townsend,WA 98368 TeL 360.379.4450 ( Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment E-mail:dcd@co.jefferson.wa.us 9S�I NGecO PERMIT FEES WORKSHEET Name QFC Parcel # 901024063 Estimated Cost of Project $5,000.00 Permit# Building Base Fees Building Base $102.00 Plan Check Review $66.30 Land Use Review Septic Review Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning New Address Public Works Total Fees $192.30 Office Use Only 1 E C l! V Receipt Number: Cash/Check/CC: ' APR - 2 ?015 Date: i Jc " RSON C uNfY .J,OF COMMUNITY DEVELOPMENT Parcel Details Page 1 of 2 1 1 I iefferson County ..:. �� Weather Station 73 ' Database Took Maps r..Yat Wlebcam Home County Info Departments - Search Parcel Number: 901024063 I 1 SEARCH Parcel Number: 901024063 Printer Friendly Owner Mailing Address: GAIL E REED FMLY TR B NICKEL & COMPANY, LLC PROPERTY TAX 7TH FLOOR 1014 VINE ST CINCINNATI OH45202-1141 Site Address: II Section: 2 School District: Chimacum (49) Qtr Section: SE1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 0211 Planning area:Tri-Area (4) Sewer: Drainage: Bank: View 1: View2: Zoning 1: UGA-C - Urban Commercial Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 5400 - Retail Trade - Food Property Description: S2 T29 R1W TX38,49,50,88,133(ELG BY 149&150) Tax,A/V, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Survey Septic Monitoring Info '( - , Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH --- Best viewed with Microsoft Internet Explorer 6.0 or later 0 Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO=901024063 4/3/2015 JOHNSON SQUARED INC • Page 1 of 1 • unfit rnicio en F panol Contaet Search L&I SEARCH A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing A Washington State Department of 4 ) Labor & Industries JOHNSON SQUARED INC Owner or tradesperson 9359 OLYMPUS BEACH RD AMY JOHNSON BAINBRIDGE IS.WA 98110 Doing business as JOHNSON SQUARED WA UBI No. Governing persons 602 221 948 AMY JOHNSON DEVIN M JOHNSON; Workers' comp Do you know if the business has employees?If so,verify the business is up-to-dale on workers'comp premiums. L&I Account ID Account is current. 052,349-00 Doing business as JOHNSON SQUARED Estimated workers reported Quarter 4 of Year 2014"1 to 3 Workers" L&I account representative T2/LINDA ALGUIRE(360)902-4678-Email:POTH235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. �J Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602221948&SAW= 4/3/2015 • • 3123!2015 AQUA TEST, INC. P.O.Box 1116 (425)432-9360 Black Diamond, WA 98010-1116 Fax:(425)4f3-9431 PROPERTY INFORMATION QFC#870 Location:1890 Irondale Road Port Hadlock Tax ID:901024063 Mail To QFC 3663 1st Ave S Use:Commercial,Food Establishment Seattle,WA System Design Flow:0 98134 Owner.QFC ON ID:SOM97-00272 Fold r ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT . Fold Here Here Inspected:11/20/2014 - Inspection Type:INTERMITTENT - Correction Status:No corrections made Company: Work Performed By Submitted 01/12/2015 by.' AQUA TEST,INC. Paul Cadwallader Matt Lee This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficiencies Noted:deficiencies must be corrected to ensure proper longevity of the Onsite Sewage System. 1 to 2 inches of ponding in DF test ports. GENERAL SITE&SYSTEM CONDITIONS The General Sile and System Conditions were: Fully Inspected All Components accessible for maintenance,secure and in good condition; YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: _ _ YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: _ _ NO Abnormal ponding present for one or more of the disposal components: NO Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe In notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): OSS Components,structures and appurtenances located per as-built/record drawing(If NO,describe YES in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Pump Tank Lift to surge This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches,If other specify): 0 Pump vault screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 6 Pumping needed: NO Pump Vault Fitter cleaned(NIA=not present): N/A Approximate Gallons to be pumped(if needed)by Certified Pumper; 0 ReportlD:415747 View inspection reports online at www.onlinerme.com Page 1 of 4 TANK:Septic Tank-2 Compartment 2140 gal This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 4 Effluent filter/screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 14 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 12 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper. 0 TANK:Septic Tank-2 Compartment 1620 gal This component was: Fully Inspected Component appears to be functioning as intended: YES 'Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES 'Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 1 Effluent filter/screen needed cleaning on anival N/A Compartment 1 Sludge accumulation(Inches,If other specify): 16 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 12 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 TANK:Surge Tank 6420ga1 This component was: Fully Inspected Component appears to be functioning as intended: YES All required baffles in place(N/A=No baffles required): YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 6 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 erobic Treatment Unit:Nibbler Unit,Manufacturer=Aqua Test Inc.