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Home My WebLink AboutSEP1975-00039Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 Evaluation of an Existing Onsite Sewage System Attach plot plan showing location of: Structures, Drainfleld, Septic Tank,.Weii,'etc ALL SPACES MUST BE FILLED IN EXCEPT AS NOTED. Indicate in space If Information Is not available (NV) or not applicable (NA). Type of Evaluation ❑ Evaluation of on-site sewage system ❑ Evaluation of Drinking Water ❑ Cl Evaluation of on-site sewage & Drinking Water ❑ Date of this inspection ' 'b I�njspe Owner or representative, report to: Name/Address/Phone 150k Reason for Routine -O & M Inspection Real Estate Transaction Office Use Only Date -a114101 Fee �,O �i Recpt `��;?�j Check��p Case # v f Complete a Permit # - Building Permit Review and/or no septic permit on file Other by a '7 3 Current owner Site Address__4-d�d Owner Phone # ! � Previous property owner name (S) if known_91 d4 -� A�,,x,4J / &CA Parcel # Sa ► 33 � p� l Subdivision, division, block and lot(s) Permitted System __yes - no Permit/case #_510F795- Date system Installed ---M-5 Age of dwelling—) 14 Li Cars # bedrooms I House occupied _ X yes no, vacant how long? Designer Installer Water Suppler Atj0tPD -7-5C — /j D «� Sample was taken _,Yes No Sample Results Well casing 12" above group Yes No Sanitary Seal in place Yes No Public: offsiteonsite. Name of System Individua'L offsite __2!�___ onsite Is well more than 100' to drainfield/disposal component `i� yes no, if not, distance is well More than 50' to tanks and effluent transport line �ves no, if not, distance ONSITE SEWAGE SYSTEM #1 - Septic TanA/-gal. Tank size _single compartment two compartment ffrz- material, Riser to grade on inlet yes no. Riser to grade on outlet vesv--�L—no z-4 1JeZZW Condition of tank,good needs repair, describe it Ij� 1st coMO, Scum (top ! yer� -:_In, sludge (ottom layer) `Z — in. 2nd comp, scumin. sludge Z i in. Was ground water observed leaking into tank ? ,yes no If yes, where was water.observed? Condition of baffles: Inlet___ good needs repair material (PVC ncret Outlet: good— needs repair material (PV concrete Screened Outlet C_no yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b))_ yes no Effluent level at outlet (mark level on circle) ( eg: Onsite Sewage System Inspection Report If effluent is below the outlet, indicate when tank was last pumped: Page 1 of 3 ' Parcel #. ®� Owner Name Lsy Does system include apump? yes no If yes, complete the next section. #2 - Puma Chamber N 1"a, 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 Was Ground water observed leaking into tank ? yes g in. If yes, where was water observed? ----- no Electrical Components Pump operating _yes 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 i min/sec. Timer Settings _______,min/sec on #3 — Dralnfleld r .__..