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HomeMy WebLinkAboutSEP2014-00026 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Peter Geerlofs MAILING ADDRESS 5331 Flagler Rd. "A� Nordland,WA 98358 e 20la PHONE (360)301 - 1919 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 8 Township 29 Range 1 E PARCEL#921081010 Subdivision Name V.28 of Surveys, P.64) D ivision Block Lot(s) Site address/Directions to site 5323 Flagler Rd., Nordland SOURCE OF SEWAGE/USE TYPE OF WORK I WATER SOURCE Residential X New Tanks(s) only Private X Residential ADU Modification Public Commercial Expansion Community Upgrade Repair X SITE SIZE 3.2 acres SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area_ Yes#SEP04-00092 Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 240 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Drainfield Length N.A. ft. Trench/Bed Width N.A. ft. Trench/Bed Depth N.A. in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Glendon Biotin r M31 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 applicat will be sea-rately judged by the rules and laws in effect at that time. Li - J/ 11"/ Z/ 4945‘ Pr•p Owner Signature Date , ! FOR OFFICE USE ONLY �( 10; PARTIA 7 ASBUILT /� �7 FI 6 /27/ A PR V D y' �V119 INSP/PUMP TEST, I ( I f iLte.da It/ ALL HOLD)REQ. METU k IA v t,\),1/400-1- rQ "Octd (AO6t a /a a!1� c� l e Date i( 1 Fee ' 2.41 Rec# HIV--V-- Check# /CIP 9 Li Case#SEP /q"OOO Z�Q co``2- JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org Phone 3bU-38b-9444 Fax 36U-3/9-4461 ON—SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14-00026 Date Received: 02/27/14 SITE ADDRESS: 5323 FLAGLER RD Date Issued: 07/21/14 NORDLAND, WA 98358 Date Expires: 10/21/14 APPLICANT: J PETER GEERLOFS PHONE: GLENDA GEERLOFS 5331 FLAGLER RD NORDLAND WA 983589617 LEGAL DESCRIPTION: S8 T29 R1E TAX 15(ENLG)TL TAX F PARCEL#: 921081010 Section: 8 Township: 29N Range: 1E DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: GLENDON BIOFILTER-M31 No. of Gallons per Day: 240 Type of work: REP Drainfield Trench Septic Tank Length: feet Width: feet Depth: 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 Envir mental 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.: SEP14-00026 1.) This permit was issued to correct a violation of WAC 246-272A for a existing septic system that is not functioning correctly. The permit must be completed within 90 days of the date of issuance. 2.) H - THIS SEPTIC SYSTEM PERMIT REQUIRED A PERMIT FROM WA. DOT FOR CROSS„II1G A HWY. PERMIT/FRANCHISE # 30415 WAS ISSUED. �- IC FINAL APPROVAL FROM DOT OF THE CROSSING PERMIT IS REQUIRED PRIOR TO FINALI , �O/ APPROVAL OF THIS SEPTIC PERMIT. CONTACT WILLIAM WONCH @ 360-570-6746 ' �1J, � 3.) There are 2 water sewer crossings. Both must be certified by the designer and Both must beC atleast 18" below the water line ' 4.) Health Dept. required to observe pressure test with system designer when system fully �i Xbey installed/complete, 48 hours notice to be provided for scheduling. 5.) 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. 6.) 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. 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.) 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 246-272A 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 11.) Setbacks to existing well, 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 12.) Setback to surface waters- 50' required from tanks. 13.) Dry season installation required. 14.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 15.) 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. 16.) 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. 17.) This approval is for a Septic Tank replacement only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. SEP14-00026 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 7/21/2014 18.) The site plan as submitted with the Septic Tank Repair application on February 27, 2014 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated March 5, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 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 project reviewed and approved as a Shoreline Exemption under Jefferson County Shoreline Master Program Article 9(3)(A)(2). 21.) The site plan was reviewed by the Department of Community Development on 3/4/2014 and it was determined exempt from critical area review 18.22.270(6). No critical area review was required for the replacement of the existing septic tank. 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. 22.) 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. 23.) 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. SEP14-00026 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 7/21/2014 ' t JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING • Designer Mfeiee Permit# SEP /4 -Oat,2� Installer kEV/A/ , 77//V / sW' -D ox6-"ev477/vb Parcel # 2-/ Gam/ O/D Electrician Design Flow Z 4.