B01 ATTACH J05 - Design and County Permit.pdf

1l KITSAP PUBLIC

HEALTH DISTRICT

HEAL TH OFFICER DECISION

Memo#:

Tax ID#:

Application Type: Building Site Application - Repair RP ACCT ID:

Expiration:

Contractor of Record

345 6th Street, Suite 300 Bremerton, WA 98337 360-728-2235

135566 3900-004-006-0001 1472067 09/20/2021

Property Information

2919 NE ALDER ST

Bremerton WA 98310

Contractor Name: ENVIRONMENTAL DESIGN LLC Contractor Phone#: (360) 219-3343

Applicant

Indian Health Services 4060 Wheaton Way Suite E Bremerton WA 98310

Health Officer Decision for Onsite Sewage System

Approved Name of Inspector:

(See Conditions Below) KIMBERLY JONES

Health Officer Decision for Water Supply

Date:

08/24/2020

DO NOT ISSUE BUILDING PERMIT WITH THIS BSA-REPAIR

This application has not been reviewed for drinking water adequacy. Future building permit activities will require water adequacy review per Local Health Ordinance 2018-01, Section 6.

'2 Approved Name of Inspector: , t--__ (_Se_e_c_on_di_tio_ns_ B_e_low_) __ ~_K_/M_B_E_R_L_Y_J_O_N_E_S _ ____ _,__08_/2_4_/2_0_2_0 _________ -i

Date:

Final Decision: Approved

Kitsap Public Health District kitsappublichealth.org l·r KITSAP PUBLIC

HEALTH DISTRICT

1. '

1~·1 '"',I'!,. n rJI · · IL!C Hr~:i.1 ·1 :--: i Jiffl ~;1(;1

345 6th Street, Suite 300 Bremerton, WA 98337 360-728-2235

BUILDING SITE APPLICATION ~'fi411\.l~mfli·i4

FOR WATER SUPPLY & ONSITE SEWAGE SYSTEM 135566

BUILDING SITE INFORMATION

Building Site Address -Street, City, Zip Code:

2919 NE Alder Street, Bremerton Assessor Tax Account Number:

Indian Health Services Eva-Marie.East@ihs.gov Mailing Address - Street, City, State, lip Code:

4060 Wheaton Way, Suite E, Bremerton, WA 98310

APPLICATION GENERAL PROPOSAL

Application Type:

0New

@ Repair (no building permit needed)

D Modification (building permit needed)

D Building Clearance with Compliance

Application Use Type:

@ Residential

D Multi-Family

D Community

D Commercial

Application Water Type:

~ Public Water

D Private Water (residential only)

D This is a Redesign (describe what is being changed) OR a Building Clearance with Compliance (describe proposal)

I certify that (1) the information contained in this application is true and accurate to the best of my knowledge; (2) the application represents my intended use of this property; and (3) any related building permits for which I apply for will be consistent with the plans and specifications contained in this application.

I acknowledge and understand that I, along with my contractors, are responsible for adhering to the conditions of approval of this application and are responsible for conforming to applicable Kitsap County Board of Health ordinances and Washington State Department of Health regulations for onsite sewage systems and water supply.

I acknowledge and understand that the design, location, and construction of my onsite sewage system and/or well is/are critical and of a sensitive nature, and I agree to protect these areas as required by the regulations.

I understand that once this application is submitted and/or approved, any changes to, or variations from, the information or conditions related to this plan may require a revised application submittal and/or could result in the revocation, denial, or suspension of this application or a related building permit and that this application will fully expire within 3 (three) years and 30 (thirty) days from the original date of application submittal.

I understand that I have the right to appeal the Health Office(s decision concerning this application pursuant to the regulations, and that approval of this application does not guarantee that a building permit will be issued.

Date

08/13/2020 Intake Notes - Health District Use Only

Designer/Engineer Contact Phone Number:

(360) 219-3343 Designer/Engineer E-Mail Address:

becky@environmentaldesignllc.com

APPROVED

FOR SEWAGE SYSTE"-11 REPAIR ONLY

Drinking Water Adequacy not reviewed

RECEIVED,

AUG 21 2020

KITSAP PUBLIC

DRINKING WATER & ONSITE SEW~~E~~TION SHEET

Assessor Tax Account Number:

