HomeMy WebLinkAboutSEP1973-00117- ar`�/ -,tet , 49.P -73-117 7-5
903 E. Caroline OLYMPIC HEALTH DISTRICT
Port Angeles SE61AGE DISPOSAL PERMIT APPLICATION
Submit an Duplicate
Court SrrS,
House- rpm �1--.`,
Port Townsend ,b;nsor� (Ao c -r `C
OtiaIVER R�--�" ADDRESS
DIRECTIONS FOR LOCATING SITE��g� Q
F �_ S
Permit No; 3 5 53
Builder
Date a f ()3
PHONE 'MS- — 0_�57
V�
APPLICATION IS. HEREBY MADE TO: INSTALL N34 SYSTEM,._REPAIR EXISTING SYSTEM Y�
OF BEDROOMS I BASDIENT t SITE SIZE NAME OF
DRAINFIELD LENGTHS �A ►IDTH ;I" DEPTH 6)SJ #LINES SEPTIC TANK SIZE
DRAW A DETAILED PLOT PLAN BELOW
4�_
I
N
.o
1.
+w�a �/I.+ Aj 1 ,Z"I1J I LVVKSIVIY V11 L7.Li.iJj .LlYYKL1LK1•.^' 111.Li7
PERMIT UNLESS PRIOR APPROVAL OT-ITAIMM FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION V SIGNATURE OF APPLICANgtC
APPROVED DATE �l�i�73 INSPECTED
SANITARIAN'S CONMENTS:
I CERTIFY THAT THI SYS AS INST T APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NKME_ .�...
G
County Health Department Receipt No -.' ye ,56 "o
802 Sheridan Ave. Fee:
a Port Townsend, WA 98368, -- —
206-385-0722 Date: 17- a/-
i
EVALUATION OF IMIVIDM SAGE DISPOSAL SYESM AMID/OR NUM SUPPZY R E C E I VE d„
Information Requested: K Individual Sewage Disposal System SEP 21 '89
_ Water -supply Public Private
Applicants Name y1 wr l e t K&r t k it Marl Cc- npleted R� rt To: JEFF. (-UUNTY
Owners Name I t. e ALN D&T.
Address-- -7 V 14 a Id uz i K YZ AJ, `'�
/ L0r V C. W , S"o S- Lt"s- : T � l
Phone : � g � � O � t�k� Ir `lg
Number of bedrooms
Previous Owner (if Known) k. Year Installed
Legal Description: Section Townshi 2 Range 2 l TN 6
Street Address _(-/t) '3,;L &., Q N o 'Cl 1a 'Cl
�,_ .r r: ►:,• -�� �s i, r i • • DEV L4 ce :� r
dP S
a %L� 4 v -e
SEWAGE DISPOSAL SYSTEM* '�
Permitted system _ yes no
Installed prior to permit requirement yes no
Sewage noted on ground at time of inspection* yes � no
House is unoccupied therefore an evaluation of drainfield performance is
not passible at this time.
A review of our records indicate that this system was designed to
.service a bedrew-m residence. This system is not considered
adequate for a bedroom residences unless it is sized per current
regulations.
Septic tank should be pumped if no -t done within past 3 - 5 years.
1
�- dere '
WATER SUPPLY
Well casing 12" above ground yes no
Sanitary seal in place yes no
Well 100' from drainfield yes _ no
Water sample talon yes no `
Sample results
Ooamnents :
Date G- .G1 Time ,,ctv
En irr ental 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.
EESFORM 11/88
INDIVIDUAL SEWAGE DISPOSAL INSPECTION FORM Date -� A
r /�
APPROVED YES NO ENVIRONMENTALIST l . ry N4k!1 ty`
,�pp�� �(n�
Address 1`1 dr�Q� te, t !� RA, �1A Owner t F �
} Legal Description Sz-C_ oq 1 <
Residence Commercial # of Bedrooms_ System Installer �nOL�JY�
vJ�
SEPTIC TANK
Commercial Non commercial Measurements: L
Construction Material CJ,-\CAjda Lig. Cap.
DISPOSAL FIELD
Exc. Depth Width Total Length
Rock Type
Depth Under.
System Designer.
W WD
Sq. Ft.
Over
Engineer Design Yes Type Engineer Approval Letter Yes
Well 50 feet from tank 100 feet from leach field
Well installed at time of septic system inspection Yes No Public Water
Owner:
SOIL INFORMATION
t«l iA
Legal Description: Section Township ®`E -M Range
Subdivision
Division Block Lot
Date Logged: - 1 — ��_ - t rat -� o t
Include soil textural characteristics and the depths at which significant
changes occur. Be sure to include depth where mottling or impermeable
layers occur. 1
Soil Log #1
�to in. g3LsrA. t
toin. CZ - \
to in.
to in.
Anticipated water table_Q!�5 in.
Roots to . �`_� inches
Soil Log #3
to in.
to in.
to in.
to in.
Anticipated water table in.
Roots to inches
Soil Log #5
to in.
to in.
to in.
to in.
Anticipated water table In.
Roots to inches
Soil Log #2
to in.
Qj_tokin.
to in.
to in.
Anticipated water table in.
Roots to inches
Soil Log #4
to in.
to in.
to in.
to in.
Anticipated water table in.
Roots to inches
Soil Log #6
to in.
to in.
to in.
to in.
Anticipated water table in.
Roots to inches
bra;
USEFUL Aw"i $VIl =GWS FOR SOIL CLASS -E wl IOIi
DK. -
DARK
SND. -
SAND
FN. -
FINE
SR. -
BROWN
LS. -
LOAMY SAND
MED.
- MEDIUM
TN. -
TAN
SL. -
SANDY LOAM
CRS.
- COARSE
OR. -
ORANGE
SIL. -
SILT LOAM
GRV.
- GRAVELLY
GRY:-
GRAY
SCL. -
SANDY CLAY LOAM
COB.
- COBBLY
YL. -
YELLOW
SICL.-
SILTY CLAY LOAM
RK. -
ROCKY
BL. -
BLUE
CL. -
CLAY LOAM
CPT'D.-COMPACTED
C. -
CLAY
CMT'D.-CEMENTED
V. -
VERY
X. -
EXTREMELY
MOT. -
MOTTLING
RT. -
ROOT DEPTH
FNT. -
FAINTLY
DIST. -
DISTINCTLY
PROM. -
PROMINATELY
SLT. -
SLIGHTLY
Screen: 01
Parcel # 000921093017
Geo Cd 292109303211
CASEY SHORT PLAT
LOT 1
SUBJ TO EASE V522/P140
Mode: INQUIRI
Auto Roll: OFF
Nbad Cd 3220
* Taxpayer Cd ROBI 2400 ROBINSON, KAREN B T/P Chg Dt 6/29/1994
* Title Owner T/P Chg Usr SS
Tax Code 0211 Status Tx TAXABLE Land Use 1100 RES -SINGLE
Affidavit 60415 Vol/Page / C/U Code S/C Cd
1 1 R 0%11A A r1 //1A 10%#% -9 A F% 0% r1 AI r•An TT TI r• A 1 0%MM A ri I IA r%