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HomeMy WebLinkAboutSWG Onsite Survey - 6/3/1994 ON-SITE SEWAGE SYSTEM SURVEY LOWER HOOD CANAL CLEAN WATER DISTRICT PROJECT: LHC AREA: &4 RFI FAIR DATE: 6-:I-24 OWNER INFORMATION: TITLE: MR, MRS, MS (circle one). North Mason School District (Belfair Elementary) FIRST NAME: LAST NAME: ADDRESS: NE 22900 Hwy. 3 CITY: Belfair STATE: WA ZLP; 98528 OWNER'S PHONE: 275-2883 OCCUPANT'S PHONE: same SITE INFORMATION (Mark SAME if same as above) PARCEL# 19919 ---- an 60000 OCCUPANT'S TITLE: MR, MRS, MS (circle one) FIRST NAME: Same LAST NAME: ADDRESS: CITY: STATE: _ ZIP; NUMBER OF RESIDENTS: 500 WELL DEPTH 250 Elementary School RESIDENCE TYPE: -,( F- Full Time Residence; S- Seasonal Residence; Qt-Recreational Residence; C - Commercial; I -Industrial; M- Multi-family Residence; V- Vacant) ON-SITE SEWAGE SYSTEM TYPE: S •p Enter all that apply. ( S - Standard tank and drainfield; P- Pressure Distribution; F-Sand Filter, M- Mound; T - Deep Trench; H- Out House; O - Other; U- Unknown '70, 177, 189 INSTALLATION DATE YEAR LAST PUMPED: '9 1 Enter Year or U- Unknown GENERAL LOCATION OF SYSTEM: F, e,s F-Front Yard; B -Back Yard; S - Side Yard; A- Adjacent Lot; U-Unknown PERMISSION FOR ACCESS TO INSPECT THE ON-SITE SYSTEM(YIN) y - (NOTE*Mason County Health Code provides tight of entry provisions. However, our policy is to gain permission to access on-site systems. Your cooperation is appreciated and saves valuable time and money for Mason County. Applicable codes pertaining to this matter will be provided for you upon request.) SIGNATURE �Jc ,.vn�. �� DATE lr _ .3 Comments: DO YOU WANT TO RECEIVE INFORMATION ABOUT WATER CONSERVATION? y (Y/N) Reviu May 27, 1994 w � . U X Lu I • aui W j O N. LLI cr -35 U z �t 9, • r , w� � � • S 'S s I A er LOWER HOOD CANAL FIELD INSPECTION FORM ® Initial Information: Area: —#� �� Added to database(Y/N): Owner Name: Permission to Inspect ?: , Site Address: __ l{ _ Appointment Required ?: ,1 Parcel#: Appointment Date: Occupant Name: Inspections: Levell: Level 1C: Zc>/,f4 Level2: Inspection Team: Updated database(Y/N): Inspection Results: Distance between septic tank and surface water: (ft) Distance between septic tank and well: (g) Distance between drainfield and surface water: (g) Distance between drainfield and well: (fi) Occupancy(occupantstbedrooms): $c4oet Other(Larger on-site, business..ete...): !Apt ._ � 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/100ml. _ An unpermitted outhouse was observed. Other: Additional Comments: JC�P.r..n i r•�f—rrµ5 S f D 6C f v. Q fGSA System Classification: Pass: Fail: Suspect: Failure Priority: �: ume..mlmy mww.2: V�aro,oee�`u'f'eW—W—IM:.rtke w.mr,wl b.-or�m.rooV.;w<3n van.xp.from .4..-�5:qi Ay geYr.f off)M8 aurfuc wafer.0:Olher wat<epYbk maplhtian.;m¢muomny filing ryetane va e�leeing SITE DIAGRAM G1�a��o,Ms n o tt K ACKET RESULTS Becks u d Senn I Retrieval Senn 2 Retrieval Senn 3 Re .111 Sik t:umbn Date Dale RnuM Dale Dale Rnulta Dale Dale RuuRa Date Dale Raulla Placd Retrieve Placed Retrieve Pland Retrieve Placed Retrieve BACTERIOLOGICAL RESULTS Site Date Results Number LOWER HOOD CANAL FIELD INSPECTION FORM Initial Information: �^ L/ Area: �' ek f Added to database(Y/N): Owner Name: * &4& .A S Ur a,21 ( Permission to Inspect?: Site Address: ?2QtlC7 w.!3 Appointment Required ?: Ac) Parcel#: Appointment Date: Occupant Name: Inspections: Level 1: Level 1C: R jZ004 Level2: Inspection Team: Updated database(Y/I): Inspection Results: Distance between septic tank and surface water: (ft) Distance between septic tank and well: � (ft) Distance between drainfield and surface water. (ft) Distance between drainfield and well: — (ft) Occupancy(occupants/bedrooms): SU^00I Other(Larger on-site, business..etc...): U D� 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>200BU100ml. _ An unpermitted outhouse was observed. Other: Additional Comments: r System Classification: / Pass: Fail: Suspect: Failure Priority: medeu © 1: alrcas aiwY mAstM.2: Vinul Dyq opca a rvAwing wwere wkrio{wRwc wYu,aW houw a cuepmk wp6<3a VM.Sry.fwm SHW.3: aur ks ing ealuent va waekg euAwe wekr.4:Other waeeepWk meklla�iow:wtnminwYy Oiing ryekm�va rntnior wrfwe wry.5:Pr'vneHlY weWetice(aJm) SITE DIAGRAM playsGtd I )F DYE PACKET RESULTS Ilack�ound Saiez 1 Relneval Sena]ReNeval Sena l Retrieval Site Number Date Date Raulls Dad Date Raulta Dale Da Results Dak Date Raulla Placed Retrieve Placed Retrieve Placed Retrieve P1.d Retrieve BACTERIOLOGICAL RESULTS Site Date Results Number • LOWER HOOD CANAL FIELD INSPECTION FORM OInitial Information: r `/ Area: /} Q,�Tat_l r Added to database(Y/N): Owner Name: 0. Vft soe 4b ". ej( Permission to Inspect ?: ✓ Site Address: -Z 2 4 op 4 Y 3 Appointment Required ?: Parcel#: Appointment Date: Occupant Name: Inspections: I ' Leven: Level IC: Level2: Inspection Team: �5 I I Updated database(Y": Inspection Results: Distance between septic tank and surface water: (ft) Distance between septic tank and well: (ft) Distance between drainfield and surface water: (ft) Distance between drainfield and well: (ft) Occupancy(occupants/bedrooms): SCt.vo/ Other(Larger on-site,business..etc...): unl�A _4,,"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 coliforrn count of>200fc/100m1. _ An unpemtitted outhouse was observed. Other: Additional Comments: r/ System Classification: / Pass: „/ Fail: Suspect: Failure Priority: r 1: amw S N W rtie¢d.2: eff Dye, nW a wincing We 4: m�ering a cV4 k m wl ; m<eee y wig V Vut.Sep. mg saW.3: s r.5: niy eaNmt ou minivg eurrece w.ler.4:OWer umccrylable uelW.lim.;minrmltlmaY 4i1'ry ryetm.M eNawg vurfce w.¢r.3:Prwnrib.e.w+lc.(mor) SITE DIAGRAM 10 DYE PACKET RESULTS BukgourW Seri.I Retrieval S 6.2 Retrieval &d.3 Retrieval Site Number Dale Date R.ulta Date Date R.ulla Dale Dale R.uN Date Dale R®ulb Placed Retrieve Placed Retrieve Placed Retrieve Placed Retrieve BACTERIOLOGICAL RESULTS Site Date Results Number •