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HomeMy WebLinkAboutSEP2014-00007 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION ,-. PROPERTY OWNER Q L/'1. . 4 r�G-I B�el�k� C- �� -- MAILING ADDRESS ��,5� ! ( 7.3 'JC_�c cI E XJ��C.1 e. PHONE ( 9...<7 ) ticlie,'-, SYSTEM DESIGNER SCI IS Alf e- Designer Phone# �() 192– (3ec LEGAL DESCRIPTION: Section ZZ-Township 29/// Range ZW PARCEL# 1O iZ'-mod 1 I Subdivision Name sky Yid /k L 1 _ � Division Block Lot(s) I Site address/Directions to site /�� fit,�� � i,(?� I�GI eGa� y`,� / SOURCE OF SEW)GE/USE TYPE O FORK WATER SOURCE Residential �/ New ..-W---- ew g l- Tank/s only Private Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE Z f ' 5`?/SQ SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes# Alternative Redesign No �, - SYSTEM DETAILS Number of Gallons/day p 3 ® Soil type(attach soil eval.) Application Rate 0. O gal./sq.ft./day Drainfield Length3( S 7 ft. Trench Width/0 9 ft. Trench/Bed Depth iz.' in. Septic Tank size len, gal. Pump Chamber size /et5,0 gal. TYPE of system on a/4/O 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 1 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 application will be separat judged by the rules and laws in effect at that time. '' i,,I , t&&, L. C 04. zi p (3 / Pro rty Owner Signature Date FOR OFFICE USE ONLY �p w ,�1 3 ( PARTIAL ASBUILT "�d l l , FINAL AP RIE� �/ / INSP/PUMP TEST*17/ l 7 R6144 C 1 t"I f" // ALL HOLD REQ.MET //"� (� oa 14 olsy 1LD9S Date I 1 iI l U Fee (p LO T.) Rec# J t_j 0 s3 Check#Z.2.1 --+ Case#SEP 1 — H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC `= JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 p`Y1tf 4<YL"� www.jeffersoncountypub lichealth.org Phone 3b0-3t3b-U444 Fax 3tiU-3/9-4415/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14-00007 Date Received: 01/07/14 Date Issued: 03/11/14 SITE ADDRESS: MISTY RIDGE RD Date Expires: 03/11/17 APPLICANT: DOUGLAS R CLARK TRUSTEE PHONE: CARMEN L CLARK TRUSTEE 16561 CREEKSIDE RD RIVERSIDE CA 925036549 LEGAL DESCRIPTION: SKY VIEW HEIGHTS LOT 11 W/SUBJ TO EASEMENT SUBJ/REST COVT#541463 PARCEL* 902225011 Section: 22 Township: 29N Range: 02 W DESIGNER: ERIC HIBBARD PHONE: 360-683-6300 SOILS APPLICATION INC. P. O. BOX 1120 CARLSBORG WA 98324 SYSTEM DESCRIPTION: MOUND No. of Gallons per Day: 360 Type of work: NEW Drainfield Trench Septic Tank Length: 36 feet Width: 10 feet Depth: 12 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. A/W Jefferson County Environmental 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.: SEP14-00007 1.) A remote alarm for the pump tank is required at the home 2.) Contact the health department befor changing the location of the pump tank. 3.) The transport line cleanouts must be placed in a riser w/ a lid. 4.) Dry season installation required. 5.) H - AS PER WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE SYSTEMS REQUIRE THATA 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 6.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 7.) 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. 8.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. 9.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 10.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 11.) 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. 12.) 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. 13.) 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. 14.) 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. 15.) Contact designer prior to installation for staking of drainfield area. 16.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 17.) 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. 18.) 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. 19.) 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. SEP14-00007 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 3/11/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98' ASBUILT INSPECTION REPORT For RECORD DRAWIN ^8 I> Designer /'� 8/? O Permit# SEP /- /-001:70 Installer /�J -�L/�� 7� Parcel # q C?