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HomeMy WebLinkAboutSEP1973-00201j0 J 141 , 903 . Caroline OLYMPIC HEALTH DISTRICT Permit No.' 1�3 Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Court House Port Townsend &-, L"4 0.1 DIRECTIONS FOR LOCATING S Zg 0. p Submit In Duplicate Builder Date (� 73 ADDRFSS_'_�\",`- PHONE APPLICATION IS H=BY MADE TO% INSTALL Y.11P SYSTEM REPAIR EXISTING SYSTEM ®; LA L � DRAINFIELD LENGTH 1: WIDTH Z, DEPTH ,R #LINES . 3 SEPTIC TANK =�RAU1 A DETAILED PLOT PIJ ,N BELOW. SEE INSTRUCTIONS. SOIL TYPE ®- d t Z W w Esk oR, I ---•- ---•».-- — -..---- vac'. -u1 Mwxj u.wsvaxL rAjtMQ.I....LVVH11W1V VR Al-4:rj .LLIVA"VA-XGO7...1.A1v PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTM17T. DATE OF INSTALLATION SIGNATURE OF APPLICANT APPRcvID DATE 6 A(b3 INSPECTED BY �� - DATE 4? is l a 3 SANITARIAN'S COMM]JNTS: X21 �-�� I CERTI HEALTH ROVED BY THE DATE Iffil Nj �U W --8 I I IS ME OF BUILDING. N0. OF BEDROOMS BASEMENT SITE SIZA NAME OF INSTALLER ®; LA L � DRAINFIELD LENGTH 1: WIDTH Z, DEPTH ,R #LINES . 3 SEPTIC TANK =�RAU1 A DETAILED PLOT PIJ ,N BELOW. SEE INSTRUCTIONS. SOIL TYPE ®- d t Z W w Esk oR, I ---•- ---•».-- — -..---- vac'. -u1 Mwxj u.wsvaxL rAjtMQ.I....LVVH11W1V VR Al-4:rj .LLIVA"VA-XGO7...1.A1v PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTM17T. DATE OF INSTALLATION SIGNATURE OF APPLICANT APPRcvID DATE 6 A(b3 INSPECTED BY �� - DATE 4? is l a 3 SANITARIAN'S COMM]JNTS: X21 �-�� I CERTI HEALTH ROVED BY THE DATE Iffil Nj �U W --8 r ' JEFFERSON COUNTY HEALTH DEPARTMENT 802 SHERIDAN AVENUE INSTALLER; PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. (206) 385-0722 BUILDER SEWAGE DISPOSAL PERMIT DATE /M J -;Z I— Submit in Duplicate 19 ��i ¢I s' M� luu� /vim s*a�% Owner Address Phone iu� M � rte_ up" �AJ� �tea! �, MA40�-- R . H&m-f is 4-19 P..&*P (ism HOU it APA )Z7 A40st F—AGO I A Directions for locating site `lam Ai- fftu - INSTALL NEW SYSTEM ❑ REPLACE SYSTEM ❑ PARTIAL REPAIR 2' T TYPE OF NO. OF SITE BUILDING ` tW % BEDROOMS Z-- BASEMENT O .SIZE Ito X 60 6 N DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING oCo SOIL LOGS v 0 - t,) S 1�> Din O 40 Z Ne- $ 3(v Dig two holes per site. (min.) 4' deep - 2' dia. - 50' apart & flag r m O D r v N n O Z CO) m O Z IR z v z Cn < z z �o D. Z G7 APPLICA n ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT I'' LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES HIS PERMIT UNLESS PRIOR APPROVAL IS OBTAINED _FROM THE "FAITH IIFP R11 TMFNT Drainfield Length Width g' Deptli X0`8 # Lings-74 - Tank Size- --Dal. cD COMMENTS: (TWO COMPARTMENTS) M ED DATE .INSPECTED I certif"hat this system was installed in a manner a INSTALLER'S SIGNATURE- DATE JCHDI1-78 PARTIAUFIRAL DA' the Health Delya en DATEINS ALLED ,RECORD • ` 1 `• ' ` _ "' SCHOOL HEALTH DISEASE CENSUS " .. CHIl"l M" SCHOOLS CiI 4WM— , WASHING#N ` 1"amily Name pupil's given name s ONO,— RM a��rrg� enn d�x+eet`3ons� o w sHwjZ be taken in ark emarge_nqy 1f,parents arid not ane. Mxthplade d- Date of Birth Monti Day Year n� q, R HOW teajephbne 13narg �' tele e V' Family I o cr ' Father's Fist Name 4, THIS RJPIL HAD year IMMIINI2A'lit NB AMID' ZESTS YM Scarlet Fever, s Smallpox vaccination Idt. <� Rheumatic Fever S=3.lpcx vacdnatibn 2nd Whooping .Cough ,...:.. Baby Shots Hatd Measles.'- _.