HomeMy WebLinkAboutSEP2014-00141 of q
of 1
or
Jefferson County Department of Community Development • ,')III i
621 Sheridan St, Port Townsend WA 98368,(360)379-4450 �, A.r '1®,,-
SEPTIC PERMIT APPLICATION ,, 04. ,''� '
PROPERTY OWNER H I O E iEY S A l�Z 1" r'♦,
5100259 A
MAILING ADDRESS • ° •I 1 K: . j' - PA _ERICSEN II
. . re Q A UC •t�l$1 b 15E I NER.. t
PHONE ( 70 7 ) .241 - ,7 8 77 EKPI• S 02/11 :1
i 1-9-ii4
SYSTEM DESIGNER g'R t CS E(1) lG N Designer Phone# 366 -3O I-0 3a2
LEGAL DESCRIPTION: Section 34 Township 3O N Range MI PARCEL# 41 G I8065 0 1
Subdivision Name, 110 KYDA-LE Division 02- Block _ Lot(s) I-5, 45 1 n
Site address/Directions to site ' e
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential 'l . New Tank/s only Private
Residential ADU Modification Public P V
Commercial Expansion
Community Upgrade
Repair X SITE SIZE w•24i-415
SYSTEM TYPE Partial Repair-(tank) (drainfield) •A, Previous Evaluation
Conventional k, Designate Reserve Area Yes# SEP.Pi- 115
Alternative Redesign No
SYSTEM DETAILS
Number of Gallons/day alit) Soil type 4 (attach soil eval.) Application Rate . 5 3 galisq.ft/day
Drainfield Length 161 ft Trench Width 3 ft. Trench/Bed Depth 30-31 in.
Septic Tank size e-A. l 000 gal. Pump Chamber size I.
TYPE of system C oR\1e.K-1"IO A \ T ev■L
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.
DISpLAIMER 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 tti t
you will later obtain permission to build a permanent residence or other structure on this parcel. Any
future application will .--parately judged by the rules and laws in effect at that time.i /2-7/ °44
/ • . -rty Owner Signature Date
/za
FOR OFRCE USE ONLY 1`-PC� I/��//6. ! ^� f�`'IC. PARTIAL i1 /1S— ASBUILT / FINAI Ot '
AP ROVED �
INSP/PUMP TEST P ^ *OA■' 4 '
ALL HOLD REQ.MET
00' - � i
Date ) 7.41 6 )) Fee 1 Z L( Rec# 1 S` 1 . Check# LIS 53 Case#sEP /Li- a)' 1
H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC
JEFFERSON COUNTY PUBLIC HEALTH
"sfie 615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublicheakh.org
1-"hone 3bU-38b-5444 i-ax 36U-3/9-448f
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP14-00141 Date Received: 12/10/14
SITE ADDRESS: 151 7TH AVE Date Issued: 01/08/15 Date Expires: 04/08/15
PORT HADLOCK, WA 98339
APPLICANT: HIROE KEYSAR PHONE:
204 KALA POINT DR
PORT TOWNSEND WA 98368-9530
LEGAL DESCRIPTION: IRONDALE#2 BLK 55 LTS 1 THRU 5,45 THRU 48 SUBJ/REST COVT 561132/561133
PARCEL#: 961805501 Section: 34 Township: 30N Range: 1W
DESIGNER: BERNT ERICSEN PHONE: 360-301-0324
293 PINECREST DRIVE
PORT TOWNSEND WA 98368
SYSTEM DESCRIPTION: CONVENTIONAL TRENCH
No. of Gallons per Day: 240 Type of work: REP
Drainfield Trench Septic Tank
Length: 150 feet Width: 3 feet Depth: 30 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 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
CONDITIONS OF APPROVAL- PERMIT NO.: SEP14-00141
1.) This permit was issued to correct a violation of WAC 246-272A for a failed drainfield. The permit
must be completed within 90 days of the date of issuance.
2.) The transport line to the existing failed drainfield must be abandoned.
3.) MAXIMUM TRENCH DEPTH, < 36 INCHES
4.) A screen shall be provided at the outlet of the septic tank.
5.) 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.
6.) 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.
7.) Approval/issuance of a sewage disposal permit or installation of a septic system does not
guarantee the approval of other development or a building permit on this site. Future buildings that
require connection to an on-site sewage system (OSS) shall only be approved if the OSS meets
the current standards and codes in effect at the time of the building application.
8.) 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
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.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent.
14.) 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.
15.) Low use water fixtures recommended, 1.6 gal. flush toilets and 2.5 gpm shower heads.
