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HomeMy WebLinkAboutSEP1970-00104JEFFERSON COUNTY PUBLIC HEALTH 6 {M 615 Sheridan Street •Port Townsend *Washington • 98368 www.jeffersoncountypublichealth.org December 15, 2008 WALTER NETTLE 520 SE CRESCENT DR SHELTON WA985847723 RE: Evaluation of existing septic system 81 MUSTANG LN, BRINNON 98320 SEP70-104, Septic System Corrections Required To Whom It May Concern: An evaluation of the existing sewage -disposal system (EES) was completed on December 10, 2008. This inspection found that the outlet baffle on the septic tank has deteriorated. It is recommended that you have this repaired immediately; allowing solids to reach the drainfield may lead to premature failure. The purpose of proper maintenance is so the County, for the benefit and protection of the public's health, is assured by this department that these systems are designed, installed and maintained in a proper manner. Please contact a licensed designer to have the system repaired. A copy of the as - built and a list of designers that have submitted work to Jefferson County have been included with this letter. If you have further questions please contact this office at 385-9444. Sincerely, Angela Pieratt Environmental Health Specialist cc: file, Dale WurtsmitHr,& Claudia Gregory4x 9�-1045 30,1 COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES NATURAL RESOURCES MAIN: 360-385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: 360-385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360-385-9401 • Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 Evaluation of an.Exlsting Onsite Sewage System (EES) Draw on the back of this sheet a current plot plan showing location of: Buildings, Drainflelds, Septic Tanks, Wells, etc OR attach a current plot plan Identifying these items. ALL SPACES MUST BE FILLED IN. If Information Is not available enter (NV) or not applicable (NA). Type of Evaluation Evaluation of on-site sewage system ❑ Evaluation of drinking water ❑ ❑ ❑ Evaluation of onsite sewage & drinking water ❑ Office Use Only Date 01 ` Q Fee Q Recptl Check,_] Case #`70-1 Reason for Evaluation Routine Operation and Monitoring Inspection Real Estate transaction Complete a Permit # Building Permit Review and/or no septic permit on file Other, explain Date of evaluation Xfk k00 F) Inspected by Q* W1 1 (En* , L(.IV) Tax Parcel.# Q t f4 oo 1 Permitted System -X-yes no Permittcase # SEP '7b -- t o�l- Subdivision, Division, Block and Lot(s) 1�►T7'�'_ o�.v , "—v k -A3 Lot Size ti or Dimensions X Current Owner Site Address R� Owner Phone # ►NV Previous property owner name(s) - (NN if not known) 4 Directions to Site Fn, pT s ` �&w. pa. IF -NX Date System Installed L� -"w Age of DwellinS # Bedrooms --Q House Occupied ves_ no, vacant how long` a 14 ke.1 Who installed system? r)\.&bNE e- ,ate _ Send completed report to: Owner DEC 1 1 Name Mailing Address PhonetemaiUfax Realtor or Other Representative Name C'-o�,n ,�� ` �tZ �s-+LA,3PIA Camay' Mailing Address p o {3" 2� V Phnno%ms!fi( w 1 -2 / _ X74/_..LL-N 1 _. _ 4 n i _92 r. C .�.. EES Evaluation Form_07-30-04_pdf page 1 of 5 Include the following items on your plot plan; E3 Property boundaries u Names of adjacent streets E3 Driveways and parking spaces o Surface water (ponds,creeks, etc) v Buiidings(residence, sheds, garages, etc) j PLOT PLAN -date prepared 1 n. �nnV, GOQNW- E3 Wells o , Septic tank o Drainfield (enter NN if unknown) Ll North Arrow YIEW C:1LJ 0 cc ® LL gyp fJA w,t& -LL' W /\ I;T NOT TO SCALE M Permit # or Parcel # -e--g I;? b �- Evaluation of an Exisfing On its a Sewag _0 /30/04_pdf MM N D CC 1 1 2003 --J -� ENVIRWCHECK, L.L.C. 1612 Hastings Ave. W. Port Townsend, WA 96'368 mage. 2 of 5 Date of Insoection k akooA inspected by , Dale Wuftffib (En4kochocko UQ Water Supply (fill in only if water supply is . being tested in this evaluation) Sample was taken Yes