__�_._._. Boosted+ r. ' 3 -Day Measles �. DT - Chicken pox Meas les. Vaccine Mumps �.�..._ Tuberailin Test Frequent Colds X -Ray t,,PO Tonsi]stis Polio lst 2nd ... 3rd Allergies Oral Polio Eczema Tuberculosis Contact moo Operations, Hospitalizations, etc:.. Signed Date . r ( ) FOR YOUR INFORMATION ( ) PLEASE RESPOND JEFFERSON COUNTY HEALTH DEPARTMENT ( ) PER YOUR REQUEST 802 Sheridan, 2nd Floor, Port Townsend, WA 98368 • (206) 385-0722 ` a DATE: ADDRESS: FROM: rNA'c' SU BJ ECT: z�('c►AI . MESSAGE: x .5AO^-� SEPTIC@NSE ` Janet Welch, R.S. �LGS1�Jr SYSM,44 FRIUA-)6 ' P.O. Box 1221 Hadlock, WA 98339 ,JEFFERSON COUNTY HEALM r 802 SHERIDAN A INSTALLER PORT TOWNSEND. WASHINGT 9 68 RECEIPT NO. b (206) 385-0722 0 1991 5v. 0 9 / BUILDER DATE WFr SEWAGE DISPOSAL PECOUNT EALTH DEPT. t7 AA)/J I/r4rJR)�tili 1D 2� Owner Address Phone ;H/2ra��srn 15taan)n 390 Directions for locating site INSTALL NEW SYSTEM O REPLACE SYSTEM ❑ PARTIAL REPAif -- TANKIDRAINF1ELDd. TYPE OF BUILOlNG 'Z NO. OF SEUROOMS c17 BASEMENT N SITE ,SIZE 1200 Previous site evaluation by Health Departments/g4,)j&�dSZ� Yes No Depth to maximum seasonal water table 0 v Source of potable wat.=r supply — Public Private k Source type: Drilled well k . -Dug well Other EVERY APPLICANT HAS THE RIGHT OF APPEAL AS PER JEFFERSON COUNTY ORDINANCE 2-77. SOIL TYPE DESCRIPTION 1) 2) 1 3) 4) D co F" Cn �cn z� .0 Cnn ANY REMO OF OR FW—OR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DtRjIAINF I ELD r AREA MAY C.`:CATE SITE CONDITIONS THAT ARE I N BUILDING OR SEWAGLE E D I SPONSAL PLANTHE S. Ol I ONCLtID I NG SEWAGE DISPOSAL SYSTEM. _PLUMING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept. for final inspection). STUB OUT PLUA'BING ABOVE FOUNDATION FOOTING. Drainfield Length Trench width 3t Trench depth No.lines -Tank size Soil type and application rate used for design j!%- GPD/ft2 , r COMMENTS : S �`O �.J Q6 eSSu.r` � � ®, O ' J P laO �� r-1 % 1 OQII.cj ChM �S� -�v,r . 1- 7 AP ROV O DATE INSPECTED PARTIAL/FINAL DATE 1 certify that this system was installed in a manner approved by the Health Department- INSTALLER'S epartmentINSTALLER'S SIGNATURE DATE DATE INSTALLED JCH0/7--;84 oto U JEFFERSON COUNTY HEALTH DEPARTMENT 802 SHERIDAN AVENUE PORT TOWNSEND, WASHINGTON 98368 (206) 385-0722 SEWAGE DISPOSAL PERMIT ON-SITE SEWAGE DISPOSAL PERMIT NO. 91-279 ISSUE DATE: June 27, 1991 Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON ISSUED TO: CHARLES AND SHARON O'HARA LEGAL DESCRIPTION: Section 4. Township 29, Range 1E (Permit valid at this address ONLY) PARCEL NUMBER: 977-700-072 SEWAGE DISPOSAL SYSTEM DESIGNED BY: SEPTIC SENSE DATE RECEIVED JUNE 20, 1991 JOB NO. THIS PERMIT IS ISSUED FOR A PERIOD OF ONE YEAR (UNLESS OTHERWISE STATED BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR ON- SITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO. 1-83. DATE OF EXPIRATION: JUNE 27, 1992 THIS PERMIT WILL EXPIRE ONE YEAR FROM DATE ISSUED. APPLICAITI©N I=OR RENEWAL FOR ONE YEAR WITHIN 30 DAYS BEFORE EXPIRATION. Jefferson Co. Environmental Health Specialist The property owner will be responsible for the accurate location of all property lines. Any removal of or major disturbance of soil in the primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system. Any change in building or sewage disposal plans (including plumbing stubout location) and/or location