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HomeMy WebLinkAboutSEP2013-00090 av or 111 Jefferson County Deparbnent of Community Development / , $ 621 Sheridan St,Port Townsend WA 98368,(360)379-4450 i,1. ov wn. ,,n. 1� SEPTIC PERMIT APPLICATION r •.•-• , I, 0,44-PROPERTY OWNER St k.f IS r Lo ' t ��1 MAILING ADDRESS t..934-4-us ia. B.FRNT•PAi I12ERICSEN".All r3 "t el_ ' / .1 i ' 9 ,q - Li( isiSEti bE IGNEti.. {F -����∎`�����..f, PHONE - ( i 4f? ) 3$ - 45 40 R s o2tur _ if SYSTEMDESWNER Erl'e.-Sea i)eSijn Designer Phone# 3�a®"e3f�t-(33ay- -�,-i LEGAL DESCRIPTION: Section '1 Township 3t M Range I IA! PARCEL• 001011014 Subdivision Name Division Block Lots) Site address/Directions to site I Q I S i 1 V e.i. berry "Pt. JUL 2 9 2013 SOURCE OF SEWAGERISE TYPE OF WORK WATER SOURCE Residential IQ New $. Tanks only _ Private )( Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 4 *titres SYSTEM TYPE Partial Repair-(tank) (drainfietd) Previous Evaluation Conventional Designate Reserve Area Yes# Alternative X Redesign No X SYSTEM DETAILS Number of Gallons/day 0240 Soil type 4 (attach soil eval.) Application Rate r5 be . . 4, gal/sq.ft/day Drainfield Length ill+ ft. Trench Width 3 ft. TrenchBed Depth I g in. Septic Tank size I POO gal. Pump Chamber size 1 000 gal. TYPE of system Fre-SSuril ct fediCA v:5—@,tp 1� - (� (tests that the information provided herein is true and correct to the best of by sZo""�- N-0 J CW\ (S 1 S Y1rl and void.a reemttosave, indemn and hold loss Jef a an ag 6\,... }}.� rsonable attorney's fees and expenses which may in any way accrue against .?. .i.,,' �-c.Ur t�Q (�` e U F G\ s granting of this permit 1 Jefferson County and its employees,representatives or agents for the sole (4\('S _ `1Q L'U -"\Arul inspections. Staff's access and right of entry wii# be assumed unless the the application that he or she requires prior notice. Inspections shall occur L. notification before entry 1�- � Pir'Y1 Ith Officer may appeal.Appeals shall be submitted to the Health Division in ` -k 0 \NS eQette,k hf( e decision. • 11 )n-site sewage system that meets the state and county. ii- SQ-A 1 �-6� C� ion. This application for an onsite sewage system DOES iC1OC *royals. For example, it DOES NOT GUARANTEE that 1 1 cb ermanent residence or other structure on this parcel. Any ( 1 • j ,.}� w �, by the rules and laws in effect at that time. r� - d • ' s 1 .. 7.76'7 .o« _ _-.-__, _._.._ .7.4ature _ Data .),,d) /OA /,. Ile�c{-, amUSAoareY ��nn , (�/ I/� I PAR I f ASBUILT'``�� �g1 7 Ft l 5 APPROVED /INSP/PUMP TEST , t �PUB /� Q 1 i I�fç1 ALL HOLDEQ.MET ' ' i.. ! /10 6'L( ii(A a�iTT l6/17 R.; z z d( / Date Fee ReC# Si Iei C Case SEP H:\WEB\PDFs\Septic\septicyermitapp_2008. C/ �� ^ ''''' 'r7.-A-6 ,p� . C / I`J �l J�1 '/,.V J LSD[ �, �SUNF CfJ JEFFERSON COUNTY PUBLIC HEALTH WSJ{f;t1n. 615 Sheridan Street •Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org Ffione 36U-3bb-9444 1-ax 3bO-;i/9-44tf/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP13-00090 Date Received: 07/29/13 Date Issued: 10/11/13 SITE ADDRESS: 191 SILVER BERRY PL Date Expires: 01/11/14 PORT TOWNSEND, WA 98368 APPLICANT: STANISLAW LORECKI PHONE: 360-385-9566 300 LOFTUS RD PORT TOWNSEND WA 983689054 LEGAL DESCRIPTION: S7 T3ON R1W E1/2 NE SE NE PARCEL#: 001071014 Section: 7 Township: 30N Range: 01 W DESIGNER: BERNT ERICSEN PHONE: 360-301-0324 293 PINECREST DRIVE PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: PRESSURIZED TRENCH No. of Gallons per Day: 240 Type of work: NEW Drainfield Trench Septic Tank Length: 144 feet Width: 3 feet Depth: 18 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-Si ewage Systems, codified in JCC 8.15 as amended. This permit may not be renewed. 110471-- 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 Dec 10 13 10:58a Ericsen Design 360-379-5344 p.1 INSTALLATION START NOTIFICATION DATE SENT CPF4E.SSURE TEST NOTIFICATION �f DATE SENT 1 4 i L i3 This form shall be faxed or emailed ONE working day prior to starting construction Jefferson County Public Health -Environmental Health Dept. Phone: 360-385-9444 FAX: 360-379-4487 EMAIL: septic@co.jefferson.wa.us PERMIT OWNER .S'-"LI!.Ili, Cliyj L o e.k IA SITE LOCATION I ei 1 6 i 1 vex- ia r e -Pk- PARCEL NUMBER OC) en 1 0 SEP NUMBER — 0 �` y INSTALLER M . , _ ` t\ ' O ACT PHONE 3 too-Z.01-6 3a 44 DATE FOR INSPECTION BSc t' 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 _ • . ( v\ 10 12Dt )( ?_> PRESSURE TEST SCHEDULED (1-:d Y\IVIL ifkg- cx/A je--Q1CL: 1#\045,14. fipt7A3Z,2 CONDITIONS OF APPROVAL - PERMIT NO.: SEP13-00090 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.) 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. 3.) This permit was issued to correct a violation of WAC 246-272A. The permit must be completed within 90 days of the date of issuance. 