0 Proposed

@Existing 0 Private

D Individual

0 2-Party

B. SOIL EVALUATION PROFILES

Soil Evaluation Date

05/15/2020

City of Bremerton AsSESSOR TAX ACCOUNT NUMBERS FOR PROPERTIES SERVED BY WELL

Water Connection 1 (Parcel with Well) Water Connection 2 (Parcel connected to Well)

SOIL LOG NUMBERS MUST CORRELATE WITH SITE PLAN -INDICATE TOTAL

EXCAVATED DEPTH, SOIL TYPES, WATER TABLE LEVEL & DEPTH OF RESTRICTIVE LAYER

SOIL LOG #1 SOILLOG#2 SOILLOG#3 SOILLOG#4

Downslope Side Measurements Downslope Side Measurements Downslope Side Measurements Downslope Side Measurements

0-23" Brown Silt Loam 23+ Gry Sand, COM

C. DAILY FLOW-TANKAGE-TREATMENT

DESIGNED MAX SEWAGE FLOW TRASH/SEPTIC/PUMP TANKS

240 ~ Size (gall 9IY Gallons Per Day 0 Trash Tank ---

PROPOSED RESIDENTIAL BEDROOMS

Maximum Bedrooms

PROPOSED TREATMENT LEVEL

l:!l'septic Tank 1200

MPumpTank 1000

TL B !if" Other N500

D. DISPERSAL COMPONENT CONSTRUCTION

APPRCVED

FOR SEWAGE SYSTI M REPAIR ONLY

Drinking Water Adeqt acy not reviewed

ADVANCED TREATMENT INFORMATION

[!I" Proprietary Advanced Treatment

Manufacturer: Nu Water/ OSCAR II

Model:

0 Non-Proprietary Advanced Treatment

Device Type:

DISPERSAL COMPONENT SIZING TRENCH CONSTRUCTION PROFILE

Hydraulic Loading Rate of Dispersal Area: 0.4

Minimum Dispersal 1 -0() Area (Sq. Ft.) In Primary: __ \I ____ _

Minimum Linear Feet or Dimensions:

DISTRIBUTION METHOD

22.s X11

A. Slope in Primary %

E. Additional Cover Required _6_ inches

D. Trench Width

B. Maximum Trench depth _6_inches ii( Infiltrative

0 A. Percent Slope in Primary: ____ _

B. Maximum Trench Depth:

(Downslope SJde Measurements)

C. Vertical Separation:

D. Trench Width:

'5''

·It''

0 Gravity Distribution

D Pressure Distribution

0 Drip Irrigation

(i Other: OSCAR 11 E. Additional Cover Required: ___ 6 __ ,M,., Environmental Design, LLC.

Septic Design• Wetlands• Site Planning •Excavation

901 L Street, Centralia, WA 98531 Phone: (360)219-3343

August 13, 2020

Prepared For:

Indian Health Services (Brown) 4060 Wheaton Way, Suite E Bremerton, WA 98310

Site Address:

2919 NE Alder Street, Bremerton

County: Kitsap

Tax Parcel Number: 3900-004-006-0001

EIVED

AUG 21 2020

H:1.TSAP PUBLIC

Purpose: LTH DISTRICT A site and soil evaluation was completed for the property located at 2919 NE Alder Street in Bremerton on May 15, 2020 by Environmental Design, LLC. The purpose of the site and soil evaluation is to determine the suitability of an On-Site Wastewater system. In order to determine if a site is suitable a minimum of three test pits were dug and evaluated for suitability. The site was evaluated to determine that the slope and size were suitable and to determine if the proposed on-site wastewater would be able to meet county and Washington State WAC 246-272A regulations.

Proposal:

The client is proposing a 2-bedroom on-site septic system to serve an existing 2-bedroom residence that is currently being served by a failed septic system. For a 2-bedroom system the estimated wastewater produced is 240 gallons per day based on the calculation of each bedroom producing 120 gallons per day.

Site Description:

The site is currently vacant land. The site is located in Section 18, Township 24 North of Range 02 East.

Hydrology:

The site appears to be well drained. There did not appear to be any areas of ponding at the site or in the area of the proposed drainfield.

Water Source:

The water source will be an existing city water connection. The water line will be located 10 feet away from the proposed On-Site Wastewater system or the transport line will be sleeved to meet the requirements of WAC 246-272A.

Soil Description:

According to the Natural Resources Conservation Service (NRCS) the property soil is mapped as Harstine Gravelly Ashy Sandy Loam. The test pit profile did not appear to be consistent with the Harstine Gravelly Ashy Sandy Loam series.

