HomeMy WebLinkAboutSEP2004-00185 c '
07/13/04 08:17 FAX 3603855910 SEPTIC SENSE 102
JeTrerson County Department of Community Development F v I- r r-
621 Sheridan St., Port Townsend WA 98368, (360) 379'.4L
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SEPTIC PERMIT APPLICATION P.
PROPERTY OWNER _ILO— al- 4 t e j"'.
MAILING ADDRESS /41' D. d X nir
PHONE Area Code ( 3 6 O ) 7 7 9-7S Yo2 K 7/0 0 glee J 3753 b of om.
SYSTEM DESIGNER e)7
LEGAL DESCRIPTION: Section 02-6:, Township ot9eVRange Df E. PARCEL# Sal 6 '"e,, ,
Subdivision Name (,t)A-/-,i CpUC 71:2106 Division Block Lot(s) al„
SITE LOCATION f ! O F - Zip Code 9e3()5
SOURCE OF SEWAGE: Residential ✓ Residential ADU Commercial Community
TYPE OF WORK: New�k____ Redesign Upgrade Repair Partial (tank) (drainfield)
Expansion _ Designate Reserve Area
Conventional )( _ Alternative_ Drainfield Length /5c) ft. Trench Width 3 ft.
Number of Gallons/day 36.o Trench/Bed Depth A(Jpr,20 in. Number of Lines
Site Size 02. • 1 S a re< Septic Tank size /000 gal. Pump Chamber size_ gal.
Water Source: private public t� Soil type _ 3 (ATTACH SOIL EVAL.)
Previous eval / no. SEP,49u.ed Application Rate ,g gal./sq.ft,/day
TYPE OF SYSTEM CO j3 f)7N77(11,1A1
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 coats,
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 it's employees, representatives or agents
for the purpose of application review and any required later inspections. Access and right of entry to the
applicant's property or structure shall be requested and shall occur during regular business hours.
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. T
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 rug:- and laws in effect at that time.
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i( FOR OFFICE USE ONLY �^ ,�C —
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IMPERMEABLE MATERIAL/
SEASONAL SATURATION
A. Trench Depth 020 inches
B. (p inches of drainrock below pipe
C. >,5& y inches of vertical separation from trench bottom to impermeable
material/seasonal saturation
D. /OM inches of fill (if needed)
E. Trench width .56 inches
NOTES:
ATTACH DETAILED DESIGN OF SYSTEM
ONSITE SEWAGE DISPOSAL
SYSTEM DESIGN
Date 7/30/61/
Property Owner ‘II AA i9 ( Litk'
System Designer 5 tt c ,5--e/056-
Legal Description: Section Township Range tw/- 6.5-o33
Subcliv%ion Game Division Block Lot(s)
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I. CALCULATIONS
If for residential use:
Number of Bedrooms: 3 x 120 G.P.D. _ 8rQO total G.P.D.
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate ,?3" G.P.D./ft. squared
(see page 214 of the EPA Design Manual)
DRAINFIELD SIZING:
Absorption area: /S� square feet (total G.P.D. ;G.P.D./ft. squared)
Trench or bed width .3 feet
Trench or bed length /5c) lineal feet (sq. ft. :trench or bed width)
II. APPURTENANCES
Septic Tank Size MOO gallons
Pump Requirements (If Necessary) 4)74
Elevation difference in feet
Friction loss
Pump capacity should be G.P.M. at T.D.H.
Number of doses per day
Dosing volume gallons
Pump chamber size gallons r re
L JUL 30
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H:\home\pincntr\infohlth\sewd sn
-AAPR 6-2M05 11 :21 AM SHOLD. EXCAVTING. INC. 360 379 6892 P. 02
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CONVENTIONAL SYSTEM A$BUILT INSPECTION REPORT
INSTALLER, 4 4/ a+Ga da TW PARCEL# 1/ 6503
Permit Owner ►es ts eY permit 00/2S
DRAINFIELD r TRENCH ' ogEr H z' � STANK/ #4F 11 AL/
LENGTH ISD
Tank w, SIB BEDRM;3 DAY_
IF PUMP AND PUMP CHAMBER REQUIRED: Size /"fti Shroud/
Float Arrangement
High water float-distance to top of tanklemergency..storage
Dose drawdown (#of Inches) tt Ga 1Ions/0ose
Timer/Dose Counter Info
Pump Size!Manufacturer •�
I CERTIFY THIS ONSITE SEWAU SYS AS INSTALLED AS DESIGNED, PER PLAN..—..... -- .— ___
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SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 (800) 831-2678
PERMIT #: SEP04-00185 Date Received: 08/02/04
SITE ADDRESS: ALPINE CT Date Issued: 08/19/04
PORT LUDLOW, WA 98365 Date Expires: 08/19/07
APPLICANT: JAMES R LE CUYER PHONE: (360)779-7592 (OFFICE)
JODY A LE CUYER
PO BOX 56
KINGSTON WA 98346
SUBDIVISION: WHITE ROCK COVE TRACTS DIV II BLOCK: LOT: TR21+
PARCEL#: 821265033 Section: 26 Township: 28N Range: 01 E
DESIGNER: JANET WELCH, RS PHONE: (360)385-5910
SEPTIC SENSE
PO BOX 1221
PORT HADLOCK WA 98339
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.