of house or drainfield invalidates this permit unless prior approval is obtained from the Jefferson Co. Health Dept. HEALTH DEPARTNMfr MUST BE CALLED FOR FINAL IPSPECTI0N. SYSTEM DESCRIPTION TYPE OF SYSTEM: SHALLOW PRESSURIZED DISTRIBUTION SYSTEM Drainfield Trench Trench Tank Size Length 180' Width 3' Depth 68" 1000 gallons CONDITIONS 1. PUD MONITORING CONTRACT REQUIRED. Page 2 FOR OFFICE USE ONLY FOR FINAL INSPECTION INFORMATION AND APPROVAL SYSTEM INSTALLED BY ABSORPTION AREA: DRAINFIELD TRENCH TRENCH TRENCH LENGTH WIDTH DEPTH SIZE PRESSURE TEST OBSERVED DATE APPROVED SPECIALIST DATE` COMMENTS NAME PERMIT NUMBER INVENTORY FORM FOR ALTERNATIVE AND EXPERIMENTAL SYSTEMS See reverse side for instructions. Call (206) 586-8134 or SCAN 321-8134 for assistance. [31 COUNTY* C) ey � d S�District Office: [41 DATE INSTALLED: [sl PERMIT 16] TAX PARCEL #: REPORT181 C• r EI) ,a,_ • • :r _ [101 PERMIT (4 all that apply) [111 EXPECTED USE -,o USE FREQUENCY N all appy) O Newngle Family Dwelling VWvll Time (residence, business) Repair O Multiple Family Dwelling 0 Part Time (church) O Expansion / Alteration 0 Non -Commercial: (School, Community Center, Etc.?) 0 Seasonal (summer camp, sld resort, cabin) 0 Large On -Site O Temporary (work site, fairgrounds) O Commercial: (Type of Business?) COMBINED WASTEWATER OR BLACKWATER SYSTEM INFORMATION SECTION [131 WASTEWATER Of this information is for a blackwater system, complete the next section for the gnywater system.) .Combined Wastewater 0 Blackwater System 0 High Strength. (141 PRE-TREATMENT D Septic Tank . 0 Aerobic Device 0 Experimental: 1171 NON DISCHARGING TOILETS / UNITS 0 Composting 0 Incinerating [1s) ENHANCED TREATMENT 0 Aerobic Device (if preceded by septic tank) 0 Intermittent Sand Filter 0 Stratified Sand Filter D Recirculating Gravel Filter 0 Experimental: [[1(61 FINAL TREATMENT/ DISPOSAL (4 all that apply) XSSAS 0 Gravelless Pipe Drainfield System 0 Graveness Chamber Drainfield System 0 Alternating Drainfield 0 Dosing Drainfield (non -pressurized) 0 Experimental: Distribution: 0 Gravity )dPressure Trench / bed -bottom depth: X<3 Fr. 0 >3 Fr. BODS: 0 Pit/ Vault (181 ENHANCED TREATMENT / FINAL TREATMENT / DISPOSAL 0 all that apply) TSS: 0 Holding Tank 0 Sand -Lined Drainfield Trench / Bed G/O: 0 For enhanced treatment in Type 1, coarse soil conditions. 0 To reach suitable soils deeper than 3 Fr. 0 Mound [t9l NAME OF CERTIFIED PROPRIETARY DEVICE (If part of system) GREYWATER SYSTEM INFORMATION SECTION [2o] WASTEWATER [211 PRE-TREATMENT [221 ENHANCED TREATMENT [231 FINAL TREATMENT / DISPOSAL (i all that apply) (Complete this section 0 Septic Tank O Aerobic Device 0 SSAS For gteywater system 0 Aerobic Device (if preceded by septic tank) 0 Graveness Pipe Drainfield System if previous section is 0 Experimental: 0 Intermittent Sand Filter 0 Gravelless Chamber Drainfield System for blackwater system) 0 Stratified Sand Filter 0 Alternating Drainfield 0 Recirculating Gravel Filter 0 Dosing Drainfield (non -pressurized) 0 High Strength: (aa1 NON -DISCHARGING 0 Experimental: 0 Experimental: BODS: UN1T TSS: 0 Holding Tank Distribution: 0 Gravity 0 Pressure G/O: Trench / bed -bottom depth: 0 r3 FT. 0 >3 Fr. 1251 ENHANCED TREATMENT / FINAL TREATMENT / DISPOSAL 0 all that apply) 0 Sand -Lined Dndnfield Trench / Bed 0 For enhanced treatment in Type 1, coarse soil conditions. 