HomeMy WebLinkAboutSEP2012-00012 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Quinten Shay , d,+;
MAILING ADDRESS 179 Groves Way e, w �++
Port Ludlow, 98365 ,,' ' S odz +'+
PHONE ( 360 ) 516-3082 (Bill Eisenhart-contact) ;' s����ar .++
y�rnnro►��ast� '•
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SYSTEM DESIGNER Suzanne Martin Designer Phone# (360)554-0224
LEGAL DESCRIPTION: Section 19 Township 27N Range 1E PARCEL# 721 194 012
Subdivision Name Thorndyke Short Plat,#3„ Division Block Lot(s) 3 enlg by tax 5
Ito fl2.ciA "ao
Site address/Directions to site-1-79-Groves Way-Port Ludlow
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential _ New ✓ Tank/s only Private ✓
Residential ADU ✓ Modification_ Public
Commercial, Expansion_
Community Upgrade
Repair SITE SIZE 342996 sf
SYSTEM TYPE , Repair-(tank) (drainfield) Previous Evaluation
Conventional Designate RPsprve Area Yes# SEP90-00566
Alternative Redesign N o . —
SYSTEM DETAILS
Number of Gallons/day 360 Soil type 314 (attach soil eval.) Application Rate D-80--0.6 gal./sq.ft./day •
Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 12-24" in.
Septic Tank size 1000 min gal. Pump Chamber size n/a gal. \
TYPE OF Conventional trench&establish reserve area for SEP90-00566(r1r`Qw. �5.J
By signing the application form, the applicant/owner attests that the information provided herein 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. Staffs 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 •= • -ion to build a permanent residence or other structure on this parcel. Any
future applica ill b- epar dged by the rules and laws in effect at that time.
IMEMITWMICODOSteire Date
FOR OFFICE USE ONLY A
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A" ROVED
INSP/PUMP TEST PUD_
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forms\Suz\2008 SPA.DOC
SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450
PERMIT #: SEP12-00012 Date Received: 01/24/12
SITE ADDRESS: 179 GROVES WAY Date Issued: 04/03/12
PORT LUDLOW, WA 98365 Date Expires: 04/03/15
APPLICANT: QUINTEN SHAY PHONE:
179 GROVES WAY
PORT LUDLOW WA 98365
LEGAL DESCRIPTION: THORNDYKE BAY SHORT PLAT#3 LOT 3(ENLG BY TAX 5)
PARCEL* 721194012 Section: 19 Township: 27N Range: 01 E
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
SEPTICS BY SUZANNE
PO BOX 125
CHIMACUM WA 98325
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.
Permit issued to CONSTRUCT,ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN
JEFFERSON COUNTY,WASHINGTON
Thls 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 8.15 amended per ordinance no.
06-0719-07. This permit may not be renewed. 7
Jefferson Cou Environm-ntal Health Specialist
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.
HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION.
SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH
No. of Gallons per Day: 360 Type of work: NEW
Drainfield Trench Septic Tank
Length: 200 feet Width: 3 feet Depth: 12 inches Size: 1,000 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL - PERMIT NO.: SEP12-00012
1.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
2.) 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
3.) 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.
4.) Notification of the start of construction shall be faxed or emailed to Jefferson County
Public Health ONE WORKING DAY prior to start.
5.) 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.
6.) A vegetative buffer of 50-feet to all septic systems shall be permanently maintained from
the top or edge of the Landslide Hazard Area (Steep Slope). All buffers shall be
measured perpendicularly from the top or toe of the Landslide Hazard Area.
7.) H -An asbuilt drawing and certification of completion by 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.) When/if designated reserve area is utilized an alternative system providing an additional
level of treatment may be required and must comply with code at the time of application
for use.
10.) Contact designer prior to installation for staking of drainfield area.
11.) Divert all sources of drainage, including roof drains away from septic tank and drainfield
area.
12.) 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.
13.) 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 design and operation of
stormwater and drainage control systems.
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I:\F_SEP_Permitmod.rpt
14.) The application was reviewed by the Jefferson County staff for the potential presence of
Critical Areas under the provisions of the Unified Development Code (UDC). After al
Geographic Information Systems mapping review the following Critical Areas were
confirmed to be present on the subject property: landslide hazard area.
15.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
16.) A Geotechnical Report dated June 16, 2006 and amended on September 6, 2006
prepared by Quadra Engineering for adjacent parcel 721194011. The report addressed
the stability of the geologic hazard area. A setback of 100-feet for structures and 50-feet
for septic system shall be measured perpendicularly from the top or toe of the geologic
hazard (steep slope).
17.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall
be made to the Landslide Hazard Area or its associated buffer without prior authorization
by the UDC Administrator.
18.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
19.) 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.
20.) 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.
21.) All construction activities shall not encroach upon the Landslide Hazard buffer. This
includes the storage or preparation of materials.
3 of 3
11/22/19
I:\F_SEP_Permitmod.rpt
1
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JUL 3 1 7
CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT
Installer: Quinten Shay(homeowner) Parcel it 721 194 012
Permit Owner: Quinten Shay Permit# SEP12-00012
Designer: Suzanne Martin Design Flow: 360 gpd
Site Address: -4.79-Groves Way-Port Ludlow
1 i0 p4-/1 A.OR caaP-
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAL/DAY
LENGTH 200 36" 12"/12"cover 1000 3 360gpd
IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen
Tank Size:
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
COMMENTS (inspection notes, changes from design or deficiencies installation)Attach additional sheet(s)if necessary
Installed 2 compartment, concrete septic tank and distribution box. Risers, clean-out, speed levellers and outlet filter have
been installed. Inspections of trench bottoms, piping,gravel, d-box were inspected by designer during construction
All OSS Component installation have met or exceeded State and local codes and regulations.