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 s tems, codified 8.15 amended per ordinance no. 08-0921-00. This
permit may not be renewed.
L ATKI S, Jefferson County Environmental Health Specialist
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.
HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION.
SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH
No. of Gallons per Day: 360 Type of work: NEW
Drainfield Trench Septic Tank
Length: 150 feet Width: 3 feet Depth: 20 inches Size: 1,000 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST. PORT TOWNSEND WA 98368 360 379-4450
SOIL EVALUATION
PROPERTY OWNER (.Pr(-ci fee
SYSTEM DESIGNER S-EP t,., gENA,,
LEGAL DESCRIPTION: Section Township Range Parcel # g /..c;(5-O,?i,3
Subdivision Name Division Block Lot(s)
Date Logged: 7g/e Q y Logged By:
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' to ,30 in.i�'"$" C.J/e ,.� (� toxin./9/(f
II Ito__ in./nS � rte' 5b to in./C
a� )
to in i° stiooaaa ' / to in.
�Q JANET .44LcH
to in (..:r • . ; 0. .► to in
EXP!1 ES 12/12
Anticipated water table>gJ in. Anticipated water table,V in.
Roots to 7 inches - Roots to (() inches
Health Dept. Comments' S C'ksz, Health Dept. Comments
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SOIL LOG #3 SOIL LOG #4
0 to in. S +'0,- 6 to 02V in. -I G/,e
34 to(06 in. 4/5- 7` > ztvK Or to in. 6 wv/7
to in. 5o to (/ in. /17c
to in. to in.
Anticipated water tabled) in. Anticipated water table> i3 in.
Roots to &.) inches Roots to Su inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #5 SOIL LOG #6
to in. to in.
to in. to in.
to in. to in.
to in. to in.
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:\INFOHLTH1SOIL.FRM 1/00
CONDITIONS OF APPROVAL - PERMIT NO.: SEP04-00185
1.) 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.
2.) As per Jefferson County Code 8.15 all onsite sewage systems require monitoring.
Monitoring shall be provided by an approved entity. THIS SYSTEM IS REQUIRED TO BE
INSPECTED EVERY 3 YEARS..
3.) An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
4.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from
tanks and effluent transport lines.
5.) 10'separation required between a Water line and all portions of the onsite sewage
system; effluent transport line, tanks, treatment and disposal components.
6.) A 30' setback shall be maintained from the disposal component and reserve area to any
downslope footing, curtain or interceptor drain or drainage ditch.
7.) All components of the septic system are to be completely protected from vehicular traffic
or mechanical disturbance.
8.) Permanent barriers are required along/around primary and reserve drainfield areas to
protect from parking, driving, and other land disturbing activities prior to final.
9.) Drainlines are to be installed along the natural contours.
10.) Divert all sources of drainage, including roof drains away from septic tank and drainfield
area.
11.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent.
12.) Risers are required to grade with secured lids over both compartments and over the
outlet of the septic tank for inspection and maintenance/monitoring. Minimum 20" riser
over inlet.
13.) Distribution boxes shall be fitted with a riser to grade, constructed of durable materials and
a secured lid, adequately sized to allow visible inspection of the liquid level in the box.
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.) 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.
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.) The application was reviewed by the Jefferson County staff for the potential presence of
Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development
Code (UDC). After an initial Geographic Information Systems mapping review and an
investigative site inspection, the following ESAs were confirmed to be present on the
subject property:Critical Aquifer Recharge Area.
2 of 2
11/22/19
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