HomeMy WebLinkAbout12M- SepticAuthenlisign ID: 947BA9E7-FF89-EC11-A507-501AC5E43BFD
Awr0 C&N*j LLC
1612 Hastings Ave. West
Port Townsend, WA 98368
mwi To: Ronald Hough
311134 HWY 101
Brinnon, WA
98$20
'• fi•� •�� i, fi Li
EFFERSON COUNTY DCD
360-379-9400
- PROPERTY INFORMATION
House
Location: 311134 HWY 101
Brinnon
Tax ID: 602213015
Use: Residential, Single Family
GENERAL SYSTEM TYPE: Gravity Bed
ON ID: SOM1990-00160
Fold ON -SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT
Here Inspected: 01/21/2022 - Inspection Type: PROPERTY SALE - Correction Status: All corrections made
Company: Work Pertbrmed By: Submitted 0112112022 by:
Enviro Check, LLC Dale Wurtsmith Dale Wurtsmlth
This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development.
COMMENTS & GENERAL INSPECTION NOTES
1- The tank needed to be pumped and was pumped by Enviro Check, LLC.
2- Risers are now mandatory and Enviro Check, LLC Installed risers.
3- SYSTEM- What I observed was consistent with County Inspection Form.
APPURTENANCES- An "Updated -Site -Plan" 1s en route to county.
Note- Contact county for more information.
GENERAL SITE & SYSTEM CONDITIONS
ine uenerai Jae ano ayscem s.onomons were:
All Components accessible for maintenance, secure and in good condition:
Surfacing effluent from any component [induding mound seepage]:
Components appear to be watertight - no v64 leaks'
Improper encroachment (roads, buildings, etc.)_onto ccmponent(s):
Component settling problems observed:
Abnormal pond€ng present for one or more of the disposal components:
Subsudsoe components adequately covered ----- - T
Owner -compliance issues noted
Site maintenance required (e.g. Landscape maintenance) If yes, describe In comments: -�
Occupant compliance problem (occupant not operating [lie system properly). If YES, doscrlbe in notes:
if deficiencies were identified on lest inspection were they corrected before or during this inspection?
(If NO, describe in rncles, NA= no deficiencies on last report):
OSS Components, structures and appurtenances located per as-built/record drawing (reference Septic
Permit # In notes). If NO, describe in notes and if no as -built exists or changes made, state NO and
provide record to Health Dept:
Alterations made to the OSS (valves adjusted, timer settings modified, ports installed, etc.) ( If YES,
describe In notes):
The houselstruclure was vacant or used iPfrequenlly, assessment of the drainfold was not po5slble.
Is the SEP case In a finike- completed status? (if NO explain in comments)
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
Fully Inspectea
NO
NO.._...---
YES
NO
--- - - - — - NO - —
WA
YES
YES
NO
NIA
NO-- 1
NO I
NO
YES
This component was:
Fully Inspected
Component appears to be functioning as intended:
YES
Effluent level within operational limits (if NO explain In comments): T _
YES
All required baffles in place (NIA = No baffles required): -
YES
Effluent Filter Cleaned (N/A = Not Present):
NIA
Effluent filter/screen needed cleaning on anivalT
No
Compartment 1 Sam accumulation (Inches, if other specify):
12
Compartment 1 Sludge accumulation (Inches, If other specify): �—
10
Compartment 2 Scum accumulation (inches, If other specify):
r
Fold
Here
ReporlID: 1035252 View inspection reports online at www.onlinerme.com Page 1 of 2
Aulhenfisign ID: B47BA9E7-FF89-EC1 1 -A507-501 AC5E43BFD
Compartment 2 Sludge accumulation (Inaws, if other specify):
9
Pumping needed:
YES
Corrected
Approximate Gallons to be pumped (if needed) by Certified Pumper: v
1150
7hIs component was:
Fully IrgpcclBd
Component appears to be functioning as intended:
YES
Ponding present? If YES explain In corrlments:
N/A
"infield was vacuumed, flushed or hydro -jetted? (If YES, explain in comments)
NO
7hk rsporf fndlcetea ceRah drerecierfatics alMe omits sewage ayaem at the dme or NdX. to na way la Ihta report a gv,—,,nn of operaabn or A&m perfarrnorrcn.
