HomeMy WebLinkAboutSEP2013-00057 •
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Jefferson County Department of Community Development a ��� `
621 Sheridan St.,Port Townsend WA 98368,(360)379-4450 �,. . '"` �!
SEPTIC PERMIT APPLICATION
PROPERTY OWNER r h(1 P / 0 CU" 1l: I I . '10�
MAILING ADDRESS *F 'iv I : �_ a a.; 48.
�t o6�f SEN
PHONE ( 366 ) 674 3-/31? t
SYSTEM DESIGNER e r l e s i✓S sj r1 Designer Phone# 3(0 0 '3 0 1 -C3 3,,t
LEGAL DESCRIPTION: Section 13 Township ✓0 iJ Range..).1A) PARCEL# (340.1_0000 4
Subdivision Name Cheey-le, \)t.U L Division 4. Block Lots) 4
Site address/Directions to site (?l&C
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential )t New Tank/s only _ Private
Resntial ADt1 Modification Public X
Commercial Expansion
Community Upgrade SITE SEE g,10041-
SYSTEM TYPE Parini Repair-(tank) x (drainfekl) Previous Evaluation
Conventional ')it Designate Reserve Area Yes It .'Ow► SO
Alternative Redesign No
SYSTEM DETAILS
Number of Gallons/day Soil type (attach soft eval.) Application Rate galisq.ft./day
Drainfieid Length ft Trench Width ft. Trench/Bed Depth in.
'Septic Tank size gal. Pump Chamber size gal
J
TYPE of s n I n si-&l l f�l e v�) ,e 'ed yf'a h�C By signing the application form, the applicant/owner attests that the information provided •n is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this
application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson
County against all liabilities,judgments, court costs,reasonable attorney's fees and expenses which may in any way accrue against
Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole
purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the
applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry
Appeal—A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in
writing within fifteen days after receiving written notice of the decision.
DISCLAIMER-This application is for an on-site sewage system that meets the state and county
standards in effect on the date of application. This application for an onsite sewage system DOES
NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that
you will later obtain permission to build a permanent residence or other structure on this parcel. Any
future applicatio II separately j • =• ,y the rules and laws in effect at that time.
3Ot /_3
Property , Signature
FOR OFACE USEOAR_Y I W C�
PARTIAL ASBUILTaeda 1 ( /3 ANAL �C/
ROVED
INSP/PUMP TEST 516\%q
ALL HOLD REQ.MET
3 � Rec4/ . f Check# Ca . 7
H:\WEB\PDFs\septic\septicpermitapp 20 0Et.DOC
JEFFERSON OU TY PUBLIC HEALTH
615 Sheridan Street •Port Townsend*Washington •98368
www.jeffersoncountyp ub licheaith.org
Pffone`"360"- ; - . .. ax •s- :T_".._....°.....
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP13-00057 Date Received: 05/07/13
SITE ADDRESS: 70 DENNIS BLVD Date Issued: 05/16/13
PORT TOWNSEND, WA 98368 Date Expires: 08/16/13
APPLICANT: JOHN A TONAN PHONE:
PEGGY E TONAN
PO BOX 1962
PORT TOWNSEND WA 983680068
LEGAL DESCRIPTION: CAPE GEORGE VILLAGE DIV 2 LOT 4
PARCEL#: 940200004 Section: 13 Township: 30N Range: 02 W
DESIGNER: BERNT ERICSEN PHONE: 360-301-0324
293 PINECREST DRIVE
PORT TOWNSEND WA 98368
SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS
No. of Gallons per Day: Type of work: REP
Drainfield Trench Septic Tank
Length: feet Width: feet Depth: inches Size: 1,000 gallons
DISCLAIMER-This approval is for an on-site sewage system that meets the state and county standards in effect on the
date of application. This approval for an on-site sewage system DOES NOT assure you of any other County approvals. For
example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure
on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. All construction
and development activities must comply with all permit conditions,state and local codes, and Recommended Standards and
Guidance documents in effect when the permit is issued.
The property owner is responsible for the accurate location of all property lines.Any removal of or major disturbance of soil in the
primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system.
Any change in drainfield or tank location may invalidate this permit unless prior approval is obtained from the Jefferson County
Environmental Health Division. If during excavation or development of the site an area of potential archeological significance is
uncovered,all activity in the immediate area shall be halted,and the UDC Administrator shall be notified at once.
Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL
SYSTEM IN JEFFERSON COUNTY,WASHINGTON
This permit is issued for a period of three years (unless otherwise stated above) in accordance with
Jefferson County Rules and Regulations for On-Site Sewage Systems, codified in JCC 8.15 as amended.
This permit may not be renewed.
