HomeMy WebLinkAboutSWG Onsite Survey - 7/18/1995 �..-
ON-SITE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
Project: LHC Area: 11 Toonervill_ . Date: b 145
OWNER INFORMATION :
CROWELL C SUSAN
PO BOX 1389
BELFAIR WA 98528
SITE INFORMATION • —�
22311-76-00110
Parcel# : Owner's Phone: 3?2- 2755
Ad$¢ s: l.,6�o ��— ity: State: WA— zip:478,62�
Building Type: (F-Full Time Residence; S - Seasonal Residence; C -Commercial;
M - Multi-family Residence; V - Vacant )
Septic System Type: S (S - Standard tank and drainfield; P - Pressure Distribution;
F - sand Filter; M - Mound; T - Deep Trench; H - Out House;
O - Other; U - Unknown)
Installation Date: /990 Year Last Pumped: 6? _ (Enter Year or U- U,�o»n)
System Location: (F;;Front Yard; B - Back Yard; S -Side Yard; A - Adjacent,Lot;
U - Unknown)
Number of Residents: (( Shoreline(YIN): AJ
OCCUPANT INFORMATI&(complete only if different than owner):
Occupant's Title: (tit, tms, ms) First Name: .614sa+.n Last Name: do10c )C"_
Occupant's Phone: c3`72-Z75 9
Would you like Information on Water Conservation? (YEN)
Would you be interested in a Community Workshop? (YEN)
PERMISSION FOR ACCESS TO INSPECT THE SEPTIC SYSTEM.- IV (FIN)
SIGNATURE: 0. >QtAar, a Date:
Comments:
LOWER HOOD CANAL FIELD INSPECTION FORM
Initial Information:
Area: !1 Added to database(Y/1):
Owner Name: S�s@ Gamma"Je� Permission to Inspect 7: TSB
Site Address: Appointment Required T ASZ
Parcel Appointment Date: B
Occupant Name:
Inspections:
Level 1: f 5 Level lC: `� ( S 4 S Level 2:
Inspection Team: Nc j Updated database(Y/N):
Inspection Results: f
Distance between septic tank and surface water:
Distance between septic tank and well: I D
Distance between drainfield and surface water: 00 —(ft)
Distance between drainfield and well: DU (ft)
Occupancy(occupantstbedrooms): I
Other(Larger on-site, business..etc...
/ ):
V The septic system appeared to be functioning at the time of the inspection; no obvious
problems were observed.
The drainfield area may be compromised due to vehicular traffic. (i.e.: parking, driving)
There are indications of poor system maintenance. (i.e.: lack of regular pumping; leaky
plumbing, slow drains, excessive chemical dumping, high water usage)
Construction was noted in the drainfield area.
Sewage was observed entering surface water, confirmed by visual dye and fecal icolifofm
count of>200fctI00ml.
An unpemvtted outhouse was observed.
Other:
Additional Comments:
System Classification•
Pass: Suspect:
Failure Priority:
l: MO W j*"rel".2: VimW Dye, W m=U609�290 90"int auf� w2w,outbw a ccupods widk<3ft Vogt SW.frm
SHW.3: SmLcmt wpmt dfkimt nat coraiat rmfrt ama.♦:Od"mucaphbb:kdaHd ; 'fa t 4'dCWX not mcrM9
mdf Wax 5:rnmuOy ACS&Cb"(odor)
SITE DIAGRAM
DYE PACKET RESULTS
B-kVv nd Sarin 1 Reftwwl lain 2 Retrieval $aria 3 Retrieval
sae
Numbs Date Date Rmft Date Date Rnuaa Date Date Aeadh Date Date Rnuac
Paced Retrieve Placed Retrieve Placed Retrieve Placed Retrieve
BACTERIOLOGICAL RESULTS
Site Date Results
Number