HomeMy WebLinkAboutSEP2014-00127 TIVC 1-u, 7-1
SEP
Now filed to
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Jefferson County Department of Community Development ���'
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION
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PROPERTY OWNER �l
James &Trudy Davis sy �
MAILING ADDRESS PO Box 2014 �P., '.'tf
Port Townsend, WA :� 5;� 2 y �,
,* Suzanne L Mahn 'f
PHONE ( 360 ) 732-4084 Trcrx ritnaN�a•' b
SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304
LEGAL DESCRIPTION: Section 16 Township 30N Range 1W PARCEL# 963301 201-207
Subdivision Name Irvings Park Add'n & vac sts Division Block 12-17
Site address/Directions to site 1891 &1893 So Jacob Miller Road-Port Townsend
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential ✓ New Tank/s only Private ✓
Residential ADU Modification Public it Commercial }, Expansion_
Community Upgrade
Repair ✓ + SITE SIZE +/-sf
SYSTEM TYPE Partial Repair-(tank) ✓ (drainfield) Previous Evaluation
Conventional ✓ Designate RPRPrve Area Yes# SEP87-00257
Alternative Redesign No .
SYSTEM DETAILS
Number of Gallons/day 750 ex Soil type ex (attach soil eval.) Application Rate ex qal./sq.ft./day
Drainfield Length ex ft. Trench Width ex ft. Trench/Bed Depth ex in.
Septic Tank size 2000 gal. Pump Chamber size_n/a gal.
1 TYPE OF Tank replacement
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this
application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson
County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against
Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole
purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the
applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry
Appeal—A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in
writing within fifteen days after receiving written notice of the decision.
DISCLAIMER-This application is for an on-site sewage system that meets the state and county
standards in effect on the date of application. This application for an onsite sewage system DOES
NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that
you will later obtain permission to build a permanent residence or other structure on this parcel. Any
future appli 'II be separately judged by the rules and laws in effect at that time.
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Property Owner Signature Date
FOR OFFICE USE ONLY Q J /
IZI /I PARTIAL lit 6/j 1 CD ASBUILT e•Jd lid- FIN'16. °?s/ ."
APPROV� Mit
INSP/PUMP TEST Pt)B '� '1l)\" z
Date U/z1i�1ee ALL HOLD Rec#T j tj " /�,F I? y Check# 370 Zd Case#SEP It- — j Z-I-
r'\Dcr„*Rants any Sct in5rA,. acr ar* n\My n'c”"*^erts\wy d^c""*^®Dts, 7.^ris\*^hh2o\74ffcrscr r,,,,nt_y\.,gffro
forms\Suz\2008 SPA.DOC
o� co, JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
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www.jeffersoncountypublicheakh.org
1-'none 360-38b-9444 Fax 3bU-3/9-44 I
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP14-00127 Date Received: 10/28/14
Date Issued: 12/26/14
SITE ADDRESS: 1891 S JACOB MILLER RD Date Expires: 03/26/15
PORT TOWNSEND, WA 98368
APPLICANT: JAMES L DAVIS PHONE: 360-385-1489
TRUDY DAVIS
PO BOX 2014
PORT TOWNSEND WA 98368-0089
LEGAL DESCRIPTION: IRVING PARK ADDITION BLK 13 LOTS 1 THRU 10&VAC ST
PARCEL#: 963301301 Section: 16 Township: 30N Range: 1W
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
PO BOX 125
CHIMACUM WA 98325
SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS
No. of Gallons per Day: 750 Type of work: REP
Drainfield Trench Septic Tank
Length: feet Width: feet Depth: inches Size: 2,000 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.
/////7
Jefferson County Environ ental 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.: SEP14-00127
1.) This permit was issued to correct a violation of WAC 246-272A for a well drilled too close to septic
tanks. The permit must be completed within 90 days of the date of issuance.
2.) H - THE EXISTING WATER LINE THAT SERVES THE PALINDROME FROM THE RESIDENCE
MUST BE LOCATED. THE NEW SEWAGE EFFLUENT LINE MUST BE 10' OR MORE FROM
THIS AND ANY WATER LINE AND 50' FROM THE EXISTING WELL.