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.) An anti-siphon device may be required if the elevation at the drainfield is lower than the pump chamber and siphoning is noted. 6.) H - Permanent barriers are required along/around primary and reserve drainfield areas to protect from parking, driving, and other land disturbing activities prior to final. 7.) MAXIMUM TRENCH DEPTH 18 INCHES 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.) 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. 10.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 11.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 12.) 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. 13.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 14.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 15.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required and must comply with code at the time of application for use. 16.) A 30' setback shall be maintained from the disposal component and reserve area to any downslope footing, curtain or interceptor drain or drainage ditch. 17.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. 18.) Drainlines are to be installed along the natural contours. SEP13-00090 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 10/11/2013 19.) Contact designer prior to installation for staking of drainfield area. 20.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 21.) Pump chamber shall be water tight and a minimum capacity of 1000 gallons. It shall be equipped with a control panel outside within line of sight of the pump chamber. The panel shall have an audio and visual alarm, a cycle counter and a riser to grade. It shall be UL listed and meet L&I requirements. 22.) A screen shall be provided either at the outlet of the septic tank or around the pump or at both locations. A pump shroud is required if only an outlet baffle filter is used. 23.) Dose counter and elapsed time meter are required in the control panel for all system components. 24.) 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. 25.) 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. 26.) 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. 27.) 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. SEP13-00090 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 10/11/2013 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING Designer ER t C .3 N 'E5 ( C- I\I Permit# SEP ) 3 'Q Installer OW V)E E ( H AR l`( 1 ZjItEr K i)Parcel# ON t 01 i C) 1 T Electrician 'I Design Flow 248 C-?Ft) Property Owner S TAO\S LAW J Ifi E C_K I Site Address 1 q t S I L EZ SERR'( Pb. Answer all questions or indicate NA DATE Tanks. Pumps and Controls INSP. Tank (manufacturer, size, baffles) S ho I d C t o o O C a.Q. (16144 ) I l-ri 13 Pump chamber(manufacturer, size) bi '` ', Screen(s)and/or Pump Shroud (type, location) • . ►' • II A ,,. ._ `� (tom# ld- ba le_-Ti(t-ear l'n S , Tankk. ( u-C Jfe. EFL+) Were Tanks tested onsite for water tightness? Ye 1 No I I-5-13 Panel Model AQUA \}J CR . SM: IPCS . -I5 " 3341 Ia.- t - 13 Pump 1 - Man./Model Li bet j J Flow Rate 25 opm `' Pump Location (i.e. garage, treatment unit, basement) Plj .m e TiLVI k Float/transducer settings Inches Timer from bottom of tank- On/off- c2 a. in. Functions: On t, (Z fmin/Sec_ Veto- 3 4 in. Off- .234.6 se a,hr Alarm - 3 6 in. Veto On- l', 3h fmin S&.. Storage Above High Water Alarm .qs:2 gal. Veto Off- 24O sec/ 42 r Dose Counter Reading O #gallons/dose 3r) gal. Elap. Time Meter Reading 3 min/hrs Pump Throttled? C5/ No Dose Drawdown (in inches) {% in. (f1 y n I U{A a.) La -e.raJ a Pump 2 - Man./Model Flow Rate qpm Pump Location(Le. 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/No 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) Z- ' = 1 ' . r. ` A s _. : i b62, High L. = 14,0 I \J a= i .. ( ,1 H:IWEBIONSITE1Asbuilt_Report_Form.doc 04I28/10page 1 of 2 > 1 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 I No ATU (manufacturer; model) Alarm tested Yes I No Disinfection Unit(manufacturer, type, model) Independent Alarm Yes/No Drainfield Transport Pipe size, schd, diameter "Sat 4D Manifold size/schd . $G } � l i-' 13 Lateral Size/schd I 4 " It Orifice size 8' Barrier Material Ate u 4;Iis!, Cover Material/Depth " 1,4- I, -13 Residual Head (lat.