Job Number: 2019-260 Client Name: HIS (Brown)

The NRCS describes the Harstine Gravelly Ashy Sandy Loam is described as moderately steep soil that is well drained. In a typical profile, the surface layer is covered with a thin mat of undecomposed very strongly acid needles and wood._ The surface layer is then dark yellowish brown gravelly sandy loam about 5 inches thick. The subsoil is about 31 inches thick and is dark yellowish brown, brown, and dark brown gravelly sandy loam. The substratum extends to a depth of 60 inches or more and is compact glacial till that is cemented in places.

Test Pit Description:

In order to complete a site and soil evaluation according to WAC 246-272A a minimum of three test pits need to be evaluated. For this site a total of 3 test pits were evaluated and labeled in the field for the locations of the On-Site Wastewater System. The test pits are as described below:

Test Pit #1 0-23" Brown silt loam, moderate subangular blocky structure 23+" Gray sand, common distinct mottle

Restrictive at 23" due to high water table

Soil Loading Rate:

The type of soil appears to be a Type 5 with a soil loading rate of 0.4 according to WAC 246-272A.

System Requirements:

The site appears to be suitable for an OSCAR system in the proposed drainfield location. The system requirements are concluded based on the suitability of the soil, the slope of the site and the site conditions.

Conclusion:

The site described as 2919 NE Alder Street in Bremerton appears to have a slope of about 0-5% in the proposed drainfield area. The site has a suitable soil depth of 23" in the proposed drainfield location and is suitable for an OSCAR system to serve the proposed residence.

Report Completed by:

Becky Rieger Licensed Designer

-0 2 Job Number: 2019-260

Client Name: HIS (Brown) w z w ALDER STREET f;

I= 1-------,~=s..,..,1~:1=.--/J-1/

NE ALDER STREET

VICINITY MAP

60 FT

;)/','{C:i-;', '"""'ti! EXISTING WALK WAY

EXISTING 2-BEDROOM

RESIDENCE

. □ROVED AP' M REPAIR ONLY

SEWAGE SYSTE

FOR t reviewed . . Water Adequacy no onn1<1ng

I

LL

r-- 0> L.O 0 ..-w z w a..

a:::

a..

60 FT

I

LL

CD

a, L.O 0 ..-

EXISTING SEPTIC TANK TO

BE ABANDONED PER STATE

AND COUNTY CODE

Environmental Design, LLC.

Septic Design • Wetlands • Mapping

901 L Street Centralia, Wa. 98531

(360) 219-3343

N r LEGEND

J: HUll

~ TEST PIT

EXISTING VEU.

RECEIVED

PRDPIISEII VEU.

r

AUG 21 2020

KITSAP PUBLIC

HEALTHO'JISTRICT 20 -

p~

- -1" = 20 FT

PD\rlER

STUMP

REPAIR

PROPERTY LINES SHOWN AS

RECORDED IN VOL 6 OF PLATS PG 47

THE PROPERTY LINES IN THIS MAP ARE

APPROXIMATE AND ARE NOT INTENDED

TO BE USED AS A SURVEY.

CUENT NAME: !HS - AUTUMN BROWN

MAIUNG ADDRESS: 4060 \./HEATON \v A Y, SUITE E

BREMERTON, 'WA 98310

PHONE NUMBER: 360.536.6159

SITE ADDRESS: 2919 NE ALDER STREET, BREMERTON

PARCEL NUMBER: 3900-004-006-0001

PERMIT NUMBER:

DRAFTED BY: BJR JOB NUMBER: 2019-260

REVIEWED BY: BJR DATE: 08/07/2020

S-T-R: 18-24N-02E roger_hargrove@hotmail.com Typewritten text

NE ALDER STREET

APPROVED - -

FOR SEWAGE SYSTE\1 REPAIR ONLY

Drinking Water Adequacy not reviewed --------------~~.......-r-------.--T"·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-/\:)

EXISTING WALK WAY

EXISTING 2-BED~ OOM

RESIDENCE

PROPOSED SEPTIC TANK

SEE PAGE 3 FOR DETAILS

PROPOSED NUWATER TANK

SEE PAGE 3 FOR DETAILS

)/it' '"' .. :,, "?l~i;

PROPOSED OSCAR II DRAINFIELD

SEE PAGE 5 FOR DETAILS

c:;g:J

5' w z :::::i w a..

0::::

a..