Jefferson County Envir• mental Health Specialist
This permit with conditions must be onsite during all phases of construction
HEALTH DEPARTMENT MUST BE CONTACTED FOR FINAL INSPECTION.
SPECIAL CONDITIONS APPLY - SEE ADDITIONAL PAGES
CONDITIONS OF APPROVAL - PERMIT NO.: SEP13-00057
.,1.
1.) The new septic tank must be a minimum of 5 teet,frprn the existing home.
2.) This permit was issued to correct a violation of WAC 246-272A. The permit must be completed
within 90 days of the date of issuance.
3.) H - Existing tank shall be properly abandoned. It shall be pumped and filled with clean fill.
Documentation to be provided to Health Dept. prior to final.
4.) H - AS PER WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE
SYSTEMS REQUIRE THAT A RESTRICTIVE COVENANT REGARDING THE MONITORING OF
THE ONSITE SEPTIC SYSTEM BE RECORDED TO THE PROPERTY TITLE. THE PROPERTY
OWNER SHALL ASSURE THAT MONITORING IS PROVIDED BY AN APPROVED ENTITY AT
THE FREQUENCY DEFINED PER STATE WAC 246-272A AND JEFFERSON COUNTY CODE
8.15 AS ADOPTED OR AMENDED.
A COPY OF THE RECORDED OPERATIONS AND MONITORING AGREEMENT IS REQUIRED
PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL PERMIT
5.) Designer must be contacted prior to start of construction and for inspections during installation.
DESIGNER IS REQUIRED TO DO A PRECOVER INSPECTION ON ALL TYPES OF SYSTEMS.
6.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
, 4
7.) H -An asbuilt drawing and certification of completiprOy the Designer is required prior to final
approval.
8.) Before final approval is given, the designer shall provide an operations and maintenance manual to
the property owner and the Health Department. The manual must instruct the owner of the on site
sewage system on the ways to properly operate and maintain all components of the system.
9.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
10.) Distribution boxes shall be fitted with a riser to grade, constructed of durable materials and a
secured lid, adequately sized to allow visible inspection of the liquid level in the box.
11.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other
development or a building permit on this site. Compliance with other Jefferson County and
Washington State Codes is required.
12.) All construction and development activities must comply with all permit conditions, Washington
State and Jefferson County Codes and Recommended Standards and Guidance documents in
effect when the permit is issued.
13.) Approval of this sewage disposal permit does not preclude the permit holder from complying with
the Unified Development Code for other/future development on the site.
14.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion
and sediment during construction. BMPs shall address permanent measures to stabilize soil
exposed during construction, and in the desigili:aittAPeration of stormwater and drainage control
systems.
SEP13-00057 Page 2 of 2
Widemark\data\forms\F_SEP_Permitmod.rpt 5/16/2013
CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT
INSTALLER Er lCS&in Ex_ (TCA>em k LI haw) PARCEL# g*00200004
Permit Owner JOhnij .A3c3� 7onah Permit # See ( 3" t27
ABSORPTION AREA:
DRAINFIELD TRENCH TRENCH TANK #OF #GAL/
LENGTH WIDTH DEPTH SIZE IaOO BEDRMS DAY
Tank Shroud/
IF PUMP AND PUMP CHAMBER REQUIRED: Size Screen
Float Arrangement
High water float—distance to top of tank/emergency storage
Dose drawdown (#of inches) #Gallons/Dose
Timer/Dose Counter info Pump Size!Manufacturer
I CERTIFY THIS ONSITE SEWAGE SYSTEM S INSTALLED AS DESIGNED,PER PLAN APPROVED
6- 16- 13 I!vviA' ran 4-19-t3
DATE APPROVED Des incr t SIGNATURE DATE
13e-1J.J S Tank "D box t n•ata S ic1 7'a-,-1 k �e-cow, lssiakled
a- Q-GMezt "RZCOrLbra )I YZq
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\� - - - Note:
New"D"Box . K �-_ "4�B C,D, E, F, and G
and Riser i0 Oi Existing tank Ex. Concrete Exposed (4-29- 13 )
G F ,L--- Decommissioned Slab Ex. Shed
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10'10" 11'4" Measurements:
< > AtoC=9'6"
Ex. SEP 80- 10 Existing A to D = 18'9"
W 1 BDRM
Ex. Garage A to E=29'
o $ ^„ Home g 3 A to F=38'6"
NJ x x h . A to G =44'
z c al ;`� A to J =51'6"
A to K=52'6"
04 N B to C=51'6"
J J J I BtoD=54'6"
X w 'u5 �A I BtoE=59'4"
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I BtoF= 15'6"
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Existing Asphalt I 4
B to J =9'
I Drive I B to K= 14'
Inspection Pons-- `— — — —I I
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-
75.09' ( I 0 20'
e S 87°19'56"E 15.54'
Ex.Water Meter tm.
