HomeMy WebLinkAboutSEP2012-00133 Jefferson County Department of Community Development
621 Sheridan St.,Port Townsend WA 98368,(360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER ROBERT& MARY FISH
MAILING ADDRESS 2751 WEST VALLEY ROAD
•
CHIMACUM, WA 98325-9792
PHONE ( 910 ) 457-9864
SYSTEM DESIGNER NATHAN N. CLEAVER Designer Phone# (360) 598-6546
LEGAL DESCRIPTION: Section 30 Township 30N Range 1W PARCEL# 001-305-032
Subdivision Name DISCOVERY BAY RIDGE Division IV Block Lot(s) 32
Site address/Directions to site BLUE RIDGE ROAD, PORT TOWNSEND, WA 98368 z 14 6
SOURCE OF SEWAGE/USE TYPE OF ORK WATER SOURCE
Residential V New Tank/s only Private
Residential ADU Modification Public�-
Commercial Expansion
Community Upgrade
Repair SITE SIZE 217,000+1-
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previou%kyAlizatimi
Conventional Designate Re erve Area Yes#
Alternative Redesign ' No
SYSTEM DETAILS
Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 galJsq.ftfda
Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 6 in.
Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal.
TYPE of system SHALLOW PRESSURE
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 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.
Property Owner Signature Date
i R OFFICE USE ONLY
1 2- .E ED PARTIA4 el� I ASBUILT 0 1 FINAL
55
PPR
INSP/PUMP TEST % 2O ►1 PUD
ALL HOLD RE ,MET
UU 1
Date If '" 1 Fee t) Rec# V2:Zeck# �� Case#SEP
H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC �C
JEFFERSON COUNTY L HEALTH
615 Sheridan Street*Port Townsend*Washington *98368
www.jeffersoncountyp ublicheatth.org
__...._............._._.. _.._Phone.360-°3'85=94"44 r ax 360:3(9-4481
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP12-00133 Date Received: 11/20/12
SITE ADDRESS: BLUE RIDGE RD Date Issued: 01/25/13
PORT TOWNSEND, WA 98368 Date Expire . 01/25/16
APPLICANT: ROBERT B FISH PHONE:
MARY M FISH
2751 W VALLEY RD
CHIMACUM WA 983259792
LEGAL DESCRIPTION: DISCOVERY BAY RIDGE DIV IV PARCEL 32 SUBJ TO EASE
PARCEL#: 001305032 Section: 30 Township: 30N Range: 01 W
DESIGNER: NATHAN CLEAVER PHONE: 360-598-6546
NATHAN CLEAVER SEPTIC DESIGN
1990 KIMBALL ST. NW
POULSBO WA 98370
SYSTEM DESCRIPTION: PRESSURIZED TRENCH
No. of Gallons per Day: 360 Type of work: NEW
Drainfield Trench Septic Tank
Length: 200 feet Width: 3 feet Depth: 6 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 ntal 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.: SEP12-00133
1.) If the control panel is located at the pump tank a remote alarm will be required at the home.
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.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
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.) 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.
9.) Septic tank and pump chamber to be water tight. Extra protection (i.e. Bentonite) to be used
around inlet, outlet, and risers due to high water table.
10.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
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.) 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.
14.) 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.
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.
16.) Site plan dated 11-19-2012 is consistent with Discovery Bay Ridge Division IV Plat.
SEP12-00133 Page 2 of 3
\\tidemark\data\forms\F_SEP_Perm itmod.rpt 1/25/2013
17.) The site plan received on 11-20-12 was reviewed by the Department of Community Development
on 1-7-12 and it was determined the new septic system meets the requirements in Jefferson
County Code 18.22.330(2). A stream typing letter recevied from DNR, Ross Goodwin, dated
10-10-02 for the Discovery Ridge IV plat identifies no streams on parcels. Any future permits on
this site are subject to review for consistency with applicable codes and ordinances and does not
preclude review and condition which may be placed on future permits.
18.) This parcel was created through Discovery Bay Ridge IV under AFN 463493 recorded 12-18-2002,
Volume 1 page 116 thru 118 with the Jefferson County Auditor's office.