#&ft. Head) 7 a-6A 4P —l~rrp of e e.G� U The laterals/pods were balanced es / No n I� Source/Manufacturer of DrainrocklGravelless chambers C-6-1-1-811 Drainrock Clean? Cam'/ No If no, what action taken? Mound/Glendon Site Prep Drainfield Length 144 ft Width .3 ft Depth 4o-1$ inches Caps for measuring residual head stored (location) i h rl+rd I -Pam COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary S 11`184i111 eJL r-_ desuin b 3 Yii-o r Health Department Inspection issues resolved /No! NA If yes how? -Ertl 11 Se4 r&igek 'tf &)f-e,ien ?U m Ir'ow' C.a u Arc )�© r Users Manual Provided to Homeowner M ARTY LOT?r Ck I Date IA-13-13 Tank/component Decommissioning Report Attached Yes/ No/ NA Installer Certification attached/signed No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer CERTITY T9fE INFORMATION PROVIDED ABOVE WAS VERI)=IEED BY INSPECTION, Tiff SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED byJE)ERSON couNTY to JI+/l (DATE) OR ThA r C#f t NC,ES IAV€BEEN NOTED AND "ME SYSTEM IN COMPLIANCE WIT# WAC 246-272. 4 0, .11, 44.A/ ' 1 Q- t 3 -i 3 5106.251 Designer Signature Date License# H:1WEBM©NSITE\Asbuilt_Report Form.doC 04/28/10page 2 of 2 .W099 0 o l 1 T' O } N m 8 m _® -.ma Ij W Q E W O CL a)omc=i� � a eg o w 0 ce > o Z c H N - F- i j O r - W Q N W ` c ....1 Ot� iDViV � � oa — a. r OtoLoLo , ON0 @ W Q fn Ear ,_ e- �- Q) O J v CO I=1 II II II II 11 II II � Q NUOWOOWLL W Q a ��� 0 0 O O O O O Q J O t �' � QQQmmmm Z W C ■ Z J 5 i' W Q Q LL CO O J �� tit fn fA d0• -) O/ i i N. b la 5(' O / N. \// zo i c / / a) \ / 0 0 / / °' / o �v \ o / rn o c \ �/ v a J / Y fn co / �9s1 / i �� _° °p5T�1 I L ,� co I p om t 154 o i U 0 i9 S — t /' NI N/ , \ \ / / Ni � ,/, 1 ` Q \ I X X < O �3/5\ CO \\ / N. I CO CU --I -� O (NI / 1 /C p \ OO 7 /•1 \ > /� ■ \\ � � // o 11 M N / 1 \ / °o v '"� + , i 13.80�lpol N M rn ebb 0£9 ,.�` / — _ -- i ,� �. . '" LCI 0 0 0 �:1��'yy W G W ` 4• -4 ..A .g- :Or — .- z• 5. ',` ��t J3 1 \t-Z t b'a N in co I • • l • 00 o0 -Ir` �X ° 0° � zm ■ —1 3 m — Z W \ N o D 0 �, N A > m 1 co \\ m r 0 \ '-km T. Dm I \ s c `', m X I I / ' \ ` Z • 0 m 1 \ m w < N \ x r r r' m N w I \\ y 01 = C 0 13 °x°- x x i \ o m 3 D o w ca ca 1 m I \ ' —I m Z = \ m N co ro G) \ W 0 0) 7 N at \` / S < O \ O O < 1 18' 00 \ m 8' N W u, ca . ism N2 n 1 1 Ng t � 1 1 1 ®1x 1 0 ® r\`.. I 0 = 4I z: s ' "� i ‘,. I 4t. = Q I 7,0410c 1S6`I •4 P s A _ 0 1 0'rfr m / ❑ i'% : '� / a � 0 o� i \ / / a , o0 ' a 0 / o—O O ' � � ///\\ I I ;, ask / o. .::2 0 P / = g / / d o / // J / illit / F' CP / F..., Check one: INSTALLATION START NOTIFICATION DATE SENT .... ` '" ti I I PRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT This form shall be faxed or emailed ONE working day prior to starring construction OR a minimum of 48 hours prior to pressure/pump test Jefferson County Public Health-Environmental Health Dept. Phone: 360-385-9444 FAX: 360-3794487 EMAIL: septic .jefferson.wa.us PERMIT OWNER , J c :,.. ` ..�.S ..c c ..° `... SITE LOCATION `\` '.` c PARCEL NUMBER Nc) c\Q SEP NUMBER i s.°-c.. O` INSTALLER C''k.. c ale �'"-C, %- ,CONTACT PHONE, %Q.\- DATE FOR INSPECTION SYSTEM WILL REQUIRE PRESSURE TEST - YES NO *The designer is required tx 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':: /0/'>1 /1 1 MONITORING AGREEMENT MAILED DATE/INITIALS PRESSURE TEST SCHEDULED �. x ■� t Lo — t _. t F nk l y{ t .®� c— D E mil- t.' ,ks r r ._.I "y i Y Y ., ,... +a �(z. r .i t 0 - SE', ',GE DISPOSAL DESIGN 4 A,. , ;■ '. for Construction I Date Stanislaw Lorecki • wn j.: ++, 001071014j,' ` ` `r ;,` P. +/ Project Description: ; 5100259 BERNT PAUL ERICSEN..`�1+ • •« BM DE t NER + Install new 2 bedroom pressurized septic system. OA Install Septic Tank: It-11- Install two compartment mono-pour concrete equipped with water and airtight un vented risers to grade. Tank shall be water tight. Fill tank with water after placement, to be observed by Designer. Septic tank is to be 1000 gallons. Tank to be set on 6" of pea gravel. An outlet baffle filter is required in the septic tank. Screen size to be 1/16".Use Tuf - Tite EF - 4. Pump Tank: Pump tank shall be mono-pour concrete equipped with water and airtight un vented riser to grade. Tank shall be water tight. Fill tank with water after placement, to be observed by Designer. Tank to be 1000 gallons. Tank to be set on 6" of pea gravel. Control Panel The control panel is to be mounted outside, within site of the pump chamber on a post or on a wall of the residence. Use an Aquaworx Panel and transducer. Pump Need pump capable of 22.4 GPM @ 17.1 TDH. Orenco PF 2005 or equivalent. Pump to be installed inside a shroud. Transport Line Approximately 50' of 2" SCH 40 ending with 2" long sweep 90 in valve box to grade. Use 2" tees with 2" x 1" bushings and 1" gate valves for each lateral. Install risers to grade over valves. Drainfield Trench depth 18". Trench bottom el.