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Home My WebLink AboutCRT99-0185 - CRT Application - 10/5/1999 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SSELTiON, WA 98584 (360)427-900 FAX 427-7798 APPLICATION FOR ENVIRONMENTAL HEALTH REfffV]]EW Receipt LNO:Date of Paym "Vie 1L•7� V 1 Septic or Water R L B I 5 iM!i) Property Evaluation ($.+ SO Hr) = iERMIT ASSISTANCE CENTER INSTRUCTIONS r nappifeat �1. An application is considered complete when the fee is paid, Parts 1-4 ofthe ion form are completed. (assistance will be provided upon request for coapletfn.9 Part Two), the necessary paperwork is attached, and required soft 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 site review requires more than 1 hour of work, the department will charge the applicant an additional hourly rate of S50/hour as set forth by the Mason Canty Board of Health. PART 1: APPLICANT/PARCEL(IDENTIFICATION NA249 OF APPLICANT aKi�l�-KL lal TELEPHONE SITS/HOUSE ADDRESS 7'� �� • ��/,VL/� - MKLING ADDRESS I V WR Ct -1 ll-1 he ACREAGE city 22 State 2 p GJ 0 ASSESSOR'S PARCEL NUMBER _3 2- LEGAL PROPERTY DESCRIPTION 7✓��-h W N .(�rPsury (pl3b� T,TrA'�o,F ��7�5 Tr3sz�SF#Z/�/ SUBDIVISION (If Applicable) DIV BLR LOT _— DIREC�TTIONS FOR LO('ATING� TE u..�w -rz� ly�rrr,a 1 Qn > M� �L�.�(Sc�•1 pL�> _ (fit PPMx ,Cep rH'.., o nn�,r.l ^.::L\[.Et1;r...,_ �a�> A S I I ,\\ Sketch location of property in thi space. I a M,r�`r''`3' I H:\ON-SISS\QalSVIEN.H aevlelm 212S199 Page 3 PART 2: PURPOSE OF APPLICATION X 71fo:1:iowwaPinnPg1:' ?ION ONE ing for a bank loan and the bank has asked for an evaluation of the n nJ Septic System (Fee: $85) • Age of System • Age of Noose • Number of Bedrooms • Name of Last Owner • Is house currently occupied? Yes - Attach pumperrs report, dated within last 3 years, stating whether the system was pumped, the size and condition of the tank, and the condition of the baffles. n lJ water System (Fee: $85) • Number of service connections an pterj tfemt / ' 14 • If public water system: He= OT System 02,6473 P wrl NM-1 Both (Fee: $100) • Provide information shown above for both septic and water systems 2n_ OPTION TWO L^J I am applying for a building permit and environmental health has required an evaluation of the following: n L-i Existing septic System (Fee: $85) • Age of System • Number of Bedrooms - • Name of Last Owner • is house currently occupledt Yes No • Attach pumpeNs report, dated within last 3 years, stating whether the system was pumped, 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. n nJ Reserve Area for Future system Repair (Fee: $85) • Two properly excavated pits are 6 ft deep must be ready for inspection by the department. n :J Both (Fee: S85) • Provide information shown above for both septic system and reserve area N:1cer-SrrelesOtSWEW if aevisien 2/26/99 Page 2 4C OPTION TMME L^J I am interested in )morning in general terms the suitability of a parcel for septic system placement. (Fees $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 F�LF UIa this space to draw a detailed plot plan, or attac A detailed plot plan i that s ows the precise location of the test holes, existing septic systems, dimensions of the property, and t on of any its, roads, or other buildings on the property. I I i I I I I I I I I I I I I I i I I � I I - I I I I j I I I o\- CIA— PART 4: AUTHO ATIO APPLICANT JAI � MTE O O N,lcw-SITS%MGUSZEV.Of Revfaloo I/29/99 Page 3 PART 5: HEALTH DEPARTMENT FINDINGS - OFFICIAL USE ONLY SA. DETERMINATION OF APPLICABLE STANDARDS The primary drainfield area must meet the foltowing standards: n n LJ Meet current standards LJ Standard marine system n is No overt failure LJ Not applicable. The reserve drainfield area must have site characteristics that could support a septic system that would met the following standards: n n LJ Meet current standards. LJ Meet marine repair standards. n LJ Meet marine expansion standards. Hot applicable. 