No Sample Results Well casing 12" -above ground Yes No Sanitary Seal in place Yes ------ No Public: offsite onsite Name of System Individual: offsite - onsite Is well more than 100' to drainfield/disposal component __yes_ no, 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_a�QD #1 - Septic -Tank Tank size k3bot) gal.mr _)Lsingle compartment two compartment ep gj&a-iE material Riser to grade on inlet no. Riser to grade on outlet _yes )S,no Condition of tank X _good needs repair, describe 1st comp. Scum (top layer) a in. sludge (bottom layer) :a6 in. 2nd comp. scum in. sludge in. Was ground water observed leaking Into tank ? no If yes, where was water observed? Condition of baffles: Inlet )L d;a_—_Peeds repair material (PVC ) Outlet —good --- —needs repair __material (PV ncret ) Screened Outlet _X_no __yes, condition _ dean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (Ib))_L_ yes no Effluent level at outlet (mark level on circle) If effluent Is below the outlet indicate when tank was last pumped: eg: 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? ves no Condition of tank goal needs repair, describe Solids In Tank (tee 8.15.150) _yes .no scum in. sludge in. Was Ground water observed leaking Into tank ? no If yes, where was water observed? Screen around pump?no yes, condition_ clean dirty/dogged Shroud around pump? _-_---po _yes Electrical Components Pump operating jes 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/see. Timer Settings min/sec on Min/hrs off Floats secured: Y" no Permit # or Parcel evaluation of an _pdf page 3 of 5 #3 Drainfleid Appropriate Vegetation in area )S, yes no. Describe vegetationL'�i2� C-1 Indications of surfacing sewage (check one) __yes, if yes,. describe and diagram on plot plan X no drainfield area is overgrown and not observable Signs of parking/driving in area —Yes no drainfield area unknown Ground settling or erosion --yes )k _no overgrown/not observable Monitoring Port Observations (if.present): Residual Head ____yes, # of inches no Ponding in trench Yes, # of inches of ponded effluent no Repair area is? Available as shown on permit X None evaluated or shown on permit Addendum (page 5) is attached for evaluation of Treatment Unit or detailed evaluation of drainfleid _—___yes_X.no COMMENTS (attach additional sheet if necessary): #1-A. Risers are mandatory on next inspection. �i , —C"Eiti o�T1..+�C' '43A�'1-� �1sS �ES'EAtoR�£fl• other (A) The house/ dweffifi§ *au assessment of drainfiield ft0be ladd. r } SEE ATTACHED ADDENDUM Was a System Problem IdentMed? Yes _�C ff yes, what section #. JdJL'*I_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 nformation provided is based on a review of County records and my direst observations at the time of Inspection. Name/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 #, Evaluation of an E _07/30/04_pdf DEC 1 ) L:_�r page.4 of 5 ADDENDUM Enviro CCheck, L.L.C. Company Disclaimer DATEk:�. $408 ADDRESS. d1 M�crabG b, �a��P OWNER 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 firture. Because of the numerous factors (usage, soil characteristics, previous failures, etc.) which may affect the proper function of a septic system. And the inability of our company to supervise or monitor the use of the system, or to inspect none visible areas of the system, this report shall not be construed as a warranty by our company that the system will fimction properly for any particular owner or buyer. Eirviro Check, L.L c. disclaims any warranty, expressed or implied, arising from the inspection/evaluation of the septic system or this report/evaluation. We are also not ascertaining the impact the system is having on the groundwater table 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. Enviro Check, LLC EES reports do not state where the exact location of drmfields are located- Only the general area is indicated, based on permit information that may or may not be correct. Enviro Check, L.L.C. will not be held responsible in any way for information being undisclosed (intentionally or -unintentionally) by Jefferson County employees, property owner, representative or other parties of interest. All reports, including E.E.S. inspection reports are subject to any change by Jefferson County Environmental Health Department. Enviro Check, LLC is not liable for any such changes. All panties are encourages to check county records for any information regarding properties. Com n Enviro Check, LLC. 