(Route to house
(FILE NAME
not verified ) DENNIS BLVD PEGGY TONAN.TRV
SCALE DATE DRAWN BY
20 Ft/In 9-19-2013 Bemt Ericsen
JOB REVISION SHEET
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Ex. SEP 80- 10 Existing A to D= 18'9"
w 1 BDRM A to E=29'
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Nt Wi° 9�cSEN +'•4 I PGE 019`- tstruot'on MAY 0 6 2013
BER ul ! 5
L. Date
54,-13
John / Peggy Tonan
940200004
Project Description
Pump, collapse and fill existing leaking septic tank ( See SOM 80 — 10 dated 12 —
20 — 12 ) Install New Septic Tank, Transport Line, "D" Box ( If deemed necessary by
Designer ) Verify that system was installed per permit SEP 80 10 to obtain "Final"
Septic Tank
Install New 1000 gallon two compartment septic tank. Install water tight risers to
grade on all tank lid openings. Tank to be water tight, fill with water after placement ,
to be observed by Designer. Tank to be set on 6" of Pea Gravel. An outlet baffle filter
is required in septic tank. Use Orenco FTJPW 0418 or equivalent, to be approved
by Designer.
Existing Septic Tank
Pump, collapse and fill. Provide Tank Abandonment form and Pumpers Receipt to
Designer.
Transport Line
Install 4" 3034 sewer pipe from building stub out to New septic tank @2% minimum
grade and from tank to "D" box @ 1% min.
"D" Box
"D" box to be evaluated at time of installation to determine if replacement needed.
P �
MAY 2013
Install speed-levelers and water level prior to designers "as built" inspection.
Drain field
Existing ends of drain lines were exposed on 4 — 29 — 13. Lines 1 and 2 were dry,
Line 3 was slightly ponded ( due to uneven distribution in "D" Box ) Inspection ports
were installed at ends of drain lines.
Inspections
Designer needs to be contacted for a pre-construction meeting prior to construction
to discuss details and to set up schedule for inspections. Designer is responsible
for submitting "Record" drawing, and must be called prior to backfilling system.
General Construction Notes
1. The work described herein consists of construction of an on-site
wastewater system.
2. The contractor shall be knowledgeable and experienced in the
construction of this type of wastewater system and shall hold a valid
certificate from Jefferson County Division of Environmental Health.
"Approved" septic plans must be on site during construction.
3. If during the installation of the system the contractor finds soil conditions
that may lead to premature failure of the system, construction shall be
terminated immediately and the designer notified. Such soil conditions
may include groundwater, fill, clay, highly compacted soil, bedrock or
excessively permeable soils.
a. Any inconsistencies, errors, or omissions that, in the opinion of the
installer, would compromise the quality of the wastewater system
shall be reported to the designer prior to construction.
2
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4. Backfill in traffic areas shall be pitrun gravel and compacted. All gravity
pipe shall conform to ASTM D 3034, All gravity and transport pipe shall be
bedded, using native or imported material free of rocks, debris and sharp
objects.
5. All exposed soil shall be seeded and mulched prior to the final inspection.
Seed shall be spread at an approximate rate of 10 lbs. per 5,000 sq. ft.
6. The installer shall be responsible for constructing the system according to
plans and conditions of permit and shall be responsible for its proper
operation and function for one year. The owner shall be responsible for
operating and maintaining the wastewater system in accordance with
WAC 246-272A-0270.
7. Any changes, substitutions, or deviation from these plans shall be
approved by the designer and by the Jefferson County Environmental
Health Department.
8. The installer shall grade to divert all surface water runoff away from tanks
and drainfield/reserve areas.
9. The bottom of the trench or bed may be inspected by the designer prior to
placing drain rock and shall not exceed +/- '/2" from level. Place filter
fabric over drain rock prior to backfilling.
10. Setbacks to all known water lines shall be a minimum of 10'. No crossing
of water lines with any septic component shall be allowed, except as
included in septic design approved by Jefferson County Health
Department.
11. Setback from the house foundation wall shall be 10' minimum to drainfield,
5' minimum to tanks and 2' minimum to non-perforated sewer pipes. Water
saving appliances, fixtures, and practices are to be used.
3
t
12. The septic and pump tanks, drainfield and reserve areas are to be
protected from vehicular traffic or mechanical disturbance.
13. The designer is to provide the as-built and letter of certification.
14. This system has been designed in accordance with WAC 246-272-A-0270
and the most current Department of Health "Recommended Standards
and Guidelines for Pressure Distribution Systems," and has been
approved by the Jefferson County Health Department. Nevertheless,
negligence or improper action on the part of the users could result in the
premature failure or malfunction of the system or its components.
MAY 0 6 2013
4