___,min/hrs off Floats secured ves no ,� Appropriate Vegetation in area yes no. Describe vegetation LAWN W ELL, indications of surfacing sewage yes, if yes, describe and diagragm on plot plan no overgrown/ not observable Signs of parking/driving In area ves no Ground settling or -erosion , . ves no overgrown/not observable Monitoring Port Observations: Residual Head _____-,ye5, # of inches no Ponding in trench ves # of inches of ponded effluent no Repair area is adequate ____ limited none available, described' ��'f�j�y,/�-'j��a Complete this section if system is permitted but did not receive an OK to cover or final approval OR there was no septic permit on file. Describe materials & Lrvejn drainfield construction: D -box present - yes if yes, material Drainline � no I rigid PVC corrugated flex pipe clay tile concrete the seepage pit or cesspool other Drainfielddimensions length _ width __ # of drain lines Do obser�ations coincide with permitted system requirements/conditions? _yeS no Comments: eVA-L >,- t2 ILE -5ee-v QCA tJ i:7 1 ELD -::-::> 4j3f (_L_ tV At_ U"0"_ e0 tq/u C> V ti t I t>)-- C'm ID QA�N.L t )J E-5. W) UL/ &7EID 't PAZ> 4 P6 t>.:E) 1 Onsite Sewage System Inspection Report Document8 Page 2 of 3 r] Parcel Owner Name C� �. #4 - Treatment Unit (Sandfilter, Proprietary Device, etc) Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage ves, if yes, describe and diagram on plot plan no overgrown/not observable Riser to grade? ves no Signs of parking/driving in area ves no Ground settling or erosion as no overgrown/not observable Monitoring ports in good condition ves no none present/no port found Monitoring Port Observations Residual Head ves, if yes, # of inches no. if no, notify Owner immediately Ponding in trench ves, if yes, # of inches of ponded effluent no Electrical Components Pump operating ves no, if 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 yes no COMMENTS P-20AA N '�b L T /A PP>b3cr2.� T h*T P� N V-.1 eU D'. Tlf L LJC-L� n p VIE P U kv\ E TIM i 4t;, 1&0' SWAN Prim T-�Vs --Crt-1 E Cit -.1-3) W Ci L t. A e)A PvZb 'PW- Ly � � 1� ► �� r � �+v TUTU '?-C C-,?L=V E L -O P M L NT D -N T -q- C Pv�W Pee`/ uu) LL IZ� Q 0 6 ecV � 121 � I CAI-k� ® C, b LVD � LA -� Was a System roblem Identified? Yes If yes, what section #. No,)_ I certify that the information provided is based on a review of County records and my direct observations at th ime of inspection. a ame/Signature ate No guarantee of future performance is implied or granted based on the information contained in this report. This report constitutes a summary of findings only. Onsite Sewage System Inspection Report Page 3 of 3 Document8 4oAL. D�-. +aAr 1"5 �I',Ij . Lft NVQ/ �mnf,r °C 6 9 � 0, 4 bar. , tTs" ori `rhe.. W s i d C, 4 `lac t4l� &* 5-0,( Q 5 Out WT - lav 5�+�,c �- ? 333 oP- 17L w j I ne 6'q 44- +i �; eAeT 6P; i • e2nic ��. Jefferson County Department of Community Development 621 Sheridan St.. Port Townsend WA 98368 (360) 379-4450 MONITORING INSPECTION CERTIFICATION The system ser•rrng 2�� on parcel � 2-137 �I , permit " was most recently inscected on I �2- by ---7- �� as specified in Jefferson County Code 8.15.150. The above referenced system is in compliance with the Mon itoringlinspection schedule identified in Table 1 of Jefferson County Code 8.95. See report completed ` �b ' for information on the condition of the onsite sewage system. REQUIRED OR RECOMMENDED REPAIRS/MODIFICATIONS TO THE 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 Table 1 requires that this system receive an inspection: Annually ery 3 years er•� 6 years other as specified in the sewage disposal permit conditions - An ;^soection will be required at the time of sale if the system does not comply with the schedule set by Tac:e ' as described above. 