0 To reach suitable soils deeper than 3 FT. 0 Mound 1261 NAME OF CERTIFIED PROPRIETARY DEVICE (If part of system): [271 SOIL TYPE (By Textural Class): 1 2 3 4 A 6 (251 SLOPE (In percent (%) only.): % [291 SOIL NAME (By SCS Soil Series Classification System, Only): [301 SOIL DEPTH (From original surface to restrictive layer or watertable.x eo indnes. (311 VERTICAL SEPARATION (From drainfield trench- / bed -bottom to restrictive layer or watertable.): �� inches. 1321 SOIL LOADING RATE (Includes Basal Area Loading Rate for mounds.): -� �,_ GALRr Z/DAY 1331 FILL LOADING RATE (Includes Filter Media Loading Rate for sand (and gravel) filters and mounds-): GAL./FT Z/DAY [ 1 TOTAL DAILY DESIGN FLOW: _ GALLONWAY 1351 LAT SIZE 1&0:1 ACRES (Square feet! 4350 SgFt. Acre ) INSTRUCTIONS FOR COMETIM THE INVENTORY FORM [1) DOH Database Identification Number:, This space for official use only. DOH will assign a special ID# as part of the database operatic. 121 Monitor Dates This space for official use only. DOH will assign the schedule of monitoring dates. (31 Countr. Please indicate the appropriate county or health district. For Ding County, indicate District Office in space provided. 141 Date Installed Use the actual Installation dare, or the date closest, such as the final inspection date. Do NOT use the permit Issuance date. J!if Pe_rmit #: This Is the local identification number. This should be the minimum Information you would need to locate the permit information in your files. Items #6 and #7 provnde space for Tax Pavel dumber and System Address. 161 Tax Parcel #: Also known as the Assessor's Parcel Number. Optional, as additional information for locating permit records in the files. [71 System Address. Optional, as additional information for locating permit records in the files. 181 Report Completed By: Name of staff pew who completed the report in case clarification or additional information is needed. [91 Phoma Number. Telephone numberof the person indicated in Item 8. (101 Permit: Indicate whether the permit was for a new, repair, expansion / alteration, cc a Forge, on-site system. (111 F.xt>ected Use: Check appropriate box. For Commercial activities, indicate the type, at8fth as restaurant; knodwinat, mini -mart, etc. (12) Use Frequency: Check all that apply. Items 13 through 19 for a combined wastewater or blackwater "in. 1131 Wastewater: Indicate if system Is for combined wastewater or blackwater. If the site is a commercial facility with a high-strength wastewater, indicate and provide test results, if known. [141 Pre Treatment: Indicate type of pre4matmett unit used. 1151 Enhanced Treatment Indicate type of enhanced treatment, if used. a the system selected combines enhanced treatment with final treatment and disposal, use Item #18. (161Final Treatment / Dis mh Indicate type of final treatment / disposal used. If the system selected combines enhanced treatment with final treatment and disposal, use Item 818. Indicate method of distribution and the depth from final grade to the trench / bed bottom. [17) Non-Dischargin¢ Toilets / Units: Indicate unit selected if a eon-disdtarging unit is used in a blackwater / greywater system. 