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HomeMy WebLinkAboutSEP2013-00009 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Melody Stone MAILING ADDRESS 516 N.Jefferson Ave. \04 s) Mason City, IA 50401 PHONE (641 )424-8344 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 13 Township 30 Range 2W PARCEL#940500051 Subdivision Name Cape George Village Division 3 Block Lot(s) 52 Site address/Directions to site 61 Cedar Dr., Port Townsend SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tanks(s) only Private Residential ADU Modification Public X Commercial Expansion Community Upgrade . I Repair X SITE SIZE 13,086 sq. ft. SYSTEM TYPE Previous Evaluation Partial Repair- (tank) (drainfield) Conventional Designate Reserve Area Yes #SEP90-508 dC�- 3_ Alternative X Redesign No SYSTEM DETAILS Gal./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 Biofilter 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 FOR OFFICE USE ONLY PARTIAL _ ASBUILT 11140 FINAL b irvoy APPROVED INSP/PUMP TEST 411 [13 PUD 16 /1_3 _ ALL HOLD R�Q. MET Nil ,' OK-5/1n`4 Date .,/,3 ) Fee �`� ' yec# `36'5 Check# J � Case#SEP —.43 C:\Data\Wpw\County&State Forms\Jefferson\Septic Permit Forms\Glendons\Stone 940500051.wpd COUNTY LI HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 wwwjeffe rson countyp ub lic hea tth.o rg one ..- : -. ax • ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP13-00009 Date Received: 01/25/13 Date Issued: 03/06/13 SITE ADDRESS: 61 CEDAR DR Date Expires: 06/06/13 PORT TOWNSEND, WA 98368 APPLICANT: JACOB F RODECK PHONE: AKA JACK RODECK TRUSTEE 516 N JEFFERSON AVE MASON CITY IA 504013152 LEGAL DESCRIPTION: CAPE GEORGE VILLAGE DIV 3 LOT 52 PARCEL#: 940500051 Section: 13 Township: 30N Range: 02 W 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 Enviro 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.: SEP13-00009 1.) H -3 wetseason monitoring ports must be installed as show. An application is required for a wetseason evaluation prior to 12/31/13. 2.) H - This system MAY not comply with the current On-Site Sewage code. A WETSEASON EVALUATION IS REQUIRED TO DETERMINE COMPLIANCE. If It does not meet the standards of WAC 246-272A for 12" of vertical separation then a copy of this permit and conditions will be recorded with the Jefferson County Auditor, and future developement and improvements will be severly limited on this property.. 3.) H -Existing water line to be re-routed 10' or more from new tanks. 4.) Curtain Drain required a minimum of 10' upgradient of primary and reserve drainfields. 5.) THe existing shed on the drainfield is to be removed. 6.) The existing drainfield may be encountered during installation. Contact the designer and the health department if the existing drainfield if exposed in the primary infiltrative area of the new system. Remove portion of existing drainfield below infiltrative area as per design. 7.) 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. 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.) 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. 10.) 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. 11.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 12.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 13.) 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 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.) Dry season installation required. 16.) 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. SEP13-00009 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 3/6/2013 17.) 