``- ZZS ©/ Electrician DOU/j 6 L7 Design.Flow 3 6-0 . ... . .. . .. Property Owner G1-4✓14 Site Address /72—5 1 7 6 13 Z Answer all questions or indicate NA DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) /COO �37--'y �L21-CO / Pump chamber (manufacturer, size) Se2r!776 /l• Screen(s)and/or Pump Shroud (type, location) /, Were Tanks tested onsite for water tightness? Yes / No Panel Model /942r//7 ' Timer Model -7E--7°C-----f-C, ./ 3/ Pump 1 - Man./Model e---2-73C---73 Flow.Rate I/0 qpm rr Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Timer from bottom of tank- On/off - / in. Functions: On sec Algo Veto - .s in. Off , se ,, r/hr Alarm - 3 in. Veto On - / sec/min Storage Above High Water Alarm '7/ gal. Veto Off- / KO • . sec/min/hr Dose Counter Reading D= coax .t/ 'o/ # gallons/dose O gal.. Elap. Time Meter Reading Mr5 3 : /3 rnin/hrs Pump Throttled? .Yes / ; Dose Drawdown (in inches) in. Pump 2 -< Man./Model Flow Rate qpm Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Timer from bottom of tank- On/off- in. Functions: On sec/min Veto - in. Off sec/min/hr Alarm - in. Veto On - sec/min. Storage Above High Water.Alarm..::: ... gal. Veto Off- sec/min/hr Dose Counter Reading # gallons/dose gal. Elap. Time Meter Reading min/hrs Pump Throttled? Yes / No If additional pumps-complete the info in this table Dose Drawdown (in inches) in. for each and attach. Other Timer functions & settings (e.g. override on/off) H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 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, schd, diameter a 5C W3/G Manifold size/schd sit c ' "VC- 7-3/ Orifice size ,r6 t r Lateral Size/schd /1,7,"( Barrier Material Cover Material/Depth /Z-7g (i Residual Head (lat.# & ft. Head) c 7?).-97/47r /( The laterals/pods were balanced . / No Source/Manufacturer of Drainrock/Gravelless chambers C C-7 Drainrock Clean?4 / No If no, what action taken? Mound/Glendon Site Prep 0,t' /- Drainfield Length ft Width ft Depth inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary /72077S--(;57.,/v0 40.0 '70 , , c Lc77Oe CoGC- - mo/17.O f✓1O7k /' 3-j vA--Do c= 7774vor f: s6Z7: h7 lid f` 7 7j: 77z- q07,5v c40ss ,-'6= ollc ,f,'r9? c.r`f 7-c_174- Health Department Inspection issues resolved Yes / No / NA If yes how? Users:Manual.Provided:to.;Homeowner S' '',._ ( ' ,;Date . Tank/component Decommissioning Report Attached. Yes / No / Installer Certification attached/signed Yes No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY 71-fE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED b-y JEFFERSON COUNTY •I,` (DATE) OR Ti-(AT CHANGES HAVE BEEN NOTED AND 11 T7-HE SYSTEM IS IN COMPLIANCE WIT-14 WAC 246-272. !!!�`' t` Designer Signature Date License# '- .‘ C H8x � , V.. 1,D DESIGNER H:\WEBIONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 EXPIRES 11-18.20 f �l / \ , / Z- / - 331' \ 60' 1. M b ,n ru," 1) . .\ 03 (J)A3 / O oM co xi N / C D Z C O /0/ tj ZD�° y z®O Z Oa =O 0 ua CDla ft m°m 0 z a 1)11 a� ° z °00 w v-0 „ m -I Cr--' Oa n ril-0 71 a-< m2 ti 0 Co, X O C A Zr�c)-< 0 0ti�r ° Z 0 O D z ° < 03o - Ili 0Cn * c', AMII •..s CI xI , S T I .. % � Y� _ T3 Z \,...qST� R Fri 7 D G * .. 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C Z -c w m°• 53 TIMBERLINE DR o z ^N) w MOUND SYSTEM FOR SEQUIM, WA 98382 CLARK PH (360) 683-6300 E-MAIL SOILSAPP®GMAIL.COM Jefferson County Environmental Health Dept. 615 Sheridan St., Port Townsend, WA 98368 SOIL EVALUATION Property Owner-Doug Clark _ y System Designer- Soils Applications LLC. ERIC HIBBARD LEGAL DESCRIPTION: Section-22 Township-29N Range-2W Parcel# 902-225-011 Subdivision Sky View Heights LLS Division V 11 P81 Lot 11 Date Logged: 12-9-2013 Logged by: Eric Hibbard Include soil textural characteristics and depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG#1 Health Dept. Comments: 0" to 2": Organic Loam 2" to 8": Dark Brown sandy loam 1 .3 8" to 28": Tan gravelly sandy loam 28" L to 30 . Till � L � � Observed water table n/a to-e`+ e- Roots to 28" SOIL LOG#2 Health Dept. Comments: 0" to 2": Organic Loam 2" to 9": Dark Brown very gravelly sandy loam 9" to 24": Tan very gravelly sandy loam 24" to 26": Till ` a/1. r 5-a E �- Observed water table @ n/a a' ( 33° l,r � f r Roots to 24" SOIL LOG#3 Health Dept. Comments: 0" to 3": Organic Loam 3" to 9": Dark Brown gravelly sandy loam 9" to 32": Tan gravelly sandy loam rd ru 4 1 ar v, 1/,41 ' 70" egP to 33": r i oc Observed water table @ n/a Roots to 32" SOIL LOG#3 Health Dept. Comments: 0" to 3": Organic Loam 3" to 12": Dark Brown gravelly sandy loam 1 to 36": Tan . . - sandy loam 36" to 37": olid rock !,(, \I C.C` ,, l: or,c4iL t ilT