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HomeMy WebLinkAboutSEP2013-00125 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Allan Kiesler MAILING ADDRESS 14102-148th Place SE Renton,WA 98059 PHONE (425)226-1446 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 17 Township 28 Range 1 E PARCEL#821175004 Subdivision Name Survey of Port Ludlow No.6,V.9 of Surveys P.40 Division Block Lot(s) 11 Site address/Directions to site South on Oak Bay Rd., right on Osprey Ridge Dr., left on Bluebird Ln., project site is a..roximatel 250 feet ahead on ri.ht. at end of Bluebird Ln. I •r ► >t_ • SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New X Tanks(s)only Private Residential ADU Modification Public X Commercial Expansion Community Upgrade Repair SITE SIZE 5.46 acres+/- SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional X Designate Reserve Area Yes#SEP07-282 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Trench Length 200 ft. Trench Width 3 ft. Trench Depth — -e--11�6iin.. Septic Tank size 1,000 gal. Pump Chamber size n.a. gal. �� w l TYPE OF SYSTEM Conventional Gravit Drainfield with:ravel CAS_ravelless o•tions 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. F or 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 wil be separately judged by the rules and laws in effect at that time. .(///L I /0- 2'J Property Owner Signature Date 2, FOR OFFICE USE ONLY / t PARTIAL ASBUILT ] l N FINAL AP ROVED INSP/PUMP TEST PUD I I ALL HOLD REQ.MET 1d _, Date 1 I'S Fee 5S Rec# 1'4 o1 Check# I O O O� Case#SEP K —I �� JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •98368 www.jeffersoncountypublichealth.o rg I'none MU-Mb-9444 Fax MU-3/9-44tt/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP13-00125 Date Received: 10/28/13 Date Issued: 01/23/14 SITE ADDRESS: 100 BLUEBIRD LN Date Expires: 01/23/17 APPLICANT: ALLAN J KIESLER PHONE: NANCY C KIESLER 14102 148TH PL SE RENTON WA 980597324 LEGAL DESCRIPTION: PORT LUDLOW NO 6 LOT 11 V9/P40&41 S8-17-28N-R1E SUBJ TO EASE PARCEL#: 821175004 Section: 17 Township: 28N Range: 01 E DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: CONVENTIONAL TRENCH No. of Gallons per Day: 360 Type of work: NEW Drainfield Trench Septic Tank Length: 200 feet Width: 3 feet Depth: 16 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 Environ ental 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.: SEP13-00125 1.) MAXIMUM TRENCH DEPTH 16 INCHES 2.) 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. 3.) H - AS PER WAC 246-272AAND 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 4.) 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. 5.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 6.) H -An asbuilt drawing and certification of completion by the Designer is required prior to final approval. 7.) 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. 8.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 9.) 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. 10.) 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. 11.) 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. 12.) This system as designed and approved is sized for only one single family residence. It is not sized for an Accessory Dwelling Unit (ADU). The minimum daily design flow per residence is 240 GPD. 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. SEP13-00125 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 1/23/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING =! Designer MI 1e/144e- 6- .' e'IAs Permit# SEP / 3–.04 :)/ Z 5 Installer E te4 /✓&t//GZ , C,“":4 7"°/Al& Parcel # 82.E /7 S Cho¢ Electrician Design Flow 360 Property Owner AlLZ A7A/ GEC Site Address /00 L —' 13/2.p Z// P0R7- LV2 L4- IArA9 9g.Y&s-- Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) / z Cois-r/-' 1/►�I3AF�L�S E/47: /Z ' -Z5=lg- Pump chamber (manufacturer, size) Screen(s)and/or Pump Shroud (type, location) Were Tanks tested onsite for water tightness? Yes / No Panel Model Timer Model Pump 1 – Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) /transducer settings Timer Functions: (above bottom of transducer) On/off- On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) Pump 