1181 Enhanced Treatment / Final Tteatnhent /Disposal: If the system selected combines enhanced treatment with final treatment and disposal, indicate type used. For sand - lined trench or bed, indicate the reasea selected. (19) Certified Proprietary Device- Indicate the name and manufacturer if a proprietary device is teed. Must be on the DOH / TRC list of certified proprietary devices. Items 2D through 26 for a greywater system only., (in conjunction with a blackwater system above, items 13 through 19.) 1201 Wastewater. Complete this section if a greywater system Is used. If the site is a commercial facility with a high-strength wastewater, indicate and provide test results, if known. (211 Pre-treatment: See Item #14. [221 Enhanced Treatment See Item #15. 1231 Final Treatment / Disposal: See Item #16. [241 Non-Dischanging Unit: Indicate if a Holding Tank is used for greywater. 125] Enhanced Treatment / Final Tmah%ent / Disposal: See Item #18. [261 Certified Proprietary Device: See Item #19. [27] Soil Type: if the soil is used for final treatment or disposal, indicate the soil texture (soil type) used for sWng and design. 1281 Slope: Indicated the ground -surface slope in percent, to the nearest whole %. DO NOT use degrees. [291 Soil Name: Fill in if the SCS Soil Series Classification System soil name is known. Otherwise, leave Mark. 1301 Soil Depth: fp Inches only, ideate the total soil de^ from original ground surface to any restrictive layer or watettable addressed in the system design. This figure DO —NOT include fill depths, mar depth of media sand in mound or sand filter. 1311 Vertical Separation: In inches only, indicate die total separation between the trench (or ba!) bottom and the restrictive layer or watertable. For mounds this is the media depth plus the original soil depth at the upslope edge of the gravel bed. For sand -lined trenches or beds this is the media depth plus the original soil depth directly below the filter media. For sand filter this is the depth of media sand plus the depth of original soil immediately below the receiving drainfield trench. 1321 Sal [�oading (tate Indicate the design soil loading rate for the final treatment / disposal component. For mounds and fills, indicate the rate used in basal area calarlations. For sand -lined draintield trenches or beds, indicate the loading rate used for the sand media (in this case, the media loading rate is determined by the soil loading rate below it, but no greater than 1.2 gallons/day/square foot} (33) Fill Loading Rate: Indicate the design fill (or filter media) loading rate. Applies to mounds, sand filters, and sand -lined drainfield trenches or beds. Leave blank if till is used only for cover. [34) Total Daily Desitin Flow:. Indicate design flow, in gallons per day. (35) Lot Size: Indicate the lot size (gross land area) in acres. Please convert square feet to acres. PLEASE RETURN THIS FORM AS SOON AFTER COMPLIMON AS POSSIBLE To. Washington State Department of Health Local Environmental I-lealth Support / On -Site Mail Star LD -11 Olympia, Washington 9004 a` �3 S �2 a � a JEFFERSON COUNTY HEALTH DEPARTMENT ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN Date: (-31'91 Designer: 041 S Legal Description: Section y Township -� 9 Range Subdivision Division Block Lot Owner: e&gP.1FY QA)Y .i,VA/?