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 Ordinamces, and to the best of my ability, correct. Dale mith Co -Manager SAMPLING (Septic tank) Date - PH Result- DO esult DO Result - T p. Result - Counter Settinu- PC SF Hour Meter- PC SF DEC 11 L:eJ'v 903 East Caroline 'Fort Angeles SEP 7 0 OLYMPIC HEALTH DISTRICT Permit No Fee Paid I; .SEWAGE DISPOSAL PE11MIT APPLICATION Submit in Duplicate LEGAL DESCRIPTION /.2,3 ' PHONE DIRECTIONS FOR LOCATING SITE i APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM/ REPASR EXTST12M SYSTEM E OF BUILDING N0. OF BEDROOMS BASEMENTSITE SIZE NAME OF INSTALLER )N THE VERS SI , DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATiOT Property lines Location of building Location of septic tank Location of drainfield Slope of land G! 7. Driveways, patios, carport, etc. 8. Streams or bodies of water nearby ctl 9. Location of percolation test holes 10. Septic tank size 41d" gallons 11. Length of proposed drainfield Water lines & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS iDepth Time require to ercolation rate Type of soil Rerc. *No. 1 of hole seep last 6 in.- (divide time by 6) Perc. No. 2 Pere, No. 3. DRAINFIELD LENGTH ..,= WIDTH ��e DEPTH .2,� N0, OF LINES. !-!�_- I T .__._ IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER AS DESIGNED AND APPROVED ON THIS APPLICATION, APPROX. DATE OF INSTALLATION Signature of Applicant SANITARIAN'S COMMENTS: PLAN APPROVED DISAPPROVED DATE �1 DATE INSPECTED SANITARIAN REMARKS: 5-68 � � � O'✓.�-vim y /36/�� � � FF WAR RIETWIME rk 1 Oil 71 at, v b1i M, �1' I'll, 1 77 Ilip 7� 7, A �s AN tam ID B'SL1 QW, ODIPAIR] 1400 'NOO IT jJ f '1� 110 l 777,,�- 1 �;r- �1� �77' Sum �I� llYlll Jmil�� �` "Piro, A 31 poll fit I1114 fit li", IJ� �Iwebj Oil jq 10, 1 TO 11 1 !L I� . Y ��I I� �I 1 ,I� 1 M� I ' -L 4 F 4 ij 1, I] All I M f 1 �R �tl [It JAH D 1 J �, I I 1 _ f 1 �II 4 H I o Vol I 803 East Caroline OLYMPIC HEALTH DISTRICT y Port Angeles BUILDING SITE INSPECTION APPLICATION Submit in Duplicate OWNERSt&J ADDRESS TD&)r; LEGAL DESCRI`VTIO-97N ourt House Port Towneeft DATE a 4 DIRECTIONS FOR LOCATING SITE AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. RESIDENCE _ COMMERCIAL BUILDING OTHER Lie a - 0. BEDROOMS BASEMENT SITE SIE ,SOURGE OF WATER TYPE OF SOIL"�® �2�7�IL 2V*kG9WTH TO WATER TABWJQ i JI CRAW A SKETCH in the space below* indicating location of building in relatiop to other buildings, property lines, well, streams or other bodies of waters Indicate proposed location of sewage disposal system. f to SC L)k We C ZO® f - 5� R ID) Egan �. Lfo D APR 151970 o Date of Site Inspection_ z._ 1-7- 7 0 Approved' Disapproved * See reverse side for remarkq,' Lig APPLICANTS SIGNATURE Seiiitarian THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT, A SEPARATE PERMIT IS NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD. oox -T T— T 602342Q01 ptn. St 2 0,24 a. 4.10 o. :ATED 8/4/69 ze 142 132133 11 O�Q 4, \ \ \ SAND BAR 27 141 134 Q \ 140 135 QQ� 39 \ (4.10c.) 28 139 P 35 \ 139 136 29 137 37 30 36 QUESTION OF OWNERSHIP SOUTH OF P� RIVER. NOW INCLUDED IN 602342001 �1 31 35 3z 33 34 12.75 o. A 1 ,es 5 �'O 1 'Q OWT 227 9 �O 2 268 OOSCC` 184 194 163 10 A N 11 3 6160 99 • � to N 12 `gg A 182Z /t'Q440 N 62 13 67 \ 56 181 O 190 1 14 6o 63 64 55 179 M 15 79 65 56 64 W 18 78 al A 82 ���. 