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HomeMy WebLinkAboutSEP2014-00084 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Frank Shun MAILING ADDRESS 21401 -52nd Ave.S.E. Woodinville,WA 98072 PHONE (425)483-7300 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 9 Township 29 Range 1 E PARCEL#921093022 Subdivision Name V.3 Short Plats, P.94) Division Block Lot(s) Site address/Directions to site 176 Baldwin Rd., Nordland 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 6.2 acres SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional X Designate Reserve Area Yes#SEP96-00095 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Drainfield Length 120.0 ft. Drainfield Width 3 ft. Drainfield Depth 6 to 18 in. Septic Tank size 1,000 gal. Pump Chamber size gal. TYPE OF SYSTEM Reduced size gravelless chamber gravity drainfield 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. Staff's 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 require i r 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. / -�• >N�/i �o /3-Zo/g Property Owner Signature Date FOR OFFICE USE ONLY / c11(5.--al /a`i//S PARTIAL i- ASBUILT FINA AP 1 D INSP/PUMP TEST Pdcht0 1\041 + ,A, l ALL HrO)LD,REQ.MET �l Date (1 12_D \ Fee ',MI Rec# /5-0 5 5 a Check# - to/- Case#SEP I"I V s c( (:N JEFFERSON COUNTY PUBLIC HEALTH " r 615 Sheridan Street•Port Townsend•Washington •98368 www.jeffersoncountypubhchealth.org 1-'hone 3b0-ddb-9444 i-ax 3b0-3/9-446/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14-00084 Date Received: 06/20/14 Date Issued: 10/07/14 SITE ADDRESS: 176 BALDWIN RD Date Expires: 10/07/17 NORDLAND, WA 98358 APPLICANT: SHARON BUCK PHONE: FRANK SHURI 21401 52ND AVE SE WOODINVILLE WA 980725308 LEGAL DESCRIPTION: AVERY SHORT PLAT LOT 2(REVISED) SUBJ/EASE PARCEL#: 921093022 Section: 9 Township: 29N Range: 1E DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: CONVENTIONAL TRENCH/RED-GRAN No. of Gallons per Day: 360 Type of work: NEW Drainfield Trench Septic Tank Length: 120 feet Width: 3 feet Depth: 6 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 En ' onmental 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.: SEP14-00084 1.) Contact designer prior to installation for staking of drainfield area. Installation other than designed may invalidate this permit. 2.) This system has been designed using gravelless chambers and a reduced size drainfield. Gravelless Chambers must be used. 3.) A specific wire mesh is to be placed on the entire lateral trench bottom. Substitutions must be approved by the designer and health department. 4.) 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. 5.) 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. 6.) This septic system has been designed taking sizing reductions of the drainfield area. This permit has been issued based on the understanding that the applicant has signed an affidavit that they are making an informed decision and are aware of the increased risks. 7.) 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. 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.) 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 246-272AAND 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 11.) 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. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 13.) 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. 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.) 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. 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. SEP14-00084 Page 2 of 3 \\tidemark\data\forms\F SEP_Permitmod.rpt 10/7/2014 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.) An approved eagle management plan requirement is stated on the Avery Short Plat, specifying that an individual property owner, when purchasing a lot, is to develop a management plan with the Washington Department of Fish and Wildlife (WDFW). With federal delisting of the bald eagle, WDFW stopped developing Bald Eagle Management Plans (the property was purchased July 22, 2013, after the WDFW stopped developing Bald Eagle Management Plans.) In this situation, the applicant must contact the United States Fish and Wildlife Service for a determination if a bald eagle plan is necessary. On October 3, 2014, the USFWS has determined that this project does not require a bald eagle permit or management plan. 19.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 20.) The site plan as submitted with the septic application on 6/20/2014 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the site plan shall be resubmitted for review and approval by Jefferson County Department of Community Development. 21.) This approval is for a septic system only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. SEP14-00084 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 10/7/2014 • JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING Designer /4/e1/47C- L- /e`!' Permit# SEi5,1 -GYM 4• Installer S/fdG!� Parcel # 9 Z/ 093 4202- Electrician Design Flow 360 • Property Owner ./-77014/Vie S/IfO2/ .71 sy.4/2e, Bt)Ci Site Address / 76 B- L W/N /Z b ! N4121>4Aiv jam/ W-! 983S`8 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) / C 6mez. Iw/e3 FGGgS ov -Ge7"E'/zre-/2 /D-Z7-/4- Pump chamber (manufacturer, size) Screen(s)and/or Pump Shroud (type, location) Were Tanks tested onsite for water tightness? Yes / No Panel Model Timer Model Pump 1 - 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) 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 12/01/14 page 1 of 2 Pre-Treatment Date lnsp 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 Transport Pipe Size/Sch. 4"Ilsr/4 D 30 34-- Manifold Size/Sch. Orifice Diameter Lateral Size/Sch. Barrier Material GP ve'GG e•.SS -GHQ'-T8 i/Z.5 Cover Material/Depth Co 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 3 ft Depth 17.-- 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 , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No/ NA If yes how? Users Manual Provided to Homeowner IN' 7-1 Recr,eE:). 2 /2111A//Ai Date Tank/component Decommissioning Report Attached Yes / No 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(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 6y these periodic inspections,the system complies with all the conditions noted in the permit as approved by Jefferson County /0-7-/4- (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 1- 7—/3 5100110 Designer Signatu Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 12/01/14 page 2 of 2 = va 0a� rm Q n !.o v �AOnjr+IO q Z N �eq PH-I C yN h v � x k in 'p+i n� CD <n�61. 11 T n '(o n d i� �. n) 1- g co to 0 N I 03 � .v ti' O\ pp N VI 0 N,."tip. 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Deeney (Creative Design Solutions, Inc.) regarding the proposed reduced size septic system design as authorized by State Guidelines: • As with any septic system, the proposed system is designed to function satisfactorily as long as only typical residential strength waste water is introduced into the system in quantities typical for the designated number of bedrooms (all as outlined in the Operation and Maintenance Manual). A reduced size septic system does not have the safety factor available in a full sized septic system, therefore, as with any system, care must be exercised to ensure only typical residential wastewater strength and wastewater quantities are introduced into the system. If greater than typical residential wastewater strength and/or quantities were to be introduced into a reduced size septic system then there would be a greater possibility for drainfield failure than with a full sized system. Therefore, proper Operation and Maintenance of the system correspondingly more important than with a full sized septic system. • Although Washington State Department of Health (DOH)Guidelines authorize the septic system size reductions proposed in this design, there is a logical corresponding decrease of the "safety factor" in comparison to constructing a full size septic system. Long term monitoring of reduced size drainfields utilizing gravelless chambers will help clarify the degree (if any) to which this safety factor is reduced. With this affidavit I acknowledge the responsibility and importance of ensuring proper Operation and Maintenance of this system in light of the lower safety factor inherent with septic systems constructed smaller than full sized. 5IfAAi C-13-2aq Signature Date rtra,vtle.. 3. 51 ii i Print Name C:1DatalW pw\County&State Forms WeffersonReductions\Affidavit\Reduced Drainfield Affidavit-Filled Out(Rev.1).wpd