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HomeMy WebLinkAboutSEP2012-00072 Jefferson County Department of Community Development 621 Sheridan St.,Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION JUN f :ff. 2;14? PROPERTY OWNER GARRETT& DIANNA LARSEN MAILING ADDRESS 120 MARINER PLACE PORT LUDLOW, WA 98365-8738 PHONE ( 206 ) 790-4860 SYSTEM DESIGNER NATHAN N. CLEAVER Designer Phone# 360-598-6546 LEGAL DESCRIPTION: Section 23 Township 28N Range 1 E PARCEL# 983-401-403 Subdivision Name PARADISE BAY ESTATES Division Block 14 Lot(s) 3 Site address/Directions to site 171 SHORE DRIVE, PORT LUDLOW SOURCE OF SEJV F)AGE/USE TYPE OIVORK WATER SOURCE Residential 1/ New �/ Tank/s only Private i Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 12,303 +/- SYSI�EM TYPE Partial Repair-(tank) (drainfeld) Previous valu tion Conventional Designate Reserve Area Yes#OTH11-00023 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 240 Soil type 4 (attach soil eval.) Application Rate 0'6 gal./sq.ft./day Drainfield Length 20.334 ft. Trench Width 15 ft. Trench/Bed Depth NA in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE of system M-31 GLENDON BIOFILTER By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur during regular business hours. Initial here if you require notification before entry Appeal—A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision. DISCLAIMER-This application is for an on-site sewage system that meets the state and county standards in effect on the date of application. This application for an onsite sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain p- missio o build a permanent residence or other structure on this parcel. Any future application wil •e se tely judged by the rules and laws in effect at that time. - Property Owner Signature Date • FOR OFFICE USE ONLY Abittl PARTIAL ASBUILT i',', FINAL'__"_"`_ APPROVED INSP/PUMP TEST 7- '��I��� PUD I * ebl" 2 26 I g 0 ALL HOLD Lip.MET Dat -/ ( Fee_ 3 Rec# /3602g9.- 0f' Check#3,45-—1 Case#SEP i H:\WEB\PDFs\Septic\septicpermitapp_2008.DOC 4Zt- Li. 00/eiiii , . i i g ,ec3 6,0a&I,L , JEFFERSON TY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 www.jeffersoncountypubllchealth.org -.--_....-.......-.........p one 4tib 444' Fax .360":3/9-4413f ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP12-00072 Date Received: 06/14/12 Date Issued: 11/07/12 SITE ADDRESS: 171 SHORE DR Date Expires: 11/07/15 PORT LUDLOW, WA 98365 APPLICANT: GARRETT LARSEN PHONE: 206-842-9984 DIANNA L LARSEN 120 MARINER PL PORT LUDLOW WA 983658738 LEGAL DESCRIPTION: PARADISE BAY ESTATES BLK 14 LOT 3 PARCEL#: 983401403 Section: 23 Township: 28N Range: 01 E DESIGNER: NATHAN CLEAVER PHONE: 360-598-6546 NATHAN CLEAVER SEPTIC DESIGN 1990 KIMBALL ST. NW POULSBO WA 98370 SYSTEM DESCRIPTION: GLENDON BIOFILTER-M31 No. of Gallons per Day: 240 Type of work: NEW Drainfield Trench Septic Tank Length: 20 feet Width: 15feet Depth: inches Size: 1,000 gallons DISCLAIMER-This approval is for an on-site sewage system that meets the state and county standards in effect on the date of application. This approval for an on-site sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. All construction and development activities must comply with all permit conditions, state and local codes, and Recommended Standards and Guidance documents in effect when the permit is issued. The property owner is responsible for the accurate location of all property lines.Any removal of or major disturbance of soil in the primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system. Any change in drainfield or tank location may invalidate this permit unless prior approval is obtained from the Jefferson County Environmental Health Division. If during excavation or development of the site an area of potential archeological significance is uncovered, all activity in the immediate area shall be halted, and the UDC Administrator shall be notified at once. Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON This permit is issued for a period of three years (unless otherwise stated above) in accordance with Jefferson County Rules and Regulations for On-Site Sewage Systems, codified in JCC 8.15 as amended. This permit may not be renewed. Jefferson County Envir mental Health Specialist This permit with conditions must be onsite during all phases of construction HEALTH DEPARTMENT MUST BE CONTACTED FOR FINAL INSPECTION. SPECIAL CONDITIONS APPLY - SEE ADDITIONAL PAGES CONDITIONS OF APPROVAL - PERMIT NO.: SEP12-00072 1.) H -Tanks must be traffic rated w/ iron riser lids if placed in the driven way, certification required at the time of final inspection. 2.) The area of the western most pod has fill that is to be removed. Contact the designer prior to removal of fill and assure that proper grade is attained. 3.) H - Permanent barriers may be required along/around primary and reserve drainfield areas to protect from parking, driving, and other land disturbing activities prior to final. 4.) 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 5.) 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. 6.) Existing Curtain Drain installed. A minimum of 10' must be maintained to the nearest pod and the tightline must extend 30' below the reserve area 7.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 8.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 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.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 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.) Dry season installation required. 14.) 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. 15.) 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. 16.) Contact designer prior to installation for staking of drainfield area. 17.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. SEP12-00072 Page 2 of 3 \\tidemark\data\forms\F_SE P_Perm itmod.rpt 11/7/2012 18.) This site has been granted a waiver from WAC 246-272A and JC Code 8.15. Under Jefferson County Policy 97-2. The site requires a minimum land area of 18000sq/ft.. 12101 sq/ft are available on the site. Compliance with conditions of the waiver are required, a maximum of 302 occasional peak gallons of waste water per day can be applied to the site. 19.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Unified Development Code for other/future development on the site. 20.) 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. SEP12-00072 Page 3 of 3 \\tidemark\data\forms\F_S EP_Permitmod.rpt 11/7/2012 S, i VN W JEFFERSON COUNTY PUBLIC HEALTH. 615 SHERIDAN. PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING ��`o,` Designer NAr%.IA.0 CLFAvEl2• Permit# SEP (L-OGO4-2 `� Installer k.E0 Jo1-1ES Parcel # 9i(3-tioI- /o3 Electrician €' ?w2 \-'6 TR c- Design Flow 2,44U Property Owner Ci AanErr L4LSEN Site Address II-1 Sti-olg-e DItivE 1 f o,zr L.ubLow Answer all questions or indicate NA DATE Tanks. Pumps and Controls INSP. Tank (manufacturer, size, baffles) RAGGelvtANI J 1 SOO ap,lho 1 2. c_otnnp . $ Irp?DMS Pump chamber (manufacturer, size) I4ActeanAAtI, 11 D00(1.4 N) 5 t ? 