67 77 Be 76 69 53 ,�• .9 ` 92 Z v 17 83 107 106 84��/`/� 7s 74 61 70 / 80 O ,e A85 105 72 7+ �9 n 19 104 as 87 �P�.F� $ 20 103 106 109 102 Be as \ 9283 co co 21 W > 110 101 so 100 99 91 94 Z 22 0 111 128 112 98 /y • O�G^I%1/ 48 95 49 23 Q 127 113 126 97 ^1 114 ,4^/L 47 98 46 24 O O 1 125 124 119 ` 116 46 143 Q Q.�S d / . 123 117 129 122 Ila T ! 44 43 Tx 18 1 Q 130 ry�/C 131 121 J 42 _ 120 Q� 4.10 o. :ATED 8/4/69 ze 142 132133 11 O�Q 4, \ \ \ SAND BAR 27 141 134 Q \ 140 135 QQ� 39 \ (4.10c.) 28 139 P 35 \ 139 136 29 137 37 30 36 QUESTION OF OWNERSHIP SOUTH OF P� RIVER. NOW INCLUDED IN 602342001 �1 31 35 3z 33 34 12.75 o. A 1 Parcel Print Parcel Number. 966900116 05/14/2007 Owner Mailing Address: WALTER B NETTLE 520 SE CRESCENT DR SHELTON WA 985847723 Site Address: 81 MUSTANG LN BRINNON 98320 Section: 34 School District: Brinnon (46) Qtr Section: NW1/4 Fre Dist: Brinnon (4) Township: Tax Status: Taxable Range: 2W Tax Code: 440 Planning area: Brinnon (11) Sub Division: LAZY C RANCH DIV 1 Land Use Code: 1101 - MOBILE HOMES (owns mobile & land) 74 FLAMINGO 60X12 S#11840724 Property Description: LAZY C RANCH DIV 1 1 LOT 123 n No Photo Available Page 1 of 1 http://www.co jefferson.wa.us/assessors/Pareel/parcelprint.asp?PARCEL NO=966900116+... 1/9/2008 Assessor Detail Building #1 Parcel Number: 966900116 Building Number Year Built Year Remodeled 1 1975 0 Building Exterior Building Area Building Interior Building Type: MOBILE 1st Floor Area: 0 Int. Walls (Cabin): Building Style: SINGLE MOBILE HOME 2nd Floor Area: 0 Heat: FORCED AIR Foundation: POST & BLOCK/PIERS 3rd Floor Area: 0 Exterior: METAL (RIBBED) Loft Area: 0 Floor Cover (1): VINYL Roof Cover:BUILT-UP Attic Area: 0 Floor Cover (2): CARPET Total Area: 624 Basement Area: 0 Building Rooms Mobile Home Garage Bedrooms: 2 Make: FLAMINGOType: Full Baths: 1 Model:Area: 0 Half Baths: 0 Length: 52 Exterior: Width: 12 Roof: Year Built: 1975 Carport Square Footage: 0 Skirting: Wood Area: 624 1st Addition 2nd Addition Type: AdditionsType: Area: 208Area: 0 Year Built: 0 Year Built: 0 Exterior: Metal (Ribbed) Exterior: Roof: Built-up Roof: To view another building associated with this parcel. Select building a 1 2 Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Page 1 of 1 http://www.co jeferson.wa.us/assessors/parcel/assessordetail.asp?Parcel_NO=966900116 1/9/2008 ADW" In "" properly [Mlvd. 0 REAL ESTATE EXCISE TAX 0 OHAPTER 92.46 ROW aMcN a county ir/a/xr6f. PLEASE' TYPE OR PRINT CWTER 46&91 WAC . f I waewunu [ 7) rev mn . r Pefum urCn V NEW OWNER'S Name -�---- ---T— 966 W$ARCEL NUMBERS PERMANENT ADDRESS FOR ALL PROPERTY Boost TAX RELATED CORRESPONDENCE City/Stele ZIP t FAA" DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED COUNTY L..1 W CITY OF Lot 123, LAZY C RANCH, blViSiON 1, as per plat recorded 1n Volume 5 of Plats, Pages 9 to 11 inclusive, records of Jefferson County, Washington. Together with that certain 1974 Flamingo mobile home, 60 x 12, Serial No. 11840724, TPO @1430. d is this property aurraeuy: YES NO @ Desorlptlon of personal pro;" If included W sale (halrffure, a Classified d designated tie lorea,artd? rS4.P❑ til"enoe9, aloe Classified as current use land (open apace, farm and aaftultural, ortimbern Chapter 84.34 RCW 0, Ifexemptionclatmed.explailt Exempt from property tax under r"prord ❑ Ism erg 2mIW8 Chapter 84.38 RCW? 1� Van L. Boblet ® Walter R. Mettle Nance property under Chapter 84.20RCW? Name 0 ❑ land land Date of Sale or Commyene Insircreact a 1) Withprevieusty with Mamie have used bufiding (frees Selo Price 1! Personal Property (deduct) 111 S 16,500.00 © 5790 W. 8th SP#13 1707 Bowmi N.W. a (Q NOTICE OF CONTINUANCE iRCYtrI86.33 er RCW 84.94] Street 85364 If the now owner(s) of land that to classified or designated as Current use or forest 811/0 s * 98907 lam) wbh(ee) to continue the classification or deslgeatloh of such land, the new o t oxurera)' at aldgsn�bbellaow, I1 