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Home My WebLink AboutCRT99-0200 - CRT Application - 10/21/1999 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIIASS15r POST OFFIC T BO%I666 SHELTDN, WA 98584 F6 427-900 APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW Receipt NO: Date of Payment: I Septic or Water Review Oas) : Both 100) : Property Evaluation $8 INSTRUCTIONS ��l�1(� �(//�(�(�� M lication is considered complete when the fee is paid, Parts 1-4 ofof th ica ton fora arFea leted. 1• a� Paperwork is atta and (assistance will be provided upon request for completing Pert Two), the necessary papa cNed, required coil evaluation holes have been excavated. and provide the applicant kith a 2. lifter a completed application is received, staff will inspect the property written report. 3. if the site review requires more than 1 hour of work, the department will charge the applicant an additional hourly rate of t50/hour as set forth by the Mason County Board of Health. PART 1: A.PPLICANT/PARCEL IDENTIFICATION NAN$ OF APPLICANT ^!/. /-Z—��z - TELEPHONE (360) 9f-7 9;9 SITE/HOUSE ADDRESS /V /P&f'j /V Whore Rd 13�/�a�f G�� N82LING ADDRESS .5697 Wid gXdan Cf - . i I.0 ACREAGE State Zip ASSESSOR'S PARCEL NUMBER 3 �2 3�j.�- - �- - —a n- LEGTiL PROPERTY DESCRIPTION �altri-o Iv BLR _� LOT SUBDIVISION (if Applicable D rr a - r- / L T L - --- . DIRECTIONS FO LOCATING SITE r lG rY7l I PT /.tJr a'>L r } C'/ a •r �'� /��1- ~ S�nr l d , Sketch location of property in this space. Ke toff-SlrflEffiU'VIEw•K lCevlrloa 3/26/99 Pw9e 1 i �•: ,mom�. PART 2: PURPOSE OF APPLICATION OT( 2A OPTION ONE �l/cZ/vB/70r. To Cie�BYmnnC {'ea.ribilS�y COrnan�nr� Yd:� • ` lof dra aim • -y -k , .�•D serve 5 Pro�er�ic^r if �he atlacheal i 3 I am applying for a bank loan and the bank hae asked for an evalua ion o the followings d efMi9nen>'- 3 r�' /i•/IAe. r, rtwo beolYo.M ija..etial r - a p , P U Septic System (Fee: $85) • Age of system • Age of House • Number of Bedrooms • Rage of last Owner • is house currently occupied? Yea tto • Attach purper's report, dated Within last 3 years, stating whether the system Sias pumped, I e size and cadition of the tank, and the condition of the baffles. n lJ Water Systek (Fee: $85) - • Ruder of service connections on Water system • if public Water system: R� o System f-i WFl R xr lJ Both (Fee: wo) • provide information sham above for both 28 OPTION TWO U I am applying for a building permit an evaluation of the following: n lJ Existing septic System (Fee: $85) _ • Age of system . Humber of Bedrooms • game of last Owner • is house currently oecepfed7 - • Attach purper's report, dated Within last 3 yearsg stating whether the system Was pumped, the size and condition of the tank, and the condition of the baffles. • if the origin&( septic permit "Mot be located and system less then 5 years old, apply for new On-site sewage Disposal Permit. • if the original septic permit cannot be located and system care than 5 years old, submit efl9nxd as-built drawing from cacti fed desfgner or professional engineer. n l-i Reserve Area for Future System Repair (Fee: $85) • Two properly excavated pits are 4 ft deep rust be ready for Inspection by the department. n lJ Both (Fee: $85) • Provide information shown above for both septic system and reserve area wrlav-SITE1FSmlS'IQl.W Rev9rlon S/76/99 page 2 i 2C. OPTION IZOM i^J I am interested in ImoWiu9 in general terms the suitability of a parcel for septic system placement. (Feet $85 base, plus $50/hour after first hour) Describe the intended use of the property and the reason for requesting the review: PART 3: PLOT PLAN use this space to draw a detailed plot plan, or attach one to this application. A detaited plot plan s one that shows the precise location of the test holes, existing septic systems, dimensions of the property, and{tocation of any wetts, roads, or other buildings an the property. I r I Aloe -aHaehed i PART 4: AUTHORIZATION APPLICANT DATE Nr1aw-SSTf1E1 t •w Revtalao 2129110 Page 3 ' ham. y! 11 PART 5: HEALTH DEPARTMENT FINDINGS - OFFICIAL USE ONLY j 5A. DETERMZttATION OF APPLICABLE STANDARDS The primary drafnffeld area must met the following standards: n n U Meet current standards U standard marine system n n U Mo overt failure U Mot applicable. The reserve drafnffeld area Rust have site characteristics that could support a septic system the would meet the follaytfns standards: n Meet current standards. U Meet marine r it standards. U M t marine