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Home My WebLink AboutCRT95-0037 - SWG As-Built - 3/17/1995 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFF E BOX 1666 SHELTO , WA 98584 ( 6) 427-9670 427-7798 APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW Receipt No: I Date of Payment: — I RECEIVED Septic or water Revi $60) - i MA 117 1"5 Both ($100) : Ikrqjarty Evan ( 0/hr) : I HEAL H SERVICES INSTRUCTIONS �(�/� (—////yJ� (///1 t. An application is considered complete when the fee is Od, Parts 9-4 Jf the appl Ofon form ibre i oapleted. (assistance will be provided upon request for completing Part Two), the necessary paperwork is atti shed, and required soil evaluation holes have been excavated. 2. After a completed application is received, staff will inspect the property and provide the applicant with a - written report. 3. If the project requires the excavation of more than 3 test holes, the department my charge the api titan an hourly rate of $40/hour as set forth by the wason County Board of wealth. PART 1: APPLICANTT/PARCEL IDENTIFICATION /NAME OF APPLICANT _ R /[�/'o/C 13y-v/ TELEPHONE 3160 Z 7! 4 S Z SITE/HOUSE ADDRESS NC /66 / T bA/- fa MAILING ADDRESS NC /66/ 7-44..yy IF,-U" /?oar Ley 4 W SEafq IF�� ACREAGE 7 S ASSESSOR'S PARCEL NUMBER 3 7 Z [ 2 _ 3 _ O G 0 L LEGAL PROPERTY DESCRIPTION SUBDIVISION (If Applicable) "� J DIV _/BLK LOT _ DIRECTIONS FOR LOCAT7t1G SITE 12 '"" ' I'�5 K iv�v/'/t S�ior� /Po 4d �vov-, Sell""-,:— TaCc R A /tA -asSt'. kn T14Ky--( &-- o gr'2 4 I c O tlevA 1.7-,—µ /[A f7 O K IVEll61 Sketch location of property in this space. I I I I I I I n I I VCI VY�yt � l I I I I E:\ON-SITE\ERREVZEW.W Revi ion 1215194 Page No. 1 CASE HISTORY FOR CASE NO.: CRT95-0037 PATRICK BARRY NE1661 TAHUYA RIVER RD TAHUYA 03/21/95 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By CRTA100 Application received 03/17/95 / / 03/20/95 DONE TN 03/20/95 TN CRTB200 Septic review / / / / 03/20/95 Confirmed that there is 88 lineal feet DONE JGD 03/21/95 JGD of 3 foot wide trenching that is functioning with no indication of any ponding of effluent and no clogging mat occlusion of the drainfield gravels. There is 36 inches of vertical separation beneath the base of the field set at 36 inch depth (i.e. the allowable maximum depth). No evidence of any ground water to depth of 78 inches. The soil types and distribution suggest that part of the system might be within a class 4 soil; however, the condition of the exposed drainfield gravels would appear to suggest that the bulk of the system is within the influence of the observed class 3 soil. The system is only 12 feet shy of the required sizing of a 2-bedroom residence utilizing a loamy sand soil but would be 45 feet short of the requirement for a class 4 soil. The reserve has 80 inches of sandy loam (Class 4 soil) with no evidence of any ground water intrusion nor was there any ponding of the heavy rainfall occurring prior to, and following, the digging of the holes. The reserve meets all setback requirements; whereas, the existing system would meet the well setback but is 68-70 ft. from the present high river level. There is room to extend each lateral by 15 feet should uprading be required---this would bring the system into compliance with sizing for the more restrictive class 4 soil. r PART 2: PURPOSE OF APPLICATION 2A. OPTION ONE 11 IJ I am applying for a bank loan and the bank has asked for an evaluation of the following: n LJ Septic System (Fee: $60) • Age of System Age of House Number of Bedrooms Name of Last Owner Is house currently occupied? • Attach pumpers report, dated within last 2 years, stating whether the system was pLvqx d, the size and condition of the tank, and the condition of the baffles. n LJ Water System (Fee: $60) • Number of service connections on water system • If public water system: ame of system n U Both (Fee: $100) WFI Number • Provide information shown above for both septic and water systems 2B.. OPTION TWO r1 LP I an applying for a building permit, and environmental health has required an evaluation of the following: r_1 U Existing Septic System (Fee: $60) Age of System • Number of Bedrooms • Name of Last Owner • Is house currently occupied? ems • Attach pumper's report, dated within lest 3 