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HomeMy WebLinkAboutWQS Sanitary Survey - 5/2/2001 LOWER FOOD CANAL FIELD INSPECTION FORM C Initial Information: O Area: Added to database(Y/l�: Owner Name: De6/,.�. Efl,FeJ a Permission to Inspect 7. Site Address: /t/ E 14o G l/e, APpomunent Required 7: — Parcel t2: 1 2-83o SI- 00017 Appointment Date: Occupant Name: Inspections: Level 2: Level 1: Level IC: Inspection Team: Updated database(Y/t): Inspection Results: Distance between septic tank and surface water: I o u + (ft) Distance between septic tank and well: l u o + (ft) Distance between drainfield and surface water: 1 a u 1- (ft) Distance between drainfield and well. Occupancy(occupants/bedrooms): Other(Larger on-site, business..etc...): v/ The septic system appeared to be,functioning at the time of the inspection; no obvious G 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>200fd100m1. _ An unpeinutted outhouse was observed. Other: Additional Comments: SystemQasdrication: i Pass: Suspect: Failure Priority: _ _ . .. a4a vdc,wtYww a au�pm4+t�<aM1 Van.Sep.frvm © I: m.uc Fjq mlael.Y YrW nYc.apm arwbq c-+'cic mai[ e,uCAmr,bumac�'GSor vem..ot ma'v� 91N.): Sai4c'n(W�'L davaw[Nvq sA vaR.�:Oarimmp�bk wrtz.uv.3:Primuny.�.mGn(aGae) PART 6: HEALTH DEPARTMENT DETERAHNATION - OFFICIAL USE ONLY 6A. PRIMARY DRAINFIRLD SYSTEM The primary drainfield area was inspected by staff and pertinent records were reviewed. The following determination was made: n U The system appeared to be functioning adequately at the time of inspection and and meets current design standards. The system appeared to be functioning adequately at the time of inspection. n U Not applicable. Comments: 68. RESERVE DRAINFIELD AREA The reserve drainfield area was inspected by staff and the soil was evaluated. Site characteristics indicated an area exists that could support a septic system that would meet the following standards: n u Current standards. n u Marine expansion standards. n U Marine repair standards, Treatment Standard Not applicable. Comments: 6C. WATER SYSTEM The water system wa evaluated by st<andthell wing determination was made: The water source con 'sta of anll that appears to be a satisfactory source of able ingle family residence. The water was sampled, and coliform b te to be absent. The water source is a publi wat appears to be in substantial compliance with applicab regu Comments ................................. ....................................... ................................. .::::::::::::::::::::::::::::c::::::......::c......:::n::::.....::::::::::n:::::::..:::::::Y.......:::: :::............. Findings and detervinations of this review reflect observed conditions as they existed on the day the evaluation was performed. absolutely nc claim is made by this office, either expressed or implied, concerning future success or failure of the systems erd sites evaluated. Resource land and critical area checklist may be repaired by Department of Coamnity Developaenc prior to issuance of developmental permitt..�-F��`.� INSPECTOR DATE O1 ^M-^ n S:\M'-SISa\P'ImSVIBr.'.M Revision 3/36/99 Page I 5D. SOIL CONDITIONS TEST HOLE H1 TEST HOLE #2 TEST HOLE #3 Depth to reetr. layer IV11epthtotr. layer Depth to reetr. layer Soil Type: Soil Type: ' FINDING SCORE + /tanceto eline: i SE. OTHER NOTES AND COMMENTS i H:ke -917w� OtC✓ W.v Aevlelrn 2126199 Page 5 PART 5: HEALTH DEPARTMENT FINDINGS - OFFICIAL USE ONLY 5A. DETERL@TATION OF APPLICABLE STANDARDS The primary dreinfield area lust meet the following standards: n - n u Meet current standards u Standard marine system n No overt failure u Not applicable. The eserve dreinfield area Brut he. site characteristics that could support a septic system that would met the following standards: n n u Meet current stands rds. u Meet marine repair standards. n u Meet wrine expansion standards. 14 Not applicable. 