THE EXISTING WATER LINE MAY NEED TO BE RELOCATED. CONTACT THE HEALTH
DEPARTMENT FOR ANY SITUATION OTHER THAN ABOVE.
3.) 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.
4.) H - Existing tankS shall be properly abandoned. THEY shall be pumped and filled with clean fill.
Documentation to be provided to Health Dept. prior to final.
5.) Water usage monitoring shall be conducted weekly during the two peak use months and monthly
thereafter. These monitoring results shall be submitted to the Jefferson County Health Dept.
These results are required prior to future approval of any permits that utilize this septic system.
6.) Waste Strength (BOD, TSS, Grease and oils) MAY be required annually for any future food service
or other commercial activities utilizing this septic system. Responsibility is that of the owner.
Results are to be submitted to the Jefferson County Health Dept.
7.) H -An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
8.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed
by current code.
9.) 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.
10.) H - AS PER WAC 246-272AAND 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
11.) 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.
12.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
13.) 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.
14.) 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.
SEP14-00127 Page 2 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 12/26/2014
15.) This onsite sewage system is designed for domestic strength wastewater only. Disposal of any
other waste strength is considered a violation of this permit.
16.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion
and sediment during construction. BMPs shall address permanent measures to stabilize soil
exposed during construction, and in the design and operation of stormwater and drainage control
systems.
SEP14-00127 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 12/26/2014
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FEB 092015
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CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT .f E''-` ' ' ,
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Installer: Tim Thomas(Ericsen Excavating) Parcel # 963 301 301
Permit Owner: James&Trudy Davis Permit# 14-00127(tank only);SEP87-257(dranfield)
Designer: Suzanne Martin Design Flow: 750 gpd
Site Address: 1891 South Jacob Miller Road-Port Townsend,WA 98368
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GALJDAY
LENGTH SEP87-257(300Lf 3'wide trench;42-48"deep) 2000 gallon n/a 7500gpd
IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen
Tank Size: n/a
Float Arrangement
High water float—distance to top of tank/emergency storage
Dose drawdown(#of inches) #Gallons/Dose
Timer/Dose Counter info Pump Size/Manufacturer
COMMENTS (inspection notes, changes from design or deficiencies installation)Attach additional sheet(s) if necessary
Installed 2 compartment,2000 gallon, Peninsula, concrete septic tank. Risers and outlet filter have been installed.
All OSS Component installation have met or exceeded State and local codes and regulations.
2.) Existing water line has been relocated
4.) Tanks have been properly abandoned
Users Manual Provided to Homeowner mailed 5 Feb 15 Date
ATTACH ASBUILT DRAWING signed by Designer or stamped/signed by a Licensed Professional Engineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS
VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED
AS DESIGNED AND APPROVED by JEFFERSON COUNTY
(DATE)OR THAT CHANGES HAVE BEEN 2,
NOTED ' ■ F' THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272 A-'= ��+`,
5 February 2015 5100342 .4..1-r ''',.
Designer.ignature Date License# =, , 5 o 42 y
Suzanne L M arti n ,,
osia vi,ns
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JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street • Port Townsend •Washington • 98368 /
"'.`'9 www.jeffersoncountypublichealth.org t�.,u,•
CERTIFICATION OF TANK ABANDONMENT ,4 G 9 2 0/5.
-.rl to
11 r� r/fi/1 j.
Parcel number /6_J o/ 3 a /
Address /660 S ,�,�r° 7, //es, /ecl Owner Name si rlil n z' . l`211dd y `)p ;1
Septic Permit# (if applicable) c-F /V-" l 2 7
Individual/Company Certifying Abandonment
Phone Number 092 29.§--.?6,-,2__
I certify that the septic tank and/or pump chamber on the above referenced site
has been abandoned to Washington State and Jefferson County Public Health
Requirements.