16.) H - This permit is granted based on the recorded RESTRICTIVE COVENANT combining lots to
meet the minimum land area required under WAC 246-272A Onsite Sewage Code. COVENANT
recorded 561132
17.) 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.
SEP14-00141 Page 2 of 3
\\tidemark\data\forms\F_SEP_Perm itmod.rpt 1/8/2015
18.) 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.
SEP14-00141 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 1/8/2015
• CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT
INSTALLER ER(Cseti et. ( -Toby (<I ui AM ) PARCEL# R G '18 015 56
Permit Owner N I R0 6 KEN( S A-R Permit # 5E? 14 - 141
ABSORPTION AREA:
DRAINFIELD TRENCH TRENCH TANK #OF #GAL/
LENGTH Iii 0 WIDTH 3 DEPTH 34-36, SIZE (-bc o BEDRMS 2 DAY .240
Tank Shroud/
IF PUMP AND PUMP CHAMBER REQUIRED: Size — Screen
Float Arrangement
High water float-distance to top of tanklemergency storage
Dose drawdown(#of inches) #Gallons/Dose --
Timer/Dose Counter info Pump Size/Manufacturer
I CERTIFY THIS ONSITE SEWAGE SYSTEM AS INSTALLED AS DESIGNED, PER PLAN APPROVED
of -08 - 16 �e " ?fie,-) 1--,22— ►ti
DATE APPROVED 'Des,knee SIGNATURE DATE
566 ATT-c-HED Re.LORD `DRA4WIN�.,
RECEIVED
JAN 26 2015
Jefferson County
Environmental Hll,
Moore St.
25.00' 25.00' 25.00' 25.00' 25.00'
• , 9i •I •
S 90000'00-W II I; _, — ' Fence
II r .1 r...) - I
0 II .1 - o-- Inspection Ports
CTi it .P 110 0 1-- 0
0 .' ,.-,-
51.50' I • 8' 8' IV 61'
II ! k >
Ex. Fence ll ! co N Proposed
o Ne+Fence I ° u, Reserve
rve
(Diainfeld arrier) I w w ° Area
' V
w X I I . W
o rn I I b Inspection Ports ° o
0 3 I n. g
0 0 co I I I o
0) '
o I � I
�� �� m I ! I l c) I
"HE_Cila orato14 1 al
�«0V, Iv e W Fence r'" "� 4"ASTM 3034
,. w, , 0 cLD 1 /o Slope
,srt , !p , CA)
SEP 84-193
�� e ",t'` ,�1 _. m N B A" to "DJ Box"Crushed"
y� a '" •• #� A. Existing Drive/
4 ;� 8 SEW. 44` _ _
,,� Parking
oviekuita4;11060teialibmbMaltActOtellVvviv••J
'••• -1 , �1 1� \i l' �® ter.. i.. l
K X 1
Measurements: Cr rt
A to C=23'6" =ra 0 0
BtoC=33' ° to .0
m a
Ex. 1000 Gal.
x Septic Tlnk
rn (with risers
to grade);
/.FILE NALAE OWNER
N HIROE I'EYSAR.TRV Keysar
° SCALE ; DATE DRAWN BY N
20 Ft/In ; 1-22-2015 Bemt Ericsen o
PARCEL;# REVISION SHEET
961805501 1/1 1/1
Thi map drawn with TRAVE• E PC,Software
0 20'
mil moo Ili =I r r
o 0
•
rn Lot 47 Lot 48
1'
(-FILE NAME OWNER 1 f
HIROE KEYSAR.TRV Keysar <.,M'
SCALE DATE DRAWN BY , (d
5\C2 30 Ft/In 12-9-2014 Bemt Ericsen ‘-- ,)
, 7
(3�`.. 'O� PARCEL# REVISION SHEET
�cQat• 5 961805501 1/1 1/1
�Gt
G.S.1c5\.,-'
k9 •G •I This map drawn with TRAVERSE PC,Software
5r .t
$ I Moore St.
`' /� 25.00' 25.00' 25.00' 25.00' 25.00•
S so°oo'oo°W { { S/� 7 / —_ r— _ Fence iii I
1- r . x I o O
(31 -PI• co
•I { CO I
N
o { r- N {�
n in n Proposed
oposed< W w {w{ Reserve
W { I I Area W
m� in o
iC I I I o. 1----Tf4,1% �� d va
�`� ( S/L1 _
"141 . i _1 C:99 ��A v 0 Fence
yor.-"- CI-` °6 e sg,�r° w o-
3 o 94 K
.
m
a o X. ,I Existing Drive/
;, --_--- -}f 5' - t
--- - '-- ----f'irkirng-
0 IQ
3 W
'alb m Ca ' 1►
OK,' - 0h � B �
• r 4, . ..k.. 4e
4
'rc� '�. /A,44, x Ex. 1000 Gal. IL
i ... i o Septi Tank
' .. 0+ (Install risers
i 10Q ii to grade)
ip BERNT ti ERICSEN''•.
f 11
�arewi�w°maW..air SEP$4-193 0
EXP`1 1✓ 11/i4
•
is-ci -
0 0 ,F 0
vii cn r y r
`�O
0 Co
0 30' Water
M
_ _NMI Meter
Price St.
Moore St. "`et,
25.00' 25.00' 25.00' 25.00' 25.00'
I � R
S 90°00'00"W 7, / Inspection Ports N.Fence
I S/L2 - - - - - - - - -,
j T p
m I—
r O
0 0 l t o 0
V., -P I co j : W 8' 8' N
o , m
r—
I I w N
r
I j
I I
o F 0 o Proposed
y A�vs5.5 o v
oc.?fl ctof4 Reserve
C Area.7„t � ¶0. ` j o CD
P
to I I ii y\,r b I
� o
c) 0 ! I o0
I I I u)
I I I 1 Ili- l
S/L1 J
t _ _ _ . ___ .. ._ _ _
�
�' '' if, Fence
Ac\' , ` n
* F CD
ac g
V
n
0 ■ v. o [3-1
.I ! P. g m
,0; .:�I� °-��—, ; Existing Drive/
T.: ---- ;t ,arking
Ar6.<,' 4, ' . .1 r. o o t lerls (
1. 5100259
HOC BERNT PAUL ERICSEN'•. +4, rn '
r C I Oa
11.111101M4116110011MIMVInellaNIWIMIlig IN ..-..
EXPl'r S 02/11/1.j
I
lot,-C_1 I' Ex. 10014 Gal.
Septic Tank
(Install risers
to grade)
R') SEP 844193
(FILE NAME OWIlE1 1 N
HIROE IIEYSAR.TRV Keysr °
SCALE DATE PRAWN BY
'- 20 Ft/In 12-9-2014 Bemt Ericsen
'PARCEL# REVISION SHEET
0 _ 20' .98.180551p1 1/1 1/1 1
NM O r \ Thi$map drawn with TRAVEF$SE PC,Software
II= r-i- 0 s'' I
-p —. , i
01 ' "1
P.
i'
KYA-1 614180(; 401
--,w--7 s3',:z4-•::-r r.. - i -t
- 2I
as-marzrea \
, , ----y . . I,MUM GRIM
t: - \i- ----- -... -
um MI6 C u s
MI - -
�- , - _v Box
ME irirr
P 7 �-�.- APB FILTER
MESILESTS
1.G
= TANS ,..a-C . •
a�
'�.. re , r„A b
- �'8`, a
�� a
Trench Profile ( No Scale )
(See Notes For Details) Finish Grade ti
Geotextile Filter Fabric Native Baddill Inspection Port I ill
4°ASTM D2729°Peet"
'- .�... __.ter-.._....._�. ;.. _ _-. ._. . .. ._._... >... _. .._ k r y i ��•.-, r _ -._ . s'.3C_ .._ ;._. _
End Trench "D" Box
4°ASTM D2729
III 44 AVM 3031 , To Drainfield
FRoM 5E 1,11C TAIL f (Solid)
.t ad 314"to 11/2"
:-;;;=:-;-:•:,„•:.:i;;;;:-,:;:. Clean Drainrock
6"Min.Under Pipe
oil
t
iA oovi, 0-,..;!,).
0,P, ,, ,4 iirl# ''
aQ. ;SERNT PAUL ERICSEN•,. vo
E ''T- 02! 1 i,-)
I)-41 4
„c-(,-x; f
e
y
r„'-'.'-',.. 75:51,.C.:(1 '3'(:.' ' A, , 0** 110 ,,,.„.
.,,,,,e
s„,, .,,,,,,2_,, ,,,,,, , ,
,, 0. ... . .,i
,c-,- Hiroe Keysar ,, :51 51
961805501 A 'BERNT PAUL iICSEN% fie@
.010.w`w•loww w�.��004i,10•wi,
-i-1 - 11
Project Description p ..-G -e4
Replace failed drainfield ( SEP 84- 193 ), install new transport line "D” box and
drainfield.