expansion standards. U Not applic le. 5B. WATER SYS YES ILa INDIVIDUAL HATER SYSTEM r u u A water s is was taken by health department staf and analyzed. Total coltform bacteri were determined t be absent. Laboratory results are ttached to this report. n n LJ 1J The welt cap was inspected. The sanitary sea appears satisfactory. n n LJ U The well using was nspeeted. The cast projected above ground and ground was sloped a�tay from the using. n n u U The well site was inupec No sap a systems, chemical storage fecil(ties, aarnme pit , animal feed lots, or other obvious s s of Lamination were located within a 100 foot radius of a well. ,PLMLI TER SYSTEM n n u LJ Records indicate water camp ng frements are being satisfied. n n U u Records indicate the wat Facility nventory form is current. n n U U Department files twnt n water system fun and Letter of approval? - 5C. SEPTIC SYSTEM YES 110 n n u LJ The septic to was inspected by a eertlffed cep c tank pumper within the past 3 years and fond to be in satfsfact condition. A puVer's evaluatfon s attached to this report. n n U U Records fo this property contain a septic permit, de ign (1f required), final inspection 1pfxova 1, and as-built pprova(. U U The dra nf(eld site was inspected, and appears consistent ith recorded doeunents. n n U U The drafnffeld area appears to be maintained in en acceptable manner. n n U LJ The drafnffeld area (the area where the drainf(e(d is assumed to be located based on office records and/or observed site conditins) appears to be maintained in an acceptable manor. n n U U The drafnffeld area (the area where the drafnffeld Is assumed to be located based on office�records and/or observed cite cond(tins) show no indication of overt fat lure at the time of inspection. K'jCN-s g OWzLWzw.rf Revision 2/2f/99 Paye 4 SD. SOIL CONDITIONS I TEST HOLE #1 �„,,a� I TEST HOLE #2 �,. I TEST HOLE #3 I I I ° 6LI eaukA od-w,-, u l H I I Depth to restr. layer I Depth to restr.. layer (OS I Depth to restr. layer I I I I I Soil Type: +� I Soil Type: I Soil Type: I I I I I Fib i I Soil Type: L� _ I II I Soil Depth: �Qe I Slope: ( _ � I I I I Parcel Size: I Distance to Shoreline: 1 .�I SE. OTHER NOTES AM COMMENTS 4 n I i 1 ASP L)d 1 .0 a -6.1 Vs, Nr hv'SIY6IPB"ZEW.I/ Revigiw 21261st 'P v 5 PART 6: HEALTH DEPARTMENT DETERAUNATION - OFFICIAL US* ONLY GA. PRIMARY DRAINFIELD SYSTEM The primary drainfield area was inspected by staff and pertinent recor Is were reviewed. The following determination was made: U The sys m appeared to be functioning adequately at the time of inspection and 4 \current design standards. f1 , U The system appeared to be functioning adequately at;the time of injipection. u Not applicabl Comments: 6E. RESERVE DRAIINFIELD AREA The reserve drainfield are was inspected y staff and the soil was ev4uated. Site characteristics indicat d an area ists that could support a septic system that would meet the following tandar F'I . U Current standards. I u Marine expansion standards. U Marine repair standards, Batmen Standard u Not applicable. Comments: I CC. WATER SYSTEM The water system evaluated by staff and the llowing determination �as made: n u The water s urce consists of an individual wel that appears to be a satisfact source of potable water for a sing family residence. ', The wafer was samp d, and coliform bacteria were found to be absent. i r--r U The wa er source is a public water system that. appears to be in substantial compliance with applicable regulations. Comments: ......................................N.:. .. ................. ....................................................................................................................................................... .............................................................................................................. Findings and determinations of this review reftect observed conditions as they existed on the day the eval�atfon was performed. Absotutely no claim is made by this office, either expressed or implied, concerning future success or failure of the systems and sites evatuated. Resource land and critical area checklist may be required by Department of Comnnity Development prior to Issuance of devetopmentat permit. INSPECTOR DATE .Z/ (P l N:\oN-SITE1�atEVIF2I.N xeylelea 212C111 Page IF w. ts ��a�s sc� ocoos'_ ,�s some 3aass 1 1 � I t 1 { r 0 C _ ,. . 0017) , r r •�i� I I pr:/led !Jell ►� Test ho%o • 1'laww IYOO rer p dam/ Seafi� Ta•+X=O �,�G�� G9�• 9a4