5'

EXISTING SEPTIC TANK TO

BE ABANDONED PER STATE

AND COUNTY CODE

PROPOSED PUMP CHAMBER

SEE PAGE 4 FOR DETAILS

Environmental Design, LLC.

Septic Design • Wetlands • Mapping

901 L Street Centralia, Wa. 98531

(360) 219-3343

LEGEND

X HUll

N

~ TEST PIT

& EXISTING VEU.

~ PRtl'DSEll 'tlELL p~ Pm/ER

0 STUMP

0 20 40 - -- -1" = 20 FT

EXISTING SEPTIC TANK SHALL

BE PUMPED BY AN APPROVED

PUMPER, HA VE LID REMOVED

AND VOID FILLED vlITH SOIL

OR GRAVEL AS PER

vlAC 246-272A-0300, IVED

AUG 21 2020

KITSAP PUBLIC

EAL TH DISTRICT

CLIENT NAME: IHS - AUTUMN BROvlN

MAILING ADDRESS: 4060 vlHEA TON vi A Y, SUITE E BREMERTON, vi A 98310

PHONE NUMBER: 360.536.6159

SITE ADDRESS: 2919 NE ALDER STREET, BREMERTON

PARCEL NUMBER: 3900-004-006-0001

PERMIT NUMBER:

DRAFTED BY: BJR JOB NUMBER: 2019-260

REVIEWED BY: BJR DATE: 08/07/2020

S-T-R: 18-24N-02E

CLEAN OUT

ELE.: 98.7

CLEANOUT /24" TANK LID

TO GRADE

4" PVC

24" TANK RISER

24" TANK ADAPTER

EFFLUENT FILTER

ORENCO BIOTUBE

#fTPS043628

1/16" MESH REQUIRED

1150 GALLON SEPTIC TANK

Scale: 1" = 2'

SEPTIC TANK INSTALLATION:

1) EXCAVATE HOLE DEEP ENOUGH FOR THE TANKAND BACK

FILL DEPTH.

2) IF SURFACE WATER IS ENCOUNTERED DURING EXCAVATION

TANKS MUST BE SECURED TO PREVENT FLOATING. IT IS THE

RECOMMENDATION OF ENVIRONMENTAL DESIGN THAT ALL

TANKS BE SECURED ON EACH INSTALL.

3) MAKE SURE BOTTOM OF TANK HOLE IS LEVEL AND THE SOIL IS

UNDISTURBED TO PREVENT SETTLING.

4) IF THE EXCAVTION IS TOO DEEP FILL THE HOLE IN AS

NECESSARY USING PEA GRAVEL OR WASHED SAND UNTIL THE

TANK IS AT THE PROPER ELEVATION

5) TANKS SHALL BE INSTALLED TO ENSURE POSITIVE FLOW AT

ALL TIME BY INSTALLING THE INLET INVERT OF THE SUCCESSIVE

TANK A MINIMUM OF 2 INCHES BELOW THE OUTLET INVERT OF

THE PRECEEDING TANK.

6) ALL CLEANOUTS, INSPECTION AND ACCESS RISERS MUST BE

ADEQUATELY SEALED SO THEY ARE WATER TIGHT.

7) BACKFILLING THE TANKS MUST BE COMPLETED ACCORDING

TO THE MANUFACTURER'S RECOMMENDATIONS AND SHALL NOT

DAMAGE THE TANKS.

8) SLOPE GRADE AWAY FROM RISERS.

WAlER TIGHT

RISER (TYP)

TRASH CHAMBER

OPERATING CAPACITY: 417 GALLONS

FLOOD CAPACITY: 490 GALLONS

DIGESTER CHAMBER

OPERATING CAPACITY. 421 GALLONS

FLOOD CAPACITY' 494 GALLONS

NUWATER TANK

SEE ATTACHED DETAILS

TESTING FOR WATER TIGHTNESS:

STONE-FREE NATIVE SOIL

OR COMPACTED SAND

OVER STONY SOIL

ALL TANKS MUST BE TESTED FOR WATER-TIGHTNESS AT THE

CONSTRUCTION SITE AND BE INSPECTED BY THE INSTALLER,

DESIGNER AND/OR THE LOCAL HEALTH OFFICER.

TO TEST FOR WATER TIGHTNESS:

1) SEAL THE EMPTY TANK

2) SEAL ALL ACCESS OPENINGS, RISERS, INLET AND OUTLET

PIPES.