_QAj 6#A/,',q Address: 4/yc5 L��i I. CALCULATIONS If for residential use: Number of bedrooms: x 120 G.P.D. _ SEPfiIe SENSE Janet Welch, R.S. P.O. Box 1221 Hadlock, WA 98339 c7 10 Total G.P.D. If for non-residential use, attach calculations used to determine G.P.D. Soil texture waste water application rate .6G.P.D./ft. squared (see page 214 of the EPA Design Manual) DRAINFIELD SIZING: Absorption area: `r7�3,� square feet (Total GPD GPD/ft squared) Trench or bed width J feet Trench or bed length / /' �� 'Aineal feet (sq. ft. — trench or bed width) II. APPURTENANCES Septic Tank Size /!%QO gallonsF�r.rntic7 Pump Requirements (If Necessary) Elevation difference in feet 5 L) Friction loss C;?. /,-) t Pump capacity should be gpm at l/ TDH Number of doses per day Dosing volume /2L) gallons Pump chamber size _'�5700 gallons JUN 2 0 1991 JEFF- COUNTY HEALTH DEPT. III. DRAINFIELD CROSS SECTION E if C Impermeable material/ Seasonal saturation. G A. Trench Depth inches B. �� y inches of drainrock below pipe C. moi" inches of vertical separation from trench bottom to impermeable material/seasonal saturation D. IF`` inches of fill (if needed) E. Trench width 1-31/1 inches Notes: ., JUN 2 0 1991 Attach detailed design of system JEFF. CouigB , HEALTH DEPS'. O'HARA SPECIFICATIONS, pg 1 of 2 DRAINFIELD Trench depth, 6 to 8 inches maximum Lateral length, 60 feet, 3 total Lateral diameter, 1.25 inches, class 160 or better Orifice configuration: all orifices except the last one in each lateral to be at 6 o'clock. Last orifice at 12 o'clock. Rotate to this position and glue after pressure testing. Orifice diameter, 3/16 inch Orifice spacing, all lines. 4.0'. 15 per line, first orifice at 24" from manifold Manifold length, 22 feet Transport length, 30 feet Manifold and transport diameter, 2", class 160 or better Filter fabric is to be used PUMP CHAMBER Chamber to be coated concrete or equivalent Dose volume, 120 gallons (2x a day) Storage above alarm, 240 gallons Recommended chamber size 500 gallons Need pump capable of 28 gpm at 11' TDH Ball valve to be adjusted to provide 2 to 6 feet resi- dual head NOTES Watersaving appliances, fixtures, and practices are to be used. Inspection ports are to be located as noted: one to the distal orifice in Line A and one to the bottom of the trench in Line C. Drainfield to be installed during suitable soil con- ditions. The septic tank, pump chamber, transport line, reserve area, and drainfield are to be completely protected from vehicular traffic or mechanical disturbance. Installer to verify pump requirement when location of pump chamber is determined. R E C04 E Q JUN 2 0 1991 JEFF. CUU1�Ty HEALTH DEPT. O'HARA SPECIFICATIONS, pg 2 of 2 Designer to be called for inspections at the following stages: at pressure test and when construction is complete. Designer is to provide as built and certification. Location of drainlines can be altered slightly to avoid hitting existing lines. The existing tank may be used if it is in good con- dition, is 2 compartment, and at least 700 gallon capacity. _. Drainfield is to be protected from horses or cattle. This system has been designed in accordance with WAC 248-96 and the "Guidelines for Pressure Distribution Systems" and has been approved by the Jefferson County Health Department. Nevertheless, negligence or im- proper action on the part of the users could result in premature failure or malfunction of the system or its components. W JUN 2 0 1991 JEFF. COU -qy°y HEALTH DEPT. twspEC 70h) pmier •tO TR.EMU4 ROTTO&L ail/ �� !L D IJA)e C tvo,2� 100. Iq 7rAl►1 N uA.)E s /00.0' u,)Ea tOO.iW 0 0 v 0tUC► SI tNJPEGT7c)o PI02.t Toolvolicz C,mg,eL.r..S 4AjD,,%w 3 O'StSi�'fl �A14t"EL �, DEslEr,UE'd T9'-/ �i4,VET LJEl�1 � R,�S.