HomeMy WebLinkAboutSEP1975-00085903 E. Caroline 11 EF—S" OLYMPIC HEALTH DISTRIft
Port. Angeles V� as • 91 SEWAGE DISPOSAL PERMIT APPLICATION
Submit in DuE irate Builder
Court House'
Port Townsend 10 ';a-eee 8 Date '�TS..C...:.
10DIRECT ONS FOR LOCATING SITE Lots 53. 54 55 c�s�.oCk i�� `S �i TTl ai nn i-
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APPLICATION IS HEREBY MADE TO: INSTALL NE SYgTEM REPAIR EXISTING SYSTEM
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DAT`F INSTALLATION SIGNATURE OF APPLICANT Vt,-
A,PPROM DATE / INSPECTED BY
SANITARIAN'S COlUiENTS :
I CERTIFY THAT THISjn?TEM vAS DTS LED IN THE MANNER APPROVED BY THE
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SITE EVALUATION REPORT"
JEFFERSON COUNTY HEALTH DEPT.
Multi -Service Building
802 Sheridan Avenue
Port Townsend, Washington 98368
(206) 385.0722
Applicant A. F. South
Address: 135 Elk Drive
Brinnon, WA 98320
Telephone: 796-4789
THIS REPORT DOES NOT CONSTITUTE APPROVAL OF A
BUILDING OR SEWAGE DISPOSAL PERMIT. THOSE
PERMITS SHALL BE GRANTED ONLY UPON APPLICATION
AND WILL BE REVIEWED IN ACCORDANCE WITH
CONDITIONS AND REGULATIONS EXISTING ON THE DATE
OF THE PERMIT APPLICATION. THIS REPORT IS NOT A
PERMIT APPLICATION.
Receipt ,No: 2835
Feer $30.00
Date: 8-14-81
Sec. 16 Twn. 25N Rg 2W
Diva 7, Blk 15, Lots 53-54-55
Legal Description (Div.. elk.. Loll
Directions for Locating Site (Draw map on baC4
Site size 190 x 139'
Seller
Buyer
evaluation of existing system
1 request this site evaluation for 1 single family residence or
INSTRUCTIONS: A minimum or two soil log holes at least 4 feet deep, 2 feet diameter, and 50 feet apart must be dug in the proposed
drainfield area and flagged before the evaluation is made. See attached instruction sheet.
A site evaluation of the above property was made on 8-20-81 by this department and the
property has been found:
K ACCEPTABLE - Soil and site conditions are acceptable for installation of a sewage disposal system, as requested above, under
existing conditions and regulations.
❑ CONDITIONALLY ACCEPTABLE - Soil and site conditions are acceptable for installation of a sewage disposal system, as requested
above, under existing conditions and regulations, provided THE CONDITIONS SET OUT BELOW
ARE MET.
❑ UNACCEPTABLE - Soil and site conditions are unacceptable for Installation of a septic tank system.
COMMENTS:
24 x 40 to be added in same place as existing structures.
System functioning in a proper manner on this date.
SOIL LOGS:
Respectfully,
Merilee L. Blaine, R.S.
ENVIRONMENTAL HEALTH SPECIALIST