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HomeMy WebLinkAboutSEP2013-00102 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION ,FP- PROPERTY OWNER A. MICHAEL GOULD &ARTHEA J. CARR-GOULD 2013 MAILING ADDRESS P.O. BOX 3500-404 SISTERS, OR 97759-3500 PHONE ( 3‘0 ) 3 c1C1 — 33'72_ SYSTEM DESIGNER NATHAN N. CLEAVER Designer Phone# (360) 598-6546 LEGAL DESCRIPTION: Section 27 Township 29N Range 1W PARCEL# 901-274-010 Subdivision Name Division Block Lot(s) tax5 Site address/Directions to site 334 COUNTRY MEADOW ROAD, CHIMACUM SOURCE OF SEy11AGE/USE TYPE OF WORK WATER SOURCE Residential 1 New V Tank/s only Private Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 668,645+/- SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evatu tion Conventional v Designate Reserve Area Yes#ZGNdo-00045 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 480 Soil type 3 (attach soil eval.) Application Rate 0.8 gal./sq.ft./day Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 24 in. Septic Tank size 1,000 gal. Pump Chamber size NA gal. TYPE of system STANDARD GRAVITY DISTRIBUTION 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 assur,, •u of any other County approvals. For example, it DOES NOT GUARANTEE that you will Ia.-r ob ain permission to build a permanent residence or other structure on this parcel. Any future a.•licati n will be separately judged by the rules and laws in effect at that time. Property Owner Signature Date FOR OFFICE USE ONLY l iviz3 PARTIAL ASBUILT '4 1 J t FINA ` 94 APPROVED INSP/PUMP TEST Auld 9 Q4IN ALL HOLD REQ.MET Date��� F ` Rec# Check# C Case#SEP13 l�2-- H:\WEB\PDFs\Septic\septic ermitapp 2008.DOC JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •98368 117d f.,'yyySC': www.jeffersoncountyp ublichealth.org I-'none 3tiU-365-9444 Fax 36U-3/9-446/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP13-00102 Date Received: 09/06/13 SITE ADDRESS: 334 COUNTRY MEADOW RD Date Issued: 10/23/13 CHIMACUM, WA 98325 Date Expires: 10/23/16 APPLICANT: A MICHAEL GOULD PHONE: ARTHEA J CARR GOULD PO BOX 117 CHIMACUM WA 98325 LEGAL DESCRIPTION: S27 T29 R1W TAX 5 (LESS PTN TAX 32)WITH EASE PARCEL#: 901274010 Section: 27 Township: 29N Range: 01 W DESIGNER: NATHAN CLEAVER PHONE: 360-598-6546 NATHAN CLEAVER SEPTIC DESIGN 1990 KIMBALL ST. NW POULSBO WA 98370 SYSTEM DESCRIPTION: CONVENTIONAL TRENCH No. of Gallons per Day: 480 Type of work: NEW Drainfield Trench Septic Tank Length: 200 feet Width: 3 feet Depth: 24 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 Envi nmental 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.: SEP13-00102 1.) 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. 2.) Compliance with the conditions of the Site Plan Approval Advance Determination is required. 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 246-272AAND 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.) 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. 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. SEP13-00102 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 10/23/2013 CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT INSTALLER l M (.1• S PARCEL# g0/ —27g-WO :,EP 4014 Permit Owner WildM EL ,4 WE4 601AD Permit # MCP/3-00/OZ, ABSORPTION AREA: DRAINFIELD i TRENCH TRENCH ,, TANK #OF ,1 #GAL/ LENGTH 1'f`4 WIDTH 3,5 DEPTH /S SIZE BEDRMS T DAY WM Tank Shroud/ IF PUMP AND PUMP CHAMBER REQUIRED: Size /V?• 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 WAS INSTALLED AS DESIGNED, PER PLAN APPROVED ' r1ATF INSTALLER SIGNATURE DATE INSTALLED Its .5, ({I 0 NATHAN N CLEAVER '+7 EXPIRES MAINTENANCE BASICS *There is a "filter sock" in the outlet baffle of the septic tank.The filter sock should be pulled out and hosed off every 6 months to avoid clogging and backing up into the house. Rubber gloves and other precautions must be taken to avoid contact with sewage. *The tank should be pumped every 3-5 years. •The drain field area needs to be seeded to prevent erosion. •The D-box should be opened once a year to make sure that the outlet pipes are all level. Rubber gloves and other precautions must be taken to avoid contact with sewage. There is a "Speed Leveler" dial on each outlet pipe that can be turned to level the outlets •The large green lids on the septic tank and the green cover over the D-Box must be secured at all times with screws or bolts to prevent hazard and tampering. •Keep all traffic and heavy equipment off the drain field area. *Septic systems are only capable of treating and disposing of normal human waste, toilet paper and water. Some mild soaps and cleaners are also expected to go to the system as part of household cleaning. •Do not dispose of chemicals, harsh cleaning agents, medications, garbage disposal waste, etc. to the septic system. Please feel free to call with any questions. 360-598-6546 Nathan N. Cleaver Licensed Onsite Wastewater Treatment System Designer ASBUILT CONVENTIONAL FR _05-1 0-04. ddf _ RECORD DRAWING \ ) , \ S 89°03'04" E \\ N — __SF.PTIC DETAIL SHEET SCALE: 1" = 50' THIS IS NOT A SURVEY N \ N \ 1 LEGEND \ \ ►% 10' No Build ` 100%Reserve Area \ t Soil Log \40'x 70' = 2,800 Sq Ft �, N \ ---- Building Envelope \ / '� 100%Primary Area / Setback (4) 50' Laterals; 5' O.C. - \ Align To Contours / -- — Existing Component 1-k-1\ \ \ Tree \�O \ \\� \ /%//�; (A) Clean Out + jt� / (B) Septic Tank ?) �\�� \ (C) Filter Sock 1 / (D) D-Box , // / m a c / c� -..,A / V f \ S �ti © �_ D Proposed Building Envelope RV Dump s t . I 75' F o k() l Existing Barn If \ ,' / / - I� \\ _ / , / / O .1 N -- / 100' / f \ . I - , 24 /■ Existing Well— Well Setback I o Existing Tractor Barn 1 \ MEASURE TABLE / \ RV 43.3' 18.8' A 3.4' 63.4' / \ "Y,' 21.4' 57.0' / \ B 22.7' 60.9' _— \ \ C 25.5' 65.8' \ D 27.8' 70.5' � \ \ 1 28.0' 75.0' 2 31.6' 74.6' LL \ 3 37.6' 75.0' 0� \ 4 86.0' 129.5' 5 84.5' 130.0' M .t �� \ 6 81.7' 129.2' °' \ � 15.350 d" \ b \ / Nathan Cleaver Septic Design, Inc. Z \ Phone: (360) 598-6546,Fax: 360-598-6548 ' !N~� / 1990 Kimball St.NW,Poulsbo,WA 98370 ' 'i ,'+ E-mail:nathan@nathancleaver.com• '-I'r ' • ;�/ / CUSTOMER: MIKE GOULD •ofs� TAX ID#: 901-274-010 6iQy`Q �'a/ LOCATION: 334 Country Meadow Rd,Chimacum t 1. DRAWN BY: RMC, NNC, ICS Q? ATHAN N Ce�AVER -?��� DESIGN BY: NATHAN CLEAVER I . .. D, Si ... R I` `14PMIAPI'�� !�� DATE: 12 MAR 2008, REV: 1 DEC 2008, EXPI' 26 MAR 2013, 31 JUL 2013, !// REV: 28 APR 2014 A 100% Reserve 2,800ldq F ) RECORD / DRAWING \ . _ (40' x70' = 2800S Ft 100% Primary Drainfield Area ( \ (3) 58' Laterals; 3.5' Wide \ ___ Aligned To Contours Iiil Total: 609 Sq Ft N 517' �� S 89°03'04"E SCALE: 1"=100' \\ \� / THIS IS NOT A SURVEY I --,___...,.. ,,T\\,,,,,,,, 7 I LEGEND \ N 17 1,4 10' No Build \' N > I ` N, \ / I Soil Log N 0 N N. ` o ———— Building Envelope \ �, c, / I \ , �G��y� Setback \ ', \ '; l 1" I ——-- Existing Component \ \\ _ o \. ./ I Tree \ \ I N �a l c ` f! \ \ �°' Q4 t © • * D N ` — / (A) Clean Out 4BDRMSFR ,.? c,) / . B / 1 RV Dump (B) Septic Tank (-7 5'...._ r -- a } t • © m� � (C) Filter Sock ,\ r / o�m�m / (D) D-Box m .., /, / ®r )\ 100' Existing Barn Well Setback Existing Tractor Barn 100' 7 S 89°03'04"E Existing Well 1 \ I 7 °o \ / STREAM B I ' co / w m y / o, r, �a \ -----_,... _____, °° \ N 15.350 acres \, -' O / N Z \ a,M / \ 0 N \ O \ // I I / V \ Ditch A 1 I. WETLAND to Country Meadow Rd■ \ I Existing Driveway -,. - ., / 60' Easement 272.46' // / / MEASURE TABLE 7 ;, „ / i Vii,,..��......., ,, /,,. / '' .:.... / RV 43.3' 18.8' / A 3.4' 63.4' / "Y" 21.4' 57.0' I / B 22.7' 60.9' C 25.5' 65.8' ( D 27.8' 70.5' N. - 1 28.0' 75.0' 2 31.6' 74.6' b TT 7 3 37.6' 75.0' 4 86.0' 129.5' WETLAND \ 5 84.5' 130.0' 1 / 6 81T 129.2' I / I / / Nathan Cleaver Septic Design, Inc. Phone: (360) 598-6546,Fax: 360-598-6548 / N 89°56'05"W it. / 1990 Kimball St.NW,Poulsbo,WA 98370 344.59' ,IQ,, . -,' j E-mail:nathanQnathancleaver.com I / rr ...•. CUSTOMER: MIKE GOULD /" M� 'oc wns�ti•�\ TAX ID#: 901-274-010 y"�`' 9.2�� 4�P N I? ':A LOCATION: 334 Country Meadow Rd,Chimacum 111..1.q. s, 2si ��� DRAWN BY: RMC,NNC, ICS \ z-.1...1', • • NATHAN CIEA--R '. R "' ' ; . . .;;;1 R ■ DESIGN BY: NATHAN CLEAVER EXPIRES DATE: 12 MAR 2008,REV: 1 DEC 2008, 26 MAR 2013, 31 JUL 2013, REV: 28 APR 2014 / 100% Reserve Drainfield Area 7 — (40' x 70' = 2,800 Sq Ft) \ 100% Primary Drainfield Area I (4) 50' Laterals; 5' O.C. I \ � � Align To Contours I N 517' ` \ SCALE: 1"=100' S 89°03'04"E -" J THIS IS NOT A SURVEY 7 \ 292' \ 1 LEGEND \ 4nj \ I F 1 \ ~ ' > 1 ., 10' No Build •-, / I r Soil Log �. o \ ———— Building Envelope �� i , , ,, _ _ I Setback 1 1,1‘.(.."