Signature <LL_ --> = Date 2 -V- <
Print Name Y77 s - 4 '4-
Pump receipt attached
DEVELOPMENTAL.L.. DlISABII.ITIE.S PUBLIC HEALTH ENVIRONMENTAL,f� HEALTH
MAIN'360385-9400 Ai 1;!'$',"':i :':.. C,;v:;1'i-i. :; ,`:.!,;'.ir, MAIN: 360385-9444
FAX: 36(}385-9401 HEALTHIER COMMUNITY FAX: 360385-940'I
.... .
rr ryn. 2495 Cape George Road
L.�IV Port Townsend,WA 98368
ISEPTIC TANK OPERATIONAL REPORT 360-385-7155 . 360-457-4121
® /-' k Date of Service /.... C:=>2./-; i\ /,')r 1
Technicians signature . ,,.„..„
/..,, -
Service provided for t r .Af 7 /4-45/if cry Adi
Address /1) s'1
Phone ?A/.r . 't) / (,}e-/1,4--/ .. ..
Job Address 74 ,e /'-�r/�' 'jiYt);;-1j' A, 9 .J/(oi' ./19 /f//= /;(i f •' , , r
Last Date Pumped 7 #people in home ) #bedrooms
SEPTIC TANK
Size of tank/7222 Gallons Compartments: Single Double
Material: Concrete yr' Polyethylene Metal Other(specify)
Conditions of septic tank: Good t/ Poor
Was ground water observed leaking into tank?Yes No_______
If yes, where was water observed? .
Effluent running back into tank from drainfield? Yes No
Riser to grade on inlet:Yes i No_Riser to grade on outlet:Yes v''No_Riser to grade on cleanout access: Yesi--=-No _
If no risers, were risers installed? Yes No
Solids in Tank: 1st compartment Scum (top layer) 0 in. sludge(bottom layer) 03 in.
2nd compartment scum (top layer) 1) in. sludge (bottom layer) I in.
BAFFLES
Condition of inlet baffle: Good , Needs Repair Repaired Material f 9•C--
` Needs Repair Repaired Material ,'�_= , r_,,---'t
Condition of center baffle: Good 4�;
Condition of outlet baffle: Good 1.--r,-
..`r Needs Repair Repaired Material
Type of outlet baffle: Unscreened �-°" r
Screened Filtered Material
Cleaned outlet baffle and/or screen: Yes No -
PUMP CHAMBER / EFFLUENT PUMP
Does the system include a pump? Yes No If Yes, complete the following
Size of Tank Gallon
Riser to grade: Yes No NIf no,was riser installed: Yes No
Material: Concrete Polly'ethyllene Metal_ Other(specify)
Was ground water observed leaking into tank?Y es .r"` No
If yes, where was water observed? --•>‹.
Depth of accumulated sludge in pump tank ►nohks
Was the effluent tank pumped? Yes No `-�,,
Recommended additional information ° .,tee
Condition of Pump: Working Not Working `w. Needs repair
Condition of Alarm: Working Not Working Needs repair
Pump cycle drawdown: Inches Time for pump cycle • minutes/sec.
Comments: t r2 X 6 /r i /9/./49--t::14-/ lr -, 5,,' ,1/ /:i,,„y ;
1 t ,
' alogig
r a L 2495 Cape George Road
I Port Townsend,WA 98368
SEPTIC TANK OPERATIONAL REPORT 360-385-7155 . 360-457-4121
Date of Service �''" r),./;Km ' ()(-)
Technicians signature �-, ._ _i, �.r,
Service provided for gecif/t)7 /' '=t( 'S()4 2
Address ) A72 7&
Phone ?O:) ?c:.)/ - oe)/Y. z.;
Job Address f 7:53//- 41Z.., /4i a )M > 1�r / , --5� i/�' 3/!. �/�/,/ '! %/ /-,'; ;,,
Last Date Pumped #people in home #bedrooms
SEPTIC TANK
Size of tank I(iYii i Gallons Compartments: Single Double
Material: Concrete Polyethylene Metal Other(specify)
Conditions of septic tank: Good V Poor
Was ground water observed leaking into tank?Yes No
If yes,where was water observed?
Effluent running back into tank from drainfield? Yes No -
Riser to grade on inlet: Yes v''No_ Riser to grade on outlet: Yes eko_Riser to grade on cleanout access: Yes ---No
If no risers, were risers installed? Yes No
Solids in Tank: 1st compartment Scum (top layer) (-) in. sludge (bottom layer) I in.
