HomeMy WebLinkAboutWQS2023-00063 - WQS Sanitary Survey - 4/14/2023 `,NAG•r'r.�.1,
MASON COUNTY
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• ✓.--. COMMUNITY SERVICES
MASON COUNTY PUBLIC HEALTH Sanitary Survey and Dye Test Form
Sanitary Survey Case#: ' '°52.0 Z3 — 00063
Dates of Site Visits: / / /
PROPERTY INFORMATION: Parcel Number: t 1-330 - 'rj'1 - Q00
Site Address: 70 NE (NH Q \r./w Occupant(if Different): Sum ' Ste ue &rµ4 j
�J // Phone: 3(0 2,290 (Vl%DW r So 9
Owner: Number of Occupants: Z Number of Bedrooms:_
Mailing Address: Water supply: Public ❑ Individual U
SEPTIC SYSTEM INFORMATION: OSS CHECKLIST: •
System type : G✓awlty Install Date: I / 17/1169 Plumbing leaks or back-ups U Additives ❑
Risers? Y ❑ N;X O&M Current? Y ❑ N , Garbage disposal used ❑ Dishwasher? ❑ ,
Date of last O&M: f—t�� - 6l1 q/Zp i 7 (Pu�,�Record Drawing on file Y $ N ❑
O&M issues? N ❑ Yg tAti4S imps 0 16 / yWt SCGN
Notes:
FIELD INSPECTION INFORMATION: OSS System Protection: 1. ❑ OSS is well-maintained, no
Inspector: JJ 5't .'Powl • observable disturbances.2. ❑ Evidence of occasional soil
Distance between septic tank and SW: < 50 ft. compaction or disturbance 3.,'Evidence of vehicles, heavy
Distance between septic tank and well: ft. equipment, livestock, cuts, soil removal
Distance between drainfield and SW: < 5O ft. OSS access/location: 1. ❑ Known with easy access 2.4
Distance between drainfield and well: ft. Known without easy access/markers 3. ❑ Unknown
Shoreline Property: Yes_NoX Water Body: Vt taw- a. Landscape/cover Condition: 1. ❑Well maintained proper
Animals: Dogs (#): I Cittk/5 Pleivly vegetative cover 2. No vegetative cover,trees near df,
Livestock: (Type &#) h,W overgrown 3. ❑ Lush vegetation, hydrophilic veg,trees on df
OSS Summary Condition: ❑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, paved),construction in the df
area ,surface water flow ❑poor vegetation management (trees, lush grass, no vegetation) other: r)ypviy)
There are indications of poor system O&M:Mlack of regular O&M CI Unsatisfactory Service Event❑leaky plumbing Uslow
drains ❑excessive chemical dumping ❑high water usage ❑ other:
FINAL RATING OSS: • .
❑ NAP ❑ NO RECORD DRAWING ❑ CONCERN ❑ SUSPECT. FAILURE
❑ An unpermitted outhouse was observed ❑A greywater discharge was identified
EDUCATIONAL INFORMATION PROVIDED: ❑Septic Care [JOSS Manual ❑Living By the Water ❑Back to Basics ❑
Landscaping the Drainfield ❑Shore bank ❑Shoreline Living Resources ❑O&M Schedule ❑Rain Gardens ❑Composting
❑Pesticides/Herbicides/Fertilizers ❑Watering(plants/lawn) ❑Native Plants
❑ Other:
Notes:
•
Updated 11/6/2017
If Flows Emanating from this Property are Potentially Impacting Water Quality,Complete the Following:
In the box below,indicate sources/areas of animal waste,surface water flows, locations of OSS,and where samples/dye tests were
collected/placed on the property. For consistency, indicate distances and directions on the drawing(Not To Scale). For additional
information please attach additional sheets
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Notes: 191( e- Ste, 4 I 0.�Mows to 12e, 6krevivyed(yl�j 'Yd'Vj/Y1G({n/G1 'err, a)
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Dye Test Date: Dye Used:
Control (F0) Pack Week#1 (Fl) Pack Week#2 (F2) Pack Week#3 (F3) Pack Week#4 (F4)
Placed Retrieved Result Placed Retrieved Result Placed Retrieved Result Placed Retrieved Result Placed Retrieved Results
r5� 1 9/7 4f 14 q/IN L(/t( ,+44+ 4/tt Y/2,'6
;. 2 4/7 /11.1 tj/ly ti/2. — ti/24 4JII
3
4
5
6
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8
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9
10
EC
WATER SAMPLE DATA: ( per 100mL) EC/loo, L
Water Sample Taken: Date: 3/t1/t3 Inspector: J J 5 Result:)2420 /100 mL Location: l^YC—0 i s
Water Sample Taken: Date: 9/3/23 Inspector:..)5 Result:..y 6l /100 mL Location: LNG. 0 ( 5
Water Sample Taken: Date:9/10/1.3 Inspector:JJ S Result: 2-1 LI F /100 mL Location:(.YC - 015
Water Sample Taken: Date:'{/2g/13 Inspector:33 S_ Result:WtO-0 /100 mL Location:Lk -D15
updated 11/b/2u17