the now owners) dotes) not desire to cautious such ffi V NEW OWNER'S Name -�---- ---T— 966 W$ARCEL NUMBERS PERMANENT ADDRESS FOR ALL PROPERTY Boost TAX RELATED CORRESPONDENCE City/Stele ZIP t FAA" DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED COUNTY L..1 W CITY OF Lot 123, LAZY C RANCH, blViSiON 1, as per plat recorded 1n Volume 5 of Plats, Pages 9 to 11 inclusive, records of Jefferson County, Washington. Together with that certain 1974 Flamingo mobile home, 60 x 12, Serial No. 11840724, TPO @1430. d is this property aurraeuy: YES NO @ Desorlptlon of personal pro;" If included W sale (halrffure, a Classified d designated tie lorea,artd? rS4.P❑ til"enoe9, aloe Classified as current use land (open apace, farm and aaftultural, ortimbern Chapter 84.34 RCW 0, Ifexemptionclatmed.explailt Exempt from property tax under r"prord ❑ Ism erg 2mIW8 Chapter 84.38 RCW? 1� Rebelving apootal valuation as historic Statutory Warranty need property under Chapter 84.20RCW? Type Property: u land only ❑ land with new bu0ding. Type of amment ❑ land land Date of Sale or Commyene Insircreact a 1) Withprevieusty with Mamie have used bufiding (frees Selo Price 1! Personal Property (deduct) 111 S 16,500.00 SEE TAX 0BUGAAON9 ON REVERSE SWE Taxable Sale Price 1.30 8 221.1101 a (Q NOTICE OF CONTINUANCE iRCYtrI86.33 er RCW 84.94] Eiffi xcaoTax SWISS/ � � �� 41.25 If the now owner(s) of land that to classified or designated as Current use or forest Local 4! ffi lam) wbh(ee) to continue the classification or deslgeatloh of such land, the new Delinquent Penalty 81 ffi 262.37 oxurera)' at aldgsn�bbellaow, I1 the now owners) dotes) not desire to cautious such ffi dawficatin orRCW 84.88. 20 end 140 or ROW 544,34.1003 she bItan. all cornponsefing or e additional tan0 ppaeyable by the seller Total Tax Due (SEE 15 ON REMS E SIDE) or tranaferar at the time of sale. The county assessor must determine If the land Q transferred qualities to oontinue classification or designation and must so indicate below. Signatures do not nacessedly masa the and will remain hr classification or AFFIDAVIT It b no longer qualifies, it wig be removed and de comooneating taxes Wig be rtppo", An raw owoera must sign. I CERTiFY UNDER PENALI Y OF PERJURY UNDER THE LAWS OF This land ❑ does ❑ does not quality THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT (coo #6 a ro reverse for penalties). for continuance. WIM AweueaR DATE SIGNATURE Van L. Boblet (3) NOTICE OF COMPLIANCE (Chapter 84.28 RCYO NAME (prlat) If the saw owner(a) of properly with special valuation as historic property 13 x V ha wlsh(a) to continue this special valuation the now owners) must els below. it DATE 8 PLACE OF MG M-9/2.) 41 - the now owners) dc(ea) not desire to continue gush special valuation, all adds. tax on oulated pursuant to Chapter 84.28 RCW, shall be due and payable � � (lunate): yrantart eMoelgroMor a agarrt/g►aatee'a agent by the seller er transferor at the time of Isle. (3) OWNER(S) SIGMTURE Address o1 residence or ala so of business of Demon elgnklg (specify): Same as gran Or The following optional quastione are requested by ROW 69.46. 120 rri�"''" ' NO 1a;propsity st the time of vale: now YES NO e. DDconveyance Waive a bade, partial i La. Subject to elderly, disability, or physical improvement["target corporate affilisto 0. related parties, 1 ❑ 2M ❑ 2D( trust, receivership or as ? exampliont 1 L Isere grerdoo acting as a nominee fes a third 1 ❑ 29 L¢. Does building, 9 any. have a heat pump or solar party? 1❑ 2® r, beefing of eeelhhg system? Q. Principal use: •a. Does this conveyance divide a current parcel of and? 1 ❑ ry i,i 2r- i ©agrfoultnral U condominium 3 ❑ temreetininal ;d. Does an include current croft or roarobantebie 1 ❑ 2 4 apt (4+ uM1s) t❑� btduahlal g residential timber? LJ �&mcblle home a Umber FOR TREASURER'S USE ONLY r : 9. -$[l FORIA REV 84-000114. (Vsa) -rhes COUNTY TRFJISURER