= 94.65 ( Bench Mark= Top of Well Head= 100' ) . SE VACE DISPOSAL DESIGN A ,, d for Const tion [V See detail page for trench and inspection port details. Laterals 1 - 3, 48' (16- 118th inch orifices, 3' on center @ 12 o'clock ) 1" SCH 40. All laterals end with long sweep 90, with screw on caps inside valve boxes to grade. Enclose additional caps with 1/8 " orifice inside baggie in valve box. IA IA (4 it rn 1. G rfS The first and last orifices shall be approximately 18" from the beginning and end of each lateral. Install orifice shields after pressure test. Cover with filter fabric before backfilling. Install inspection port to trench bottom 10' from beginning of each lateral as shown on trench detail page. Dose 30 gallons, 6 times per day ( 180 gpd ) 75% of peak. 5' min. residual head required. Misc. Contractor to contact designer prior to construction to set up pre-construction meeting, and inspection schedule. Contractor to flush laterals prior to contacting designer for pressure test. General Construction Notes 1. The work described herein consists of construction of an on-site wastewater system. 2. The contractor shall be knowledgeable and experienced in the construction of this type of wastewater system and shall hold a valid certificate from Jefferson County Division of Environmental Health. 3. If during the installation of the system the contractor finds soil conditions that may lead to premature failure of the system, construction shall be terminated immediately and the designer notified. Such soil conditions may include groundwater, fill, clay, highly compacted soil, bedrock or excessively permeable soils. a. Any inconsistencies, errors, or omissions that, in the opinion of the 2 SEWAGE DISPOSAL DESIGN v d for Construction f r, Date installer, would compromise the quality of the wastewater system shall be reported to the designer prior to construction. 4. Transport pipe and laterals shall be Schedule 40 PVC, unless otherwise stated in design, solvent welded joints. All fittings shall be Schedule 40. All transport pipe in traffic areas shall be Schedule 40. Backfill in traffic areas shall be pitrun gravel and compacted. All gravity pipe shall conform to ASTM D 3034. All gravity and transport pipe shall be bedded, using native or imported material free of rocks, debris and sharp objects. Double case in traffic areas with 6" ASTM D 3034. 5. All exposed soil shall be seeded and mulched prior to the final inspection. Seed shall be spread at an approximate rate of 10 lbs. per 5,000 sq. ft. 6. The installer shall be responsible for constructing the system according to plans and conditions of permit and shall be responsible for its proper operation and function for one year. The owner shall be responsible for operating and maintaining the wastewater system in accordance with WAC 246-272A-15501. 7. Any changes, substitutions, or deviation from these plans shall be approved by the designer and by the Jefferson County Environmental Health Department. 8. The installer shall grade to divert all surface water runoff away from tanks and drainfieldfreserve areas. 9. The bottom of the trench or bed may be inspected by the designer prior to placing sand fill or drain rock and shall not exceed +1- Y2" from level. 10. Notify designer 48 hrs. prior to pressure test, after permanent power has been connected to panel and L. and 1. inspection complete. Any deletions from plans, or necessary adjustments, shall be completed by installer. 11. Setbacks to all known water lines shall be a minimum of 10'. No crossing of water lines with any septic component shall be allowed, except as included in septic design approved by Jefferson County Health Department. 12. Setback from the building foundation wall shall be 10' minimum to 3 I 4 drainfield, 5' minimum to tanks and 2' minimum to non-perforated sewer pipes. 13. Setback from property lines, easements lines, and driveways shall be a minimum of 5', for both drainfield and reserve areas. 14. Water saving appliances, fixtures, and practices are to be used. 15. The septic and pump tanks, drainfield and reserve areas are to be protected from vehicular traffic or mechanical disturbance. 16. The installer is to verify pump requirements at the time of installation. 17. The designer is to provide the as-built and letter of certification. 18. This system has been designed in accordance with WAC 246-272 A and the most current Department of Health "Recommended Standards and Guidelines for Pressure Distribution Systems," and has been approved by the Jefferson County Health Department. Nevertheless, negligence or improper action on the part of the users could result in the premature failure or malfunction of the system or its components. c_rW ,GE DISPOSAL L DE T:IG 1 Q for Con, tr r-r, 4 . . , 330.68 o • N 88°57'53"E --\ /FILE NAME Stanislaw Lorecki.TRV SCALE DATE DRAWN BY 80 Ft/In 4-26-2012 Bemt Ericsen JOB REVISION SHEET \_ 001071014 1/1 1/1 1 This map drawn with TRAVERSE PC,Software 0 80' NM MI NE MI SEWAGE DISP SAL DEIGN 1\ A,DPro ':::c1 for onstructon OP IC Ii - tC:3 ill 4 1, , or 4 f, V ,4J13 Aiv sr. f .40;' .. 