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. 18.) Contact designer prior to installation for staking of drainfield area. 19.) 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. SEP13-00009 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 3/6/2013 ) 3 -005 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT 4 I For RECORD DRAWING Designer /"V %/s461.1_, Permit # SEP I �� Installer CV/'/N N,d G-7z .S'f-i✓OG D EXCs¢v-177t"6- Parcel # 94 Electrician Design Floyd Z 4'0 Property Owner ..'4Cc> Site Address '/ G'" "1:>,192 ate, , J ,feri AI .E rs� 64449 c2 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. iftc Tank (manufacturer, size, baffles) /4 z C', , 4jj�f �G �s °/G 7 �Z 0.- /`"t - Pump chamber (manufacturer, size) / 2c / Screen(s)and/or Pump Shroud (type, location) pUos-il� l'-4 ) 160/4-A001?-&• Were Tanks tested onsite for water tightness? Yes / No Panel Model AeP e-P/94''/ /PG —.SG Timer Model 1)114-2.01 --X e3-?/-/ 3 Pump 1 - Man./Model oREA/Ca Flow Rate ! 3.7 gpm B-Z/- i 3 Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank ZZ.62" Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off- c On - 7sg c Veto - 71 ,q " Off- /4 S 3s ee Alarm - 71 • 5 " Veto On - 7s EC Storage Above High Water Alarm 3z'/ gal. Veto Off- /44-1,/1/4" Dose Counter Reading 4 L''S-E5- ce, vt>os s # gallons/dose /. 6 Elap. Time Meter Reading /5frr w / /s4& Pump Throttled? Ye No Dose Drawdown (in inches) 0•O7 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 - Veto - Off- 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 05/10/13 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 _E /, • Transport Pipe Size/Sch. ���SC"; f -S ize/Sch. / SC/,S ite 8-2/-13 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 4O8 , Autoclear set at Z&' doses min-sec. *c34c F, (1) k/c,, 7-a tN Pk- T-fo.0/(moo rtz ' 7-/SzAlieS Health Department Inspection issues resolved Yes / No I NA If yes how? Users Manual Provided to Homeowner Virw 92Fec, 4(Au/wG Date Tank/component Decommissioning Report Attache Ye / No/ NA Installer Certification attached/signed Ye / 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 revealed by these periodic inspections,the system complies with all the conditions noted in the permit as approved by Jefferson County 3` /10—/3 (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 11, 0-24-13 5100110 Designer Signature Date License# Ai,C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 05/10/13 page 2 of 2 cnv 2) Q°q Z O ` �, . 0 -may 2N, no co Z... , 0 ° �a CA 17�7\ a 8�1 F� �� N CD m o r,rri W 2 cn A;m . o,�, .. + ° 1. 0 Z l7 - o o cY,O 3 m\ T !sue %////// a a u E N ,, OZ r \ 2 ,////// °o v° o o ° o o N D p �i m 6 L��/./ B o O o 0q w a 2 =�iNll/ (7.1 o ° am° 4 -' _ _ N 1d46'45'E 66.24 -' /N1d45'45E 0 mac) 23.68 • �� liii CEDAR DRIVE p - I__ a yk — y -AZT ,Tf ZOO° io _ EXISTING GRAVEL rn 1'� r-_- =-------- 0 DRIVEWAY r I _ "-0 1d4645` E _ 0_ _ 110.40 l OZgl M I 1 om�,, fi I CI-II_ _ /, G coNCR m -.0 o �`Q L �O x 0� ~vm i0��0 to Q: II!:!I z0m2 �viv4' 2�� m m 20 I moc) �'Im `/ o m"-oa � �iZo�0�o � 0 n 0m 0 m�z � Ok w2m....„1„ � yOya •'I ti nod .m + M� � ~ n m0m rn� y�°2�Cn O W cb oi -��; �m aw % 9) m0o 1w y Cr0 N oN 111 0 o � w# ^� m zo�cnzo r �o 2T o � caw 00�v, (n1tiz1 n m om 01 8 2 a i - �2 ' m I i� tm�mi aim °iw o= m , ,o � 41$1, � � ,p,-,z°I Oa oZ°�zz �� Op � Zy Bo Z Z �� Z m� � ����� o Ni J 2-0 C ° °� io y o��� Z m2NZ0� O � I p�� mo ' ° °nn~a o a- / \a = I m 2 3. b°m o 0/UI � ."""""""" 