4/30/2017 2:19:40 PM On-Site Septic System Property Transfer Report Application Summary: Submitted: 4/30/2017 2:19:06 PM Completed: 4/30/2017 2:19:06 PM Addresses Applicant's Address neil drawbridge p.o.box 2806 vashon, WA 98070 Application No: 36695 Contact Methods Email: ndrawbridge@netzero.com Phone: 206-463-5815 OSM #: 49 Property Owner Richard SCHRUM 2423 111 Ave E Seattle, WA 98102 Contact Methods Email: Phone: 206-856-2994 Property Being Reported Tax Parcel Number Assessors Parcel Number: 888700-0655 Seller's Agent Contact Methods Email: Buyer's Agent Contact Methods Email: Title or Escrow Company Contact Methods Email: Application ID: 36695 On-Site Septic System Property Transfer Report Applications powered by the SkipThePaper
Property Address 10967 103RD AV SW Vashon, WA Questions Overview Q: Is the house occupied? A: Yes Q: The Construction Record Drawing included is A: Modified Q: Water Supply A: Municipal Q: Approved bedrooms according to site design A: 4 Septic System - General Q: Date tank pumped last (N/A if unknown) A: April 20,2017 Q: Tank accessibility (If tanks are not accessible, the Title 13 code at the time of system approval shall apply) A: All of the tanks are accessible. Q: At the time of this inspection were any risers or monitoring ports installed? A: Yes Q: Detail what was installed A: risers with lids on septic tank Q: Upon evaluation of the septic system were any repairs made? A: No Gravity Septic Systems Q: Is the septic system gravity? A: No Pressure Distribution Septic Systems Q: Does the septic system utilize pressure distribution? A: Yes Application ID: 36695 On-Site Septic System Property Transfer Report Applications powered by the SkipThePaper
Q: Pressure test results equal distribution (Not required) A: System is Pressure Distribution, but the test was not performed. Q: further action for unequal distribution test A: n/a OSM Certification Q: I certify to the best of my knowledge, that this inspection report is true, accurate and complete. A: Yes Service Summary Service OSS operation and maintenance program fee $184.80 Processing Fee. TE: this charge is from OnlineRME, LLC. $10.00 Payment Log Date Amount Description Bank Response Fee Total charges for application: $194.80 4/30/2017 $184.80 Application Fee This transaction has been approved. 4/30/2017 $10.00 Processing Fee This transaction has been approved. Total amount Paid: $194.80 Application ID: 36695 On-Site Septic System Property Transfer Report Applications powered by the SkipThePaper
4/30/2017 OPERATION / PERFORMANCE MONITORING REPORT Environmental Health Division, 14350 SE Eastgate Way, Bellevue, WA 98007, Tel. (206) 477-8050 Inspection Type: PROPERTY SALE - Correction Status: No corrections needed Tax ID: 8887000655 Inspection Date: 04/27/2017 GENERAL SYSTEM TYPE: Pressure Distribution Customer / Property Owner Name: Richard SCHRUM Site Address: 10967 103RD AV SW City: Vashon Mail Address: 2423 111th Ave E City: Seattle, WA Zip: 98102 OSM Company: Kevin Bergin Construction OSM Name: Neil Drawbridge OSM Tel#: 206-463-5815 Submitted 04/30/2017 by: COMMENTS & GENERAL INSPECTION TES No Deficiencies Noted Septic inspection for sale of inspection. Septic tank and pump tank pumped prior to inspection (April 20, 2017). Risers and lids installed on septic tank at time of inspection. Tracer dye was added to pump tank during septic pump discharge test with no surfacing of effluent. GENERAL SITE & SYSTEM CONDITIONS The General Site and System Conditions were: All Components accessible for maintenance, secure and in good condition: If a dye test was performed, did the dye surface? (N/A if no dye test) Effluent leaking onto the surface of the ground from any component? (If yes, explain in comments) Improper encroachment (roads, buildings, etc.) onto component(s): Component settling problems observed: Subsurface components adequately covered Period average daily flow (gallons per day) Site maintenance required (e.g. Landscape maintenance) If yes, describe in comments: Occupant compliance problem (occupant not operating the system properly). If, describe in notes: Structures connected to onsite sewage system occupied. If explain in comments: Alterations made to the OSS (valves adjusted, timer settings modified, ports installed, etc.) (If, describe in notes): Risers and lids secured: OSS Working Properly Pre-failing Signs Record Drawing Modified Record Drawing New unknown ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK: Septic Tank - 2 Compartment, Manufacturer= Local Manufacturer - Concrete 1125 gallon Manufacturer: Local Manufacturer Model: Concrete This component was: Effluent level within operational limits (if explain in comments): All required baffles in place (N/A = No baffles required): Effluent Filter Cleaned (N/A = Not Present): Compartment 1 Scum accumulation (Inches, if other specify): 0" Compartment 1 Sludge accumulation (Inches, if other specify): 0" Compartment 2 Scum accumulation (Inches, if other specify): 0" Compartment 2 Sludge accumulation (Inches, if other specify): 0" Pumping needed: A modification/repair was completed on the component (If yes, provide detail in comments): ReportID: 589548 View inspection reports online at www.onlinerme.com Page 1 of 2
TANK: Pump Tank, Manufacturer= Local Manufacturer - Concrete 1125 gallon Manufacturer: Local Manufacturer Model: Concrete This component was: Compartment 1 Scum accumulation (Inches, if other specify): 0" Compartment 1 Sludge accumulation (Inches, if other specify): 0" Pumping needed: A modification/repair was completed on the component (If yes, provide detail in comments): Panel: Alarm - High Water This component was: Alarm mechanism functioning as intended: A modification/repair was completed on the component (If yes, provide detail in comments): Pump: Effluent Pump This component was: Controls functioning: Pump Vault Filter cleaned (N/A = not present): N/A Tested gallons per minute flow: 35 A modification/repair was completed on the component (If yes, provide detail in comments): Drainfield (disposal): Pressure Manufacturer: Site Constructed This component was: Component settling problems observed: Surface water, downspouts diverted away from drainfield: Evidence of vehicular traffic or livestock over drainfield: Balancing valves functioning properly (NA = Not Present): N/A LPD dose gpm, design rate gpm. unknown LPD dose gpm, monitored rate gpm. 35 Purge valves functioning properly (NA = Not Present): N/A Observation ports present and accessible: N/A A method, such as aeration, was used to reduce clogging of the biomat in this component (If yes, provide detail in comments): Lateral lines jetted: A modification/repair was completed on the component (If yes, provide detail in comments): This report indicates certain characteristics of the onsite sewage system at the time of visit. In no way is this report a guarantee of operation or future performance. ReportID: 589548 View inspection reports online at www.onlinerme.com Page 2 of 2