HomeMy WebLinkAboutWQS Sanitary Survey - 9/2/1994 ON-SITE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
Project: LEC Area: b'd AFT.FAiR Date:
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OWNER INFORMATTON
12330 Fit 00034 WILS1775 i
FREE, R b JEANNETTE C WILSON Owner's Phone: oZ75_-0
NE 41 SCHOONER CT
BF_LFAIR WA 4D528
SITE INFORMATTON : z nn tX--- (DI I),e, uir -�q•
Pazcel rY : a/ 3 D—�— On03 Well Depth:
Address: NL Hb City: 6P/_ aiY State: WA Zip:
Building Type' (F-FuB Time Residoace; S - Se nat Reddeace; C -Commercial;
M - Muld-famdy Resideam; V - Vacam )
Septic System Type: 6 (S - Swulard bak ad dcw field; P - Pmw.Diatnbw a;
F - Sand Film,; M - Mouud; T - Deep Treaeh; H - ow House;
O - Other; U - ualmo.)
Installation Date: 0_ Year Last Pumped: U (Ema, Yea,o, U- Uab.r )
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System Location:L (F -From Yard; B - Beck Yud: S -Side Yard; A - Adj.=1d;
U - Unknown)
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Number of Residents: Q Shoreline (Y/I):
j OCCUPANT INFORMATION(comolem only if diffemm,haa ownfrl:
Occupant's Title: _ (ma erns, ms) First Name: Last Name:
Occupant's Phone: -
Would you like Information on Water Conservation? (YIN)
Would you be interested in a Community Workshop? (YIN)
PERMISSION FOR ACCESS TO INSPECT(THHE�SEPTIC SYSTEM: � ))(YIN)
j SIGNATLTW X. � ez_)Y. h� Date:
Comments
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S-7/-9/ D7 1- /Asl65f ?e zweLcl/9•r.
�E14AGE -?' a l7 �i 'Pfl•1�
MASON COUNTY DEPARTMENT OF GENERAL SERVIC
ENVIRONMENTAL HEALTH _ T i - I E •. BB
303 NORTH 4TH/P.O.ROX i 86/SHELTON,WA 88584
P14ONE(208)427-8670 '• t 'f•• ••i•yi ' i'
Old ! PPEpvdd
'y �c.Fsni2fEl . Cr):•..g•s•r _ __2�e-_-_a-53 T ',•
1gO%RlY ONN[E
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mNERAcroR F!1.�N'K nz/�1rCRc9Es'G'.° •^�-- r •E�(r•. yv 4s t'• is By .�.
UGu vEscnl%IDN — r' •• ;-' '.4 >Vi'��+ �`, •' `.
5f1 eD�tTYPE Ir e+ 's .+-bip;
GAT 3 OF
BUILD NG 1C fJY_ BEDROOMS LOT
(T i ,,.Fier�i iy yM•4 s ii•j�, ♦�..
SINGLE RESIDENCE PUBLR:WATER r
WATER SYSEFM SYSrFN ® NAME - ✓ R�.{.+• •�YR••y4 i•j4
COMMERCIAL GNEv 04 Pd61tc w4RT{s ' • ' `
LIQUID WASTE c.P.D. " * •• ••
-•a"xs• -T•sEl a"ykt� E. i••F.
DIRECTIONS TO—SITE: -vv • e � R to is {'
♦�M E\ E,
L �c...rI2 TANK4lj�f�T fit' �•>E•• -
n cr 'I di.� r T 4G F �}f ••s�•ii E '
I ISIRIGUTION'�,! • ;�4�.•E'T. .
r EILTFYfiO'IDN ILIIE�P y+•••• •*' I j:6DARF�iEET '
f hr b[�ctE Ibe GLMG r �i"ts•�1•4y}Ws••s '�• ••{`
Irn Ri ITT On fiT eon d2llt ••kyj BRAN Of a''
Go' i'be • ' ••" t• Pu
Fi .f Cov{ri'- D n ' •'_'i�•i`: • y6+ '!wDRPAret •�-
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DDgoG 4''it • t' STD L
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SITE PLAN AND SPECIAL STIPULATIONS ° {r `• iu
(INDICATE DIRECTION OF DRAINAGE) F
G"'rs•/ ftt�� �f+b/ W
70
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31360
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-,�,�..._.��.••,.- Wr•NR'O{PCECOPY:YpLpY-INSLNLLEF9 DORY'%NN' -QYINEpB COO';GREEN-BGIIDIND MR.
LOWER HOOD CANAL FIELD INSPECTION FORM
• Initial Information: 1� 5�
Area: rW �L( R7 f Prt , � Added to dateb
Owner Name: (�r3 I u� Permission to Inspect Inspect .
?:
Site Address: Appointment Required T:
Parcel#:
Appointment Date:
Occupant Name: y�tyn,p —
Inspections: ++
Level l: Level IC: 20 Level 2:
Inspection Team: Updated database(Y/N):
Inspection Results: �`�`�
Distance between septic tank and surface water (g)
Distance between septic tank and well: (@)
Distance between drainfield and surface water. (g)
Distance between drainfield and well: (g)
Occupancy(occupants/bedrooms):
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>200fr/100m1.
_ An unpermitted outhouse was observed.
./ Other: n o
Additional Comments: l
System Qassifation:
Pass: Fail: Suspect:
Failure Priority:
rvrda�
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P r:Med frorn Mason County G;
pr n'&o from?dassc County D"S