7 -he acove:nforimation is based on review of the file and does not imply or grant a guarantee of curre^t or uture system performance. igna:ure of 'efferson County Employee Date LL1 ;j 6 UT bE) - ��rC �� wi�L �E �e�Qu►►�t � fv-=�;pPE-C-Ti SE P'7 0-59 P 903 E. Caroline OLYMPIC HEALTH DISTRICT Port Angeles SEWAGE DISPGSA ERMIT APPLICATION I Court House G660, �kQ Port Townsend cN. _ —, DIRECTIONS FOR LOCATING It `C: " --a APPLICATION IS R Permit No. .t u licate Builde . ' Date S ? S ! INSTALL NEW SYSTEM XX -PE OF BUILDING I NO. OF BEDROOMS BASEMENT SITE SIZ. IL DRAINFIELD LENGTH`C�, :I.IDTH DEPTH#LINES I _ i w �• �� 33�� •ca1� NQ.��• IR EXISTING SYSTEK_____ qS ��S:—Z' NAME OF INSTALLER EPTIC TANK SIZE IONS. SOIL TYPE << a /r;� MY CHANGE IN BUILDING OR SE' -AGE DISPOSAL PLANS, LOCATION OR SIT , INVALIDATES THIS Q!)Q PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. � DATE OF INSTALLATION` SIGNATURE OF APPLICANT APPR% ---------'DATE Y—INSPECTED BY(��&A A �y� SANITARIAN, S COMMENTS: 1 I CERTIFY THAT THIS PYSTEM HEALTH DEAPRTMENTX/ — w_ s G IN r tu.� yxu u�ttA Njup f BY THE f r a r -sots Cn•rnrs 6-r p ^)i Or,.a•rr++rnr . Co.r11r Cn.r•rno sr . F� t : o.•-+Ic�C lass �'�-� �- _ 1 . u — - — — N [ 1 LOC Y pl..p ar••.I na+.. S VV SIC". Or -- POA` — I t [ t P. Sw FROrA $Nil RS( CTIOryor RUADA' C'�hthe O/nrr sOR•r.r Ililr•Ott O• tanOma•r—}- LEGAL DESCRIPTION c�Y`Qt.I�S hOi L ► l L jl.Of• SupQ.r.%.On z € conn lax humor• % Sen.on --- S.rfr•nn iownan.o fv^IT- 11. TYPE AND COST OF BUILDING TYPE OF IMPROVEMENT �j Nrw building 0 Aed•s.on GAltr.at.on 0 Repa•• replacement 0 V..ccking O Mor.ng I•eloca`.on) OFoundai.on only OWNE RSHIP 0P..rart (.ntl.r.dual, co.po.at•on, - nonprof.t institution, etc.) []Public (Federal, Stale or foo+ 9OV0 BUILDING TYPE �S.nolr F am'sv Q Mutt'-Fam-IV number of units O Hotel. Motel_ Go•m•lory number of un.n -- 0 MOD.Ie Home O Chher - Sprafy MOBILITY Q New County Resident 1, 1n.% structu•r 10 vire the rVs•orn1.01 Or curnrrretc•al needs of those rrnp'ofed at either the US Nair s Tt•drnt or Indian Island Far -1 -2 -es)' 0 YES ONO USE Kull -time Residence [DSccond Home Rec•tonon Cabin, rtc. 0Second home Furu.r conte-s.on to UBC OCCUPANCY GROUP. per rr•.anrnt •es.orncr Nonresidrnt.al - Describe in detail proposed use Of bu•10•ngs_ e g . food processing pant. machine shoo. laundry building at hosp•ta'- elemrn'a.y school, secondary senool. college, parOCh.al school. pArung r-a'Aor for deDann+ent %tote, ren: a; dff.cr building. otf.rr bu•ld•ng at •n0 usn.a Diant If use of existing bu.lo•ng is be.ng enangrd cote+ proposed use Is'T zf.L .. _ 1LI nc� -b !61_ (k-_�.5 COST /Omit cenr:) A Cost of .mp•orerr•ent.. .......... S To be rns:afied but not included m rive abo.r cost a Electrical----------- ------- b. Prancing _-----------------� L Heating_ air conditioning _ ----- d __--d Ohne, frie.rator- etc.). _ . _ .... _ . t• TOTAL COST OF IMPROVEMENT 111 -SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAPAE O Masonry (-all bearing) Wood Frame 0 Structural steel 0 Re.nforcr-d Wncrete 0Other - Sprcifr PRINCIPAL TYPE OF HEATING FUEL D Gas Cl O.I .ec1r.C.tY Kee Qump Coal - 0Olher - Specify IV. IDENTIFICATION - .. Name TYPE OF SEWAGE DISPOSAL ] Public or Pr.rate `jt ISI Indt•ndua (sepne tank)etc_: TYPE OF WATER SUPPLY Q Public or pnrale company i%(Ind.wdua I ei% astern) TYPE OF FIREPLACE \DIMENSIONS m riurnoer of Stories ---------- *Total .........