HomeMy WebLinkAboutWQS Sanitary Survey - 9/19/1995 ON-SITE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
. Project: LHC Area:�� � Date: / S 5
OWNER INFORMATION
Owner's Phone:
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SITE INFORMATION :
Parcel k : I Z3`� -- S I -- OAS Well Depth:` '
Address:NE '?�;$0 SVC0^1tC o.City: 3ekl�i State: WA—
Building Type:
Septic System Type: (S - sum.nt.a.m m.mr 1a; P-w....o wAb.6..; F - uw vm ; M-
m.m; T - DX T.n.h; H-Out H...; O -O -,; U -u-&—)
1 � gc ti ��p
Installation Date: Year Last Pumped: (1w..Y...«U - uni ..)
System Location: (F-Prot.Y..a; B - a..k Y.a; S -sia.Y..a; A - nai...nt to, U- ua .n)
Number of Residents: 's Shoreline (<1oo t.a F..h w...) _(YfN)
OCCUPANT INFORMATION(a.mpi91.a.ty if ditr..eo Wen• ):
Occupant's Title'-- (MR, hms, Ms) First Name: Last Name:
Occupant's Phone:
Would you like Information on Water Conservation? (Y"
Would you be interested in a Community Workshop? (Y/N)
PERMISSION FOR ACCESS TO INSPECT THE SEPTIC SYSTEM.- Q(YrIN)
SIGNATURE: ( c�bA (Dwt^ 2-S Date: _ f I 1
Comments:
R. i..a lure 29,1994
LOWER HOOD CANAL FIELD INSPECTION FORM
Initial Information:
Area: 4 9= I Fie, Added to database(Y/I): 7d
Owner Name: ct. ks A.Nws.m Permission to Inspect?:
Site Address: NS 34 o Se�w..... I.p Appointment Required ?:
Parcel#: t z ue-S/-pcGS/ Appointment Date:
Occupant Name: CA.les w♦I�..sm
Inspections:
Level I: 9 III ki, Level 1C: 11151qT Level2:
Inspection Team: LHC3 Updated database(Y/N):
Inspection Results:
Distance between septic tank and surface water:
Distance between septic tank and well: 7w' (ft) cev:
Distance between drainfield and surface water: !Q6' (ft)
Distance between drainfield and well: LdZ> (ft) cor..w
Occupancy(occupants/bedrooms): S/3
Other(Larger on-site, business..etc...): VAI—d
The septic system appeared to be functioning at the time of the inspection; �so-ebvie(n
problern",ere-ebseeved.
�...- 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 unpemutted outhouse was observed.
Other:
Additional Comments:
System Classification: ,
Pass: Fail: Suspect:
Failure Priority:
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SITE DIAGRAM
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DYE PACKET RESULTS
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Number Dnc D- Ra�W Dtle Dtic R.0 DJc Dtl Rrsutra Dim DYc RmXs
I,= Rcai<w Pl.ad Rcvicve Pl PWd Rn.ie e
BACTERIOLOGICAL RESULTS
Site Date Results
Number