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Home My WebLink AboutCRT2007-00117 - CRT Application - 11/20/2007 MASON COUNTY DEPARTMENT OF HEALTH SERVICES 426 W CEDAR ST., PO BOX 1666, Shelton WA 98584 SHELTON(360) 427-9670 Ext: 352 ELMA(360)482-5269, BELFAIR(360)275-4467 WEB: http://www.co.mason.wa.us FAX: (360)427-7798 APPLICATION FOR ENVIRONMENTAL HEALTH REVIEW PERMIT NUMBER PAYMENT INFORMATION TYPE OF REVIEW Receipt Number: S5200700000000001011 CRT2007-00117 Payment Type: Check Septic Date of 11/20/2007 Important Notice: Findings &determinations of this review reflect observed conditions as they existed on Me daythe evaluation was preformed.Absolutely no claim is made by this office, expressed or implied concerning the future success, failure or permit approval of the system and site evaluated. ** FILL OUT APPLICATION COMPLETELY AND ACCURATELY"** An application is considered complete when the fee is paid, parts 1,2 and 3 of this application form are completed, necessary paperwork is attached (i.e. pumpers report)and when required, soil evaluation holes have been excavated. PART 1. APPLICANT PARCEL IDENTIFICATION Applicant: JACK & ELEA MITCHELL Telephone: Mailincl Address: 9012F S THOMPSON CRY: TACOMA State: WA Zip: 98444 Parcel Number: 321367500020 Site Address: ............ Brief Legal Description: TR 2 OF SURVEY 2/49 Driving Directions: SR 3 TO LAVENDER LN. LEFT @ MAILBOXES TO RIGHT @ CORNER TO END. LEFT & FOLLOW RD TO END. YELLOW FLAGS DOWN PATH. PART z TYPE OF REVIEW Septic System Age of system: Age of house: Number of bedrooms: Name of last owner: Is house currently occupied?: If not occupied, how long has it been vacant?: Water System Number of service connections on the water system?: If a public water system, name of system: WFI number: Proprety Evaluation (soil logs) Property evaluations provide, in general terms, the suitability of a parcel for septic system placement. THIS DOES NOT GUARANTEE FUTURE SEPTIC SYSTEM APPROVAL. Describe the intended use of the property and the reason for requesting the review The description of the intended use is not included in this report. PART 3. PLOT PLAN Use the space below to draw a detailed plot plan, or attach a detail plot plan to this application. The plot plan should include the following: North Arrow, Precise Location of Test Holes, Location of Existing Septic System, Dimensions of Property, Location of any Drinking Water Sources (wells, springs, etc), Roads, Easements, Surface Water, and Buildings on the Property. LOT SIZE x Acres The applicants plot plan is not included in this report. 7 7, Applicant Signature: Signature is not included in this report. Date: The date is not included in this report. CRT2007-00117 2 of 4 -PART 4. HEALTH DEPARTMENT FINDINGS -- OFFICIAL USE Septic System The septic tank was inspected by a certified septic tank pumper within the last 3 years and was found to be in satisfactory condition. A pumpers report is attached. Records for this property contain a septic permit, design, final inspection approval and an as-built drawing. The site was inspected and the system location appears to be consistent with recorded documents. The area of the on-site system appears to be maintained in an acceptable manner. Was Operation and Maintenance a condition of permit approval? Is a copy of current Operation and Maintenance report attached? Water System Individual Water System A water sample was taken by health department staff and analyzed. Total coliform bacteria were determined to be absent. Laboratory results are attached to this report. The well cap was inspected. The sanitary seal appears satisfactory The well casing was inspected. The casing projected above ground and the ground was sloped away from the casing The well site was inspected. No septic systems, chemical storage facilities, manure piles, animal feedlots or other obvious sources of contamination appeared within 100-foot radius of the well. Public Water System Records indicate water-sampling requirements are being satisfied. Records indicate the Water Facility Inventory form is current. Department files contain water system design and letter of approval Soil Conditions Test Hole#1 Test �Hole #2 Test Hole #3 0-35 LOAM 0-30 LOAM 0-45 LOAM 35+ MOTTLED 30+ MOTTLED 45+ MOTTLED Soil Type 4 Soil Type 4 Soil Type 4 Restr. Layer 35 Restr. Layer 30 Restr. Layer 45 Slope Slope Slope Distant to Shoreline Distant to Shoreline Distant to Shoreline CRT2007-00117 3 of 4 PART S. HEALTH DEPARTMENT OBSERVATIONS -FOR OFFICIAL USE ONLY Rrimary Drainfield Staff inspected the primary drain field area and when available, pertinent records were reviewed. The following determination was made The system appears to be functioning adequately at the time of the inspection. (only applicable if system has been in use on a regular basis for the last 6 months) Sanitary Survey? Survey Results Water System Staff evaluated the water system and the following determination was made The water source consists of an individual well the appears to be a satisfactory source of potable water for a single-family residence. The water was sampled and coliform bacteria were absent. The water source is a public water system that appears to be in compliance with the applicable regulations Well Construction Permit Permit Status PART 6: COMMENTS Septic Review: There is some slope in this area, so pretreatment will be required if test hole number 2 is used. INSPECTOR j��l DATE 12/5/2007 Important Notice: Findings & determinations of this review reflect observed conditions as they existed on the day the evaluation was preformed. Absolutely no claim is made by this office, expressed or implied concerning the future success, failure or permit approval of the system and site evaluated. CRT2007-00117 4 of 4