HomeMy WebLinkAboutSEP1971-00029FA
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903 East Caroline CLYMPI'C HEALTH AI CT Permit No. .,�..�
Port Angeles Fee Paid
SEWAGE DISPOSAL PS RMI PPLICATION SEf"1 I � C�C3oZ�
Submit in iu i i.,ate
-DESS - DATE � � / � f3
3iAML A
LEGAL DESCRIPTION - V 1v A N g � �� �� : Q$I? I -1.663 _ PHONES
DIRECTIONS FOR LOCATING SITE Ih -,ti; &J o Y L & kJa
APPLICATIONISHEREBY MADE TO: INSTALL NEW SYSTEM%1-`1'1REPAIR EXISTING SYSTEM,
x.'73 a.� �`C4ij,09#'9A/ al
YPE OF BUILDING NO..OF BEDROOMS _BASEMENT SITE SIZE NAME OF INSTALLED
GIJ THE REVERSE S D DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING I9FORKAIL7ui
1. Property lines To Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby,
3. Location of septic tank. 9, Location of percolation test holes
# Locationof drainfield 10. Septic tank sjze_..��gallons
5. Slope of land lie. Length .of ,proposed drainfie.ld
6, Water lines & well(if applicable) 12. Depth'to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate--Ty—pe of soil R�
of hole seep last 6 in. (divide time by 4 L= -z;-
Pere. No. 1 ,.
Pero. No. 2
Pere. No.
DRAINFIELD LENGTH 160 D`R ` °' `�'' N0. OF LINES „
IT IS HEREBY AGREED THAT THE PROPOSED INS ALLATION WILL BE MADE IN THE MANNER
AS DESIGNED AND APPROVED.ON THIS APPLICATION.
. �
Signature ,of Appl#.cant
APPROX. DATE OF INSTALLATION` /L d 7/ ti
SANITARIANIS COMMENTS: U)
THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS ATP-70-15159--
PLAN
�c1
PLAN APPROVED DISAPPROVED DATE (�
DATE INSPECTED t4Z2424 SANITARIAN 5u
oQ
REMARKS: C , -rte / i �, ��; - r" 0 rff & r C t%' 5 � �e r1 h� LU
�le��Sae 31 1 i 7
P
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SCA;ILE--10FEET
,BETWEEN ,IVES
IRiDI ATE NORI H
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903 East Caroline OLYMPIC HEALTH DISTRICT Permit No. a e
Port Angeles `. ree. Paid S'--- �.._.
SFWAaE DISPOSAL PLR1NTT APPLICATION
• Submi�; .
AMS . `�� ,Ow '' �� . _ o A!='7
ADIRESQ ,r x, f DATE
UN 91YOW-4
LEGAL -DESCRIPTION PHONE
DI•RECTIONS' FOR LOCATING SITE _.
APPtICATION`IS HEREBY`1DE TO iST L NEW SYSTEM ,.RLVJa9 EXISTING SYSTEM
COP
. OF BEDROOMS BASEMENT SITE STZE NAME OF INSTALLE;�
YPE OF BUILDING, ATO .
E3xJ THE RE iSE:SID ,`DRAW A'DETAILED PLOT PLAN GIVING THE 'FALLOWING`INFORMA 100
1. Property.:lines 7•iways, patios, carportq etc.
2®`Location of building $Streams or bodies of water nearby.
,t
Location of sept i0_ tam g. Location of percolsi test holes
4,1 :. Lor anion `:of diainfield Y0. Sept . _tank size gr�1lotss
6+ Slope of :_land
11. Length of proposed drainfield
Water lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATI01 TEST RESULTS
Deft Time_ required , tg_ Percolation rate �,-o 1 s lrq�? y
of hole seep last 6 in. (divide time by 6)
Pere'. No. l
Pero. No. 2
Perri. No. 3• "'
'177477 77-7i
DRAINFIELD LENGTHIDTHDEPTH 'No. OF LINES,,,;
IT la nZIMM AGREED THAT THE PROPQSED INSTALLATION -WILL -BE MADE IN THE MA.? NER
AS DESIGNED AND APPROVED ON THIS APPLICATION,-!
i mature of
APPROX. DATE OF INSTALLATION
. ..= � :Applicant
SANITARIANIS COMMENTS;
THIS CONSTITUTES A P RMTT WREN HEALTH 6FFICERIS SIGNATURE APPEAW AS AP'P OVED
PLAN APPROVED DISAPPROVED DATE
DATE INSPECTED:.3ANITARhAD%;.r RENA qd i�)
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COMMUNICABLE PUBLIC HEALTH VITAL ENVIRONMENTAL HE<H
DISEASE CONTROL NURSING STATISTICS HEALTH EDUCATION
JEFFERSON COUNTY HEALT!I DEPARTMENT
Mr. Michael Bell
3815 W. Mercer Way
Mercer Island, WA
Dear Mr. Bell:
802 SHERIDAN PORT TOWNSEND. WASH. 98368 (206) 38"722
98040
June 13, 1984
We have recently received a report of a drainfield pipe running to the
beach on your property at 1090 Payne on the Coyle Peninsula:- A site
visit was made to your property and an outlet of a 4" diameter pipe
was found exposed on the beach. We have concerns on the nature of
this pipe coming from your property, and whether your property has
an acceptable means of on-site sewage disposal.
Also noted on-site was the Doland cabin located up-slope near the
stream. This cabin had a white pipe coming from the cabin._to the
stream.
Please contact this office to provide us with information on your
sewage system and pipe running to the beach. Also, please provide
us any information which you may know where we may contact the
Doland's (address or telephone number). Thank you.
Sincerely, �)
;e
John M. Eliasson, R.S.
Environmental Health Specialist
JNlE/vp
cc: J. E. Fiscbnaller, M.D., Health Officer
IN
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Nature of Complaints-
Name
omplaints-Name of person(s) causing complaint: '�fj •,. / / /`�a /% -
Address or direction: 6
Phone: Name of Person reporting:
Address: Phone:
DO NOT WRITE BELOW THIS LINE
Investigated by: Date:��
Conditions Found:---,!?- ,L!3,A-4C- -AA
�d i6+.t/ O �O f. r P ZQ K.Ct .ice 49A)r- 4y i!/ t.r ��l /ViJ�6C✓� 4Ti[ 4 SCJ
I4 �d ;Edam///D .
s
Action taken
Dates A
T
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