2nd compartment scum (top layer) t: in. sludge(bottom layer) 62 in.
BAFFLES
Condition of inlet baffle: Good V Needs Repair Repaired Material i±'1, t.—
Condition of center baffle: Good V Needs Repair Repaired Material t---1,.;- ),(-,: , !r'
Condition of outlet baffle: Good V Needs Repair Repaired_ Material /-:/(... =
Type of outlet baffle: Unscreened 1.'""` Screened Filtered Material
Cleaned outlet baffle and/or screen: Yes No
PUMP CHAMBER / EFFLUENT PUMP
Does the system include a pump? Yes No '"' If Yes, complete the following
Size of Tank Gallons
Riser to grade: Yes No ' if.,no, was riser installed: Yes No
Material: Concrete Polyethylene Metal Other(specify)
Was ground water observed leaking into tank.Yes No
If yes, where was water observed? '``,,.
Depth of accumulated sludge in pump tank ...---inches
Was the effluent tank pumped? Yes No//"--
Recommended additional inform ation
Condition of Pump: Working Not Working -....,, Needs repair
Condition of Alarm: Working Not Working �--Needs repair
Pump cycle drawdown: Inches Time for pump cycle minutes/sec.
Comments: ,. i1�L- .: e .//i`". -', // /".%:`&')/x.,z9t),,f JO/ / '7 /I ;"
01/26/2015 9:39AM FAX 3603856930 BERNT ERICSEN EXCAVATING a0001/0001
INSTALLATION START NOTIFICATION DATE SENT This form shall be faxed or emailed ONE working day prior to starting apnstruction
Jefferson County Public Health - Environmental Health Dept:
Phone: 360-385-9444
• FAX: 360-379-4487
DM{ •• septic@oo.jefferson,wa.us
PERMIT OWNER , .17'1
• Cif j' ✓4/1/ .
r
S1T LOCATION P ,/fir ?4
PARCEL NUMBER 9`1 ,.3
SEP NUMBER
INSTALLER CONTACT PHONE ,P-r`^ 6,,1,
DATE FOR INSPECTION
SYSTEM WILL REQUIRE PRESSURE TEST - YES ( -
*The designer is required to complete a pre-cover inspection of all systems. Please contact the
designer prior to beginning construction to schedule installation inspoctiohYs and pre-Construction
meeting if required per the permit or designs specifications.
Jefferson County .^._. \5 �� ._._._. .-.-.�.._. -.
Y StaffC]nl y,. i�\
MONITORINQ AGREEMENT MAILED DATE/1 Tl,�
PRESSURE TEST SCHEDULED 1`"' ``
100-4.W. / t rt c14,,Le
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!P %; JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street • Port Townsend • Washington • 98368
www.jeffe rso n cou my pu b liche a lth.o rg
MADELEINE HOUSTON August 4, 2014
PO BOX 751
PORT TOWNSEND WA 98368-0751
RE: NOTICE AND ORDER TO CORRECT-Septic System Corrections Required
Septic System Monitoring Inspection
SITE ADDRESS: 1891 S JACOB MILLER RD
PARCEL NUMBER: 963301301
CASE#: SOM87-00257
Dear: MADELEINE HOUSTON
On June 18, 2014 a monitoring inspection was completed on the above referenced property.
The following issues identified require correction:
1. The septic tank was found to be leaking. WAC 246-272A requires a tank to be watertight.
Contact a licensed Designer.
2. There is a well head approximately 25 feet from a septic tank. You must either
decommission the well or obtain a permit to move the septic tank.
Items identified above may cause damage to, or premature failure of the onsite sewage system and
constitute a violation of the following section of JCC 8.15:
> JC Code 8.15.150 (1) Operations, Maintenance and Monitoring
Jefferson County Public Health hereby gives you notice to correct the violations identified above
within thirty days of the date of this notice by doing the following:
> Hire an Onsite Wastewater Treatment Designer, or a Professional Engineer to inspect the
septic system components to verify their condition and;
> Submit the inspection report to Jefferson County Public Health, Environmental Health
Division for review to determine if additional actions are required OR submit a design for
corrective actions that complies with state and local code to the Jefferson County Public
Health, Environmental Health Division for review, and, if needed,
> If required by code obtain a Sewage Disposal Permit from Jefferson County Public Health
pursuant to JCC 8.15.080.