1S- Screen(s)and/or Pump Shroud (type, location) O02cn1G0 SC.QizeNED 1/4Vµ /Al 2q1/45- Pth,..p Tai4k, TVF.tttw ef.-It. crd&ni oale- /i) OvTLET B.4PFL Were Tanks tested onsite for water tightness? lab No 4,. Panel Model SIG -R1k'O4,400S Ti Hle.fr ,f{tr'P& tat Model 4t2. AQVl4WOFtac 11°e �.EfEek Pump 1 - Man./Model Zo61A,6R RN1 1 S3 Flow Rate NA qam __ __ Pump Location (i.e. garage, treatment unit, basement) ikw St- "be litnneiCAM16 Float/transducer settings Inches Timer from bottom of tank- On/off- • 12. in. Functions: On Np sec/min Veto - 18 in. Off- oe�11D sec/min/hr Alarm - 18 in. Veto On - 1.1.6. sec/min Storage Above High Water Alarm 2..0 _ gal. Veto Off- N/v sec/min/hr Dose Counter Reading 04 #gallons/dose )•,,I A- gal. Elap. Time Meter Reading NA min/hrs Pump Throttled? Yes /4r) Dose Drawdown (in inches) j4k in. Pump 2 - Man./Model •ZoEL't,Eit:. $►4 15/ Flow Rate Npt' arm S CtilinCAS Pump Location (i.e. garage, treatment unit, basement) Pu ■ t°T.Nk- Float/transducer settings Inches Timer from bottom of tank- On/off- It in. Functions: On 11 chnin Veto - 31 in. Off- 10 sec/ in hr Alarm - 31 in. Veto On - 11 se min Storage Above High Water Alarm 9i 0 gal. Veto Off- 10 sec,(Lnjpk'hr Dose Counter Reading 0203$ cft: OoOOp # gallons/dose 2.C.I gal. Elap. Time Meter Reading llp:Cjrpj:?j$ min/hrs Pump Throttled? Yes in.Dose Drawdown (in inches) N}� If additional pumps-complete the Info in this table for each and attach. Other Timer functions & settings (e.g. override on/off) 0-Q--0$) ALM°C. Azz_ 22-vosre H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 Pre-Treatment <6 Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes/ No ?�� Sandfilter Basin size/location �I� 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, schd, diameter Ir %SCR 40 Manifold size/schd 1"s,II{y(7 9'Se►r 2013 Orifice size NA- Lateral Size/schd ! Sci{ go 9 sorr 2er33 Barrier Material 1JA Cover Material/Depth C -33SAND `I4�� 93E�' Z013 Residual Head (lat.# &ft. Head) NA / The laterals/pods were balanced t'ea'/ No 3p 20l5. Source/Manufacturer of Drainrock/Gravelless chambers torptJ Oft I4UC Drain rock Clean? 9/ No If no, what action taken? Mound/Glendon Site Prep Ce�a Z.9 Au, ?Pt Drainfield Length 2.0 ft Width 1 5 ft Depth NA inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation)Attach additional sheet(s) if necessary Pip\/At)lit cal k ose tS # Pee t /OciAtt t D I_ieelaTif $-'?. O curt vat writ oNfoPF mMr I qµWATEL.ALA 12414 FLort-r. WIlc.t fimar a t WO*It1S64e0 ak4Aov0132.nwJ M.11100tgo A,TO ee007.11-litler ul1b0w1 PEE UAW wmt 1.411‘1E SXCAJPW L )A • L....• A ■i=. .� ;r,-.T O... .e��,P.►w- R�n J o�as a A.S %4OLO 'MSC 4Th.e Ht DgW awtAment Inspection '+ iss1s resolved tT e5/ No / N.A If yes how? Users Manual Provided to Homeowner Date 2S"FiR152O(S Tank/component Decommissioning Report Attached Yes / No / NA 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, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY l I a J//i ATE) OR THAT CHANGES HAVE BEEN NOTED AND , 'Me Septa-TA►tate. wnS VQsizet. THE SY 0 Sr!