3) FILL THE EMPTY TANK WITH WATER UNTIL THE WATER IS 2

INCHES ABOVE THE RISER CONNECTION POINT.

4) LET THE TANK SIT FOR 1 HOUR.

5) IF THERE IS A MEASUREABLE DROP IN THE WATER ELEVATION

REFILL THE TANK AND LET THE TANK STAND FOR ANOTHER

HOUR.

6) CHECK AROUND THE TANK TO LOOK FOR AREAS OF LEAKAGE.

7) THE TANK WILL PASS THE WATER-TIGHTNESS TEST WHEN THE

WATER LEVEL IS HELD FOR 1 HOUR WITH OUT ANY

MEASUREABLE LOSS.

8) IF REPAIRS HAVE TO BE MADE THE TANK WILL NEED TO BE

RETESTED AND INSPECTED BY THE INSTALLER, DESIGNER,

AND/OR LOCAL HEALTH OFFICER.

MASTIC

Environmental Design, LLC.

Septic Design • Wetlands • Mapping

901 L Street Centralia, Wa. 98531

(360) 219-3343

RECEIVED

AUG 21 2020

KITSAP PUBLIC

HEALTH DISTRICT

INST ALLER• PLEASE CALL

ENVIRONMENTAL DESIGN

REGARDING ANY QUESTIONS, CHANGES

OR CONCERNS.

PLEASE CALL BEFORE COVERING FOR

SCHEDULING OF A FINAL INSPECTION.

CUENT NAME: IHS - AUTUMN BRO\,/N

MAIUNG ADDRESS: 4060 \,/HEATON \,/AY, SUITE E

BREMERTON, v/A 98310

PHONE NUMBER: 360.536.6159

SITE ADDRESS: 2919 NE ALDER STREET, BREMERTON

PARCEL NUMBER: 3900-004-006-0001

PERMIT NUMBER:

DRAFTED BY: BJR JOB NUMBER:2019-260

REVIEWED BY: BJR DATE: 08/07/2020

1· . :· ·_4· .

► INLET ELEV. = 95. 7 .,

·;1 .,.

SEPTIC TANK INSTALLATION:

1) EXCAVATE HOLE DEEP ENOUGH FOR THE TANK AND BACK

FILL DEPTH.

2) IF SURFACE WATER IS ENCOUNTERED DURING EXCAVATION

TANKS MUST BE SECURED TO PREVENT FLOATING. IT IS THE

RECOMMENDATION OF ENVIRONMENTAL DESIGN THAT ALL

TANKS BE SECURED ON EACH INSTALL

4"

3) MAKE SURE BOTTOM OF TANK HOLE IS LEVEL AND THE SOIL IS

UNDISTURBED TO PREVENT SETTLING.

4) IF THE EXCAVTION IS TOO DEEP FILL THE HOLE IN AS

NECESSARY USING PEA GRAVEL OR WASHED SAND UNTIL THE

TANK IS AT THE PROPER ELEVATION

5) TANKS SHALL BE INSTALLED TO ENSURE POSITIVE FLOW AT

ALL TIME BY INSTALLING THE INLET INVERT OF THE SUCCESSIVE

TANK A MINIMUM OF 2 INCHES BELOW THE OUTLET INVERT OF

THE PRECEEDING TANK.

6) ALL CLEANOUTS, INSPECTION AND ACCESS RISERS MUST BE

ADEQUATELY SEALED SO THEY ARE WATER TIGHT.

7) BACKFILLING THE TANKS MUST BE COMPLETED ACCORDING

TO THE MANUFACTURER'S RECOMMENDATIONS AND SHALL NOT

DAMAGE THE TANKS.

8) SLOPE GRADE AWAY FROM RISERS.

CLARIFICA llON

ZONE

.; 4 • . 4 q·. 4 4

. 4" "

1,000 GALLON CLARIFIER/ PUMP TANK

TO HEADWORKS

FROM HEADWORKS

HIGH LEVEL ALARM FLOAT

PUMP ON FLOAT

CHECK VALVE

DRAIN FIELD PUMP

TIMER SETTINGS

SET BY LOWERIDGE

FLOAT TREE

TESTING FOR WATER TIGHTNESS:

ALL TANKS MUST BE TESTED FOR WATER-TIGHTNESS AT THE

CONSTRUCTION SITE AND BE INSPECTED BY THE INSTALLER,

DESIGNER AND/OR THE LOCAL HEALTH OFFICER.