> Contact this office at 360-385-9444 to inform me of the actions you are taking.
Please be advised that you also need to comply with other sections of Jefferson County Code, and
may need to apply for the following if applicable:
> building permit
This is obtained through the Jefferson County Department of Community Development. They can
be contacted at(360) 379-4450.
This letter is intended to serve as formal notice that no further approvals shall be granted until
corrections are made and approved by Health Department staff. Failure to comply with this notice
and order to correct violation may result in the issuance of a civil infraction notice to you pursuant to
section 180 of said regulations. The civil infraction may result in a fine of up to$513.00 per
violation per day to be assessed to you.
A permit is required for any repair or modification of an onsite sewage system, per Washington
Administrative Code 246-272A and Jefferson County Code 8.15. A list of designers that have
submitted work here is enclosed. The code sections referenced are attached for your information.
The purpose of proper maintenance is so the County, for the benefit and protection of the public's
health, is assured by this department that these systems are designed, installed and maintained in
a proper manner. We appreciate your prompt attention to this matter and if you should have further
questions please contact this office at 385-9444.
Please note that pursuant to JC Code 8.15.170 of the above regulations that any person aggrieved
by the contents of a Notice and Order to Correct Violation issued under this regulation, or by any
inspection or enforcement action conducted by Jefferson County Public Health under this regulation
may request, in writing, a hearing before the Health Officer or his/her designee. Such request shall
be presented to the Health Officer within 10 business days of the action appealed. Such a hearing,
if requested by you, will be your sole opportunity to present live testimony and witnesses in support
of your position.
Sincerely,
•rt Environmental Health Specialist
Jefferson County Public Health
360-385-9444
c: File, O&M Specialist
enc List of Designers
/
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Page 1 of 2;Davis;
Tank Cross Section-Not To Scale parcel#963301201-701
(For illustrative purposes only, actual tank configuration may vary,tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
OC
ACCESS RISER/ 88
FINISH GRADE �Q,1
r
7
I
/ - sewer line
FROM SEWAGE f
SOURCE FLOATING MAT
APPROVED
— — EFFLUENT
FILTER
SEDIMENTS maximum 1/16"filter
_�
SEPTIC TANK
,,.arlgifSlq
2000 gallon Septic tank
'-
D�c pOSR' 'l' c..ko�
��p,G fot on
Date
Page 2 of 2
Ak
N
10 ' 10 1 0 100' 200'
9 2 9 2 SCALE 1"=100 FEET
Parcel 1963 301 501 Parcel 1963 301 401
8 3 8 3
BLocfr 15 °v Bloch IS OCR TO u c��
7 1 > 7 d
6 5 6 5
Vacatedriw
4
g 10 1 IS 1
9 2 9 2
I Parcel #963 301 601 Parcel 1963 301 301
I -
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BLoch 16 BLoc• 13
I a
7 4 -0 7 4
a,
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6 5 6 5
Laurel Street
10 1 10 1
9 2 9 2
Parcel 1963 301 701 Parcel 63 301 201
a 3 v 8 3
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II
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Lot Detail prepared for:
,-,\` James&Trudy Davis
—_______________ —_____.____—____________._P_arcel#s 963301201, 301,401, 501,601,701
SEP87-00257&SEP93-00121 (not a part of
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JEFFERSON COUNTY HEALTH DEPARTMENT ` / 7
c 802 SHERIDAN AVENUE �/
INSTALLER 1 VollyALs ,T PORT TOWNSEND.WASHINGTON 98368 RECEIPT NO. 10-
(206)385-0722 ^^ 11
BUILDER SEWAGE DISPOSAL PERMIT DATE Itkc6 & Zy g
q5"- 5-2(I
Owner Address Phone
tt�� (i Ifil .. �"
q( k S o ,\c„c, �'�� y'A.1\E' ^ s'k� L C,'�J NAS 0vdl , v„ P \:.