-Nibbler Sewage Treatment System Manufacturer:Aqua Test Inc. Model:Nibbler Sewage Treatment System This component was: Fully Inspected Component appears to be functioning as intended: YES ATU Settings verified as correct: YES Foaming action normal: YES Aerobic mechanism/Air Pumps functioning as intended: YES Aerobic Mechanism cleaned: YES Feed orifices cleaned: YES Air Pump Velocity normal: YES Air intake filter cleaned: YES Alarm mechanism functioning as intended: YES Unit vented properly: YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 20 Pumping needed: NO Pumping recommended: NO Bulking noticed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: • 0 Toxicity noticed: NO Blower Alarm Mechanism functioning as intended: N/A ReportlD:415747 View inspection reports online at www.onlinerme.com Page 2 of 4 Aerobic Treatment Unit:Nibbler Unit,Manufacturer-Aqua Test Inc.-Nibbler Sewage Treatment System Manufacturer:Aqua Test Inc. Model:Nibbler Sewage Treatment System This component was: Fully Inspected Component appears to be functioning as intended: YES ATU Settings verified as correct: YES Foaming action normal: YES Aerobic mechanism/Air Pumps functioning as intended: YES Aerobic Mechanism cleaned: YES Feed orifices cleaned: YES Air Pump Velocity normal: YES Air intake filter cleaned: YES Alarm mechanism functioning as intended: YES Unit vented properly: YES Compartment 1 Scum accumulation(Inches,if other specify): o. Compartment 1 Sludge accumulation(Inches,if other specify): 24 Pumping needed: NO Pumping recommended: NO Bulking noticed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 Toxicity noticed: NO Blower Alarm Mechanism functioning as intended: N/A Aerobic Treatment Unit:Nibbler Unit,Manufacturer=Aqua Test Inc.-Nibbler Sewage Treatment System Manufacturer.Aqua Test Inc. Model:Nibbler Sewage Treatment System This component was: Fully Inspected Component appears to be functioning as intended: YES • ATU Settings verified as correct: YES Foaming action normal: YES Aerobic mechanism/Air Pumps functioning as intended: YES Aerobic Mechanism cleaned: YES • Feed orifices cleaned: YES Air Pump Velocity normal: YES Air intake filter cleaned: YES Alarm mechanism functioning as intended: YES Unit vented properly: YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 22 Pumping needed: NO Pumping recommended: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: -0 Bulking noticed: NO Toxicity noticed: NO Blower Alarm Mechanism functioning as intended: N/A TANK:Clarifying Tank(Nibbler)-2 Compartment,Manufacturer=Aqua Test Inc.-Nibbler Clarifying Tank-2 Compartment 1620 a al Manufacturer:Aqua Test Inc. Model:Nibbler Clarifying Tank•2 Compartment This component was: Fully Inspected Component appears to be functioning as intended: YES All required baffles in place(N/A=No baffles required): YES All required baffles in place: YES Air supply to outlet filter on: YES Filters cleaned(N/A=No Filter Present): YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 18 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 20 Sludge return pump operating as intended: YES Amount of sludge manually recirculated(approx)(Gallons,if other specify): 0 Pumping needed: NO Pumping recommended: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 ANK:Pump Tank 1620 gal OF PT This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Pump vault screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 6 Pumping needed: NO Pump Vault Filter cleaned(N/A=not present): N/A Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 ReportlD:415747 View inspection reports online at www.onlinerme.com Page 3 of 4 This component was: Fully Inspected Component appears to be functioning as intended: YES Lateral lines flushed: NO Average squirt height(if performed)(feet,if other specify): . Ponding present?If YES explain in comments: YES Deficient TANK:Septic Tank-2 Compartment existing This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 2 Effluent filter/screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 11 Compartment 2 Scum accumulation(Inches,if other specify): o Compartment 2 Sludge accumulation(Inches,if other specify): 10 Pumping needed: NO � Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 This report indicates certain characteristics of the omits sewage system erne time o/visit.In no way is this report a guarantee of operation or future performance. ReportlD:415747 View inspection reports online at www.onlinerme.cam Page 4 of 4