years, stating whether the system was pumpel, the size and condition of the tank, and the condition of the baffles. • If the original septic permit cannot be located and system less than 5 years old, apply for new On-Site Sewage Disposal Permit. • If the original septic permit cannot be located and system more than 5 years old, submit signed as-built drawing from certified designer or professional engineer. r� LJ Reserve Area for Future System Repair (Fee: $60) • Two properly excavated pits are 4 ft deep must be ready for inspection by the department. Both (Fee: $60) • Provide information shown above for both septic system and reserve area 2C. OPTION THREE 1-1 l I I am interested in knowing in general terms the suitability of a parce3 for septic system placement. (Fee: $40/hour) Describe the intended use of the property and the reason for requesting the review: S:%ON-BITS\MMEVIEW.W Rev'sion 1215194 PART 3: PLOT PLAN Use this space to draw a detailed plot plan, or attach one to this app ication. A deta shows the precise location of the test holes, existing septic systems, dimensions of th wells, roads, or other buildings on the property. ' 250' - I — �a 1 � 1 �'�' ``� I RICHT-OF- AY a I _ I I II / - - - - k - - - — - - ESP — / raHur aIKR\ RDAD j SIP RICHr-OF- AY MAILBOX RESERVE AREA I (NE I667) K'/p� I (APPROX �+ € IM 2 I WELL HED N o £X LIGH 1 SDRYE CAP ry h I 13 \ \ - �i NO.. 2141 PR 05E £X ^WAIN A EL=698 h I\ (SEE INSET BELOW FOR \ \a ^ R DEN E - OG KENNE REFERENCE LOCA IIM \ l W I h \J Z IN PROPfRr) `\ — --_— SEPTIC T NK SHED TO BE REM WC 1979-14'1 4' MOORE HLX NESr EDGE OF ME aY / 1� POWER OLE TAHUYA RYWR yy NOTE, L SE£MYr TO DBE T50 TAHUY RIGHT EW DETAILS I�a A R/DER SITE PLAN "_►a\ I� SCALE: 1'= 60' ;v— NOT TO SCALETint- / JGD I! ' �D _ 2y 4 d► l�U I` j PART 4: AUTHORIZATION /y/� JJ�� '�' 16W? APPLICANT /P [u"'Y DATE 3' N:\ON-SITE\ERREV .N Revi ion 2215194 - • Ill �� layer :fcat separation r � � _� : . � 11 � /� �- ' 11►. �^ ' 1 aM',A9NPM0/GI!!JI/Ids ii-:7iilwPl��ifi!#Y1/.�/11filf�i�' Iiil�7ll.�'1 :1` FIJS/1AFIh fArA •' ''.LyiPJi%L/1�' ilitl:mil•//.Al/✓I�%lf.//%/6lI!AITM �.yipRR_'AL'.LME"1_I, MOM,,!L!' 1 J7r1L�i7�>•..�:rr71i7/i�,rsJ�7.►'�,T.'..lily.�I/.:yt7f/.%�Tl%ham/i�i1l.✓i�✓L1" :w7/IL/J!��7i1✓,.i117�.7]l�j'J_'Ii}'�/%iIr�Y1f/�_ .�iy/A�ff;i/Ci3/ :.1�:11►`�UI.J��:LiJt.1�./.f/�:�/�l:Jll�'//1LiM///lili'✓,/F�//j/ilAE -;_1Li1i/Il' PART 6: HEALTH DEPARTMENT DETERMINATION - OFFICIAL USE ONLY 6A. PRIMARY DRAINFIEI.D SYSTEM The primary drainfield area was inspected by staff and pertinent records were reviewed. The following determination has been made: n U The system appeared to be functioning adequately at the time of inspection and and meets current design standards. The s s em a font i > a qua el a t e time of ins ection a�� o •nez �o � � r�nc�hj - 1__I Not applicable. 6e. The reserve drainfield area was inspected by staff and the soil was eva uated. Site characteristics indicated an area exists that could support a Sept c system that (( would meet the following standards: 1�L Current standards. n u Marine expansion standards. I—I u Marine repair standards, Treatment Standard 1-1 U Not applicable. Comments: 6C. WATER SYSTEM The water system was evaluated by staff the following determination has been made: n U The water source consists of an individual well that appears to be a satisfactory source of potable water for a single family residence The water was sampled, and coliform bacteria were found to be absent. I-1 U The water source is a public water system that appears to be in substantial compliance with applicable regulations. Comments: • • • • • • • .. •••••Findings and determinations of this review reflect observed conditions as they existed on the day the evaluation was performed. Absolutely no claim is made by this office, either expressed or implied, concerning future success or failure of the systems and sites evaluated. Resource land and critical area checklist may be required by Department of Community Development prior to issuance of developmental permit. ............................ ............................. ... ...................................................................................... ...................... INSPECTOR DATE H:\ON-SITS\EHREV1EW.W Revi ion 1215194