Thurston County Environmental Health
2000 Lakeridge Drive SW Olympia, WA 98502
(360) 867-2673 / (360) 867-2660 (Fax)
TTY/TDD 711 or 1-800-833-6388
www.co.thurston.wa.us/health/ehadm
TIME OF TRANSFER APPLICATION
Evaluation of Existing Septic System
STAFF USE ONLY DATE STAMP
STAFF USE ONLY
LABEL
NOTE: ALL APPLICATIONS AND SITE PLANS MUST BE
COMPLETED IN BLACK OR BLUE INK ONLY
Applicant Name: ________________________________________ Phone Number: ____________________________________
Mailing Address: ________________________________________ City: ______________________ State: ______ Zip: ___________
Site Information:
Tax Parcel Number: ______________________________________
Property Address: ________________________________________ City: ______________________ State: ______ Zip: __________
Legal Owner: ___________________________________________ Phone Number: _____________________________________
Type of Structure: Single-Family Multi-Family: # of Units_______ Commercial Food Service Institutional
Number of bedrooms within the residence: _____________
Septic System Information:
Was the system installed within the last twelve months? Yes No
Do all plumbing fixtures, including laundry drain, go to the septic system? Yes No
Are there any other structures connected to the septic system? Yes No | If yes, identify the structure(s): __________________________
Are there additional septic systems located on the property? Yes No | If yes, a separate application must be submitted for each system
Required Documentation from Septic System Professional:
Septic System Inspection Report filed electronically with Online RME Yes No
Septic Tank Pumping Report filed electronically with Online RME Yes No
Pumper Sketch of Septic System Attached Yes No - Record drawing found in permit archive database
If a record drawing cannot be found in the permit archive database, the pumper must prepare a sketch of the system at the time of
inspection. The sketch must accompany the Time of Transfer Application for review. Encroachments onto septic system components
(i.e. structures, driveway, etc.) must be noted on the inspection report and on the sketch.
Report Distribution Information:
Email: ___________________________________________________
Call for Pick Up: ___________________________________________ Mail to Applicant Address
I certify that the information on this application is true and correct to the best of my knowledge.
Signature: ____________________________________________________ Date: ___________________________________________
All fields must be completed. An incomplete application will not be accepted for processing.
Resubmission to receive an updated report?
Yes
No
Resubmission must be within twelve months of last issue date
