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Home My WebLink AboutSEP1974-00014IreduriP the. -following items on your plot.-plam,: ❑ `Property boundaries ®" N mes of adjacent streets a� Driveways and parking spaces ❑ Surface water (ponds,creeks, etc) M,"'�Buildings(residence, sheds, garages, etc) � PTP ElWells t Septic tank &- D'rrainfield (enter NN if unknow ca-- orth Arrow PLOT PLAN -date preparedq MUT TD 504L , IS Lth -THIS >V PY 699 i l i E t -i1 ice. up %WD M Aa 5J4A: iT, T -J tea! f1 t ,C j 4-- asty LJk*-- i- eletrI AIC - -- Lac,47 A IE �-4 it ,„� C tc a fi SCI rZI bmftd as a -Da el or appmued by X Hermit or rami �T coo Evaluation of an Existing Onsite Sewage §jystem —o# 130104, -cdf ; R -SAW SF*P 903 E. Caroline OLYMPIC HEALTH DIS CT Permit No. -40 7. Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House Port Townsend q �`'� 1 1 P�° Date /® A. ^OW yL+�_,,,__ ., ADDRESS PHONE DIRECTIONS FOR LOCATING SITE "�l-z �_� �� @may N APPLICATION IS HMMY MADE EXISTING SYSTEM DRAINFIELD LENGTH_t.16 �JIDTH_p �DEPTH #LI MQ. SEPTIC TANK SIZE5� � Ion 10 tdv cc � e�.►+�a°e .�S �K5`-•,_ `ate (.tS 1/s/9's 'AtCHANGE IN BUILDING OR SE!GE DISPOSAL PLANS:,.LOCATION OR SITE, INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HE-ALTH DEPARTMENTi DATE OF INSTALLATION f SIGNATURE OF APPLICANT DATE f/� � S?ECTED BY �.�� DATE,1/ SANITARIAN'S OIMI -t-o i -,5 �rU I CERTIFY THAT THIS HEALTH DEAPRTMENT MANNER APPROVED BY THE 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 loca oaf; Beck Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a cuia� identifying these items. _ case ALL SPACES MUST BE FILLED IN. DEC 17 2003 If information is; not available enter (NV) or not applicable (NA). Type of Evaluation R ason for Evaluation 0 Routine operation and Monitoring Inspection 5t '-Evaluation of on-site sewage system Real Estate transaction Evaluation of drinking water O Complete a Permit # D Building Permit Review and/or no septic permit on file O Evaluation of on-site sewage & drinking water O Other, explain Tax Parcel# -q y i W 46oeA/ q. Permitted System -)�yyes no Permit/case # SEP'7 Ll -1 `-{ Subdivision, Division, Block and Lot(s)1'&Dj5�- CA oQA Vi t..t idKE pl\l LOT- /S Lot Size Acres or Dimensions X Current Owner Kj riK aTLj S N-jtM 7Z6 Mcg KO iO4So/V Site Address / q/ 14t)c►4.t_c 13 c2 Rte/ PL Owner Phone # 3 60 - 3 -7? - jg� ol, Ll Previous property owner name(s) - (NN if not known) Directions to Site Front W: SotjT-M oiv SatirH f) use uE-RY _ kJam7- o n 0-.4A G-e-:OmL Rb So u rtf a N 14 a c-4.� % C- k" PL. / fbusc_ o N Date System Installed / — -7q Age of Dwelling r5 l C1 -75- #Bedrooms_ House Occupied yes no, vacant how long? Who installed system? Y L I At OSEY Send completed report to: Owner Name Mailing AddressN / Yyc u_cpE-MRY Pj-. In�ll�lSE,AIb�'�fi' 98 Phone/emaivfax360-3 72 7,S 214 �,SKAjj: /A -M703 BY C- NV I PZC- H-!✓c� Realtor or Other Representative Name Mailin JemawraY l — g ^ 11 .-" / / ti o ---Irl '% Ar 7 - !% 5SM- la -1a -o3 16Y 4RAr v SLP Z L-1-ly Include the following items on your plot plan: o Property boundaries a Wells o Names of adjacent streets a Septic tank o . Driveways and parking spaces a Drainfleld (enter NJV if unknown) o Surface water (ponds,creeks, etc) a North Arrow v Buildings(residence, sheds, garages, etc) PLOT PLAN NOT TO SCALE Permit # or Parcel # Documerdl 2 of 4 Oki N ENVIRWHECI, L.L.C. 1612 Hastings Ave. W. Port Townsend, WA 98368 Evalluation of an Existing Onsite Sewage System Date of Inspection 12,-16-03 Inspected by - s Water Supply (fill in only if water supply'is being tested in this eval 'Iitlan) Sample was taken Yes No Sample Results_' Well casing 12 above ground Yes No Sanitary Seal in place Yes No ! DEC i % Public: offsite onsite Name of System ii -- -t Individual:- offsite onsite R 4 1 I Is well more than 100' to drainfield/disposal component _yesno,. if not, dIstance Is well more than 50' to tanks and effluent transport line _yes_ no, if not, distance ONSITE SEWAGE SYSTEM # Bedrooms/gallons per day indicated in County Health Dept records for this case #1 - Septic Tank Tank size /OOC> gal. ,single compartment two compartment ('b AtCAETt' material Riser to grade on inlet yes no. Riser to grade on outlet yesno Condition of tank X good needs repair, describe 1st comp. Scum (top layer) _�_in. sludge (bottom layer) 14 in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? yes _k_ no If yes, where was water Condition of baffles: Inlet: repair material condition clean Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)) yes 2C no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: ( e9: 9 ) Does system include a pump? yes If yes, complete the next section_ no (if no skip to section 3) #2 - Pump Chamber - Tank size gal. Material. Riser to grade? yes 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 ? yes no If yes, where was water observed? Screen around pump? yes no Shroud around pump? yes no Electrical Components Pump operating ves no, describe High water alarm functions yes 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 Permit # or Parcel *Sep. Dowmentl 3 of 4 s Evaluation of an Existing Onsite Sewage System #3 - Drainfield Appropriate Vegetation in area yes no. Describe vegetation G plug Indications of surfacing sewage (check one) ves , if yes, describe and diagram on plot plan _no drainfield area is overgrown and not observable Signs of parking/driving in area __yes�no drainfield area unknown Ground settling or erosion ves no overgrown/not observable Monitoring Port Observations (if present): Residual Head ves, # of inches no Ponding in trench yes, # of inches of ponded effluent no Repair area is? Available as shown on permit __>C—None evaluated or shown on permit Addendum Is attached for evaluation of Treatment Unit or detailed evaluation of drainfield. ves�no COMMENTS (attach additional sheet if necessary): g 0117-1,- T g�! FFLE Rc PU4csrb I r H SEE ATTACHED ADDENDUM ON NeXT XrvspocrioN/ ICD �311�1,€ ,� g . Was a System Problem Identified? Yes X if yes, what section #. JL�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 i formation provided is based on a review of County records and my direct observations at the time of inspection. 1�®aoS ame/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. Permit # or Parcel #S fid/. �''r y Dommentl 4 of 4 Include the following items on your plot plan: ❑ Property boundaries ❑ Wells ❑ Names of adjacent streets ❑ Septic tank ❑ Driveways and parking spaces ❑ Drainfield (enter NN if unknown) ❑ Surface water (ponds,creeks, etc) ❑ North Arrow _ - _ 4 E3Buildings(residence, sheds, garages, etc) _ \ 1� PLOT PLAN DEC 17 tm FL T- C n m r NOT T® SCALE if I ENVIRNe-CHECK, L.L.C. 1612 Hastings Ave. W. Port Townsend, WA 98368 Permit # or Parcel #56 P 7 �I-I 9 Dmmentl 2 of 4 ` ADDENDUM Enviro Check, L.L.C. Company Disclaimer # DATE Q— Io-& ADDRESS -141 � &�j► OWNNER 6*AM 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 reportlevaluation. 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 lines/boundaries are approximations 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 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. r _ - e R. Wurtsmith Co -Manage Weather Conditions SAMPLING (Septic tank) Date - PH Result - DO Result - Temp. Result - MEASUREMENTS Counter Settine- Hour Meter - Water Usage (Ave.GPD,) Meter - Squirt Height (In feet)- ON-SITE SEWAGE DISPOSAL SURVEY OF (416_� A Street Or Division Block Lot Landmark Lot Size I. Location, Lot Size ""� 1 �j✓ II. System Owner Address Telephone Number 3Q 5- RZ 7:S Permit (?) (Previous Owner) Date Issued III. Installer L Average Number of People Served 3 Date Installed _I � h 4 Number of Bedrooms o� Time In -Service (years) to Clothes Washer Septic Tank Pumped YE ✓ NO YES NO HOW Dishwasher OFTEN YES Nom- # of Months/Years Residence Occupied? Garbage Disposal YES NO IV. Typ of cover over`drainfield. (i.e. grass, landscaping, etc.) l V. Repairs (when, what, who) Cause of Failure ' J �•► frirt/l. VI. Comments '(Over for Sketch) r Parcel Details Page 1 of 2 Parcel Number: 941400014 !` SEARCH Parcel Number: 941400014 Owner Mauling Address: KIRK GRESHAM TOMOKO TOLSON 141 HUCKLEBERRY PL PORT TOWNSEND WA983689418 Site Address: 141 HUCKLEBERRY PL PORT TOWNSEND 98368 Section: 13 School District: Port Townsend (50) Qtr Section: NE1/4 Fre Dist: Cape George (6) Township: 30N Tax Status: Taxable Range: 2W Tax Code: 161 Planning area: Quimper (2) Printer Friendly Sub Division: CAPE GEORGE VILLAGE DIV 6 Assessor's Land Use Code: 1100 - HOUSES (single units, non-farm) Property Description: CAPE GEORGE VILLAGE DIV 6 1 LOT 15 1 1 1 Click on photo for larger image. No 2nd Photo Available Permit Data assessor Bldo Data kax,ales Info LMap Parcel Plats & Surve s a HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later . Map Output Page I of I I ArcIMS HTML Viewer Map 9414MIG 94MODW4 CL II 002132027 U Legend 13 Selected Fealums Towns 941400014 Rwd Catm. Road SySteM EJ PajeebH 94140M13 002131on EC 17 94T40=? 9414CO012 iAapB ieffam= Canty calkei amcm C48 OR INFORMATIONAL PURPOSES ONLY- e'fferson County does not attest to the accuracy of the data contained herein and makes no warranty with sped to its correctness or validity. Data contained in this map is limited by the method and accuracy of its Ilection. Tue Dec 09 13:09:30 2003 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 3794450 ONSITE SEWAGE SYSTEM MONITORING INSPECTION CERTIFICATION The onsite sewage system serving parcel # q `�� j 400 D was most recently inspected by in Jefferson County Code 8.15.150. 0 permit # —/ I as specified The above referenced system is in compliance with the Monitoring/inspection schedule identified in Table 1 of Jefferson County Code 8.15. See report completed fo b for information on the condition of the onsite sewage system. ❑RECOMMENDED REPAIRS/MODIFICATIONS TO THE ONSITE SEWAGE 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 Z00(o 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. Signature of Jeffersonon Employee 14:�nl Date \\Healtliserver\home\env_hWthUinda\GD\FORMS\EES forms\MONITORING INSPECTION CERTIFICATIONI1-17-01.doc