‘I, SL / `�^\° ,, I -- — Existing Component \ \I� I 1 �` / I Tree a , D '�II /2 � � t, I v ,mom -il,- / Proposed o c ' 'O t) (A) Clean Out Building o � 1 N Envelope a " 282' -_ _ ? .7 r t 180 ..._ �r �,',,` A B a cl �Q (B) Septic Tank i i 75 ; m� (� / �' �° t L,�, (C) Filter Sock \ / / './ .e')-(7) _... ,":..;,c., / '"'. C: v \ \ o mj _ / t7 .5 •Q ✓ (D) D-Box d \ 100' 16 4,11 411 Existing Barn \ Well Setback L '� Existing \ ✓C Tractor Barn \ 1 700' Existing Well s 89°03'04°E \ / \ ,\_ 1 • 1006' V) I 'o \ 7 '. / STREAM B m ,a co �/ i.,„ v 15.350 acres ��` z a. ' "1 \ \ -- ni N )// I 1 \ Ditch A f� /- \ WETLAND to Country Meadow Rd \ 1 Existing Driveway 60' Easement =I . 272.46' / / / 7 I � I // m ` o ' \ fn)) l / WETLAND :`N° '���� , 1 251 ��i�}' NATHAN{/ CLEAVER ,1 / �) LICENS D D SI R EXPIRES / I / ' Nathan Cleaver Septic Design, Inc. / N 89°56'05"W --. ,...7,,,C,7 Z-_7. 4,1." / Phone: (360) 598-6546, Fax: 360-598-6548 344.59' / 1990 Kimball St. NW,Poulsbo,WA 98370 I E-mail:nathan @nathancleaver.com ,� / CUSTOMER: MIKE GOULD TAX ID#: 901-274-010 1 / LOCATION: 334 Country Meadow Rd,Chimacum \ / DRAWN BY: RMC, NNC, ICS \ / DESIGN BY: NATHAN CLEAVER \ / DATE: 12 MAR 2008, REV: 1 DEC 2008, \ __----- 26 MAR 2013, 31 JUL 2013 i \ 517' / \ S 89°03'04" E # (N I N ) `\__SF,PTIC D . SHEET SCALE: ," - 50, , , THIS IS NOT A SURVEY 292, N \ LEGEND \ 100%Reserve Area .. \ � �, 40' x 70' = 2,800 Sq Ft .�,� 10' No Build 100%Primary Area r`" \ ' r Soil Log T.--- (4) 50' Laterals; 5'O.C. s\ ---- Building Envelope Align To Contour Setback / / .47Existing Component N1.. " - Tree O NC \,O \ ,. ���1r (A) Clean Out i‘li, ( \ L.. / (B) Septic Tank \, �� S� / (C) Filter Sock *4?) \ - / (D) D-Box , I o` / ^b D s /2 rt` fi I i V / \ l � o`, _, Proposed Building Envelope d B A / 7 a l i : /44, f t.� o ,-,,-..,... t 1.; '/ \ )K CT.) .. ' \ `? Existing Barn / / N ° / 100'tr. 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V II TN 03 O 0) = T co N C T rt VO m Y p O ■ O co O n ( x n , p .jr�1 T W 0, II X G Q -, D0�' �� O j C cri O CO 0 0 0 �Ti G-) co Q iv p 01 0 - 0 3 c co ■■ ro -' 0 0) 2 0 N, 0& - 115 ,,/r2p13_io- ` Nathan Cleaver Septic Design Inc. Contractor Registration#: NATHACS940O2 _..3p A.-it\__ 3/12/08 Soil Logs Re: Tax Parcel #: 901-274-010 Kim Clemons Kaye 333 Country Meadows Rd Chimacum 98325 Soil Logging done on 111P K 'i.033 ii j v Soil Log#1 0-2" Duff 2-20" Loamy Medium Sand 20-66" Coarse Sand Soil Log#2 / ' , C \V /r/. lid 6/L7 --.-7/ 0-2" Duff 2-24" Loamy Medium Sand 24-66" Coarse Sat, d Soil Log#3 V 0-2"Duff --L 2-24" Loamy Medium and / S 24-66" Coarse Saud ',J i Soil Log#4 j 0-2" Duff 2-24" Loamy Medium S d 24-66" Coarse Sand 1% /lt, . /Please feel free to call with any questions. ;> Asy I . Thank you Ae 7,:; ti 2 .,,, _ )PIL.- // I--. S1p025'� ` - / /._ NA AN N CI�AVcR 1 /V, e O.VA"I I.lI-il/ .1a e r 0 EXPIRES / / " GS Nathan N. Cleaver / Licensed Onsite Wastewater Treatment System Designer. \l/ e----\ --6 \l/ Address: Telephone: 360-598-6546 1990 Kimball St. NW Fax: 360-598-6548 0 Poulsbo, WA 98370 Email: nathan @nathancleaver.com Please call ahead to make an appointment if you would like to meet with me.