TO TEST FOR WATER TIGHTNESS:

1) SEAL THE EMPTYTANK

2) SEAL ALL ACCESS OPENINGS, RISERS, INLET AND OUTLET

PIPES.

3) FILL THE EMPTY TANK WITH WATER UNTIL THE WATER IS 2

INCHES ABOVE THE RISER CONNECTION POINT.

4) LET THE TANK SIT FOR 1 HOUR.

5) IF THERE IS A MEASUREABLE DROP IN THE WATER ELEVATION

REFILL THE TANKAND LET THE TANK STAND FOR ANOTHER

HOUR.

6) CHECK AROUND THE TANK TO LOOK FOR AREAS OF LEAKAGE.

7) THE TANK WILL PASS THE WATER-TIGHTNESS TEST WHEN THE

WATER LEVEL IS HELD FOR 1 HOUR WITH OUT ANY

MEASUREABLE LOSS.

8) IF REPAIRS HAVE TO BE MADE THE TANK WILL NEED TO BE

RETESTED AND INSPECTED BY THE INSTALLER, DESIGNER,

AND/OR LOCAL HEALTH OFFICER.

Environmental Design, LLC.

Septic Design • Wetlands • Mapping

901 L Street Centralia, Wa. 98531

(360) 219-3343

RECEIVED

AUG 21 2020

KITSAP PUBLIC

HEALTH DISTRICT

INST ALLER• PLEASE CALL

ENVIRONMENTAL DESIGN

REGARDING ANY QUESTIONS, CHANGES

OR CONCERNS,

PLEASE CALL BEFORE COVERING FOR

SCHEDULING OF A FINAL INSPECTION,

CUENT NAME: IHS - AUTUMN BRO\./N

MAILING ADDRESS: 4060 \./HEATON 'JAY, SUITE E

BREMERTON, \./A 98310

PHONE NUMBER: 360.536.6159

SITE ADDRESS: 2919 NE ALDER STREET, BREMERTON

PARCEL NUMBER: 3900-004-006-0001

PERMIT NUMBER:

DRAFTED BY: BJR JOB NUMBER: 2019-260

REVIEWED BY: BJR DATE: 08/07/2020

PAGE4 OF 5

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OS-300-7

22.5 FT MIN. SHOULDER LENGTH

f ,!I\l;!llI\;[iiiiitif \J!iiiJ!iII\;!~I!!il;iI!ll:,l!i ·r:~-~,(.:.:J.:~~~ ...... :.J-4......,;~~;.,+,,,,~;.,+.,-~~~r.:H.;-)

PREPARED SOIL SURFACE" ~ ASTMC-33 SA

27 FT BASAL WIDTH

A """'==:It--, "SUPPLY

"RETURN

A --E:::t----'

4"SLIPCAP

Environmental Design, LLC.

Septic Design • Wetlands • Mapping

901 L Street r

Centralia, Wa. 98531

(360) 219-3343

RECEIVED

AUG 21 2020

KITSAP PUBLIC

HEALTH DISTRICT

INST ALLER• PLEASE CALL

ENVIRONMENTAL DESIGN

REGARDING ANY QUESTIONS, CHANGES

OR CONCERNS.

PLEASE CALL BEFORE COVERING FOR

SCHEDULING OF A FINAL INSPECTION,

CLIENT NAME: IHS - AUTUMN BRO\JN

MAILING ADDRESS: 4060 \JHEATON \JAY, SUITE E

BREMERTON, \JA 98310

PHONE NUMBER: 360.536.6159

SITT ADDRESS: 2919 NE ALDER STREET, BREMERTON

PARCEL NUMBER: 3900-004-006-0001

PERMIT NUMBER:

DRAFTED BY: BJR JOB NUMBER: 2019-260

REVIEWED BY: BJR DATE: 08/07/2020

S-T-R: 18-24N-02E-

2919 NE ALDER ST Bremerton

CHRONOLOGICAL CONTROL SHEET

Building Site Application - Repair

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Applicant: Indian Health Services Tax ID: 3900-004-006-0001 Memo: 1355668P: N/A DCD-LU: N/A

Contractor: ENVIRONMENTAL DESIGN LLC

COMPLAINTS 09/18/2019 LB Deficient Pumper Report

RECEIVED ON INITIALS ·. ACTiON TAKEN/COMMENTS ROUTE TO DATE

08/21/2020 BSJ Received via USPS, BSA-SLI attached JL;f 08/21/2020

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