=7 Property Owner P > Site Address S-32 3 l---4,44-4,E2 �D %Uo 1JL /✓[� w4 96i 35g Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles /N /y, rO,2 7'W-/o23; ZczyA'P «" , Fie,2 65-0-/4 Pump chamber (manufacturer, size r /t-//c'!L/ /¢ Screen(s)and/or Pump Shroud (type, location) Pvr-4PVrf4c9G7" 's'/dtc9$ e-is-/4- Were Tanks tested onsite for water tightness? Yes / No Panel Model /Q(.2,9W 2/2V 'P -S Timer Model 2,4W '2'X Pump 1 - Man./Model e"12- ,t-icc' P' .41)-Z.417J Flow Rate //, / gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Z I 77 5"( Float settings (above bottom of tank) /transducer settings Timer Functions: (above bottom of transducer) if On/off- G � On - q - Veto - $,cZ!' Off- /4f-t ./ 5/sic Alarm - /S, �l " Veto On - Storage Above High Water Alarm gal. Veto Off- /4/-r/N � Dose Counter Reading 51poS�,f VAS # gallons/dose /,&4' Elap. Time Meter Reading /p/,r/Af Pump Throttled? Yes / No Dose Drawdown (in inches) o. Oe Pump 2- Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) /transducer settings Timer Functions:. (above bottom of transducer) On/off- On - SEP 2 4 2014 Veto - Off- il ,J 3t' Alarm - 'Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) If additional pumps complete this info for each C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 10/29/13 page 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/Sch. /"P -r, Z'M PS/ Manifold Size/Sch. 0-/B-/¢ Orifice Diameter Lateral Size/Sch. Barrier Material Cover Material/Depth Residual Head (lat.# & ft. Head) • Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean? Yes / No If no, what action taken? Mound/Glendon Site Prep. 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 Other Aquaworx panel settings: SWarn at , ZBios at OA ,Autoclear set at Z!' doses min-sec. `C8,4c,/ '`G&-b P2/v2 7t7 /ivsP.EG.T/c:,,n.l 3<lif0/4 E-U ©/v 121SFi2 /{0/e.#r 7 f/'Re ,4A7 M1 & 5 7 l 34" 1:4;90 ; i ... . 9/f. Fa al- a v02 7-171 -• s p-76- 7`4,A/K .4 Po t-rp.G/./,/- R.E e .. SEP242014 Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner w/Th' /SEC i L> R.4W/A/G Date Tank/component Decommissioning Report Attached Q:) 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 (with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed (no backfill, except over transport pipes), and final inspection of the completed system(with exceptions as noted, if any). To the extent reveated by these periodic inspections,the system complies with all the conditions noted in the permit as approved by Jefferson County 2-21-14- (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 9-/S--i4- 5100110 Designer Signature Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 10/29/13 page 2 of 2 From: Peter Geerlofs geenofs@olympus.net Subject: Fwd:Septic System Final Documents Date: September 16,2014 at 11:10 AM • To: • RECEII/ D -2 On-Site Se . e Systems (C 246-272 WAG) SEP 4 2014 Reg for Waiver From e Regulations Jefferson COUnty • Environ .'".0,1 Health :,:,„ ( ,ft r r,by nal (1) 400,1e- 5331 Rd. 0 /4 : tItft / '04 r /,• N. . WA **8 - 9S1 s '1* .J)301-1, ' jr" "":"*;;*'2:4-W/ 44."'*••••'‘,.***-1, ••••'-i* *-• ";•. St1 /•/// PI*)Gosoort ' - "*"- • t- id, (M Pt ,, • 921 8,Ti, ,ft.11416 t, eras"Cceetty, e=lre, wA,c WAC Irernera (5) Aft swot to)• 272- e 10 foot earAraticei . . Oa* .;-.1 • (1) .. yIhend* • *itt*WWI` coflec .fitt •* ;on vAregy *.. .. aeon bbe 4.X (7) see from ' rW,frtt, t S•43* * 2„2014. z -zweritertit (8) ?ro-1-9-e-4 1 0/5c)‘szo '494. tAR cz3,4 Ne■,CX&S.,) p, ( I csv_ t_ FCA:w1**: (1rd • Typed Wearer (11) Gales A / /Class B I 3 CI .0- eat 00$ rra t 0. t1,4 „ Reel ? Yea No needea are- eft.p , Yea WAG OD.M e5ytem e. have :=Leett for their a***,,to p prt at -,•,., -4 P ...of by this the,epter WAG. Deeded 4Approvedie -.,,kjaat to it I 'A Ms. CM.'7. and Mq ‘■ •4•,,ItSki • ' Rt.• 41, 4 1.0.4, ""oz (73) 40FA dA Data IN• aosri'kaa) CREATIVE DESIGN SOLUTIONS, INC. IV" POST OFFICE BOX 2787,PORT ANGELES,WA 98362 Site/Soils Evaluations&Feasibility Reports III Sanitary Surveys Septic System Designs Construction Inspections&Certifications CDS (360)457-6353 (800)395-7296 FAX(360)457-6687 Email:mike @cds4you.com INC. September 2, 2014 SEP242014 Jefferson County Department of Community Development 3frc ' t 615 Sheridan Street :r vironmerta, belt Port Townsend, WA 98368 Subject: Attachment to Request for Waiver from State Regulations, Repair Septic System Proposal, Parcel Number 921081010, SEP14-00026 WAC Number: (4) 246-272A-0210(1) WAC Requirement: (5) 10 foot separation between pressurized water supply line and building sewer collection line / non-perforated distribution line. Waiver Sought: (6): Allow a perpendicular crossing of one pressure effluent transport line above a pressurized water supply line. Justification: (7) Construct crossing as follows: • Use 240 psi poly pipe for the pressure effluent transport pipe. • Case the pressure effluent transport pipe in 2 inch minimum Schedule 80 PVC from 10 feet East of the water line on the East side of Flagler Road to the West edge of Flagler Road. • Further case the Schedule 80 PVC casement in 4" ductile iron pipe from the East edge of Flagler Road to 10 feet East of the water line. • Install the bottom of the pressure effluent transport pipe 18 inches minimum above the top of the pressure water line. • Slope all casements to drain toward the West. • Seal the casings at the East end to keep sewage from leaking into the area around the water line. • Use compacted sand bedding/backfill at each end of the Schedule 80 PVC casings. Thank you for your consideration of this waiver. Sincerely, CREATIVE DESIGN SOLUTIONS, INC. Aft Michael S. Deeney Oct 51°10 `A Professional On-Site Wastewater `... MICHAEL S. DEENEY Treatment System Designer LICENSED DESIGNER License No. 5100110 EXPIRES 06/18/14r C:\Data\Wpw County&State Forms\DOH\Waiver\Attached Letters\Geerlofs,921081010,Waiver Letter Attachment.wpd p uD Board of Commissioners Jefferson County Barney Burke, District 1. Public Utility District Ken McMillen, District 2 Wayne G. King,District 3 September 10,2014 James G. Parker, Manager Jefferson County RECEIVED Department of Community Development 615 Sheridan Street SEP 2 4 2014 Port Townsend,WA 98368 Jeffersc,i ,—ounty Environmental Health Dear Sir/Madam: The purpose of this letter is to state that the PUD is satisfied with the work completed by Shold Excavating,Inc for 5323 Flagler Rd.,Nordland, WA 98358. This work was tied to SEP14-00026. The PUD has inspected the work certified at enclosure one. Work was coordinated with F'LTD staff,and PUD monitored the work. The PUD is satisfied that it net the required separations and conduit requirements. If you have any questions,please contact Erie Storey at 360 301 1799,or call me at 360 385 8340 es G.Par er,PE Manager Enclosure 1. Certification of Water/sewer crossing 2. Creative Design Solutions,Inc. letter, dtd 2 September 2014 3. Request for Waiver from state Regulations form PH(360)385-5800 FX(360)385-5945 230 Chin-mum RoadPP.O,Box 929,Port Hadlocic WA 98339 eustornerserviceatjeffpud.oru 310 Four Corners Road,Port Townsend,WA 98368 CERTIFICATION OF WATER/SEWER CROSSING RECEIVED Company Certifying Crossing: Shold Excavating, Inc. Phone: (360) 385 -0480 SEP 2 4 2014 Site Address: 5323 Flagler Rd., Nordland, WA 98358 :1otferS)rt c.conty Parcel Number: 921081010 Environmental Health Stream crossing as approved under SEP14-00026 I certify that the water/sewer crossing for the above described parcel was performed as follows: • 240 psi poly pipe was used for the pressure effluent transport pipe. • The pressure effluent transport pipe was cased with 2" Schedule 80 PVC from 10 feet East of the water line on the East side of Flagler Road to approximately 25 feet to the West of the West edge of Flagler Road. • The Schedule 80 PVC casement was further cased in 4" ductile iron pipe from the East edge of Flagler Road to 10 feet East of the water line. • The bottom of the ductile iron pipe was installed 24" above the top of the water line. • All casings were sloped to drain toward the West. • The casings were sealed at the East end with expanding spray foam to keep sewage from leaking into the area around the water line. • Compacted sand was placed at the West and East end of the Schedule 80 PVC casings. `` 711 fia Sef-F-3 -• 2oiq Signature Date Kett 14 M Ab/TT in Print Name C:Data}W*Cnnstric6an\CerlificationslWater-Sewer CrossingIGeedds 9214B10105GaeAofs,921081010,Cedi8catior of Water-Sewer Crossing.wpd r Check one: INSTALLATION START NOTIFICATION DATE SENT 1) I PRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT 8/5/14 This form shall be faxed or emailed ONE working day prior to starting construction OR a minimum of 48 hours prior to pressure/pump test Jefferson County Public Health - Environmental Health Dept. Phone: 360-385-9444 FAX: 360-379-4487 s _ EMAIL: septic @co.jefferson.wa.us ` PERMIT OWNER Peter Geerlofs AUG 05 2014 SITE LOCATION 5323 Flagler Rd., Nordlandl; , PARCEL NUMBER 921081010 SEP NUMBER 14-00026 INSTALLER Kevin Nutting, Shold Excavating CONTACT PHONE 360-385-0480 DATE FOR INSPECTION Will contact Randy Marx directly SYSTEM WILL REQUIRE PRESSURE TEST - YES X NO *The designer is required to complete a pre-cover inspection of all systems. Please contact the designer prior to beginning construction to schedule installation inspections and pre-construction meeting if required per the permit or designs specifications. Jefferson County Staff Only:: MONITORING AGREEMENT MAILED DATE/INITIALS PRESSURE TEST SCHEDULED ICS► �� jam, � y 4 5. 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