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HomeMy WebLinkAboutSEP2013-00127 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Shawn Tyson ''�ik+,+ MAILING ADDRESS PO Box 1288 / ,,,,Y+,� Kingston,WA 98346 si 4. u'+ PHONE ( 360 ') 271-1169 -`'�rcii o�rsut±ea"`'++'+ SYSTEM DESIGNER Suzanne Martin Designer Phone# (360)554-0224 LEGAL DESCRIPTION: Section 35 Township 28N Range I E PARCEL# 821 355 048 Subdivision Name Parcel 12(rev)v14 p157 Olympic Ridge est Division Block Lot(s) Site address/Directions to site 72 Fern Gully Place-Port Ludlow,WA 98365 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential ✓ _ New X Tank/s only ✓ Private Residential ADU Modification_ )< _ Public Commercial_ Expansion_ Community Upgrade, Repair SITE SIZE +/-136975sf SYSTEM TYPE , Repair-(tank) (drainfield) Previous Evaluation Conventional Designate RPsPrve Area Yes# SEP06-00084 Alternative Redesign No - _ SYSTEM DETAILS Number of Gallons/day 600 ex., Soil type (attach soil eval.) Application Rate __ qal./sq.ft./day Drainfield Length ft. Trench Width ft. Trench/Bed Depth - in. Septic Tank size 1500 min gal. Pump Chamber size 2000 gal. TYPE OF 1500 gallon Septic&2000 gallon Pump tank only , '1e) CE-j(i$4itn ST -t' D F By signing the application form, the applicant/owner attests that the information � 21, their knowledge. Any material falsehood or any omission of a material fact 1A___, .511application packet may result in this permit being null and void. I further agre County against all liabilities,judgments, court costs, reasonable attorney's fees E� D , ,nom,, L` , Jefferson County as a result of or in consequence of the granting of this permit. l� X '� n I further agree to provide access and right of entry to Jefferson County and its - U a 7L1�P purpose of application review and any required later inspections. Staffs aco applicant informs the County in writing at the time of the application that he o during regular business hours. Initial here if you require notification before entn (� t Appeal-A person aggrieved of a decision of the Health Officer may appeal. / i�/,;_ 1.�e,�,,,n �" /"(J writing within fifteen days after receiving written notice of the decision. /vl� //1�, r�` / / 1415 p 4 DISCLAIMER-This application is for an on-site sewage sy L �� ',_ - standards in effect on the date of application. This applicati a NOT assure you of any other County approvals. For exa Y Y h/ pp � ,�}Q- you will later obtain permission to build a permanent resident (O future application will be separately judged by the rules and lE "Mi Prope4 Owner Signature �,,n./ /IV Date -� FO OFFICE USE ONLY p p l, E f aMi PARTIAL a��t� + Vr ASBUILT ��y/ FIN 1,, 6/ AP VE Jv � �� � �T INSP/PUMP TES1i�� N l '67/q p,FJ'D l ' kb\ia'``4`� I0 4.� bl di4 ALL HOLD REQ.MET Or/1 A� � ,10(b14 ,1Q Date t(L 1 3 Fee 2-1 — Rec# / S-2 C' i Check# PI 0 Case#SEP I - ---O CI 1 Z1- ^d S.ttirgs\S',zann= Martin\My Docurie*i.- \"y documanr 7Ann..\mhh9^\T®££ar=on rom^ty\7°ffr^ forms\Suz\2008 SPA.DOC o JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org Phone 3bU-:3t3b-5444 t-ax 36U-3 I -4415/ ON—SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP13-00127 Date Received: 11/05/13 Date Issued: 01/24/14 SITE ADDRESS: 72 FERN GULLY PORT LUDLOW, WA 98365 Date Expires: 01/24/17 APPLICANT: SHAWN M TYSON PHONE: 360-271-1169 PO BOX 1288 KINGSTON WA 983461288 LEGAL DESCRIPTION: OLYMPIC RIDGE ESTATES PARCEL 12(REV) V14/P157 PARCEL#: 821355048 Section: 35 Township: 28N Range: 01 E DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224 SEPTICS BY SUZANNE PO BOX 125 CHIMACUM WA 98325 SYSTEM DESCRIPTION: SEP TANK/PUMP CHAM TO IND SYS No. of Gallons per Day: 600 Type of work: MOD Drainfield Trench Septic Tank Length: feet Width: feet Depth: inches Size: 1,500 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. Al4A, 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.: SEP13-00127 1.) H - The existing septic system must have all caps and lids secured for all tanks, D box, and drainfield ports. Required for final approval of this permit. 2.) H - The existing water spigot near the existing effluent clean-out must be moved and 10' maintained from any septic componet to any water component. 3.) Some type of energy/flow dispersion is required in the D box 4.) 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 5.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 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.) 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. 11.) 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. 12.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 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. SEP13-00127 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 1/24/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING Suzanne Martin 13-00127;+6& Designer Permit # SEP Installer Shawn Tyson (Homeowner) Parcel # 821 355 048 <QI Electrician Shawn Tyson(Homeowner) Design Flow 600gpd peak Property Owner Shawn Tyson Site Address 72 Fern Gully-Port Ludlow, WA 98365 Answer all questions or indicate NA DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) 1500 gal. Peninsula; Biotube outlet filter 6/9/14 Pump chamber (manufacturer, size) 2000 gallon Peninsula tank with shrouded pump 6/9/14 41.66 gallon/inch Screen(s)and/or Pump Shroud (type, location) Shroud around pump in pump tank 6/9/14 Were Tanks tested onsite for water tightness? © No Panel Model Infiltrator Timer Model Aquaworx 6/9/14 Pump 1 — Man./Model Liberty 280/B39623098 Flow Rate 20 qpm 6/16/14 Pump Location (i.e. garage, treatment unit, basement) in pump tank Float/transducer settings Inches Timer from bottom of tank- On/off - 20 in Functions: On =' 3 se min Veto - 31.2 in Off 32 sechr Alarm - 31.4 in Veto On 23 min Storage Above High Water Alarm 44-79a gal. Veto Off- 24 sec®hr Dose Counter Reading 0 Dose/1 2VDose # gallons/dose 10 - gal. Elap. Time Meter Reading 00:06:47 = min rs Pump Throttled? es No Dose Drawdown (in inches) 1/4 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- 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/ Noe' 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) 48 events; ID=05-08-2013; zb-09; biotube effluent filter Autoclear 2 doses; H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 j c a 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 <'4 ATU (manufacturer, model) n/a Alarm tested Yes / No 4' Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes/ No Drainfield Transport Pipe size, schd, diameter 2"pvc sch 40 Manifold size/schd n/a 6/9/14 Orifice size 4"perforated pipe previously installed Lateral Size/schd 4"previously install Barrier Material previous install Cover Material/Depth previous install Residual Head (lat.# & ft. Head) n/a The laterals/pods were balanced Yes / No Source/Manufacturer of Drainrock/Gravelless chambers previous install-infiltrator Quick 4 Drainrock Clean? Yes / No If no, what action taken? Chamber style system previous install Mound/Glendon Site Prep n/a Drainfield Length 249' previous install ft Width 3'prey. install ft Depth pre inst inches Caps for measuring residual head stored (location) n/a COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary .pump line from the installed pump tank to the existing system has been connected to the ex. septic system 24" from the inlet of the ex. 1250 gal septic tank that was previously installed. This was altered because the only 'plumbing that now enters this septic tank is the kitchen and additional baffling adds to the treatment of the •effluent. The pump line enters 24"from the inlet allowing for slowing of the effluent before it enters the septic tank's first compartment. Effluent pump is throttled and marked. eatth Department Inspection issues resolved Yes / No / NA If yes how? /V-,-2)1 0% `� i-i l,."t, ,. C e.1 -s *-;\\ . 1,1\t() `' `:k \4'x.4 x-,2„ ‘ ` " a .. X } v y'`\'..1 y'Y��y V\al,_ \?a-�`{'S`kl .k.' k Av 'S' 1-'fc--1"'. '1, Y 6. W %y t..X ''a.) ' v'''':+ \= S e ai Users Manual Provided to Homeowner ( / 5- ! Date a`�;') Tank/component Decommissioning Report Attached Y s / 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 by COUNTY (DATE) OR THAT CHANGES HAVE BEEN NOTED AND Alik#:TH E SY T M IS IN COMPLIANCE WITH WAG 246-2 72. �+ (' 5100342 ''''°'..,•.-44� e De igner Signature Date License # ...--4 5+"ox s Suzanne L Martin !, ow-. mans H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 \\:\\.0,0 St * =C' 0 6� 1- y a 67 = y 0 0 O CD 0- Q c0 m n O 7 n- Cl) .: ' m CO D 0 CD O y a r —• m A o II O / 1.i C c 1 r O a N o O C N O n co O -,-h < O \\\. C O N X 4X N a Cn 4. O 0 = CD tiIo ;; r1NkN N ,-r \\\\\\\\\\\\\\\\O 4 -I Cn Ccn -p O (0 C/) N C o ° 7 N 0' -1 N Q \x a CD (ten T. 0+ L I!; 1 a CD ^ \ C -CO CD # `\ N C� y, 7-1 r 'O =t X r------- r.@ CD ',. `\\ `\ c (n' CD 3 i 0 o \ O a o/+��' cr ` O i- w cl) /0^++ E `\\ `\ \`\ /OD n * X cr [D '` \ /n CD O I O ` Cn O ;' i C•O 3 a 0:\ (D [n O O ` ' \\ fD O o sp CD CD 4 �'. CT O a \XV \V O \\i ....e. , O O 0 0_• cn ,.r .\ O .00S)� . ,, 0 O 0 '0 9,' Q \\, ' 0�0 '`' CD O 7 CD (-D N ` OO ^ �` a) O' O a co =11 CP R.(0 CO N CD CD -0 O "O C a O. Cn -0 —. P- 5 0 ^� CD co CD m a m a su V co TI O r N 7 0 `a -' OU) (n2 s,, N `? pHiC . \ < ' D Check one: INSTALLATION START NOTIFICATION DATE SENT PRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT 16June2014 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 EMAIL: septic @co.jefferson.wa.us PERMIT OWNER _Shawn Tyson SITE LOCATION 72 Fern Gully-Port Ludlow PARCEL NUMBER 821 355 048 SEP NUMBER 1 - INSTALLER _Homeowner(Shawn Tyson) CONTACT PHONE 271-1169 DATE FOR INSPECTION SYSTEM WILL REQUIRE PRESSURE TEST - YES please 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:: \,), MO,NITQRING AGREEMENT MAILED DATE/INITIALS ICRESSURE TEST SCHEDULED ! \' I f r i d t \"»....,. t v I. 2 , Li l k \ tom ... _ 3.. _ `'""` 3(M r t -3,,,c1 C:\Users\shirleyr\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\TRGH7TWZ\Pressure Test Request SEP 1300127.docCreated on 6/10/2014 5:32:00 PM Page 2 of 3; Tyson; Parcel #821355048; 72 Fern Gully Pump Tank Detail Peninsula 2000 gallon Installed Riser _ pump tank; 41.66 gallons per inch "e "i: ."