� SALL VALVE 7DALARM PANEL Li CMECk VALVE COUPLER Fr INLET 1/8" MESN, - REMOVABLE ALARM-- • -START - - •• -SHUTOFF-- PUMP CHAMBER D 1L" JUN 2 0 1991 JEFF- L�� L V 7.y HEALTH DEPT. SOIL INFORMATION Owner: Range Legal Description: Section Township c� - T Subdivision - ------ Division Block Lot Date Logged: 6//,,3��/ Include soil textural characteristics and the depths at w:lich signiyica.it changes occur. Be sure to include depth where mottling or imoermeabi� layers occur. Soil Log #1 Q to 3,2_ in. IS wzIooY-s Sodt� to in. rD.c40Arr 066�;s to in. A07 - to in. Anticipated water table in. Roots to inches Soil Log #3 to in. Roar? �— to i n . to o to (SW/ k -14601 -- to -14 v1- to in. toy,✓P.SIr/P (r to in. r�oyP.y Anticipated water table � in. Roots to ;31v inches Soil Log #5 to in. to in. to in. to in. Anticipated water table in. Roots to inches Soil Log #2 Q to .Z--- in. _fir to in. t�!v._1�r1 rte/=Arx to in. to i n • ___ Anticipated water tab-^_, _:e;f _in Roots to chi inctges Soil Log #4 0_ to i n .v�/rs v� to in. to i n . /122L C0 o t o .i'l in. A d Y 41/ "O"!T Anticipated water table_._ in. Roots to ____ inches Soil Log #6 to 1t1. to _n. to in. to in. Anticipated water table in. Roots co inches off JUN 20 1991 I J� Q ffR,P �4 c Cl c.Lr� 0A)j III �s w lfC l oG c a.d R37 s � 0Q L y v ACIARO&) 50 1 r e JIU— ,e E T,2�i9i70 Y �i" fly I9 r'C T S � Fo,eL L _ .o ���8 %5fEe u�C- x - J 5 t X 15 = c27, 6,,W tel � uA--) LO S s 6s t �.sPd2 r 3a' x(.27 IU4A),F'v4,h ' x `` = -c2 V4l.Ue�3 u 4 - ♦ �o� 3 y / cv� rl RECEIVED JUN 2 Q 1991 91 J� HEALTH UEPT. SEPTIC SYSTEM ewage Disposal Permit New —LAepair Redesign Renewal Other Designer License Installer License Evaluation of existing system Plan Review SOLID WASTE PERMITS New Renewal Plan Review WATER Site Inspection Samples (per bottle) FOOD SERVICE Grocery Restaurant Loungefravem Temporary or Mobile Permit Food Handler Permit Reinspection Fee POOLS & SPAS Permit OTHER Specify CHAPTER 28.45 RCW PLEASE FILL OUT COMPLETELY Parcel Number 1% REAL ESTATE EXCISE TAX Is Segregation 977700072 MAKE (REMITTANCE PAYABLE TO JEFFERSON COUNTY TREASURER Required Yee � No NAM6 ................ B ARA_ A. _ LAWpggCE - ----------­---- •..._.... - - •.._.......... ........... .... .1, ......................... -• - ..� - ADDRESS 2554 Gise $txet, Port,Totmsend� _ WA _ - 98368, -------------------------•--•.....................,............. NAME CHARLES W. ...................Q....'.4....... „SHARONP. O' HARA ,_.................. ........... NA14E OF BUYER AND COMPLETE DRESS ADDRESS 4355 Sunde Rodd, N.W.! Silverdale, WA AM Send Statement to: j;b a�je listed gurghaser tapml dffst rl mm of rW properq shamed in JEFFERSON COUNTY The West one-third of the West Half of the East Half in width of bots 47 and 48 of Olson and Hambleton's Addition to Port Hambleton, as per plat recorded in Volume 2 of Plats on page 117, records of Jefferson County; EXCEPT the right of way of County Road; AND EXCEPT the East 30 feet; ALSO, the East 30 fleet of the West Halif'of Lots 47 and 48 of