Users Manual Provided to Homeowner Old/L(5 Vartel Date
ATTACH ASBUILT DRAWING si ned b Desi ner or stam e b a Licensed Professional En ineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS p g by g
VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED
AS DESIGNED AND APPROVED by JEFFERSON COUNTY
(DATE)OR THAT CHANGES HAVE BEEN %'r,
NOTE AND THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272 --Ill!,.• ( rrr
30 July 2014 5100342
De gner Signature Date License# 4,4-i.,..•,,,a 2 '•.,.11
Suzanne L Martin /r
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Page 4 of 4;Shay;
Tank Cross Section-Not To Scale Parcel#721 194 012
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
ACCESS RISER
\\ FINISH GRADE
\ I H
1-1
- — —
to distribution box
FROM SEWAGE
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS maximum 3/16"filter
SEPTIC TANK
(TYPICAL)
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Page 1 of 4;Shay;
Parcel#721 194 012
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST..PORT TOWNSEND ,WA 98368,(360) 379-400
SOIL EVALUATION
t f f
Quinten Shay ,,,1t ` , /
PROPERTY OWNER f
SYSTEM DESIGNER Suzanne Martin
2/11/11 _..
LEGAL DESCRIPTION: Section 19 Township 27N Range 1E Parcel # 721 194 012
Subdivision Name Thomdyke SP#3 Division Block Lot(s) 3 enla by tax 5
Date Logged: 11 January 2012 Logged By: Suzanne Martin
Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth
where mottling or impermeable layers occur.
SOIL LOG #1 v5\ 12, SOIL LOG #2
0 to 4 in. Dark brown sandy loam Z 0 to 10 in.Dark brown sandy loam
4 to 31 in,Reddish brown gravelly sandy loam 10 t0 29 in.Yellow brown gravelly sandy loam
31 to 50" in.Yellow brown gravelly medium sand 29 to 60+ in.Gravelly medium sand
to 50" in,Hardpan/upslope hardpan @ 57" to in.
Anticipated water table n/a in. 1 20 ilia water table �a in.
Roots to 501 inches `A-1461?-1:1 h� .vt,,e1( Roots to 39 inches
L
Health Dept. Comments t
Health De . Comments 6 Lc
1-14A0 Pa'ws „ � , ) i 2
SOIL LOG#3 SOIL LOG #4
0 to 4 in. Dark brown sandy loam 0 to 4 in. Dark brown sandy loam
4 to 15 in. dark yellow brown gravelly sandy loam 4 t0 18 in.dark yellow brown gravelly sandy loam
15 to 43 in. Yellow brown gravelly sandy loam w/silt deposits 18 t0 41 in.Yellow brown gravelly sandy loam
43 to 48+ in. Yellow brown gravelly medium sand to 41 in.hardpan MO
t:
water table n/a in. Anticipated water table n/a in. 3( iL tom”` °
Reserve area is for both
Roots to 38 inches residences. The ex. 2 bedroom Roots to 41 inches kA
Health Dept. Comments and the proposed 3 bedroom Health Dept. Comments
0Y 0 -f l 1 oic 3330 °
IL LOG #b
d ,--.. SOIL LOG #6
v� ��
to in. to in.
to in. to in.
to in. to in.
to in. to in.
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:UNFOHLTH\SOIL.FRM 1/OO
Page 32of 4;Shay;
Parcel#721 194 012
ONSITE SEWAGE DISPOSAL
SYSTEM DESIGN fP,,'
. Suzanne l Maitln +'+
Date 17 January 2012 = teas li medi7nR '+
,nz
Property Owner Quinten Shay 17January 2012
System Designer Suzanne Martin
Legal Description: Section 19 Township 27N Range 1E
Subdivision Name Thorndyke short plat#3 Division Block Lot(s) 3
I. CALCULATIONS
If for residential use:
Number of Bedrooms: 3 x 120 G.P.D. = 360 peak total G.P.D.
If for non-residential use, attach caic .'.4ns used to determine G.P.D.
Soil texture waste water application rate 0.60 G.P.D./ft. squared
(see page 214 of the EPA Design Manua
DRAINFIELD SIZING:
Absorption area: 600 square feet (total G.P.D. 4 G.P.D./ft. squared)
Trench or bed width 3'7-lineal feet
Trench or bed length feet (sq. ft.-=trench or bed width)
II. APPURTENANCES
Septic Tank Size 1000 min gallons
Pump Requirements (If Necessary)
Elevation difference in feet n/a
Friction loss
Pump capacity should be G.P.M. at T.D.H.
Number of doses per day
Dosing volume gallons
Pump chamber size gallons
H:\home\pincntr\infohlth\se wd sn
•
page 3 of 4;Shay;
Parcel#721 194 012
III. DRAINFIELD CROSS SECTION
ft ,
Suzanne/ / ann L Ma*, t�l
/ C ffri
//// pR1---annz
D /I� / 17 January 2012
J ry
a" Ora:« Rack
NATIVE SOIL
A
E
IMPERMEABLE MATERIAL/
SEASONAL SATURATION
A. Trench Depth 12-24" inches
B. 6 inches of drainrock below pipe
C. 36+ inches of vertical separation from trench bottom to impermeable
material/seasonal saturation
D. 0-12 inches of fill (if needed)
E. Trench width 36" inches
NOTES:
Reserve area may require additional treatment. The drainfield is to be installed at 12"trench
depth on East side of the proposed primary area and may be installed 24"deep on the West side.
All of the laterals must be of equal length and with level trench bottom. The distribution box must
be equipped with speed levellers and riser to the surface. The septic tank must be bedded in pea ...-
gravel and equipped with outlet filter and risers to the surface.
ATTACH DETAILED DESIGN OF SYSTEM