5B. WATER SYSTEN / YES NO INDIVIDUAL WATER SYSTEM n n LJ u water c .Ie was taken by health department staff and analyzed. Total colifom bacteria were emi red to be absent. Laboratory results are attached to this report. n n u u The l cap was impacted. The sanitary seal appears satisfactory. n n u u The well sing was inspected. The casing projected! above grand and grand was sloped away from the casing. n n iJ u The well site we inspected. No septic systens, chemical storage facilities, manure piles, animal feed lots, or other obv sources of contamination were located within a 100 foot radius of the well. BLIC WATER SYSTEM n n u u Records indite water saapl-ng requirements are being satisfied. n n u u Records f ioate the Water Facility Inweftory fom is current. n n u u Depar t files contain water cystm design and letter Of approval? 5C. SEPTIC SYSTM YES NO X�j 1-1 u The septic tank was (nspectM by a certified septic tank pmper within the past 3 years and found to be in satisfactory condition. A pu per-s evaluation is attached to this report. n u Records for this property curtain a septic pemi[, design (if required), final impaction approval, and as-built approval. n u The tlraiMleld site was impacted, and appears consistent with recorded documents. n u The drai of laid area appears to be wai ntainwd in an acceptable mercer. �F n (a u The drai of ieltl area (the area dare the drai of field is essuaretl to be located based on office records and/or observed site cenditans) appears to be ®intained in an Acceptable warner, n u The tlninfleld area ([he area dare the drai nfieltl is escmed to be located based on office records and/or observed site coditau) show no indication of avert failure at the time of impaction. a:1[N-S llffk [E ssf w Revision 2121/99 Page 4 7C. OPTION THREE n u I am interested in lmotdag is general terms the suitability of a parcel for septic system placement. (Pees $85 bass, plus $50/hour after first hour) aescrihe the intended use of the property and the reason for remmstim the review: PART 3: PLOT PLAN Use this space to draw a detailed plot plan, or attach one to this application. A detailed plot plan is one that shows the precise location of the test holes, existing septic systems, diaensimis of the property, and location of any wells, roads, or other buildings on the property. I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I PART 4: AUTHORIZATION APPLICAtTf DATE x:{W-SzmknG Vrlaw.M Seeladoo 1126/99 9a9e s PART 2: PURPOSE OF APPLICATION 2A. OPTION ONE I am applying for a bank loan and the bank ham asked for an evaluation of the fo llowing: -Septic System (Fee: S85) • Age of System Zvi ✓-fY/�'S • Age of Rouse • Molter of Bedroaas Z Name of last Owner E7'1d&32e is house currently Occupied? _ ibty Yes No - Attach pumper's report, dated within last 3 years, stating whether the system was purged, the size and condition of the tank, and the condition of the baffles. n u Water System (Fee: $85) • Number of service camectians an water system If public water system: Name of System n wFI Nuetwer u Both (Fee: S100) Provide information shown above for troth septic and water systems 2B. OPTION TNO n U I am applying for a building permit and environmental health has required an evaluation of the following: n LJ Existing Septic System (Fee: $85) - Age of System Nurber of Bedrooms Name of Last timer Is house currently occu ied? Yea xo Attach pumper's report, dated within last 3 years, stating whether the systan was pumped, the size and codition of the tank, and the corditi On of the baffles. if the original septic permit carrot be located and system less than 5 years old, apply for new on- Sit-sewage Disposal Permit. if the original septic permit carrot be located and system more than 5 years aid, submit signed as-Wilt drawing from certified designer or professional engineer. n LJ Reserve Area for Future System Repair (Fee: $85) - Two properly excavated pits are 4 It deep most be ready for inspection by the department. n LJ Both (Fee: 585) Provide information shown above for both septic system and reserve area H:%W-SI181HIX6 M If Revleleo 2126199 F'a4e 2