2 – Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) /transducer settings Timer Functions: (above bottom of transducer) On/off- On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) If additional pumps complete this info for each C:\Data\Wpw\County 8 State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 10/29/13 page 1 of 2 Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location Sand Fill met design spec? Yes / No {` ' ATU (manufacturer, model) Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe Size/Sch. 4' 30 4 )V — Manifold Size/Sch. b-2 Orifice Diameter Lateral Size/Sch. Barrier Material F/1-?-ela 1-f G Cover Material/Depth � 5G to-Z S"-/4 Residual Head (lat.# &ft. Head) Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean? / No If no, what action taken? Mound/Glendon Site Prep. Drainfield Length ZC ft Width 3 ft Depth 2- f& inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation)Attach additional sheet(s) if necessary Other Aquaworx panel settings: SWarn at , ZBios at , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No/ NA If yes how? Users Manual Provided to Homeowner IN/TH ,20e-evict vlz/9?wi w Date Tank/component Decommissioning Report Attached Yes / No I. Installer Certification attached/signed Yes / No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I certify the information provided above was verified by inspection(with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed(no backfill, except over transport pipes), and final inspection of the completed system (with exceptions as noted, if any). To the extent revealed by these periodic inspections, the system complies with all the conditions noted in the permit as approved by Jefferson County /—Z 3—/¢ (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 7./7,400 — 7"— ' ¢ 5100110 Designer Signatur- Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 10/29/13 page 2 of 2 o , ��N -00n1)yoOCA)b �, aavmocn ril r0 CCaOC^lz-nc.)� kmm2o�-0O2 npj co' 57.1k91-1 21.c, -1 e 2Z mo mu) p V � y p Noy) r-7.1)01001 ° U� �� � O Z zy�m20Al0 m2 o C Ot�2 2;n( 1 A � ( � n� N D n�"okan� Z N (/) -1 O��C� D n "I � (� N) Z OC O � IbIl ! o°a O t <p o z ■ O nl r- ) "1D " �Zt� O r � Z� eo Iv 1 �2 -it I 0 �n Z �2aa OO��Rt yocn y � `ZZ2o 2 O 1^12pO � p 0 O vjp -noc r �OOp11)1.00(0 > yr2mO aXn�2 0z k2n c' a � �10 coZ° o� coo y mrpm r o � ONa 2 p r MOSoom �O A to° °;''1 y -10 0z2 ) 2 01° 4p O Gn ■ Za z o�rjOrrt0A02 J 02 „O c) 1 2 ati2yTc� �o =oz ■ r sys[� 0k 1 5T° ■ Z I N P s 4.££ . z / 2 N V ri J NW o A \�(n 0\ -P.tft k0 +r ��� \ V 1 \ ck'yno 'r'�v (Al �c., V ro 2� O N 1 J Oa otA 1'4 c Z � ' ® x I W\A Visi " co\\ al o )3o a �� N 0 N\,t �� r` \ �o _ _ • , . 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Parcel# F / C 7 S °G'4" Backhoe Operator Job# DSO 7 / Project /.‘::),'/v 7°li3t(.._ r�/ 7.--t G Sec(Twp-Rng) N t tr-1 /7(26--(',,r HOLE NO. w 0 2 z ir- TYPE w b co ui 0 OF. DEPTH z t_ m w �. SYSTEM (Inches) U TEXTURE APPL. H �. E-- H D RATE 2 cr w 0 O DATE 0 c w F- J OBSERVED 2 (gpd/sq.ft.) U O F= O z Q < 3Z .SG 0,lp 72- > 3* F-P 00�c t- p,al. 36, r,, r Z I Z 6 se- p,la -a) >-?`1- 3¢ vG L S h' .54- a.. 5 5 --d-; 34 .,/?://5-' ¢! F- b t7 b e . tv SL m, -r.S' 3 9 riez N.,4 • }*- k4-- / IY G SG, G6;,,<-'S O.5 7/ 9 co ( <1.- 'r 1-S '.G z p 6q F--T7 /�-e s W yr s-G e7, ?9 <z. es: 1-3 >. P #1 't 3 SOIL HOLE LOGS Date 7- . '- "''7 Parcel# --Z( / 7 OQ Page `� of 7 Owner/Buyer -,-- r/-7 z ' °R HOLE w 0 NO. 2 z 0 I- TYPE 0 w Cl) u°X cc Oz OF DEPTH J APPL. < w a F- SYSTEM (Inches) H 0 TEXTURE RATE 0 O (gad/sq.ft.) O m Q DATE 2 F- OBSERVED ~O U _ 0 F- cc z • 1Q7 x/ES .,,Ic sc, d,GSat',,¢c/ taa '� t> 7 3/ G ©,to / ?fig 6Z 5-e,/57.Kr V' £-res s c_ 1-a L-5 e<6' 4vE/a tee A'z A9/r4ns'% ar- /_1 G '5 vt1.12 /4tf S G 0-7-e5/ dr8- 4:7- S 5 . P/2-Y' G S (/-re P°G4-L L'7,i) _ &f1 F b 0,y� LS v-c' SL 0,e-,a,_ 1 G l-?-e' s 1,6%' .Z 7 F-P /--.7 c- SL Vo C- S el , P`i� • /d Z2 L d• Z_ 4- >6'cr 340 A'tC,e4/4 S'6. 7, r- L ° 0, 4,„ ilP d✓�'` i-7- "5 412.7 1/ f1- 5L 4- ze- } 3 -•- ' c.--/- C - 0 .G C:\Data\Wpw\Soils\Masters\Soil Hole Logs(Rev.1).wpd '1 ! 1 ,I SOIL HOLE LOGS Date 7` `c='. 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