•Total so.:arr feet of floor mica_ all. floors, based on exterior dimensions ----------------- • Total land area. sq. It -- - - . - - - - - - NU1,ASER OF OFF-STREET PARKING SPACES Encloses, -------------•-------- Outdoors --------------------- RESIDENTIAL BUILDINGS ONLY Nurr.oer of bedrooms-_.-----.-__ TYPE OF t HANICAL Full. ....... hurnoer of bathrooms Partial _.. Mailing Address - Nurr'ber. street_ etry and Stare ZIPcode TO No. f"k% I.. I'(.�I 1 `� I I Owr+e+ 2. late License NO Conrract0 7'80 I - 1. Ar[ts.t ect --'- J EF The owner of this building an the underSlOned agree to conform to all app)tcable laws • b��qL� Address - ADWur•w Darr • s9r•ature of .opA•ont 1 � • Ll �D KJ 111 11 -1 ANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT rROVED BY �f rxfb+ .8 Ox.I•'A�' I APPROVE DBY-PERMIT FEE ISSUE DATE to $ •SV a Kilt D+ISG OF FICIAL ,5 ,Q SITE EVALUATION REPORT JEFFERSON COUNTY HEALTH DEPT. �. I Receipt No: 1757 Mufti -Service Building 802 Sheridan Avenue C) l I Fee: $45.00 Port Townsend, Washington 98368 D fi (206) 385 - 0722 Date: 2-4-86 Applicant Rich Wallace Address 830 "0" Street Sec 33 Twn 28N Rg lE Port Townsend, WA 98368 Telephone - 385-5114 THIS REPORT DOES NOT CONSTITUTE APPROVAL OF A BUILDING OR SEWAGE DISPOSAL PERMIT. THOSE PER- MITS SHALL BE GRANTED ONLY UPON APPLICATION AND WILL BE REVIEWED IN ACCORDANCE WITH CON- DITIONS AND REGULATIONS EXISTING ON THE DATE OF THE PERMIT APPLICATION. THIS REPORT IS NOT A PER- MIT APPLICATION. I request this site evaluation for: Lot 2, Shaw-Parelli Short Plat Legal DOOMptlon (ow. Blk. lot) 200 Shine Road Olmcdons for biting Otte PM map on back and attach a alts plan) Property size ' 198' x 115' Seller Richard Sarisky Buyer. Richard Wallace single family residences �` ��Evaluation of existing system (installed 1975) Number ❑- Preliminary evaluation for short subdivision ❑ Other. Do not write below this line (For office use only) A site evaluation of the above property was made on 2-12-86 by this department and the property has been found: O ACCEPTABLE - Soil and site co itions are acceptable for installation of a age disposal system, as requ ted above, under existing conditions and regulations. 0 CONDITIO LY ACCEPTABLE - Sol nd site conditions are acceptable for in ation of a sewage disposal m, as requested above, under existing Gond ns and regulations, prov ed THE CONDITIONS SET OUT BEL RE MET. 0 UNACCEPTABLE - it and site conditions a unac epatable for installation of a septi tank system. COMMENTS: No sign of system malfunction at this time. However, the north drainfield line is under the existing mobile home and the south drainfield line is under the deck. The well is approximately 80' upslope from the closest drainfield fine. It is unknown whether damage has occured to the drainfield based on site conditions observed. Recommend the septic tank be pumped and low water use fixtures utilized. Conservative water use is strongly recommended due to limited area for drainfield repair should the drainfield fail. ully, Randall M. ran . .