HomeMy WebLinkAboutSEP2013-00104 5' .
Jefferson County Department of Community Development
62't Sheridan St..Port Townsend WA 98368,(360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER V?1,,, N N1 cat 'k A � \S Z LT t.0
MAILING ADDRESS 13%911114
6 11,1/43;;, 1
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PHONE I Sk 7 —li a L'l011
SYSTEM DESIGNER \t 4 - KCi-- }� -, = Designer Phone#11.S11-1,2A- ` AbL
LEGAL DESCRIPTION: Section k Township till Ranget43 PARCEL#Sr riA S 1 t '
Subdivision Name1V- -1't F1�,. "'1A Division lock Lot(s) �'"
Sfte address/Directions to site �C t" '"� ,Ns 1�1 \)S
SOURCE OF I►AGE/USE TYPE OF WORK WATER SOURCE
' Residential A® New ). Tank/s only Private .
Residential ADU Modification ^ -0 Public_
11* Commercial Expansion
Community Upgrade Stastp • YZ t1 LOSS x f,
Repair (:oc.4 oacorAS S'eP'J I-4(o SITE SIZE'S L4' ' r
,.k..'k SYSTEM TYPE Partial Repair- tank
p (tank) (drainfietd) Previous 6valu n
Conventional f
4.r.:° Designate Reserve Area Yes# �"
Alternative Redesign X _ No
SYSTEM DETAILS V lS\ "°-(s2 1 --T5 w i4c
Number of Gallons/day Soil type (attach sal evai.) Application Rate galJsq.ft/day
Drainfield Length ft. Trench Width ft. Trench/Bed Depth in.
Septic Tank size , gal Pump Chamber size gal.
TYPE of system iVINlC i E,NAST1 '` .S 'i V-EPLAL 11M U -1ajG1Z--
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,reasonabie 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 of entry will be assumed unless the
applicant informs the County in writing at the time of the application that he or she r-. - prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry
Appear—A person aggrieved of a decision of the Health Officer may appeal.Appeals sh. •- 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
p, 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
I y w -ter obtain permission to build a permanent residence or other structure on this parcel. Any
f ure app- -tion 0 r : separately judged by the rules and laws in effect at that time.
1\ I
..alb `QIZ
Z.Z1.5
IIII Property Owner Signature Date
FOR OFFICE USE ONLY
1 It PARTIAL ASBUILT Z1 I I i FINAL 2/1.111(1
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INSP/PUI P TEST PUD Lc 3
ALL f�OI.DEa. >
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Date l C)125/l3 Fee IUD o� Rec# /C-45-0 5 Check# 289C( Case#SEP _ il
H:\WEHVgpFp\Se ic\septiQ perati.06_2008.D r
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_` JEFFERSON COUNTY PUBLIC HEALTH
qF1� 615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublichealth.o rg
rnone 3bU-3935-9444 Fax 3tiU-3/9-448/
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP13-00104 Date Received: 09/06/13
Date Issued: 10/25/13
SITE ADDRESS: 308917 HWY 101
BRINNON, WA 98320 Date Expires: 01/25/14
APPLICANT: PLEASANT HARBOR MARINA& PHONE:
GOLF RESORT LLP
308913 US HIGHWAY 101
BRINNON WA 983209719
LEGAL DESCRIPTION: PLEASANT HARBOR MARINA SHORT PLAT LOT 2 &TL TAX B-4
PARCEL#: 502152012 Section: 15 Township: 25N Range: 02 W
DESIGNER: CRAIG PECK, P.E. PHONE: 253-200-4523
SYSTEM DESCRIPTION: PUMP CHAM TO COMM SYS
No. of Gallons per Day: Type of work: NEW
Drainfield Trench Septic Tank
Length: feet Width: feet Depth: inches Size: 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.
AMA,
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.: SEP13-00104
1.) This permit was issued to correct a violation of WAC 246-272A. The permit must be completed
within 90 days of the date of issuance.
2.) The applicant shall adhere to the monitoring requirements in the archaeological monitoring report
prepared by Cultural Resource Consultants, Inc (revision date March 27, 2012) and SHALL
ENSURE THATA PROFESSIONAL ARCHAEOLOGIST IS ONSITE FOR MONITORING OF ALL
APPLICABLE AREAS DURING GROUND DISTURBANCE.
3.) This system must be constructed by an installer certified by the Jefferson County Public Health
Department per state code WAC246-272A-0250.
4.) The pump must be placed into an ORENCO PB3072 pump vault.
5.) H - Existing Septic & Pump tanks shall be properly abandoned. They shall be pumped and filled
with clean fill. Documentation to be provided to Health Dept. prior to final.
6.) H - Pump vault must be 50' from the OHW of Pleasant Harbor. Confirm w/the designer for
location.
7.) H - AS PER WAC 246-272A AND 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
8.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
9.) 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.
10.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
11.) H -An asbuilt drawing and certification of completion by the designer is required prior to final
approval.
12.) 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.
13.) 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.
14.) 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.
15.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
16.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
17.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent.
SEP13-00104 Page 2 of 3
\\tidemark\data\forms\F SEP_Permitmod.rpt 10/25/2013
18.) 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.
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.
20.) This parcel is within a no shooting area per JCC 8.50.
21.) This project was reviewed and approved as a shoreline exemption under JCC 18.25.090(5).
SEP13-00104 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 10/25/2013
A . a
''n'VE=NTIONAL SYSTEM ASBUILT INSPECTION REPORT
INSTALLER C-- - ` -\C, PANEL# ®/-1--‘ `L®`+
Permit Owner I- it #
ABSORPTION w RE:
DRAINFIELD TRENCH TRENCH TANK #OF #GA `
LENGTH WIDTH DEPTH , BEDRMS DAY
P
Tank pIi, Shroud/
IF PUMP AND PUMP CHAMBER REQUIRED: Size Screen
Float Arrangement
High water float-distance to top of tank/emergency storage 44-i s,
Dose drawdown(#of inches) ,T1 S'I #Gallons/Dose
Timer/Dose Counter info Q-_() P �V:►(C'bv�� -
Pump Size/Manufacturer �o�'� � C"'1-1(;)
I CERTI IS ONSI W GE SYSTEM WAS INSTA LE AS DESIGNED, PER PLAN APPROVED ���li.���`3
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OPTIONS : WH101 - 74 LEVEL TROLS)
W R 101 - 74 LEVEL CONTROLS)
GRADE MIDST
SLOPE AWAY FROM 1-._
STATION . al4
GRADE """'".."."..." "'g`.EN GRADE
/11111111iiffigiV r
0 / M
,
35.4" r 1 0 38.6"
( mm)899 mm j l i ` il
COVER (. 1 1 (9 mm)
INVERT
OVER DEPTH
DISCH 0
DC1-* ill
" 11 •
SI 73.4"
�b�X /,I� i< � �� (1864 mm)
L.
A.)5) \3 ---1/4111 imi , ---1
33.5" C..* MI
(851 mm) Ill O M r
DISCH �! 1 33.5"
' s0. M (851 fNLET ii_ imiL _ mm)._......
FEMALE DISCHARGE: M/4 k 29.5'-----� 44' DWV PIPE (AMARD)
(749 mm)
�DuCtIO.
PGA�1S�pSP
5 COVW t° . •rStx
P 4
Pat.'
0 (III e
AD SGS 12/22/10 C
CONCRETE BALLAST MAY BE REQUIRED OR BY SGS DATE ISSUE SCALE
SEE INSTALLATION INSTRUCTIONS
FOR DETAILS eone
SEWER SYSTEMS
MODEL WH101-74 / WR101-74
NA0057PO4