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HomeMy WebLinkAboutSEP2013-00055 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Alec Jensen MAILING ADDRESS 2525 SW Mossy Brae Rd. West Linn,OR 97068 " ` PHONE (503)789-0837 SYSTEM DESIGNER: Michael S.Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 8 Township 29 Range 1W PARCEL#974600008 Subdivision Name Mountain View Vista,V.8 Long Plats P.43 Division Block Lot(s) 8 Site address/Directions to site 353 Malamute Lane, Port Townsend SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New X Tanks(s)only Private X Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 7.71 acres SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes#SEP08-00149 Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 480 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 1,250 gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Glendon Biofilter 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 application will be separately judged by the rules and laws in effect at that time. 2hA, 2013 Property over Signature Date FOR OFFICE USE ONLY II e)A�Q/i44 .�i� �a t/ PARTIAL ASBUILT� FIN. / 4219—A D / 16 INSP/PUMP TEi Ala_6-1 wo s 1 IT ALL HOLD REQ. MET Date° `�� Fee Rec • _ '„ Check# TL� Case#SEP C:\Data\Wpw\County&State Forms\Jefferson\Septic Permit Forms\GlendonsWensen 974600008.wpd JEFFERSON TY PUBLIC HEALTH 615 Sheridan Street*Port Townsend*Washington *98368 wwwjeffe rson countyp ub lic hea itho rg Phone *•- ; - ax *e=3/9-44th__ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP13-00055 Date Received: 05/02/13 SITE ADDRESS: 353 MALAMUTE LN Date Issued: 06/20/13 PORT TOWNSEND, WA 98368 Date Expires: 06/20/16 APPLICANT: ALEC M JENSEN PHONE: LESLIE A JENSEN 2525 SW MOSSY BRAE RD WEST LINN OR 970689353 LEGAL DESCRIPTION: MOUNTAIN VIEW VISTA LOT 8 SUBJ/EASEMENTS PARCEL#: 974600008 Section: 8 Township: 29N Range: 01 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: 480 Type of work: NEW Drainfield Trench Septic Tank Length: feet Width: feet Depth: inches Size: 1,250 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 nvironmental 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' ± t EE ADDITIONAL PAGES CONDITIONS OF APPROVAL - PERMIT NO.: SEP13-00055 1.) NOTE STEEP SLOPE REQUIREMENTS FOR GLENDON PODS.. 2.) Dry season installation required. 3.) Septic tank and pump chamber to be water tight. Extra protection (i.e. Bentonite) to be used around inlet, outlet, and risers due to high water table. 4.) Contact designer prior to installation for staking of drainfield area. 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.) 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 TeTHE 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.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) 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. 11.) 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. 12.) All construction and development activities must comply with all permit conditions, Washington State and Jefferson County Codes and Recomnier q d Standards and Guidance documents in effect when the permit is issued. 13.) Divert all sources of drainage, including roof drairis,away from septic tank and drainfield area 14.) Site plan dated May 22, 2013 is consistent with Mountain View Vista Plat. This parcel was created through Mountain View Vista Plat under AFN 498362 recorded 6-18-2005, Volume 18, pages 38 thru 45 with the Jefferson County Auditor's office. 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.) Any future permits on this site are subject to review for consistency with applicable code and ordinances and does not preclude review and condition which may be placed on future permits. SEP13-00055 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 6/20/2013 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT f E " For RECORD DRAWING 2014 Designer t-T/C/f :-- Permit # SEP 13-000 SS Installer M"4.sP i/thrG`ite/a /7- 2, m., ,,"// , Parcel # 974. &"CJ oO8 Electrician Design Flow 4 Property Owner AG Site Address 35 3 A'7,stL,4.4-reir LAZ , Pe3Pr Taw/vSElJi L' if 9a 368 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) /6,6e96,94 Pump chamber (manufacturer, size) /000 a.*rz._ Go-ZS-/¢ Screen(s)and/or Pump Shroud (type, location) e.))/./it V/ULT- WAriore/Bz Were Tanks tested onsite for water tightness?6-eD No Panel Model il ' '4(A/c9, Timer Model /fGP t9/9 W®'> 6-Z5---/4-- Pump 1 - Man./Model p4 CO ):;A"146 t s Z1 Flow Rate /8-, gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank 2Z,e<< Float settings (above bottom of tank) /transducer settings Timer Functions: (above bottom of transducer) On/off- On - Z 1 S� Veto - z z.8 Off- Alarm - 2 2.B Veto On - //s�o Storage Above High Water Alarm gal. Veto Off- /¢'-f' / Q-qts�� Dose Counter-Reading c6 zw5e 4-¢,vzxst # gallons/dose 3 .3 Elap. Time Meter Reading //Aim/ b`53-gz Pump Throttled? IC/ No Dose Drawdown (in inches) O / 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 10/29/13 page 1 of 2 Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No 1, A „ r .d Sandfilter Basin size/location (; -t Out Sand Fill met design spec? Yes / No ATU (manufacturer, model) Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield n FEE1>'.? * , Transport Pipe Size/Sch. / �c ff, Mid Size/Sch. / SGE1,4e, 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 Aguaworx panel settings: SWarn at , ZBios at Ibe ,Autoclear set at 1 5 doses min-sec. Health Department Inspection issues resolved Yes / No JIf yes how? Users Manual Provided to Homeowner w/7-h9 .t'ecePle.b bled (ev//"/6 Date Tank/component Decommissioning Report Attached Yes / No / aw/ve.e Iasr Certification attached/signed 45,0 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 Co'2c'—/3 (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. /4.4# /0—/7`7 5100110 Designer Signatur 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 CERTIFICATION OF WATER/SEWER LINE CROSSING Individual Certifying Crossing: Alec Jensen Phone: (506) 789 - 0837 Site Address: 353 Malamute Lane, Port Townsend, WA 98368 Parcel Number: 974600008 Crossing as required in SEP13-00055 I certify that the water/sewer crossing for the above described parcel was performed as follows: Where the 4" PVC gravity sewage transport pipe (GSTP)from the proposed future residence (see Record Drawing), the GSTP was installed at a 90° angle to the water line at 18 inches minimum below the water line (18 inches minimum from bottom of water line to top of GSTP)for a distance of 10 feet on each side of the water line. Additionally, the water line was cased with electrical conduit for a distance of 15 feet on each side of the water/sewer crossing. //AV% Y Signature g Dat AL >_`c- J Yk. A' $C. Print Name C:\Data\Wpw\Constructjon\Certifications\Water-Sewer Crossing\Homeowner Install\Jensen,974600008,Water-Sewer Crossing.wpd in 0 xi 0oo F'!' * Vf `.o , . p M o cm�5= �qIyV F 0 2 r \ a �{ F�.% 4 4 '4 4 4 4 • \4. gk-1 i N ��f`(AAAAA 04--y 4 4 4 4 4 4 4 \ C3 (/) -0 O�v •f-�� 4 4 +� 4 4 4 4 •() 6,OD OHO• Vii; \ • E 4 4 f F F \I''ff11 �: / 4 4 4 4 4 F rn■O �3 Z •.• y,illl/1// E 4 4 4 4 4 _' 4 4 4 4 4 4 • 4 E CC 2 m `S. 0-1;"41011121. I 4 4 ZO 4 • 4 • 4 . 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