-1 4""zq,••::.".0t5,:r:T ii;`.-"1.wa.4t,'",,P4,4*Ns,.t.:...-1;..i''r.v Y_rPi:.l tia Y:i.5.'i:.,!:7,-411.h. . eV .*1;:.,,.Vi;?;.:e `'"• we ;.0.8 ,M , } The dimensions demonstrated in this illustration are examples. the transducer or %r.' ±"storage above high p requirements water;below inlet; • are: 450 gallons working volume&minimum pump tree ti additional storage above l. 450 gallons emergency storage above high ±; inlet water and below inlet of the pump tank. `e -±gal Recommend 600 gallons storage above high w. Veto set 12.2"from the water alarm. :S bottom of the bell-± {. tt 32.2"from tank bottom alarm set for±12"from ,r bottom of the bell 7. 51" 18.8"of storage above veto&below E: ±462 gal working volume invert of inlet of pump tank(±783 gal) min.450 gallons in this example. b on set 0.9"from bottom of the bell Must have minimum 2"between x; bottom of the bell and the top of the ±20"from bottom of tank shroud. to the bottom of the bell , ti� . .ye.rs`• ,'•'.,.e^F'i,1,;;;.....•.,..1-r4.• ' r'ts;.:.il•",.•... r"- . .,7,,,,vat,..;: ... ..,.'PN.,:'>i.., vT:.':Se,..g.-;1.. w.: S::. 13 I 1111'1 SEWAGE DISPOSAL DESIGN P 11:))jj\I\P(1----H 'i'l Approves for o traction 1 Oat- Ill 9 Page 3 of 3;Tyson; Parcel#821 355 048 cosi Effluent Pumps = e Incorporated I 1-800-348-9843 100 - 1 Effluent Pumps PEF;5 , PEF, PKP Series . 1 1/3 hp to 1-1/2 hp .� . . ._ tt1 1 `PEF 100 I J I I- 70 II 4.W f .wm = _� _ i 1 �1E -co . _ � as C3 y II; 1PEF O i J 30 - I 3 ..— effluent pump 15'of i j I head 10 I I 0 I 3501 PEF 3311 0 1115 gpm p 30 40 50 60 70 w4 90 Net Discharge,gpm NOW-PC-PEP-1 Rev.5.0,©9/04 Page 1 of 1 Page 1 of 3;Tyson; Tank Cross Section -Not To Scale parcel 821 355 048 (For illustrative purposes'only, actual tank configuration may vary,tanks must be on list of approved products.) SECURED LID WITH'GAS TIGHT SEAL ACCESS RISER FINISH GRADE t TO U ut CHion box FROM SEWAGE SOURCE FLOATING MAT APPROVED EFFLUENT FILTER SEDIMENTS maximum 3/16"filter / S Z. -' I POSAL DESIGN SEPTIC TANK ApprOVe4! Or ©t1 truGtit7t1 (TYPICAL) Date SECURED LID WITH GAS TIGHT SEAL THREADED UNION ACCESS RISER SERVICE FINISH GRA® VALVE di is►['_ FROM SEPTIC °'® I I ■ii PTO DRAINFIELD Li TANK Al II EMERGE Y STORAGE' , ANTI SIPHON VALVE" HIGH WATER ALARM LEVEL NORMAL TIMER OFF LEVEL WORKING VOLUM ENCLOSED P. il SEDIMENT SHR%UD - CHECK VALVE S'DIMENTS ® SUBMERSIBLE l' CENTRIFUGAL PUMP PUMP CHAMBER (TYPICAL}' AS NEEDED (..),...Si.......„...., , t , , , a 3 i , y , i , , t C1 N. \ 0. ; ° \ O 03 f • N. Q Q Q tt i-P., p o Q' —' y i W ` ( ° ` �� O N „ 1 fi; N ' rt (D O • N g � n < CP • .d K rt W ./ �e `♦♦! \...4.\,,‘ 4 1 . ca V \,,,,,ck, , p Q�. O -O • (p o°�m „o \\ "0 ®`w N rt \��If 7'C O O ` • ' ° .. ♦< 1+ ta N G3` \ ♦ ♦`♦♦ ♦♦♦ < G1 i *%a W O s I\ O ♦, ♦a O N D, CTI n n \ X A. 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