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Directions for locating site cn cn O
36Q. --.VA- .C \ A ckca*-;0-1\ ';-r-- -Sce-ccIA'scoi, ckliN .„ e) A .':,'
INSTALL NEW SYSTEM REPLACE SYSTEM❑ PARTIAL REPAIR❑ TANK/DRAINFIELD,E CO 1 j,
o
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TYPE OF ,740. OF r R SITE Cr `
BUILDING Ual..��-∎ .Dos,ce •BEDROOMS BASEMENT SIZE 7o 4,-,,,,a..., `. CO
m
's~ Previous site valuation by SOIL TYPE DESCRIPTION in
Health Department —
Yes No ✓ L 1)
0-75142g 5,4_,‘,4 J-,4/11 Z
Depth to maximum seasnn.1 �, " 6;G r../.44 watj, Il vt_ L
Soc ID A.Q- ply
ANt Sfc\i3 14-ta )( V - ?
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EVEI T OF fN77G/f/17O 0
APPS __. ^,. r r r,KSUN COUNTY �' "�
/✓A// a/hI LTG—`141/9/Z-' /�11)� r*ORDINANCE 2-77. 4) y
:' ■ i'— ,(1\
14 4 t ^4-•• '7" -/5---(7- 694, 6?/.;y 32
SI NATURE OF APPLICANT ' ' z
ANY REMOVAL OF OR MAJOR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DRAINFIELD m 0
AREA MAY CREATE SITE CONDITIONS THAT ARE UNACCEPTABLE FOR THE INSTALLATION OF A
SEWAGE DISPOSAL SYSTEM. ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS tINCLUDING 8 r
PLUIBING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept.
for final inspection). STUB OUT PLUMBING ABOVE FO !%- :' FOOTING, O
Drainfield Length + french width TYench deg,h124 •.lines 2 Tank size______ >
Soil type and application rate used for design 3 GPD/ft2 - . S p?��/!1/D p
COMMENTS: '
. -6. n Trifle/./E.6 r r
1 1
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A PROVED DA E INSPECTED PARTIAUFINAL DATE .-0 ---
m
I certify that this system was installed in a manner approved by the Health Department. - m
Lei , , , .. ,,, �fi --&-7 1
INSTALLER'S SIGNATURE DATE DATE INSTALLED
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J C H(47-484 /9" '7---4-9*4 9/:2/17
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COMMENTS:
V Recommend installation of low water use fixtures.
• Divert all sources of surface runoff from drainfield (foundation drains,
downspouts, etc.) .
• Install drainfield in exact area of soil logs,
vl/ 4. Remain 100 feet from all wells and all surface waters (includin g seasonal
V drainages) .
• Do not disturb reserve drainfield area; do not build on, drive on or pave.
6. Drainlines should be installed along natural contours.
X
7. Drainlines should be installed cross slope,
�/ . Bottoms of trenches must be level.
. Drainlines must be level.
i Distribution boxes must be set on concrete pads and water leveled.
j 11. End caps required on distribution lines.
12. Curtain drain required per instructions.
. Inspection ports required in absorption bed/downslope portion of fill.
14. Dry season installation required (summer/fall) .
Y q
15. Performance monitoring required by Health Department/PUD #1.
16. The septic tank/pump chamber/closing siphon shall be watertight to prevent
groundwater intrusion.
_! . Minimum pump chamber size —
gallons.
__ l5'. Maximum flow per cycle (4" pipe) gallons.
_I- . Owner to provide adequate size pump with audiovisual alarm,
_ '0. Set pump controls for maximum holding capacity.
. Pump to be set on foundation a minimum of 6" above chamber floor.
22. Risers to grade required for septic tank/pump tank,
23. Trenches to be installed no deeper than 12" into native soil; 18" of partial
fill (sandy loam) required for cover.
_ 2 Alternating drainfields required.
25. Recommend against the use of garbage disposal units (will severely shorten
drainfield life) .
V 26. Drainfield should be seeded soon after installation to aid in evapotrans-
/ piration of effluent.
L"27. Certified "as-built" drawing required by installer/d ,
`/2'8. Final inspection required by Health Department/ .
OTHER: