HomeMy WebLinkAboutSEP2014-00042 Jefferson County Department of Community Development °'44
621 Sheridan St., Port Townsend.WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Robert&Wendy Stafford (,1170;, i
/
MAILING ADDRESS 6007 Chennault Beach Drive
Mukilteo,WA 98275
PHONE ( 425 ) 356-7342(Wendy's Mobile) +: Suzanne LMartn '• ���f
oan-.3 2111115
SYSTEM DESIGNER Suzanne Martin Designer Phone# (360)554-0224
LEGAL DESCRIPTION: Section 4 Township 25N Range 1 W PARCEL# 501 043 005
Subdivision Name Lot 2(E179.44'of W 628.99')Is roads Division Block Lot(s)
Site address/Directions to site
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 +/-265945sf
SYSTEM TYPE Partial Repair-(tank) ✓ (drainfield) ✓ Previous Evaluation
Conventional Designate RPc rve Area Yes# SEP89-00190
Alternative ✓ Redesign No .
SYSTEM DETAILS
Number of Gallons/day 480 Soil type 3/4 (attach soil eval.) Application Rate 0.60 gal./sq.ft./day
Drainfield Length 267 ft. Trench Width 3 ft. Trench/Bed Depth 12 in.
Septic Tank size 1000 min gal. Pump Chamber size 1250 min gal.
TYPE OF Pressure trench system
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. 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
futur application wil .e separate) judged by the rules and laws in effect at that time.
,./40/4 -k /-14 `-/A//
Property nature Owner Si ate
9
lFOR OFFICE USE ONLY
13/` ' PARTIAL ASBUILT • A/ 1 FINA 7/7. Z1(,('APPRO D /
INSP/PUMP TEST g 17! `( PUD
ALL HOLD REQ.MET
Date 46 0 I/L( Fee / 2�{Rec# I -t /Ocl SG Check# I ,3) Case#SEP I -I -
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forms\Suz\2008 SPA.DOC
JEFFERSON COUNTY PUBLIC HEALTH
? " 615 Sheridan Street•Port Townsend•Washington •98368
�YYF 4r 5
www.jefferson countyp ub lichealth.o rg
I'none 3tiU-3139-9444 tax 3tiO-3/9-4413/
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP14-00042 Date Received: 04/10/14
SITE ADDRESS: 571 DONALD RD
Date Issued: 06/03/14
QUILCENE, WA 98376 Date Expires: 09/03/14
APPLICANT: ROBERT W STAFFORD PHONE:
WENDY L STAFFORD
6007 CHENNAULT BEACH DR
MUKILTEO WA 982754661
LEGAL DESCRIPTION: S4 T25 R1W LOT 2(E179.44'OF W628.99')LESS ROADS
PARCEL#: 501043005 Section: 4 Township: 25N Range: 01 W
DESIGNER: SUZANNE L MARTIN PHONE:
PO BOX 179
PORT HADLOCK WA 98339
SYSTEM DESCRIPTION: PRESSURIZED TRENCH
No. of Gallons per Day: 480 Type of work: REP
Drainfield Trench Septic Tank
Length: 267 feet Width: 3 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.
Jefferson County Environrnhal 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.: SEP14-00042
1.) This permit was issued to correct a violation of WAC 246-272A for a failing drainfield. The permit
must be completed within 90 days of the date of issuance.
2.) H -A NEW WATER LINE WAS INSTALLED TO THE HOME AFTER THE SEPTIC SYSTEM WAS
APPLIED FOR. THERE IS NOW A NEW SPIGOT NEAR THE PROPOSED SEWAGE
TRANSPORT LINE. 10 FEET MUST BE MAINTAINED FROM ANY SEPTIC COMPONENT TO
ANY WATER LINE.
THE NEW WATER LINE MUST BE LOCATED PRIOR TO INSTALLATION OF THIS SEPTIC
SYSTEM.
3.) 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 246-272AAND 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.) 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.
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.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
7.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
8.) H -An asbuilt drawing and certification of completion by the designer is required prior to final
approval.
9.) 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.
10.) 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.
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.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
14.) 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.
15.) 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.
SEP14-00042 Page 2 of 2
\\tidemark\data\forms\F SEP_Permitmod.rpt 6/3/2014
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA '%.. 8
ASBUILT INSPECTION REPORT For RECORD DRAWING 4i
Designer Suzanne Martin Permit # SEP 14-00042
Installer Shold Excavating (Evan Neville) Parcel # 501 043 005
Electrician Cascade Electric Design Flow 480gpd peak
Property Owner Robert&Wendy Stafford
Site Address 571 Donald Road-Quilcene,WA 98376
Answer all questions or indicate NA
DATE
Tanks, Pumps and Controls INSP.
Tank (manufacturer, size, baffles) 1000 Cotton;tuftite filter w/handle&risers installed 8/25/14
Pump chamber (manufacturer, size) 1500 Cotton; 29 gal/inch; anti-siphon installed 8/25/14
Screen(s)and/or Pump Shroud (type, location) shroud around pump in pump tank 8/25/14
Were Tanks tested onsite for water tightness? ED/ No
Panel Model Infiltrator Timer Model Aquaworx IPC 8/25/14
Pump 1 — Man./Model Liberty 1/2hp Flow Rate 47 QOM 8/25/14
Pump Location (i.e. garage, treatment unit, basement) Pump is in the pump tank
Float/transducer settings Inches Timer
from bottom of tank- On/off 21-525 ": in. Functions: On ��1.22 sec(int,
Veto - 35.125 in Off 240 sec hr
Alarm - 34-025 in. Veto On - .1"=22 sec/
Storage Above High Water Alarm "470/730. gal. Veto Off- -180 sec in hr
Dose Counter Reading 8 dt7u dose
# gallons/dose ;" ," 60 ' gal.
Elap. Time Meter Reading 001729 min rs Pump Throttled? Yes Na
Dose Drawdown (in inches) 2 in.
Pump 2 — Man./Model n/a Flow Rate mom
Pump Location (i.e. garage, treatment unit, basement)
Float/transducer settings Inches Timer
from bottom of tank- On/off - n/a 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",
Dose Drawdown (in inches) in. If additional pumps-complete the info in this table
for each and attach.
Other Timer functions & settings (e.g. override on/off) 71 events;Autoclear 45 seconds; I0=05-08-2013;
ZB-08; dose data taken 17 September 2014 @ pressure test
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 n/a
Sand Fill met design spec? Yes / No <94
ATU (manufacturer, model) n/a Alarm tested Yes /No
Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes /No . .
Drainfield
Transport Pipe size, schd, diameter 2"pvc sch 40 Manifold size/schd 2"pvc sch 40 8/25/14
Orifice size
1/8" Lateral Size/schd 1"pvc sch 40 8/25/14
Barrier Material filter fabric Cover Material/Depth 12"on site cover 8/25/14
Residual Head (lat.# & ft. Head) balanced pre-cover @7' 8/25/14
The laterals/pods were balanced es / No 8/25/14
Source/Manufacturer of Drainrock/Gravelless chambers Cotton
Drainrock Clean? es / No If no, what action taken?
Mound/Glendon Site Prep n/a
Drainfield Length 267 ft Width 3 ft Depth 12 inches
Caps for measuring residual head stored (location) Header box
COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional
sheet(s) if necessary
Health Department Inspection issues resolved Yes / No / NA If yes how?
Users Manual Provided to Homeowner delivered to homeowners Date 25August14
Tank/component Decommissioning Report Attached es / No / NA
Installer Certification attached/signed G/ No
ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, ruE
SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED b-y,JEFFERSON COUNTY
(DATE) OR THAT CHANGES HAVE BEEN NOTED AND
T}EE SYSTEM IS IN COMPLIANCE WIT}f WAC 246-272. 1 �a+;P,
18 September 2014 5100342
Designer Signature Date License# a
s, 42 ' r
Suzanne L Martin 1I
Erw s'.. 3 vivl5
H:\WEB\ONSITE\Asbuiit_Report_Form.doc 04/28/10page 2 of 2
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Page 3 of 5; Stafford;
Parcel # 501 043 005
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Pump Tank Detail
r 0.27
1250 gallon pump tank; Installed Riser •
±28.5 gallons per inch 7
1.66
`..l^. 1e.4:,C?y' };:? �ya< f44.1'.} •4spii_+';:1Aij rrai4:C;:i:';;1:@:,:41:1�; :" }a: '.1a...