ReplortlD: 1035252
View inspection reports online at www.onilnerme.com
Page 2 of 2
Authentisign ID: B47BA9E7-FF89-EC1 1 -A507-501 AC5E43BFD
Efte Plea for Septic System
Site Address wjM
Parcel Number
Septic Case dumber -15ER 19 'fib-Ob lop
Daze Site Plan Prepared —a
Site Plan Prepared by - _ILA 't "-3 u G Ztm
FM
B
P
RESERVE--
o4cCr
fi#w A
Include the following items on your plot
plan:
✓ North arrow
Propery► boundaries
AdJacent streetls
Driveways
surface water (ponds, creeks, etc.]
-� Buildings (residence, sheds, garages, etc)
f Wells
0
11
rA�14k ,7,
To FA,MRZY
Authentisign ID: B47BA9E7-FF89-EC11-A507-501AC5E43BFD
nHIS pl RVj t74111 EXPIP ONE YEAR P''RCM DATE ISSU®. APPLICATION
IF -OR RENEWAL FC,- -;IrE YGIR 'rr11-HI,: 30 DAYS BEFORE EXPj°ATION,
.IEFFERSON COUNTY HEALTH DEPARTMENT
802 SHERIDAN AVENUE
INSTALLER fix' PORT TOWNSEND, WASHINGTON 93369
(206) 385-0722
BUILDER
SEWAG t 11 P
C
AUG 2-61990
bwner A dress -_... _.._ _... .
'Pd ,eA� ab/ °`,¢T.1 KEPT
Directions for locating sits�� .�rar�,•e/ .//.�j hS�`
INSTALL. NEW SYSTEM fg-- REPLACE SYSTEM
TYPE OF No. OF
Pint nmG �S' BEDROOMS
Previous --site evaluation by
Health Department
Yea No
Depth to maximum seasonal
water table
Source of potable water sup y
Public Private
Source type: Drilled well
Pia �eae Dug well
P Other
EVERY APPLICANT HAS THE RIGHT OF
APPEAL AS PER JEFFERSON COUNTY
ORDINANCE 2-77.
WMV V JV%TI
AUG 3 1 1$79
RECEIPT NO.
DATE j -
/20 �
N
Photo
der4ear '00;i0eurev " u7 d
b [7
TANK/DRAINFIELO - o rn
SITE $
-SIZE
�M
Z
�J
a �a,
�..:, C
SIGNAIURE F UPI.IQANT Z
ANY . 4F UR f' 17I5� IIRE�#1VCE OF SOIL, IN THE PROPOSED OR APPROVED DRAI NFI ELD r v
AREA jvAY CFAATE SITE .CONDITIONS THAT ARE UNACCEPTABLE FOR THE I NSTALLAT I O{ j OF A
sEKAGE DISPOSAL SYSTEM- ANY CHANGE IN BUILDING OR SBIAGE DISPOSAL PLANS [ I W3 IDI NG
PL" IM STLIBOUT LocATI ON) AND/OR LOCATION OF HOUSE OR DRA I NF I ELD I NVALI DATES THIS
PERMIT UVLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH IQEPARTMERT. !Call Health Dept.
,for final inspection)- STLB OUT PLLI\IB I NG ABOVE FOL\ATION FOOTING ,,i/
17
�
DreinfieId Length yp� Trench width /S-f Ttench depth Jj-4� No. lines -'Tank size,/oW y
Soii type and application rate used for design FDlftz
CONMTS :
�S�-+1 " �.a ��,t�. �1 �� �.-� �� s►n t#�'s �#� �j �,, � -ta. a g-zc -�,, .
