HomeMy WebLinkAboutField Inspection Form - BLD Inspections - 3/28/1996 LOWER HOOD CANAL FIELD INSPECTION FORM
Initial Information:
Area: Added to database(Y/N):
Owner Name:5 'ems, e Permission to Inspect ?:
Site Address: Ai�-1c 2 &;?,;t Appointment Required T y2�
Parcel#: j 2 3,n� - L L( - >`r)0 Appointment Date:
Occupant Name:
Inspections:
Level 1: /?$J e' Level 1 C: ' j ��- Level 2:
Inspection Team: Updated database(Y/I):
Inspection Results:
Distance between septic tank and surface water: 10D t (ft)
Distance between septic tank and well: (ft)
Distance between drainfield and surface water: (ft)
Distance between drainfield and well: 'C >
Occupancy(occupants/bedrooms): Z
Other(Larger on-site, business..etc...):
_ 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 coliform
count of>200fc/100ml.
An unpermitted outhouse was observed.
Other:
Additional Comments: �
v C.Q_Q�� P 6'ell
System Classification:
Pass: Fail: Suspect:
Failure Priority:
Priaitics
1: Mneas i jury related.2: Visual Dye,open or surfacing sewage cnteriag surface w1 ,out houses or cesspools with <3ft Vert.Sep.from
SHW.3: Surfacing seeping effhuat not enwing surface water.d:other uawxcptabLe installations;mtumiucatly Wice systems not catming
surface water.5:Primanly rsthctkz(odor)
SITE DIAGRAM
I
DYE PACKET RESULTS
Background Series 1 Retrieval Series 2 Retrieval Series 3 Retrieval
site
Number Date Date Results Date Date Results Date Date Results Date Date Results
Placed Retrieve plc Retrieve Placed Retrieve Placed Retrieve
F:::
BACTERIOLOGICAL RESULTS
Site Date Results
Number
SITE DIAGRAM
DYE PACKET RESULTS
B;ickground Series I Retrieval Series 2 Retrieval Series 3 Retrieval
Site
N=ba Date Date Results Date Date Results Date Data Results Dale Date Results
Placed !I,etricvc Placed Retrieve Mood Retrieve Placed Retrieve
BACTERIOLOGICAL RESULTS
Site Date Results
Number