0, xi:ov wAL:11....,14111,it ;4- E0 pir;• `,- .. i' St w' /I _ lij <5 ..- 0 i' • I % s ,t. pi CI 7,t .• SA Ci CO CO ,- I. . -5100259 • ,A, co 9 z sr. BERNr P AUL EMMEN- S z l a,. ED i. - .,„?., NO building site, driveway, access or other appurtenance has been reviewed or approved by Jefferson County staff. . A4 N., -44 100'well '- ' I r 30.00' Well 1---i 1 (--b,,,,,,,,,,,A, Lit) le3 to (kf'ose v , kz., Q,47 v ; NI°4108"E A i c oiAocre- kG .4\ce S 88°58'03"W • i 1 • N 88°58'03"E --- 30.00' • S 1°11108-W S 88°58'03-W -^,..„........ Ai sc kiv,,,,i( -1-0 11-617sa4 -til-A:,etc() . (,) ,Ii 011113 . 317'O99. . 44)I q r 01 P \ s c N. CO U r i •• � I w r w .�---D v 'z Om cord �� , nj, o� w '*�aiui w UH 6 > 3 '`,a' m—i '' �A • . i w Q io o n r . ‘��Vt 0 co Ce ° J a O m Lt.Q LU Q d. E III. T N II z co m _ - 1- /I Z _J O , W Q Q V' m , driveway,`�/ ,,-' cO U) - ° buiidin site, bilve Yay, access °r° ,' > 6r appa�t rice has been ' o reviewed or approvedby .- // Jefferson County stoLt' \ / -.I \// , to,`/ / M Z \ / m N. / m a Iii 0 d / / i tom \ i o� U) 1 / ° \ r og ° / t II r (� -c r O— s- { a i m ( 151' of 1 / in , \ m 2_ / _.._.o' ,8 .8 \ o \ m ° / ea 1 O -: \ \\ a�ai // CD 1 X X ° ii 0 §__/ \ , _ _auO / 1 dc' 'd' X J \ i 1.' Q / i ..! J (0 \ _ (p 1 .1J ° \ N 7 N / ` \ '- a b co el ' I T po 13..80.61'.1*N i i / co i i to 3.17-0£9 — —-- p O 0 b W Oz O co co O Fr Ap gaQv '' for cyns /'u€cton ® �` . . , . . . , Lomat 06 101 1 0)4 ----- - P #14P TANK DETAii (N75) .2 COMPARTMENT SEPTIC TANK DETAIL (NTS) ()----.:: - '3.... — ..._...: -ffisErm. 7.0 si,,RFACE _ z '1/4...'''''''''''N..,,,, 'Y i' ,ii ri f'f a li -(5)i. 114,f-:-) 1.4sAresitotti 4 i . -"-- \ 'I la ' 1-",!ni Srigerait. ' IN I , Ci.....TAPiali , .i ,-‘ I , • , ..,,. 1 F 2 IP Igo 64,16,44t4 v 11 - 1 4 , t i 1 -1t.-.! 46 iikivignt vouwee i I i , r-----, 5 1 li t. zi ,,,e---- W71.87 1 1 ,-- !I -,"--- PY.4,- .-e II. -..t, 3 , * I etr "- -- CL _ .v,-----_ __ _______., ,, 1 # 1---4 i Li :. t; _ a ., 1 1 , I__ II 1 i 1 1 1%1 4 s.q P. a .''' li 11 ti • i f I H i 1 i 1 i Iri. ,.,s e-c E-4----r. 1 4 het, 3 / 1 .3 k - . z ',,-,1-3--. ,,,, ti u - A k" ' A Al - CZ/ n 3 r 1.-.1 h„.....1.... rd" ‘ E- - t t , 4: 1 t.,t- t i t i1....---_,..., -,---,-- .:2 - i I r...-- -..-z--'1,1-1-- 1- ...a-'..- -." - .t._"t-'," ) 2 t I 1 i 1 - eli PUMP I i l'"'„,) lisidilamil *) - PVC.: cr-rc;--, VALI-e' 14.!-- . .e. -4= PVC :UNION 4 1 (5) -- At-',".1O SALL VALUE' j il 1 1 I- (g) r- FVO TRANSPORT LINE (7) it‘t.-Int-g1.7.3.C3 -!: TRANSDUCCR Cal; SPAJCE SOX —20 t9) 2.r.i- Z-1!-E. Fe - Ottelf.tir.rt i-SEN Sii.--Ctfl -W- MTH L af'D r •CAT ST ?1,1 ..a.S• - 74 ' - `7- cf. s... il----, FL ..., ,..a4,, ere- ,.,..,-.-----e-,,...,v....., F.0) €1.,: - aga,74- d AM_ 2 9 2.01 _ with -Ormce in end 'For 1,-6,0,04- b.f. preSSUre t - eSting ....,- --.... _ so 1 • 1 -., i _ . ‘ 1 ov. • i .0: ... .. -... I - r or ...*-. \di iiir— Gri fi ce shields 0!..!•• . -. 4 . A iJaCITILL 41 Ilr ,' I # ...-- ..; t .,1 471 .., Av .. sr or . * VA 0, ...4' #1a. '---k.. .:,.z.---- :-#7-37-tr1/4.74i171 P *-:,,, #,,/...,, ., ...? s, ..., z • 0 X.e.\\-?,.--s.:N.e\N"--,.'..I•i i ke,--visKs\-...,,:-,;,\\<::5;::- 1 tgav ,Yr 1 . Of W 0 . 5100259 *- # - ...# 0 ik --A4.55 Alel- ) <.:7Z-. .,::_11,33,920N:_ F----a or.. BERN!'PAUL ERICSEN% 4 ,,_— Lateral 0954 ,...;,‘ V.11:3: 00:i.: lapta:=t-Ji,E,3099,,... ne,..,..crams=„54,s—Em. ‘,...........m.............,,,,,,,,,..„'Fr A''..,` ''''', ‘4,01 00',.' Pa 7*-1 (...1'''''''.... ------,. 7-0-- F.....K4 -..., Ler, \<?4,',114CR. "` .t..-0?0 --4\------ . .5riggr-=ow —, ;‘7----- ---- -- if—/ .........___ . , . ...* - ,,,,i1".; P ..1 [.! si V e 13.c ,..., ., ,---1,..---„.-. , --,-,rf3 r,... kg • 12.11J.:, „I .-.••:_--.... :\i't• cf2-2 Y.. e • - ------.•;":' •-,..)-r.,-"Vc,. 4- - 4.334.-.3.3.-; , 3,332-j:41•;-... ,„„...;-...-;:....3• .„.„ r.s.-.7:,In- .1....,,i -.4 ,* , - '?'' %1 :,----'1,.V.:C4,:i'''Z-.,•`.4: .,,'2%1 _ It7",'::-.r.„7- 1 zs lk .t.:-;!•fr-- -.:- '-- - -Jr- ti:c.c.:: -- :11..41 itp...u.L 1 --':ef--_-.3.41t:'4.1.4-'4 :::"•4t..5., ----' —lyre .. .-;-,7-:.2--.2,,f 0--• ,—. ..316,-3.3.3.....,3,,• 3i "'NC 4'3'1 11 , f .0(,... ro•, - •- .1.1 ... . ... . •4 1 4 ,,,, 1 (1) CD 0) — 34, e•3 sr, L : -X ca Ai i 4-2 0 LI— C.) 1.— • . ..,-I • A --1, 171 1- I g do . N.) tgt C.4-• ,..".1 4,1 i 1 2 P--,,, .., . 1 t. -.• ° J.? .... ...1.1. 34 1 ‘s ts to . I:3 sels es cc 7.X. v.. -14 -° -I- ..., 4 ..t .-- 0 .. u - — 1.... 4 \*. "4 B ,.. .. .... ... C;731,V6,1-r.7 11.... ..1.J..4 +..,3t r,...4 r 1('....f• ,• N.*,V:.-.•- . 1.2 Ca4"4 i i i ...4A9.....1-` e2 t .1 v3• % LC -32 vs) ..-& ...... \`11 a , . ....,4 . , d P al cf, 4 -sc - •-t %711, t r 1.-I ' .K. 334 ---i .t.