HomeMy WebLinkAboutCOM2004-00110 - COM Letters / Memos - 5/21/2004 MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
May 21 , 2004 PO BOX 1666 SHELTON, WA 98584
SHELTON (360)427-9670
FAX (360) 427-7798
ELMA (360) 482-5269
S & K TOY STORE BELFAIR (360) 275-4467
SHARON MEEDER SEATTLE (206) 464-6968
23299 N STATE ROUTE 3
Case No.: COM2004-00110 Parcel No.: 123325000920
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until
the following are completed and turned in:
ni Report within the last three years from either a septic tank pumper or an Operation
and Maintenance Specialist.
Please call me at (360)427-9670, ext. 279 if you have any questions.
Sincerely,
Amanda Reynolds
Environmental Health
Mason County Health Services
Comments:
5/21/2004 1 of 1 C0M2004-00110
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�° 9 HEALTH
Mason County Environmental Health Department
Septic Tank Pumping Report Form
Property Owner/Mailing Address le (AA ]; 1 D'C• F o )C rj 10'L
Site Address NE Z3 z.9 ( //A y 3 R-L��/.e
Tax Parcel Number'?.3.3Z s-o Legal Description 40T /9 pf r- 16
(Pumpers Finding's) All items must be filled out completely, circle answer as needed.
Septic Tank Information
1) Tank pumped and nspecte al or no
Effluent level: High / norma / low r/T
2) Tank size: !/c} gallons
3) Tank construction: i ufactured or home made
' Tank material: metal wood co> E fiberglass other
4) How many compartments? single or(iab-I)
5) Inlet Baffle condition: .atisfacto / needs repair
Outlet Baffle condition: y. . :cto / needs repair
Center Baffle condition: -, isfacto L needs repair / not applicable
Effluent filter cleaned: yes / no /4ot app is
6) Does the system have a pump chamber? yes / 0 / unknown
Did the pump chamber need to be pumped? yes / no / of applicable
7) Tank condition: damaged /6y6o�
Were the tank or the baffles repaired? yes / ® / not applicable
Solids level (optional) : Sludge / Scum
Drainfield condition: backflow into the tank / seepage in drainfield /
no observed problems
8) Location where septage was disposed . —
9) Abnormal observations: (If repairs were made, please explain)
Findings and determinations of this inspection reflect conditions as they existed on the day the septic tank
was pumped. No claim is made by this company, either expressed or implied, concerning success or failure of the
septic system.
Signature of certified pumper „,t71/6-4-L Date J
Name of Company /i . _6, �� Dl�
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