HomeMy WebLinkAboutSWG Onsite Survey - 11/4/1994 ON-SITE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
Project: Lim Area: Date:
OWNER INFORMATION:
�-J 11 Q tiC',t... Owner's Phone:
n r5s c( 490a,� �.
oij 9gSO
SITE INFORMATION:
Parcel p : ) Z 3 - Pq �- 02903o Well Depth:
Address:�� 27 City: State: RYA— Zip: 57g
Building Type:
Septic System Type: 5 (S - So Wu w d.mrWd; P- e Dimitwiloo; F- s.m Fdm, M-
m.m; T - Da T.h; H -Out Have; O -ON ; U-ueloawe)
Installation Date: " "' ?C7 Las
t st Pumped: (wee Ye....U- u�)
co System Location: J (.c-Fm Y.m; B- e.ek Yw; S -sw Y..d; A - mja. �; U - unmo..)
Number of Residents: ) Shoreline (<im R �m.ae.or Fa.h w.w) _ (Y/N)
OCCUPANT INFORMATION OCCUPANT INFORMATION(�Iete�if different than ow)differa t than ow):
Occupant's Title: _ (ha, has, Ms)till
�p_p _-Last Name:
Occupant's Phone: V fir/ I
Would you like Information on Water Conservation? (YIN)
Would you be interested in a Community Workshop? (Y/N)
PERMISSION FOR ACCESS TO INSP CT THE SEPTIC SYSTEM.• (YIN)
SIGNATURE: Date:
Comments:
co
Rcvi Jum 29, 19%
LOWER HOOD CANAL FIELD INSPECTION FORM
Initial Information:Area: tit U W4 r Added to database(Y/I): to
Owner Name: ko bt v+ 4-6 n L, ik Permission to Inspect?: Y
Site Address: d E 29 I _ Appointment Required?: td
Parcel#: IL3L9 - 14- 06090 Appointment Date:
Occupant Name: RasAW NvAIi,r4w
Inspections:
Level 1: %l 4 94 Level lC:_ /4 /44 Level 2:
Inspection Team: L4-G I Updated database(Y/I):
Inspection Results:
Distance between septic tank and surface water: I q0 t (ft)
Distance between septic tank and well: SD (ft)
Distance between drainfield and surface water: f D o (ft)
Distance between drainfield and well: .SD (ft)
Occupancy(occupants/bedrooms): I
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/100m1.
_ An unpermitted outhouse was observed.
Other: U _ rern m"_rtol e Uax k!LA 4-4 L LA c k,6-'� L bra sl auu'
lkc
Additional Comments:
System Classification:
Pass: 1/ Fail: Suspect:
Failure Priority:
Pri«itim
1: ➢Inca n*m v W.2: Vi Dyn,apm«mdmi,n Vomtawym wwmm,amhm «ccwp wish<]ftve .Sp.fim
SEM.3: Sufmus r,eflluml o«mkri,-race wa .4:J ww, ryI bk kWWYahf.ktm.M.4'milky 1�oat mMml
aM wab.f:rYsuilY rmW�cn(afar)
SITE DIAGRAM
� 09Au
I cffae./
rE
DYE PACKET RESULTS
Sim �k�O11°d Series I Rehieval Seri.]Retrieval Series 3 Retrieval
Number Date Drte R.1b Date Da Reaulb Date Date ReaWla PLced Retrieve Placd Retrieve j Placed Retrieve Deb Rmulta
Pa d Retrieve
BACTERIOLOGICAL RESULTS
Site Date Results
Number
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
October 26, 2001 PO BOX 1666 SHELTON, WA 98584
SHELTON (360)427-9670
FAX (360)427-7798
ELMA (360)482-5269
RANDY S NEATHERLIN BELFAIR (360) 275-4467
291 NE ROY BOAD RD SEATTLE (206)464-6968
BELFAIR WA 98528
Case No.:BLD2001-01117 Parcel No.:123291400030
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until
the following are completed and turned in:
Approved septic records or approved septic design for? bedrooms
Report within the last three years from either a septic tank pumper or an
Operation and Maintenance Specialist.
Please see comments at the end of this letter.
Please call me at (360)427-9670, ext. 353 if you have any questions.
Sincerely,
Cindy Waite
Environmental Health
Mason County Health Services
Comments: We will need to know how many bedrooms you will have when the
remodel is finished. We will need septic records and a satis pumpers
report.
10/2612001 1 of 1 BLD2001-01117