�� � C" " PLIANC£ WITH WAC 246-272. A liSpO ci a.r Tan1� AUao �, 25 Fee 2015 5/QD2$1 mxtrevowAla sermwt oP P,3" Designer Signature Date License# uawtos Sod'.oS p me Qvvwe V 44. * i3acti4'?vw.QvAV1�S Yknve owu CCb fl:ol powieks it to H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 tetAaMS won* Fort dc*, ( 180 Nickerson St. C T E N G I N E E R I N G �f /� ,L Sultc 302 6 ♦ G 'G /..c, I N C. a V Z S �T 9Rltt�lc,WA 1 rolecf: 1 �7 (i G d (� Date: (206)285-4512 Client: e4 j yr • `V 4.. Page Number: //y (2 6.)285-0618 (" tkida. _ ` tL.0 „io cam \ ,1 -A-��' ° +wk ....7N-Vpi- 103,\AAA-3 , • 5p ' f AL-16, 12-22-5. PcIA- -c.. _ 010..vu_ ,a5t._ kocAiLl*V-{-- . - - _0,, 1 • im/ I 41 __ - X. ____t _ -... I X \\/ ____./c. 4 4 .— , I_ 1.__ \41k A -k---- --. 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'. ',. ' . ; ' '! . . . :- : : ! ••, - : ' :, ', ; .- ' ,. • ; , ; ; : ::. : i ' - 'i , ,' . . - , - --- - . • ,, -? . i : - . . : : : : ',..._.. ..... .......! . : ; ; . , : : : : :, :. '. • ; , .,- 1, ' • , j • : : . .:, :pr 1-'-e,'1 • ' ' ' Ave' .2- : . ; . :„ . : : : :. ;: : : : : . . '. , : . : : ; : : : , r I: • / re/ / ' - 4: 6F".1Aci-i' , 'I' INGrot4 , : . . . . , . . , . . . . - . .. . - . . . . . . , . . . . . . , . . Structural Engineers Randy Marx From: Nathan Cleaver<nathan @nathancleaver.com> Sent: Monday, March 02, 2015 11:04 AM To: Randy Marx Cc: Nathan Cleaver; Garrett Larsen Subject: SEP12-00072, Garrett Larsen Randy, I am emailing to say that I am satisfied that the concrete slab that was poured over the septic and pump tank at the above referenced site. I prepared the sub grade for the concrete slab at the above site, saw the rebar per plan she it was in process of being put in place. I have also seen the concrete slab since it was poured and am satisfied that the work was done according to the engineering that was done for the slab. The actual construction of the rebar mat and placement of the concrete was done by Coho Concrete. Thanks Nathan Cleaver Nathan Cleaver Septic Design Inc. 262 NW Thompson Road Poulsbo,WA 98370 Phone: 360-598-6546 Cell: 360-620-4216 Fax: 360-598-6548 email: nathan@nathancleaver.com • Septic Design & Installation • Land Clearing • Road Building • Brush Mowing • Curtain Drains • Crawl Space Drains • Driveway Upgrades • And More ... How much value can we add to your property? wow" oil MAR 2.p15 tot ve0.04 Randy Marx From: Garrett Larsen <glarsen @thelarsenarchitects.com> Sent: Friday, February 27, 2015 2:18 PM To: Randy Marx; Nathan Cleaver Subject: Re: IM02.pdf Randy Specifications for Concrete are found on page A 2.2 of the Permitted drawings. Specifically: The concrete is 2500 PSI for Slabs with no air entrainment. The steel is ASTM A-615 Grade 60. Size per Engr. #5 The concrete was formed and poured by Coho Concrete a Licensed Concrete Contractor. The forms and steel placement was inspected by the Jefferson County Building Inspector. The work was overseen by Garrett Larsen, Architect of Record. The work was done according to plans and specifications. Regards, Garrett Larsen, Architect On Fri, Feb 27, 2015 at 9:21 AM, Randy Marx <RMarx @co.jefferson.wa.us> wrote: Hi Garrett I also need the construction and materials specs. ?ascd� Ikakx Always Working For a Safer& Healthier Jefferson County 360 385 9402 ><W> ><rrr> ><( ((o> ><((r> ><w°> >< (( "> ><{{{ ><»<> ><(((('2 Septic Permits Online (Link) Environmental Health Web Site (Link) CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message PUBLIC RECORDS ACT NOTICE: All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public Records Act,a state law found at RCW 42.56. Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)01 this e-mail unless it is exempt from disclosure wider state law,including RCW 42.56. 1 �) CA I m 1-d e•-•, ...-N /1 /..... /... ...-,. „, ,„ ..r., m c:, r) cc, ›.. ..„., _•it 1 1 4L,rn 1 z p;: ..._. ....... ...._ ....... ....... ....... f V s' ; l J co O rr O 7 rn o 3 y r' S. _ O C O N O n -o - m - 1 Z C/)^ C CD a o W :CD- v, m m =' RIVE n a o v if (c 'j N 94Z iD N S D < O CO rr N CD _ --__ .. i _ $2x .' 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O !'� Z 0 0 0 � J CO c,�0 c„ u N -- m i Wa hngton Glendon®BioFilter Design Manual , 'Decfmber 28,2009 Page 19 of 23 J(/.j F .a 1 Glendon® BioFilter Model M31 Worksheet Slopes >5 - <20% Basin Capacity,GPD 1204iQ: A .x.. Basin Dimensions8 10' L 6' W 5' D �1, /�42 Soil Absorption Rate, Gal/Fe/Day _ 0.6 � ' 1 5100251 THAN N CLEAVER .4 N LIC JS D OE 11ER ■ • Mid-Point of Basin EXPIRE 6 /i Cover Sand 5' 6' Basin 1 15.334' / Primary Area M31 Cross Section Perpendicular to Slope 15' -4 ► • 5%Slope Nathan Cleaver Septic Design, Inc. 30' Protection Zone 1990 Kimball Road NW, Poulsbo, WA 98370 Phone: (360) 598-6546, Fax: 360-598-6548 CUSTOMER: GARRETT LARSEN TAX ID#: 983-401-403 LOCATION: 171 Shore Drive, Port Ludlow Glendon BioFilter M31 >5% Slope DRAWN BY: ICS DESIGN BY: NATHAN N.CLEAVER DATE: 7 JUN 2012 Rim Required= 120 GPD X 1'/4 GPD= 30LF Rim Available= 10'+ 10'+6'+6'=32LF Per Basin X 2= 64LF Basin Volume Required= 120 GPD X 2.2ft3/GPD= 264FT3 Basin Volume Available= 10'X 6'X 5'= 300FT3 X 2= 600FT 3 Absorption Area Required = 240 GPD/ 0.6 Gal/Ft2/DAY= 400FT2 PRIMARY AREA Calculations: 15.334'X 15'=230 SqFt-30 SqFt(half basin)=200 SqFt Per Modular X 2=400SqFt RESERVE AREA Calculations: 15.334'X 15'=230 SqFt-30 SqFt(half basin)=200 SqFt Per Modular X 2=400SqFt 8 Including the annular space. O Glendon BioFilter Technologies,Inc.2009 All rights reserved. Nathan Cleaver Septic Design Inc. Contractor Registration#: NATHACS94002 e w • 6/13/12 Attn: Randy M. To: Jefferson County EH 615 Sheridan St. Port Townsend, WA 98368 Re: 171 Shore Drive, Port Ludlow, 983-401-403 Randy, The attached is a septic design for new construction. We've met several times in the office and on site to discuss the placement and soils for this property. Based on these meetings I have designed a system that meets code and the conditions of the site-ikI measured the elevation difference between the 2 downslope corners of the West most Glendon and found the actual elevation difference of the underlying soil is only a few inchesThis difference is consistent with common practice on other sites so the orientation shown on the attached drawing is appropriate. A waiver for minimum land area is attached but that is the only waiver that is needed for this site. Please feel free to contact me for any additional information or clarification. Thank you, Nathan N. Cleaver Licensed Onsite Wastewater Treatment System Designer. Address: Telephone: 360-598-6546 1990 Kimball St. NW Fax: 360-598-6548 Poulsbo, WA 98370 Email: nathan @ncsdi.com Please call ahead to make an appointment if you would like to meet with me. / 'W CO(n•" ' � u H/ / -- In O N C\i c p e O . I a . N © / d CO J NI -'JZ � Am 4 > Q v �+ f U o w 00 O U C%7 3 ti V'�M li Z a > > Z En r, A O�'•ON U V) > W ce N 1_= C Nc ` O U X23 G:.• H N N O r "/ V O N Q 111 C M — U Z -- — f� / d / / 4- N w ii O m m /' Z s O o 1- Z Z . 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