.4lfr
PARTIAL REPAIR ❑
0
SOIL TYPE DESCRIPTION
1)
2)
i
3)
4
16.qvr�7
a-• P-a�3�
Coif, lr.,, 7-IeT`r l
'APPROVED DATE- 1NSPECIEO CEAEEbM1NA DATE
t cerilly that this system was installeQ in a -manner approved by the Health DeparlmenL
INSTALLEWS SIGNATURE
.lCHDj7-.+.84
DATE
DATE INSTALLED
Aulhenlisign ID: 047BA9E7-FF89-EC11-A507-501AC5E43BFD
crj-
JEFFERSON COUNTY HEALTH DEPARTMENT Permit 0 5o - /GO
INDIVIDUAL SEWAGE DISPOSAL INSPECTION FORM Date q-iP-�,+
APPROVED YES ✓ NO ENVIRONMENTALIST eeh,
Address -3 6(v 30.. 1�. '.y"+ r o ) r ''2a2 .. Owuer 7� � �ar3� • _ -
Legal Description. 7- )2 na )ri
Residence ✓ Commercial # of Bedrooms Z- System Installer
System Designerr=.j
SEPTIC TANK
Commercial ✓ Non commercial_ Measurements: L W WD
Construction Material_rLig. Cap. I i!�rcs S. Ii�r►�-
DISPOSAL FIELD
Ere. Depth ]Z ,2a +�.� Width Feeal Length 35 Sq. Ft. 3BS
Rock Type /�, :-,✓�_ ^_ Depth Under Over
Engineer Design Yea Type Engineer Appro—al Letter Yes
Well 50 feet from tank 100 feet from leach field
Well installed at time of septic system inspection Yes No W— Public Water
Comments • -h Ae 71) ee c -7
I oi�'i�4jw�y o/ �l �/�✓� `►� Jl�orin7l�l�i /v �'r'-� �C� �/
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Authenlisign ID: B47BA9E7-FF89-EC1 1 -A507-501 AC5E43BFD
She Name: House
L-.uaa: 311134 HWY 101
Brinnon
Tax ID: 502213015
u-: Residential, Single Family
Service Company:
Enviro Check, LLC
1612 Hastings Ave. West
Port Townsend, WA 98368
360-379-9400
Serviced:01/21/2022 by: Dale Wurtsmith Submitted 01/21/2022 by:Dale Wurtsmith
Dump Loeallon: Blo-Recycling
COMMENTS
Jurisdiction ID:SOM1990-00160
Tank Pumped:
YES
_
Tank Size (Geilons)(Number only, no text):
1150
Effluent level within operational limits (if NO explain in comments):
YES
Total Gallons pumped from tank (Number only, no te)t):
1150
Effluent returning back into tank after pumping:
NO
Tank depth below grade (inches):
8
.Access Risers installed to grade (N/A if not present):
N/A
.Access Risers securely fastened (N/A if no riser present):
N/A
Tank Construction Material:
Plastic
Tank Condition Good:
YES
Roots or ground water observed leaking into the tank or around the risers:
NO
Baffles in good condition (N/A If not present):
YES
Effluent screen cleaned (N/A if not present):
N/A
Effluent surfacing around site components (N/A if not checked):
NO
Tank abandoned after pumping:
NO
Were repairs made to the Tank or Tank Components? (if YES explain in comments):
NO
Compartment 1 Scum accumulation (Inches, If other specify):
12
Compartment 1 Sludge accumulation (Inches, if other specify):
10
Compartment 2 Scum accumulation (Inches, if other specify):
1
Compartment 2 Sludge accumulation (Inches, if other specify):
9
Drainfleld was vacuumed or hydrojetted? (If YES, explain in comments)
NO
Thts report Mdketes certeln cheradedsiics orthe onsge sewage system at the than oI Walt. In no way Is M report a y,arantee of operOm or Mme pwormawe
ReportlD: 565536 View pump reports online at www.onlinerme.com Page 1 of 1