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Z° m a r�o � 3 v m �CT � caoz�oo o p m � I No V C �a2pw a a2-- 2 ° r�m a y� A)-0a 2 v�co v 0.)G" CO aAa�2e)i2 a �yp�DO�y2�O > a Q-O2I3rm02.'1: Z �cZi o`O m�avini;�Z20� `co A =te r Znypyo�^Zi"'��m vii ono cam! C mar � 4r cn <0) o`∎ 20 a220a2■ 0 NI 'ZA V/ rOr JEFFERSON COUNTY PUBLIC HEALTH NS�I,r(h 'CC" 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org May 6,2014 JACOB RODECK MELODY STONE 516 N JEFFERSON AVE MASON CITY, IA. 50401-3152 Re: WET SEASON EVALUATION OTH13-29, 61 Cedar St. Dear Jacob & Melody: This office completed wet season evaluations during the winter of 2013-2014 at the above referenced property. The results conclude that your septic system permitted under SEP13-00009 is in compliance w/the current on-site sewage code. A copy of the finaled permit is enclosed. If you have further questions please contact this office at 385-9402. Sincerely #4/ Randy Marx Environmental Health Specialist cc Mike Deeney. COMMUNITY HEALTH ENVIRONMENTAL HEALTH PUBLIC DEVELOPMENTAL DISABILITIES WATER QUALITY N MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFES AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER CO UNITY FAX: (360) 379-4487 ""' c ' Jefferson County Permit Center Fee: $ /41 • v b 621 Sheridan St., Port Townsend WA 98368 Receipt No 14U - (O 360-379-4450 Date: l 2 I1,l L 3 9,/ 0TH j-- 2,9 WET SEASON EVALUATION APPLICATION APPLICANT NAME: //'/ 14:2P 4,--' jr-ON� MAILING ADDRESS: 5/!o IV. 3EFFWRSOn/ /9 ./M/fsOi/ C/?` -', .2-. SG4 '/ PHONE: 44/- 474 - 8344. LEGAL DESCRIPTION: Section / 3 Township 30 Range 7w PARCEL NO: q7 4'0 'S`00 0$'/ Subdivision Name Division Block Lot(s) SITE LOCATION/ADDRESS: 61 G'E"D�2 1:12,j P007- Te,W./StA/!?, W.4 9151ZE,a Address of Adjacent Property SEWAGE DISPOSAL PERMIT ISSUED: Yes No SEP 13 - oODOg This evaluation does not constitute a guarantee of approval of an on-sit- -ewage disposal permit. — Signature re>2 Ave - shsivZ. Date: 2''1 1 ,y, S Hole 1: 3 7 "5 a 28' arn Hole 5: Hole 9: Hole 2:2k -"-� 1-.Q- 70 Hole 6: Hole 10: Hole 3: X34--2- . Z. Hole 7: Hole 11: Hole 4: Hole 8: Hole 12: Comments: 9Axi -7( Date: Z Hole 1: a Z �� 5 Hole 5: .. Hole 9: Hole 2: ZO 6 - 6 lg" Hole 6: Hole 10: Hole 3: i-12,3 @ ,93-)-z-+9 i Hole 7: Hole 11: Hole 4: Hole 8: Hole 12: Comments: Date: 4J /Li. Hole 1: . Hole 5: Hole 9: Hole 2: � 3C Hole 6: Hole 10: Hole 3: 1. 3 Hole 7: Hole 11: Hole 4: l Hole 8: Hole 12: Comments: C:\Data\Wpw\County Forms\Jefferson\WetSeason(rcv'd 1-6-04).wpd Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Melody Stone MAILING ADDRESS 516 N.Jefferson Ave. Mason City, IA 60401 PHONE (641 )424-8344 SYSTEM DESIGNER: Michael S.Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 13 Township 30 Range 2W PARCEL#940500051.._ Subdivision Name Cape George Village Division 3 Block Lot(s) 52 Site address/Directions to site 61 Cedar Dr.,Port Townsend SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tanks(s)only Private Residential ADU Modification Public X Commercial Expansion Community Upgrade Repair X SITE SIZE 13,086 sq. ft. SYSTEM TYPE Partial Repair-(tank) (grainfield) Previous Evaluation Conventional Designate Reserve Area Yes #SEP90-508 Alternative X Redesign No SYSTEM DETAILS Gal./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 Biofilter 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. _ ///0 2 0 Property Owner Signature Date � 1 ASBUILT 111 5/13 FINAL olialaw F OR OFFICE USE ONLY ARTIAL APPROV D �` INSP/PUMP TEST 4-i, 1t3 PUD i2 ALL HOLD R MET !V / ✓l o1 - 1D Date Fee f Rec# / /D Check# f I Case#SEP C:1Data1Wpw\County&State FormsUefferson\Septic Permit Forms\Glendons\Stone 940500051.wpd