Inlet "•"
1 transducer `� ±21"storage above high water
y (±598gal);below inlet±13.7"
The dimensions demonstrated in this 4.58 sr storage below inlet(±390gal);
.: illustration are examples. the requirements 1.74 360 gallon minimum
1> are: 480 gallons working volume&minimum
.7' 360 gallons emergency storage above veto in ` ;;
the pump tank. °q _ Veto set 17.3"from the
bottom of the bell■
The working volume shall be set at 360gpd •-
k. 4.25 r; alarm set for±17.1"from bottom of the bell;
5.27 ;-; with the veto set for 480gpd
yr — ±481.65 gal working volume
4' -min.480 gallons
r 0.167 K
:y t on set 0.4"from bottom
.�
ii
, i;' of the bell 3.,.
A
1.500 1 0 ±18"from ,
t▪F: bottom of tank :,
4; to the bottom ��
I of the bell ,
"R'!'N`i:i«
•• ,e.. .i'.`.•cwor_1.ft `t:...‘.tti-....1,.2:4::ir..';r:'.1,eve n.v.}•.gY:i;:r.,a}.L•a!s.:i_... ..r.Y;..tyttc2:4!;..w...-;'t;::o
9.5' I
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•.. SUZANNE LEA MARTIN
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System Owner: Robert &Wendy Stafford;
Parcel #501 043 005
Site Address: 571 Donald Road-Quilcene
Page 2 of 5;Stafford;
Tank Cross Section-Not To Scale parcel#501 043 005 _
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL 4
ACCESS RISER i �
FINISH GRADE
L\ 1--- ----,- --- -----:r j ._..
` % �� pump tank
FROM SEWAGE /
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS maximum 1/16"filter
SEPTIC TANK
(TYPICAL)
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Page 1 of 5; Stafford;
parcel#501 043 005
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST..PORT TOWNSEND.WA 98368. 0601 379-4450 4--1,
SOIL EVALUATION ��,•I.•ttoi
PROPERTY OWNER Robert&Wendy Stafford ,y. 5, 2 /..Its
1 Suzanne L Ma . I,
' '47C@NSgtiMOW— •t
SYSTEM DESIGNER Suzanne Martin z„ns
LEGAL DESCRIPTION: Section 4 Township 25N Range 1W Parcel # 501 043 005
Subdivision Name (E 179.44'of W 62$.99')Is rd Division Block Lot(s) 2
Date Logged: 24 March 2014 Logged By: Suzanne Martin App o
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 SOIL LOG #2
0-25" Reddish brown gravelly loamy medium sand 0-15" Dark yellow brown gravelly loamy fine sand
25-67+" Grey Ty gravelly mediu d 15-48"Yellow brown gravelly loamy medium sand
a A"t �' } ,��n� wavy boundary
1 48-53/56" dense soils
��``"��� 53/56-65+"yellow brown very gravelly medium sand
n/a f most of the roots present above 48" p
Anticipated water table in. Anticipated water le n/a in.
Roots to 241, inches , R,yy( ' I Roots to Lb inches
Health Dept. Comments Health Dept. Comm i -t i
SOIL LOG #3 SOIL LOG #4
0-24" Dark yellow brown gravelly loamy sand 0-6" Dark brown sandy loam
24-49" Light yellow brown gravelly medium sand 6-19" Yellow brown gravelly loamy sand
some compact sand @ 40" . 19-55" Yellow brown gravelly rriediurra sand
C c- ' . '� � - 3
sovu_c,,Ao.e.0 I e rola._Anticipated water t ble nla '
in. Anticipated water table n/a in.
Roots to inches +4,‘,1246:6-4 s3 4 Roots to 55 inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #5 SOIL LOG #6
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:UNFOHLTH\SOIL.FRM1/00
System Owner: Robert& Wendy Stafford;
SEP14-00042;
Parcel #501 043 005;
Site Address: 571 Donald Road-Quilcene
Pump Tank Detail RECEIVED
SEP 22 2014
anti-siphon c��, M County
{�y,
installed 1 GI iron Health
1 6.25"
•■Ali
� 1�80.25"
±16.2"storage above high
• water below inlet(±470ga1);
53 i"transducer additional storage above
inlet;±730 gal
Veto set 13.6"from the
bottom.of the bell
alarm set for±13.4"from
I bottom of the bell
1500-29 gallons gal.Cotton pump tank: 63.75" ±362.5 gal working volume
29 gallons per inch -min.360 gallons
with Aquaworx transducer#ZB-08;
4.5 with shroud on set 0.9"from bottom
I of the bell
H ±20.625"from bottom of tank to
the bottom of the bell;±4"
5.3 between bottom of bell and top of
the shroud
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/ SUZANNE LEA MARTIN .•« `St , !4 C •.. #,
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