Septic Tank
Existing 1000 gallon two compartment septic tank appears to be sound, and
may remain. Install water tight risers to grade. Install outlet baffle filter ( Orenco
FTiPW 0418 — W ) or equivalent. Pump tank prior to repair to minimize exposure
of sewage. Depth of existing tank determines drainfield depth of 30 — 36".
Transport Line
It is imperative that minimum grades are used for effuent line td "Er itox.
Install 4" 3034 sewer pipe from existing tank (approximately 60' ) to new "D"
box @ 1%. Tightline from "D" box to drainlines to be 1% min. Provide
permanent vehicle barriers to protect pipe or double case with 6" ASTM 3034
under drive areas.
"D" Box
Install 4 hole "D" box on poured in place concrete pad on undisturbed soil with
riser to grade. Install speed-levelers and water level prior to designers
inspection.
Drainfield
Install 3 ( 50' x 3') laterals as shown on plans. Install inspection ports within 5' of
each end of lateral ( Gravelless Chambers ) inside 6" round valve boxes with
risers to grade. If gravelless chambers are used install "Digger's 20 Gauge, hot
dipped galvanized wire mesh with 3/4" hexagonal openings over entire trench
bottom under chambers. Use sanitary tee 10' from beginning of lateral and at
end ( Gravel Trench ) Install 6" round valve boxes with risers to grade over tees.
Provide permanent vehicle barriers along entire length of Line 3 to protect
drainfield.
Water Lines
Maintain a minimum of 10' separation from septic components. Water line
enters on southeast side of house, no conflicts anticipated.
Inspections
Designer needs to be contacted for a pre-construction meeting prior to
construction to discuss details and to set up schedule for inspections. Designer
is responsible for submitting "Record" drawing, and must be called prior to back
filling system.
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. "Approved" septic plans
must be on site during construction.
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.
1. Any inconsistencies, errors, or omissions that, in the opinion of the
installer, would compromise the quality of the wastewater system shall be
reported to the designer prior to construction.
1. 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.
2. 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.
3. 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-0270.
4. Any changes, substitutions, or deviation from these plans shall be
approved by the designer and by the Jefferson County Environmental Health
Department.
5. The installer shall grade to divert all surface water runoff away from tanks
and drainfield/reserve areas.
6. The bottom of the trench or bed may be inspected by the designer prior to
placing drain rock and shall not exceed +/- '/z" from level. Place filter fabric over
drain rock prior to backfilling.
7. 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.
8. Setback from the house foundation wall shall be 10' minimum to
drainfield, 5' minimum to tanks and 2' minimum to non-perforated sewer pipes.
Water saving appliances, fixtures, and practices are to be used.
9. The septic and pump tanks, drainfield and reserve areas are to be
protected from vehicular traffic or mechanical disturbance.
10. The designer is to provide the as-built and letter of certification.
11. This system has been designed in accordance with WAC 246-272-A-
0270 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.
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST., PORT TOWNSEND ,WA 98368, (360) 379-4450 .._.
SOIL EVALUATION
PROPERTY OWNER T"I 1t/O e- Kea sax I)I C 1 u 20/4
SYSTEM DESIGNER E r l C S en --De S i5v
LEGAL DESCRIPTION: Section 34- Township ) Range I uJ Parcel # Qt I 666'0 1
Subdivision Name 1 YOndittle, Division Block 4b- Lot(s) 1-s 4.1-4.g
Date Logged: 7- it it Logged By: 'F)p 'n t E1't C.Sen
Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth
where mottling or impermeable layers occur.
v;.(SL
SOIL LOG #1 SOIL LOG #2
0 to 1/ in. an L/,ff1 M9 S /� (J to is in.J2n �r'Yni S .
1� to G$ in. Tan .( S'. 6252,
. 1g to 69 in.
to in. to in.
to in. to in.
Anticipated water table7,S in. Anticipated water table 76g in.
Roots to 3L inches nor f`0 Roots to 4.,,2_ inches
Health Dept. Comments �>r '.. '�4
p ��„ •`�� Health Dept. Comments
e
SOIL LOG #3 W f `" ' ^�■ SOIL LOG #4
to in. ,�� . b. / to in.
to in. ®.' BERNT L ERICSEN.." I to in
,,. .• 1
,� _ _ l ,rte- L. 1-:,� to in.
to in. i i- '3S,(4 1 .pei
to in. / ,-e1-i Lt. to in. _
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #6 SOIL LOG #6
to in. to in.
to in. to in. -.
to in. to in.
to in. to in.
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:UNFOHLTH\SOIL FRM 1/00