HomeMy WebLinkAboutSWG Onsite Survey - 2/14/1996 t ON-SYCE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
Project: LIIC Area: Date:
OWNER INFORMATION :
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SITE INFORMATION• 0 - Sw sc g'Lk-63 O z- `
Parcel # :/13�9- 'li
Owner's Phone: 2:7S- 6 2$S
Address: NC 3 s0 1 -4 w H 3 City: State: RYA_ Zip:
Sa,-.,,,.x d i 4vA�k 9N1
Building Type: CL (F-FaTn es ue Rideaee; S - Seeeooel Rm000 e; C Lommemiel;
M -Multi-femay Resklmco; V - Vacant )
Septic System Type: LA (S - Su-1-d t—k-0 d-d-fi-ld: P - Pros " D' -b"floo;
F - send Firer, M - mound; T - Doep T. h; H - om xonee;
O - Other; U - Unmotw)
Installation Date: �/- - Year Last Pumped: i,) A- _ (Erver Year or U- uhbm )
System Location: 5 (F -Front Yetd; B - Beck Yud; S -Side Y-d; A - Adieeent Lot;
U- Unlmo n)
Number of Residents: Shoreline(Y/N): __LL_
OCCUPANT INFORMATION(oomd�te only editfetmt then owver)'
Occupant's Title: _ (tie, xms. nrs) First Name: Last Name:
Occupant's Phone:
Would you like Information on Water Conservation? (YIN)
Would you be interested in a Community Workshop? (Y/N)
PERMISSION FOR ACCESS TO INSPECT TKE SEPTIC SYSTEM: (YIN)
SIGNATURE: Date:
Comments: AC/',614�id m. r M < nZ e bi m bM Mr, U� ;D rd
vI
Area Parcel 9 - q3 - oo l32 Team /
ILINeme 4Joo.�Fo.� _ Address
Phone Number
Site Visit 11 Date Time
Notes/observations:
Permission to inspect? Initial
Phone Call 11 Date Time
Notes/Observations:
Permission to inspect? Initial
Site Visit 12 Date Time
�„- Notes/observations:
Permission to inspect? initial
Phone Call f2 Date Time
Notes/Observations:
Permission to inspect? Initial
Phone Call 13 Date Time
Notes/Observations:
0 , Permission to inspect? Initial
LOWER HOOD CANAL FIELD INSPECTION FORM
Initial Information:
Area: Added to database(Y/I):
Owner Name: 1 TrrrrLFn r ; Permission to Inspect 1: _
Site Address: 501 H Appointment Required?-
Parcel#: 1231q- µ 3- 66 136 Appointment Date: ai
Occupant Name: `G,,rNn x 6
Inspections:
Level 1: 2& A L Level 10 'L�1� Level 2:
Inspection Team: L,4C Updated database(Y/N):
Inspection Results:
Distance between septic tank and surface water:
Distance between septic tank and well: IJA- (ft)Co in:m S..I S 4ew-
Distance between drainfield and surface water: Inn+- (ft)
Distance between drainfield and well: 1L-A (ft)
Occupancy(occupants/bedrooms): k
Other(Larger on-site, business-etc...): i LOIJ:d& A
jThe septic system appeared to be functioning at the time of the inspection;-ne-ebvioas—
_ 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>2000100ml.
An unpermitted outhouse was observed.
✓ Other:�alr, c. s 4,5"n o Itv< ° 1'"� i nn 1,.-,,� � wu � C�aal
44S been vcGt caA isJt A aimieix- _4PEl Iv WIAA 42 nk
Additional Comments:
System Classification:
Pass: Fail: Suspect:
Failure Priority:
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SITE DIAGRAM "
DYE PACKET RESULTS
&^�^d Sain 1 Re4icnl Seim]Retricval Scin 3 Rmienl
Silo
Numbs Dtic Dtle Rm14 I)tle Afe Raulle Ate Dab Runlh Ale Alc Revhv
PWd Re4icvc P4aed Rdrie�e P4 Rctrieve PWd Rdricve
BACTERIOLOGICAL RESULTS
Site Date Results
Number