513. WATER SYSTEM YES NO INDIVIDUAL WATER SYSTEM n n LJ LJ A water"sappLe was taken by health department aff end analyzed. Total cotiform bacteria were determined t absent. Laboratory res s.are attached to this report. n n LJ LJ The wett cap was inspec sanitary seat appears satisfactory. n n tJ LJ The welt casing we nspected. The casing r�ec\ted above ground and ground was sloped away from the casing. n n LJ system,LJ T It cite was inspected. No septic syste , chemical storage facilities, manure piles, animal feed lots, or other obvious sources of contamination were located within a 100 foot radius of the well. ,PUBLIC WATER SYSTEM a n LJ Records indicate water sampling requirements are being satisfied. 19 n LJ Records indicate the water Facility Inventory form to current. i n u Department files contain water system design and letter of approval? 5C. SEPTIC SYSTEM YES 1•0 q� n P+ LJ The septic tank was inspected by a certified septic tank punper within the past 3 years and found to be in satisfactory condition. A puaper's evaluation is attached to this report. qh n (L'" LJ Records for this property contain a septic permit, design (if required), final inspection approval, and as-(wilt approval. n U The drainfield site was inspected, and appears consistent with recorded documents. W n U FS The drainfield area appears to be maintained in an acceptable marvxr. n ro LJ P The drainf told area (the area where the drainfield is assured to be located based on office records and/or observed site conditons) appears to be maintained in an acceptable manner. LA n Lt'° LJ The drainfield area (the area where the drainfield is assured to be Loeeted based an office records and/or observed site condition) show no indication of overt failure at the time of inspection. Nr%cN-sX7V%x7aUMrzw.w Nevla9aa 2126199 Page 4 SO. SOIL CONDITIONS TT HOLE #1 I TEST HOLE #2 ( TEST HOLE #3 I I 1 I I I I I I I I I I I Depth to restr. layer I Depth to restr. layer I pth to restr. layer I I Soil Type: I oil Type: I Soil Type: I I I I FINDING SCORE I I I Soil Type: I I Soil Depth: I I Slope: " I I Parcel Size: Distance to Shor ine: I ( I 5E. OTHER NOTES AND COMM N:1ot7-SITEIERREVIEW.N Revlilm 21261SY PR9e 5 PART 6: HEALTH DEPARTMENT DETERMINATION - OFFICIAL USE ONLY 6A. PRIMARY DRAINFIELD SYSTEM The primary drainfield area was inspected by staff and pertinent records were reviewed. The following determination was made: i-1 lJ The system appeared to be functioning adequately at the time of inspection and and meets current design standards. The system appeared to be functioning adequately at the time of inspection. u Not applicable. Comments: iv-tr 4yDA'TV11f.n.'F Q <D lg1 A? 6S. RESERVE DRAINFIELD AREA The reserve drainfield area was inspected by staff and the soil was evaluated. Site characteristics indicated an area exists that could support a septic system that would meet the following standards: t1 U Current standards. I—i U Marine expansion standards. n U Marine repair standards, Treatment Standard Not applicable. Comments: , 6C. WATER SYSTEM The water system was evaluated by staff and the following determination was made: 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. n L.J The water source is a public water system that, appears to be in substantial compliance with applicable regulations. Comments: t adcr 644ak.m iS fuxvrYeHu mT Q�covptt .`(y "8""4' I A "�1 i pia ............................................................................ ...................... ................................................................................................................................... .................................................................................................................................................. 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. G INSPECTOR (Id ,4/.( ;t DATE R:%0H.5X=%ERREVIEw.w Revision 21261sy P°9e 6