Loading...
HomeMy WebLinkAboutSEP1973-00120�: /�, � ,y �7� 903 E. Caro]ire OLYMPIC HEALTH DISTRICT Permit No. Pbrt Angeles SEWAGE DISPOSAL PERMIT APPLICATIO Submit in Duplicate Builder Court House Port Townsend! � ®f_ � ate 14-cCad., 5'7 ADDRESS -- PHONE DIRECTIONS FOR LOCATING SITE 9N, - its APPLICATION IS HEREBY MADE TO: INSTALL NEVA+ SYSTEM -�AIR EXISTING SYSTEM YPE OF BUILDING NO. OF BEDROOMS BASEMENT ` SI STZ NAME OF INSTALLER DRAIIVFIELD LENGTHDEPTH #LINES SEPTIC TANK SIDE DRAWA DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE r t cenl C) a- Li 20;��-� z to _` I k° �;c r +..v.i+.Wryavu v17 1JL KxJ; LiarvaKy rldUMOt .L,VUWL.LVLV VLS b117219 J.1`vALIIJA'1'ZZ :Lnjb PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM. THE .-HEALTH DEPARTMENT. - ------- DATE OF INSTALLATION -DATEOOFINSTALLATION SIGNATURE OF APPLICA GS��, � APPROVED `�� DATE Z') INSPECTED BY i DATE _/`' /? SANITARIAN'S COMMENTS: I CERTIFY THAT THIS S !YAS INST LED IN THE MANNER APPROVED BY THE HEALTH DEAPR�T Z DATE ACTIVI-TY REPORT FILE REFERENCE: INDIVIDUAL OR ESTABLISHMENT: ADDRESS: LE ^14\5- pt QA, k, IM=R TO FOlJ=: O OrHER IONS: ........... ........... DAIZ: 19 IMESMATUE: Jefferson County Health Department 802 Sheridan Ave. �® Port Townsend, WA 98368 b " 'J '206=385-0722 SEP 0 199! Receipt No. Fee: 4- g, Date:_ 9- 3 - 9 ) EVALUATION OF RMIVIDUAL SEWAGE DISPO ' .SYS. M- A1D1OR WATER SUPPLY MEALT11-1 DAEPT, Information Recllested: X Indivi&al Sewage Disposal System -T Water Supply Public '-X— Private Applicants Name Ceti�� '��u- Mail Camplet� Report To Owners Name s fu Address s-yi 6fAi-CA; .'Al -A•vd &14 (w) 3`t(n-'1.11(6 x 10 Phone: 4(6 Zo Number of bedrooms Previous Owner (if Known) 9:. Year Installed X913 Legal Description: Section 1 Township Range IC -- Street Address S'7 iG2 ,cam ry Poi ,o r Ad . atlo 2U e-4 A 1e 983sY to property ah- M SEWAGE DISPOSAL SYSTim- Permitted system ,yes no Installed prior to permit requirement yes no Sewage noted on ground at time of inspection* yes '*"X no House is unoccupied therefore an evaluation of drainfield performance is not possible at this time. A review of our records indicate that this system was designed to service a I bedroan residence. This system is not considered adequate for a bedroom residence unless it is sized per current regulations. Septic tank should be pmmmped if not done within past 3 - S years: Fa R'4 koobc �,,; �'�'^� ,� .k ,�I�e� ��►� pis -b �-e WATF�Lt Y a Well casing 1211 abovegroundX yes nD zS` A)OOL" .. C� ca �- Sanitary seal in place -<, no Well 100' from drainfield yes_ no Water sample taken no Sample results SG��,� t c�0 ��� A fJ��F CCP -14 JA, -1 Q 6 -91 QMments: -�'o © $ �%- Ott' Date CT - I I Time 3,1 1 o /�- �I"- Nl'-l--- 1--Erwin-amental 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 mammary of findings only. EESFORM 11/88 U'V+ LM' r. _ q i n -_0 GOODMAN SEPTIC DISPOSAL P.D. Bax 233 PORT TOWNSEND, WA 98368 (206) 385-2557 CUSTOME" OIIDeR NO. PXale wre lu►we "DRM Q I .I 1 < tG o !' TAX m E° By `d TOTAL -- accompanied by this bill. `7ZumkcYou 1317 Wa,4&gW-&*mVm414M 4 R Si •r . i -W i; Cj 4 ._g (. 1.1 ®� °: v�' C. I � T. !-':p-T�`;:7 Jefferson County Planning and Building DPpart*Rnt Cour. thouRcf , 3rd Floor PO Box 1220 Port TownRend, WA 98368 206-385-9141 PFRMTT *.. :RLD91-0749 DATE RF..CF.TVED.:10/16/91 STTR ADDRESS:571 GRTFFTTHS POTNT RD : NORDT.AND, WA 98358 OWNER .......: COLLEEN MCCAHTT,T. PHONE : MATLTNG ADDR:571 GRTFFTTHS POTNT-RD :NORDLAND WA 98358 ------------------------------------------------------------------------------- CONTRACTOR ..: ROWF CONSTRUCTTON PHONE: 385-zzo-7 'MATT.TNG AnDR:4170 FLAGLER RD :NORDLAND WA 98358 CONTR. LTC #:ROWFC**148KH FXPTRATTON DATE.: 04/18/92 ARCHTTF.CT/ ..: PRONE: T)PSTGNER .... . MATT.TNG ADDR : ---- PARCFT. NOI,---021324-014--------------------------------HF.A-T-------(r�-� T.FGAT. nF.SC..: STR 32-80-01 FWM, TAX # RY: DATE.: LOT 14 BLOCK 11 GRTFTTH ESTATES SH F.T. S:: , , RY : DATE: nF.SCRTPTTON OF TMPROVFMFNT: STNGT.F FAMTT.Y RFSTDF..NCE ------------------------------------------------------------------------------- RiTTLMNG TYPE ....... RES BEDROOMS--- BATHROOMS-- MATN FT....: 1022 Rf TYPE OF TMPROVF.MENT : NF.W F..XTST .: 0 F.XTST .: 0 2Nn PL....: 551 Rf GARAGE/C.ARPORT..... : PROP..: 1 PROP..: 2 3Rn FT.....: 0 sf WOOnSTOVF.......... : TOTAT..: 1 TOTAL.! 2 BASEMENT..! 0 sf TIBC OCCUPANCY GROT7P : R3 SEWAGE. nTSP ..: SEPTTC CARPORT ...: 0 sf TYPE. OF CONST ......: WATER STTPPT.Y.: PWF.T.T. GARAGE ....: 0 Rf [7NTTS.: 0 STORTF.S!O HEAT TYPES.:HTP/ / nFCKS..... : 530 sf nTMENSTONS: -------MORTT.F ROME ------ COMMERCTAT.: 0 sf FRAME. TYPE..: MAKE.: VR- TNDTTSTRTAT.: 0 Rf FST COST.$: 57200 ST7.F.: RANK NT ... :6 ft PROD GRP..: 2090 SH SFTRACK:20 ft ------------------------------------------------------------------------------- Owner/agent ---------------- FEES -------------- Signature: type amount by date recpt PRMT $ 450.50 AK 10/16/91 59829 nate: PT.CK $ 67.58 AK 10/16/91 59829 R.C. $ 4.50 AK 10/16/91 59829 TRR v -d Ry! Date: ------------------------------- 57.2.58 TOTAL u i 17 16 15 12 TA X Jefferson County Environmental Health Department Application For Determination of Adequate Potable Water Supply Jefferson County Resolution #99-90 to provide evidence of an adequate Name 1)" Address '" RY i r, _. 17 4Q�i requires building permit applicants potable water supply. Phone/Hm Wk Assessor's Parcel ID# C611 aAj I ` Legal Descriptio'of Property Site Address J -71 Type of Evidence* (check one) Valid Water Right Permit (ach copy) att Approved Public Water (attach letter from purveyor that the system is capable of and will supply water. Include State IQ number. Environmental Health will determine if system is in compliance with State Drinking Water Regulations). Individual Well (attach copy of well logs including production test results and lab analysis for water quality parameters - total coliform, Nitrate -N, primary inorganics - and plot plan showing location of well with respect to proposed sewage system, buildings, driveways and surrounding properties). ********************************************************************* Office Use: a) Water Right Permit# b) Public Water Supply Name of Supply Washington State ID# in. -compliance yes no c) Individual Well Driller Name Date Drilled Depth Production Meets Water Quality Standards yes no Applic 1 n e ied** Not require_ Date * A temporary moratorhall be placed on approval of alternative water supply systems until appropriate design and construction guidelines have been established. **Appeals shall be filed in writing within 15 days pursuant to Jefferson County Health Department Policy Statement #2-88. 9/90: WATERSUP ci V✓ S ' to SAtdPtE COCLECTItsiRLAr=tNSLRtISC t4`.L I DEIvt o�1�t �. It Instructions are not: fp(low *npw vili.i�e•.e tea: , _ - . - DATE COIL ECTED ,. a TIMELx> COUNTY NAME NTFF Q14K YEAR bw f j •- z . u R'e ; _ TYRE QP S IF, G4. " check treatment ❑ .Filtered J _� t . Y _ 2. ❑ RAW SOURCE WATER ` 3. Q NEW CONSTRUCTION or. REPAIRS mwc= 4. ❑ OTHER (Specify) L !(SIf�i30 I.r•c+ llM�l \ V• �. ' � e COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE t ,2 3 4- :,y PREVIOUS LAB NO. PREVIOUS SAMPLE COLLECTION DATE ' 1 K `y NAME OF SYSTEM . t£ P r .4' SKCIFI7; t:OCATiOX-V01ERE.SAMR , IWM AA�TfI€P�}Ell 1 kNehen eap ® sch,04 the ebdb4 tain� ' LABORATORY RESULTS (FOR LAB USE ONLY) SAMPLE COLLE TED BY: (Name) } ,y MFft- COLIFORM STD PLATE COUNT SOURCE TYPE s ; ` COMBINATION.'. L� SURk'ACE WERE." C SPRlN(,� GQ PUFlASEA �M /ml ar OTHER 1r c; �Gr .. CCPItI OCDAGT Tfl. iot..i r..a� ��... ♦��.�. _� _y. ... - ' S � f j •- z . u R'e ; _ 1. � DRINKING WATER ❑Chlorinated (Residuak Total Free) G4. " check treatment ❑ .Filtered i A. 6 WASHINGTON + < TYPE OF SAMPLE . u 1Check only re in twi column} • . - a ; _ 1. � DRINKING WATER ❑Chlorinated (Residuak Total Free) G4. " check treatment ❑ .Filtered ,.. VUntreated or Other _ 2. ❑ RAW SOURCE WATER ` 3. Q NEW CONSTRUCTION or. REPAIRS 4. ❑ OTHER (Specify) U e COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE PREVIOUS LAB NO. PREVIOUS SAMPLE COLLECTION DATE ' REMARKS: t£ P LABORATORY RESULTS (FOR LAB USE ONLY) ,y MFft- COLIFORM STD PLATE COUNT SAMPLE NOT TESTED { /ml BECAUSE 1r c; �Gr ` MPN DILUTION ❑ Sample Too Old. rx } n TEST UNSUITABLE . /lOO ml1), ❑ CoMiuent GPowth ❑ MF COLIFORM 2. ❑ Not In Proper Container ` 4„n y,3 t TNTC ❑ insufficient Information Provided—Please j} 3• Q Excess: Debris Read Instructions on Form*K� t r p k r FECAL COLIFORM F 4.0 ' f ; FOR DIPIM(WGi WATER SAMPLES -ONLY, THESE RESULTS ARE I SATISFACTORY ❑ UNSATISFACTORY SEE REVERSE SIDE OF GREEN COPY FOR. EXPLANATION OF RESULTS .•n. LAB NO. ': DATE. TIME RECEIVED- f E¢EIVED BY , DATE REPORTED LABORATORY: l# REMARK }1218%t } <- Ddf 305-002 (REV. °@ . i �B .7 EE'FERs aN Cc�UNT Y� BT_T� Lnm NG �PPL2 CAT2 CDN Jefferson County Planning and Building Department_ Courthouse, 3rd Floor PO Box 1220 Port Townsend, WA 98368 206-385-9141 'ERMIT #.... :BLD92-0152 DATE RECEIVED.:03/13/92 SITE ADDRESS:571 GRIFFITHS POINT RD :NORDLAND, WA 98358 --------------------------------------------------------------------------------- )WNER........COLLEEN MC CAHILL 1AILING ADDR:571 GRIFFITH POINT RD :NORDLAND WA 98358 PHONE: 396-5660 SS #: 536-28-5673 - :ONTRACTOR .:CHARAWELL CONSTRUCTION PHONE: 437-2244 'MAILING ADDR:PO BOX 65026 :PORT LUDLOW WA 98365 :'.ONTR. LIC #:CHARAC*297RF EXPIRATION DATE: 05/01/92 FED I.D.: --------_---- ARCHITECT/..: PHONE )ESIGNER....:. 4AILING ADDR: ------------------------------------------------------=--------------------- - ?ARCEL NO ... :021324-014 HE T r E'GAL DESC..: STR 32-30-01 . EWM, TAS- # BY DATE: 3-1g =9° _ . __ 7,OT 14 , BLOCK 11 , GRIFITH ESTATES S E _...-- BY: DATE : `iESCRIPTION OF IMPROVEMENT: single family residence ---------------------------------------------------------------L-1 1 _ 3UILDING TYPE ...... :RES BEDROOMS--- BATHROOMS-- MAIN FL...: 952 sf TYPE OF IMPROVEMENT:NEW E;IST.: 0 EXIST.: 0 ADD'L FL..: O sf GARAGE/CARPORT.....: PROP..: 1 PROP..: 1 HTED BSMT.: O sf WOODSTOVE..........: TOTAL.: 1 TOTAL.: 1 UNHT BSMT.: 0 s: UBC OCCUPANCY GROUP: SEWAGE DISP..:SEPTIC CARPORT...: O sf TYPE OF CONST......: WATER SUPPLY.:PWELL GARAGE....: 0 sf UNITS.: 0 STORIES:0 HEAT TYPES.:EEE/ / DECKS.....: 0 sf DIMENSIONS: -------MOBILE HOME------ COMMERCIAL: 0 sf FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf EST COST.$: 38080 SIZE: BANK HT... :0 ft PROJ GRP..: 2688 SH SETBACK:O ft -------------------------- Owner/agent------------ --- FEES -------------- Signature: type amount by date recpt PRMT $ 343.00 MM 03/13/92 63927 Date: PLCK $ 51.45 MM 03/13/92 63927 B.C. $ 4.50 MM 03/13/92 63927 Issued BY __.--- Date: $ 398.95 TOTAL ? a•r Grr +���1 �1-I �i F...Dilb I - Iva j `n i ._. Wp�LL In i a N1,A j ' �__r �ctSTttyGti 1�1 j i r , ` tsFT I J � --- 3�• I ��' -gam ptzAvaS� HOMO N 1"0" i Iva 1NI I `n i ._. Wp�LL In i a N1,A N 1"0" i ► C-3 r -- CL CL - o c CL co CD CD J J O J i �o m a r C/3 r- --. Z C"13 v C7 CL -v -v C3 C3 CG CM C-- v ca r -l- I Z c CL C3 CL w cn O cn C31 3 CD CD O J 3> c r -r- 0 = :K 0 0 — CL — CD O H n Z T a C H -1� N - CL C3 it X w w C3 — -a -3 i C CL CD 0! C7 -- CD CC CD h CM CD — E i O =3 �$ IR7 CD C-3 J CL O � J O O 1 O C3 N C-3 � ^W1 , V O -P —% O O J C co O -p I O r �- 1 C-3 —I cn —1 cn m 1 -0 C C 17 W CD 0) co C13 r— oo X ro o CC3 v • r CD —I C-3 W CL r v a O r w lU ate,X C3 -tern .& C-3 CA3r r-- 3 r r . cn -P m m rn O m J w ry J —� O ► C-3 r -- CL CL - o c CL co CD CD J J O J i �o m a r C/3 r- --. Z C"13 v C7 CL -v -v C3 C3 CG CM C-- v ca r -l- I Z c CL C3 CL w cn O cn C31 3 CD CD O J 3> c r -r- 0 = :K 0 0 — CL — CD O H n Z T a C H