-4.... = - ''') ---• i... vs, ck....i • ,-0 -t t't• -II .4., .......4. c.f. Pump Selection for a Pressurized System -Single Family Residence Project Lorecki Parameters ,I » Discharge Assembly Size 2.00 inches 350 LPFEJ11111 IIIMIII MI1111111111M1111111111111110111101514111 Transport Pipe C 50 feet .. ' 1111111111111111111111111111111 111 Transport Pipe Class 40 Transport Line Size 2.00 inches 111ii1 11111111111111u. Distributing Valve Model None 111 � 1111111111111111111111111111111111111 Max Elevation Lift 10 feet 300.l11=11 11au111111111111111u Manifold Length 20 feet 1111 1�fl 111111,11 11 111 Manifold Pipe Class 20 11 ��1�11 ��■���MIEN Manifold Pipe Size 3.00 inches 1111 .�111� Number of Laterals per Cell 3 Lateral Length 48 feet �111���MIIIIIIIIIIIIIII Lateral Pipe Class 40 250 u11 11i �u Lateral Pipe Size 1.00 inches 111=111111 11111/ 1111111111 Orifice Size 1/8 inches rl 1111111111111111111011111111■ 111111111 Orifice Spacing 3 feet v 1111 uuuu.IIII111 11/111 Residual Head 5 feet Z G 1 1111111111111111111111111111111011 Flow Meter None inches f— 200.■ 111111111M11111111 1111 Add-on'Friction Losses 0 feet mar- ..M luu.11111111111 IIIII1Eql 1111 1 111111/111111111111a11111u11111 Calculations �, AU11N11111l1111ll111v Minimum Flow Rate per Orifice 0.43 gpm a 150 ��11111/1111111�,u11 Number of Orifices per Zone 51 l � ll Total Flow Rate per Zone 22.4 gpm G 111111/ �fI1'.1 ,1 .1 Number of Laterals per Zone 3 ■f III °k Flow Differential 1st/Last Orifice 5.1 % F 1111�1111� 1 •11 111111111111111111bu111/11 ■ Transport Verity 2.1 fps � 100■1111 1111111111111 111111 Ilia Frictional Head Losses 1111111111111111111111111111111111111111111111■ l 1lUMW MON Loss through Discharge 1.0 feet - 11111111111l��1 Loss in Transport 0.5 feet 11■1111111 111111111 MIN IIIIIMIIII 1MININ IMILIIII Loss in Manifold old 0.1 feet 50 111111111111111111111111111111 111 1 Loss in Manifold 0.1 feet 11111111MR 111 111 Loss in Laterals 0.6 feet Loss through Flowmeter 0.0 feet 11/1111111111111111MS=OMNI Add-on'Friction Losses 0.0 feet 1111/1/1//111111111 11 lllll ii♦i♦♦♦s mo a p_s_mel iv=-iismim On Pipe Volumes 0 Vol of Transport Line 8.7 gals 0 5 10 15 20 25 30 Vol of Manifold 3.5 gals Net Discharge(gpm) Vol of Laterals per Zone 6.5 gals Total Volume 18.7 gals Minimum Pump Requirements PumpData Legend Design Flow Rate 22.4 gpm PF2005 High Head Effluent Pump System Curve: Total Dynamic Head 17.1 feet 20 GPM,1/2HP 115/23)V 10 60Hz,2004/3060Hz Pump Curve: PF2010 High Head Effluent Pump Pump Optimal Range 20 GPM,1HP 230V 10 601-1z,2001/3060Hz Operating Point PF2015 High Head Effluent Pump Design Point �( 20 GPM,1-1/2HP s �/ 4, 2301/1 fe3 60Hz 2001/30 60Hz �•• do• O Q" • Ark. ov wn•v�� '. f+• Oresco Systems' ► i 1 Incorporated 004'•:• e. / .,,, ; Cl ell.%the Way tlrc d I a ab ld Does Wa° \ eacare / .. 5100259 rip.: BERNT PAUL ERICSEN'. ,I .i IC NSED DE I NER' 1 EXP' S rr 11/ 4.-i-7-1;L , 1 , JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 SHERIDAN ST.,PORT TOWNSEND .WA 98368,(360) 379-4450 - . - 1 .c., 4,...., . SOIL EVALUATION & j -, , itiL 2 9 2013 PROPERTY OWNER 5+4A15 I av- Lore-c-< SYSTEM DESIGNER Ert.c..„5e4-1 .1)esiej 0 LEGAL DESCRIPTION: Section 1 Township 30&) Range iljj Parcel # 00107W I if Subdivision Name Division Block Lot(s) Date Logged: 4-013- 1 a Logged By: -13 e.,-'1+ E rise Include son textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or iiripenneable layers occur. - 1 ,, ' I / i 2 SOIL LOG #1 SOIL LOG #2 I to 16 in. Taok - titt,. G. T 4 a to 7 i& to 3,2_ in. &Oa-a/4 -AU.. -S- " to 3(, in. L. f'-est..s. 1 6ritAka T 314 ..,.. i\01; to 461 in- Ceivie44.4441 I-6. Ai 1 in to 54 in. t. r—mete. . r ci , . .....- .4 t to in. , -44e %.;14 174 to 60 in. comrid t...s. . ,j .T •-• tt ,. , Is Anticipated water table .3:), in. r ,-).. • Anticipated water table 54 in. t/J-D 4P0 irk . , i.,t.:0, Roots to 3 2 inches 40,„1; :5',- - .irffio Roots to 4 inches -.0,... .. • Health Dept. Comments //Az.' •. • Health flppprt. Comments •. ' '51®2t9RiCSE14.4 Ir Wt.IP – ‘t.. i '.› .. .' til go ri, BERNrPAUL %. ta j__c5 ,,=1.be .. Nek•* , SOIL LOG #3 4ima. +401.....Naviooloimovq.v.SOIL LOG #4 • 6-.... I, no, 0 to 4 in &r. . .L., it..2.7-14 _6 to 3 in. by, (...S. L to ag in. L,-c,6 t Clect,va -1:4 ,) to ig in. Tan Las. T If to 614 in. 6atittiiii .(-old. T 3 ig to II-6 in. 6rtyci1 ii C6e.. to in lio to > in. Plate _ Anticipated water table 54 in. 14 2.0 6.4" Anticipated water table 40 in. Roots to il.q inches , ' Roots to 40 inches Health Dept. Comments Health dept. Comments f i, SOIL LOG #5 SOIL LOG #6 0 to it in. eir. , j.L. 6 to q in. 6.r, £2_ _.... 4 to j1 in. 1 /) L.-r-Md. S T:4 ti to 32 in. L., 4: 5, . IL to .24 in. Ta4 --r-mezi. .c, 1"3/4 3,2_ to 40 in.1.0_v_act . c:c, att. to 43 in. 601,Ve41 C . g . T i. 140 to `>• in. 14.1._0 Anticipated water table 43 in- H az 4.3 Anticipated water table in. Roots to 3 1,,, inches Roots to 3 I inches Health Dept. Comments Health Dept. Comments HAINFOHLTI-INSOIL.FRIA1/00 . — r 9 f ONSITE SEWAGE DISPOSAL SYSTEM DESIGN COI p 7 1014 Date ' _.2.3 102 Property Owner ,r-art t S 111, r LOY ea l System Designer en Legal Description: Section 1 Township 30 Range 11, Subdivision Name Division Block Lot(s) I. CALCULATIONS If for residential use: Number of Bedrooms: a- x 120 G.P.D. _ X46 total G.P.D. If for non-residential use, attach calculations used to determine G.P.D. Soil texture waste water application rate .56, G.P.D./ft. squared (see page 214 of the EPA Design Manual) DRAINFIELD SIZING: Absorption area: 432_ square feet (total G.P.D. + G.P.D./ft. squared) Trench or bed width 3 feet Trench or bed length /q.L} lineal feet (sq. ft. .trench or bed width) II. APPURTENANCES ,)0 1111.` Septic Tank Size 100Q gallons Pump Requirements (If Necessary) Elevation difference in feet 10 Friction loss o24 Pump capacity should be 0.4 G.P.M. at 17. 1 T.D.H. Number of doses per day (o Dosing volume 30 gallons Pump chamber size 1000 gallons ar 11 or . 11 i iv 0-WA ',A ec 5100259 if H:!homelpincntrlinfohhh\sewdsn . 4/� ' BERNT PAUL ERICSEN'- 11• 4--/7- f1 #I#. DRAINFIELD CROSS SECTION ///:// f Rik. NATIVE SOIL A C SE.A..SCNAL Sri. ..T-,.x; A. Trench Depth ($ inches 5. inches of drainrock below pipe C. VI inches of vertical separation from trench bottom to impermeable material/seasonal saturation D. C> (, inches of fill (if needed) E. Trench width 36 inches NOTES: ATTACH DETAILED DESIGN OF SYSTEM Vol I P9 00 +1 r11 Survey of a portion NEI/4, Sec. 7, Twp. 30 N., Rng. I W, W.M. Jefferson County, Washington A 4 M TNJS SNRYEY/5 BASED o.►THE WrsNW61 V LESEND ti STATE 000RD V.47F SYSTEM 62241,6'4RTN 2o.YE. t 5EAR/.Yvs ARE REL 47' rb SAlO•817D.,272.7" • =SET 1z`�REBAR W'lR CAP +MARKED "F/SCNER .2/449" T 03 DJSTANLES SNOWN ARE N 210021 r9 GROtLYO •=CALCULATED PRbnERTY CDRNER,,20E✓T/F/EO 8Y LETTER DiSTANGES WNJCX ARE/000.758 0c w/TN A FOUND J"CONDO/r W/TX CROWN ZFLL,ERB.V ' U 6R/D D/STANCES, BRASS CAP,PER PAGE 75 OF VOLUME 4 DA-SURVEYS w,Ty w TNF FOtLOW/NB RElATIONSN/PS TO TWE C4LCOLATED CORKERS% Z y i9"- /_OS.yoRry .9.60 O'/EAST Ot CAL C.CDR. 1g'-O.oS 500751, AND 0-15 EAST " " " 1C"-0.15$aorN .48e, a43 EAST " 'i x °D'-036 jDD1 AMD 0.21 EAST A. A " 3 ScimE/-=ZOO t T ads tY¢Y,E G N 89'!8'14"0 N y_u� 1J B 01 /3/948 m / �A i0.ixt ii a..1 e _II. ,, ,_ t sr st ,1 r• 6 AA AA + �� ,...x. a I ,Aw,N9• w,t r,-,444 E ,46 EASEPIE. 7- dA$°s Vey L 2y1.19 e1.oT 331.6 I I A 0 At $ $ NBYW36E a W Ol ..* 33o.29+ *tom ss1. 9 33e�- ti/ .1 en ef. 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A„©/TOR'S CERT/F/CArE Su veyores CERT/FICATE 3 ^ N t t/S� FILED Po 8402.7/80 TNn DAY.7O`f�. /984 j�� !y TNJS AMP CORRECTCT REPRESENTS A.3URYEY~DE ST AE 'l- /- aR YNDER MY O/R¢TTW'/N CONFOR,MANGE 'PAW THE AT T/IP/P A9_ /N BooK or.SURVEYS AY PAGE (/� ���111aaa •� a\ _ RE84UdREPJEM3 OF THE S N(YEY REGORDMK Acr Ar nYE AT THE REOUFST OP F.tANKL/N 7 F/SGNER. sFI� '/Jr REas.ESr OF faL1lN�1�3E�G'.7rTAC /N DEtEM6ER,/Pd4. )EPUTY CDON AY JrDR f/(ANKL/N T. t-/s2,...&-R., CERTirsc.4rF No.2144r Franklin T Fischer,PL.S,930 Washington Street, Port Townsend,We.98368, (206)385-1225 Sheet I of I • 001071 ©1 . r�1i� : t� - . '' JEFFERSON COUNTY of, F 1 '' DEPARTMENT CCMI Y UNITY ,! �f ti t 621 SeddanS Port Townsend-..w orc e' ti 360 jj79- 450-36W379-4451 Fax • httpl/www.co.jeffamon.wa.us/commdewidopmenti 100259 . rii:BERNT PAUL EMI:SEht ii Sep NER Stormwater Calculation Worksheet IMAC PROJECf/AFPLJCANTNAME S+a- ;S(kW'. Len'CC K INTEER/Medei STORMWATER MANAGEMENT flliCILMMIIRIffS:This worksheet should be completed fad to classify the proposal as%mfati,"'Medan;or'large." The size detection whether a Stormwater She Plan is requited in conjunction with a:stand-alone eto niwater management pennft appfication,ixablg permit appllcalion,or other land use approval opfication that. involves stormwater rrevlew. The basic infonmratlon wW also be helpfd for completing a Stormwater Site Plan,it readred. PARCEL SIZE fl.E,SITEI Size of parmt do2 acres An acre cortakas 43,E&pram feet. Nkilliply the savage by this size of parcel in square feat 02-1?)61R. sgfft Lancklattabbig activity is any acdvlly that restAs in movement of mutt,or a age in the existing soft cover(both vegetative and non-vegetative)and/or the existbg soil topography. !surd be rde,but are not breed to Wig,rodbg,fiEng, excavation,and compaction associated welt of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that ate indigenous to the coastal region of the Paolo Northwest and which reasonady could have been mtpected to natural,/occur on the site. Barrmies kdude species such as Douglas fir,western hemlock,western red cedar,alder,bi-ie f maple,and vine maple;study)such as wibw,elderberry,salmordreny, and sal;herbaceous plaids such as sword fern,lean flower,and fireweed. • 1.1-11_1;_t:' sir► r• • N _r �.. • • ' 1 " Calcdate the tad area to be dewed,graded,mod, Answer the followbg two moons reified to excavated,srdRor compacted for proposed development conversion of native project. Include er the area to be cleared for: Does the project Calvert%acxes to more of Construction or site sq/ft native g to lawn or landscaped areas? Drablield,septic tank,etc LOO(, sgfft Circle: Yes . We,utalbs,etc. sgfft Does the project convert 2 3f acres or nOe of native vegetation to pasta? Driveway,padd ng,tic Circle: Yes Lawn,kmdscapbg,etc sgAt Other compacted sue,etc ecltlt Total Vol uttes of Propose* Tctal Land Disturbance s ft Cut F d (cu/yd) toverl stomerater sac worksheet—REV.1WWW2003 . Impervious swaps is a hard surface that ether prevents or retards the entry of water trbn the soil mantle as tender natured concftions prior to develmm r A hard surface area which causes water to run off the sauface in greater menthes or at gus increased rate of flow from the flow presenttmcksr naauxal corhons pdor to den ebpme nt. Common byervious surfaces Vie,but are not wed to roof tops,wallovaysAlated,driveways,patting tots or etch ge areas,concrete or asphaft fad,gravel roads,packed earthen materials, and oiled,madam or Cher surfaces which uiipede the natural irMadors sknmwater. ,, TORjj�WATER CAWLATIONS—>IVPER1110USSURFACE lEOSTRIG >Nt'1N Situctinea(at Ref aroa}. ` split Structilles(all roof arm) sglft met Sklewaks Patios sglft Pates wit Solid Decks scilft Solid Decks & t (without MNration below) below) Driveway sOfft Driveway Miff Other split Ot er sift Total New spilt Total Existing aglft TOTAL NEW+TOTAL EXISTING` stint gifts a wt be teed to died(total lot coverage. The following rprestions will tote deterrrrie whether the Proposed project is considered development or redevelopment y R®EYEL.OPIIAENI- Divide the total Mgftt u pervious surface above by the size of the parcel and convert to a per e: Does the ate have 35%or more of!ebbs byervious std? Cede: Yes No FURTHER INSTRUCTIONS: If the answer is yes,the proposal Is considered redevelopment and the attached Figure 2 shot d be used to determine the applicable Mnlmunn Requkements I the answer Is no,the proposal Is considered new development and the attached Figure 1 should be used. At this jsmctrae,the mplicant should refer to the applicable Flow Chart to detonate the Maim= Requirements for stormerater management DCD ste wB help verify the classecation of the project and the mphcation req irements. For proponents of ''sum" projects who mint comply only with Requirement Stormwater Potion Prevention—an adsftional stthrretal is not respired. The proponent is sesponsible&a oryloyIng the 12 Ekeents to control erosion and prevent sediment and other poffutants from leaving the sfte durksg ten constmction phase of the project Pick up the Construction Stormwaksr Pollution Pnsanardion(SWPP}Best Management P (BUPs)Packet Payments of'taec n"projects—those that must meet only kkenum Regrtremeents #1 taoug h t5--and for large' projects—those that mutt meet all 10 fieftmtun Requirements—are required to sitomt a Stormwater Site Plan. DCD has prepared a of a Stormwater She Plan, perch:softy for rural residenthd projects. Complete the template in tie Sae Plan htstructiona and Submitkft Template or prepare a Stormwater Site Plan using the guidance in the Slxmwatar Management Manua APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet,I as the appkrettowner ate that the i formation provided hereer is true and correct to the best of my knowledge. I also certify that lifts is being made with the full knowledge and consert of all owners of the affected property. (LAKOWF831 OR PADHORIZED REPRESENTATIVE SIGNATURE) (DATE) atonement cahc worksheet—REV.10/112003 2 Check one xi INSTALLATION START NOTIFICATION DATE SENT NC::.- I I PRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT . This form shall be faxed or mailed 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@cojefferson.wa.us PERMIT OWNER Lc:A SITE LOCATION \c\N. ' .-,,',..,,,& „.,z --RSN.y;-..c,•.1 S: ‘.., K?cpc. PARCEL NUMBER OC)\.,4 )--VOZA1/4-.\ SEP NUMBER tAcD, INSTALLER ____ CONTACT PHONE v6(:).\-cc,..•,' , ID LAY-i\k-r DATE FOR INSPECTION SYSTEM WILL REQUIRE PRESSURE TEST - YES 2< 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. ••••■•••.“••••■•■11“1■.‘,..0.••••■•■••••••••••■.•••0•40.•■■■•“rtiam...•.••••••■•■•••■••••••■■•••.......•••••■.........“.••■•••wson•.•• Jefferson County Staff Only:: /0/L'11 :L.) MONITORING AGREEMENT MAILED DATE/INMALSyC_ PRESSURE TEST SCHEDULED .,... .,.. .. ,...- •,, ; - ':::' ' ' ''' ' : J\ ‘''' ‘::\''''Y'C'I . I'''• '',, k_.,,,... . .„ . . . . . . .. -. ... . , .-,... . : -