said Olson and Hambleton's Addition to Port Hambleton; 4XCEPT the right of way of the County Road; AND EXCEPT 22 square feet in the North corner thereof excepted in deed from DeEtte Duncan dated January 7, 1964 and recorded under Auditor's Fixe No. 192483, records of said county; All situate in the County of Jefferson, State of Washington. PERSONAL PROPERTY IF INCLUDED IN SALE i If tux exemption is claimed, explain fully the nature of the transfer. GROSS SALES PRICE 25, 000.00 lequity plus obligated balance) .......... .. $ PERSONAL PROPERTY (deduct) ... • • $ 25,000.00 TAXABLE SALES PRICE ... DATE OF INSTRUMENT ?111 `l6, 197$ —<— .A_._ML (On date at delivery of instrument if that is The closing date provided in contract; otherwise upon execution of contract) TYPE OF INSTRUMENT Real LEstate Contract If sale cover$ properly traded in under R.C.W. 2BAA5.1D5 give date and affidavit number of prior sale. DATE AFFIDAVIT NO. TYPE OF PROPERTY? ❑ GvmmerriR1 Q Residential [] Agricultural ❑ Industrial ❑ Recreational Q Mobile Home Site ❑ Multiplir Dwelling Q Bare Land Does sale include current crop? ❑ YES ❑ NO Served by a public sower? C] YES ❑ NO Does sale price include real estate commissipn? ❑ YES ❑ NO if more Own one county parcel number, will property ❑ be used as a Single parcel? YES ❑ NO 91 Will ' Wifl this prnperry be used with any aditlinirtg ' {►it7 f-•� ti ❑ YES tI-^-••�l NO property or;sently owned by the purchaserr?t Does this conveyance involve ? ❑ Partial Interest c,.i ❑ C r r'���,�ffiifetions ®~• �Y1•lr R�a��,P�ti� � {1 $� U�• ❑ Trust Agreement Escate Property Trade Life @state' ` A.V. C ASS 1%n EXCISE TAXZrj(}, 00 (PayRbIv within 30 days of date of sale) ...... $ PENALTY 11-4 per month) ........ �. TOTAL ........................... $ 250.00 AFFIDAVIT The undersigned being first sworn, on oath says That the foregoing is a true and correct statement of the facts pertaining 16 the transfer at the LOUuve de ribed real estate. 91 ATlJA6 Any person willfully giving false information In this affidaviT shell be subject to the PERJURY LAWS of the Stare of Washington. Subscribed and swo n to fore me this / /11L day of 18 Notary ublic 1n *d for the State of Washington ry/J residing RT / 4"' O-'"' PROCESSED BY 7-10 - �'/ AFFIDAVIT'NUMBER Map Output Page 1 of 1 ArcIMS HTML Viewer Ma t 929464@47 977MIG2977700Mi WMAM { — -- . Legend 921042M JC Roads El Fame" I D Baundafles 977=0 71 ! Z9d94 921043017I 921043004 9MOOM I221043M 92160M --- I l 921043032 1� 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 collection. Fri Aug 08 17:08:49 008 http://gisserverlservleticom.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0... 8/8/2008 Parcel Print Parcel Number: 977700072 Owner Mailing Address: CHARLES W O'HARA SHARON M O'HARA PO BOX 3531 SILVERDALE WA 983833531 Site Address: 390 MEADE RD NORDLAND 98358 05/14/2007 Section: 4 School District: Chimacum (49) Qtr Section: SWI/4 Fre Dist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1E Tax Code: 211 Planning area: Marrowstone (3) Sub Division: OLSON & HAMBLETON'S Land Use Code: 1100 - HOUSES (single units, non-farm) Page 1 of 1 Property Description: OLSON & HAMBLETON'S 1 47&48 W1/3 W1/2 E1/2 I LS E30'INC E30' OF I W1/2 LS WELL SITE http://www.co.jefferson.wa.us/assessors/parcellparcelprint.asp?PARCEL NO=977700072+... 8/8/2008