19.) The site plan dated 11-20-12 submitted for the septic application was reviewed by the Department
of Community Development and it was determined no geotechnical report was required. Any future
permits on this site are subject to review for consistency with applicable codes and ordinances. A
geotechnical report may be required for any future permits.
SEP12-00133 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 1/25/2013
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
ASBUILT INSPECTION REPORT For RECORD DRAWING
Designer Suzanne Martin Permit # SEP 12-00133
Installer Tim Thomas(Bernt Ericson Construction) Parcel # 001 305 032
Electrician Fredrickson Electric Design Flow 360gpd peak
Property Owner Jonathon Dunn ��������
Site Address 483 Blue Ridge Road-Port Townsend, WA 98368
Answer all questions or indicate NA AUG 20 20111 DATE
Tanks, Pumps and Controls INSP.
Tank (manufacturer, size, baffles) Hagerman; 1000gal; risers&Orenco filter�;llg{ n County: 8/6/14
Pump chamber (manufacturer, size)
Hagerman; 1125ga1; 22.5gal/inch; riser'iii§� R�'�i1er'tfll Hea 8tt4
Screen(s)and/or Pump Shroud (type, location) pump shroud installed around pump 8/6/14
in the pump tank
Were Tanks tested onsite for water tightness?6Wi> No
Panel Model infiltrator Timer Model Aquaworx IPC 8/6/14
Pump 1 — Man./Model Zoeller BN 152 Flow Rate 45 qpm 8/6/14
Pump Location (i.e. garage, treatment unit, basement) pump is located in the pump tank
Float/transducer settings Inches Timer
from bottom of tank- On/off - 19375 in Functions: On t sec mi
Veto - 32-075 in Off 240 sec ahr
Alarm 31.875° in Veto On - 1 �� sec
Storage Above High Water Alarm 337/540 gal. Veto Off- 180 sec min hr
Dose Counter Reading 0 dose/4-vdose #gallons/dose 45 gal.
Elap. Time Meter Reading 00:0527 mi Pump Throttled? Yes 110
Dose Drawdown (in inches) in
Pump 2 — Man./Model n/a Flow Rate qpm
Pump Location (i.e. garage, treatment unit, basement)
Float/transducer settings Inches Timer
from bottom of tank- On/off- , F in Functions: On h sec/min
Veto - in Off sec/min/hr
Alarm �� in Veto On sec/mm
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/Na
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) timer activator @ 0.90"; alarm @ 13'"
veto @ 13.2"; autoclear @30 seconds; 51 events; ID=05-08-2013
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2
Pre-Treatment Date InsD
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No
Sandfilter Basin size/location n/a n/a
Sand Fill met design spec? Yes / No
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 1"pvc sch 40 8/6/14
Orifice size 1/8 Lateral Size/schd 1"pvc sch 40 8/6/14
Barrier Material filter fabric Cover Material/Depth 18"
Residual Head (lat.# & ft. Head) 7.5 balanced pre cover 8/6/14
The laterals/pods were balanced es / No 8/6/14
Source/Manufacturer of Drainrock/Gravelless chambers cotton gravel
Drainrock Clean? ED/ No If no, what action taken?
Mound/Glendon Site Prep n/a
Drainfield Length 200 ft Width 3 ft Depth 6 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 condition#1-The home was placed closer to the drainfield than on _ rg \ Et1
.the need for two alarms, one at the home and one at the pump tank. �f V
Condition#2-covenant#585233 has been filed. AU6 2 0 2014
•Condition#9-extra protection for the septic and pump thank has been accomplished
.2 1/8"between bottom of bell and top of shroud.
Jefferson County
Health Department Inspection issues resolved Yes / No If yes how? Environmental Health
Users Manual Provided to Homeowner /8�by / ' Date
Tank/component Decommissioning Report Attached Yes / No / NA
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, THE
SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED b-y JEFFERSON COUNTY
(DATE) OR THAT CHANGES HAVE BEEN NOTED AND
THE SYSTEM IS IN COMPLIANCE WITH WAC 246-272.
18 August 2014 5100342 , <, �✓'+�
Designer Signature Date License # 52: �,++
• sun..L Martin" +)
" DB@
ow- -.vnns
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2
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