HomeMy WebLinkAboutSEP2012-00026 Jefferson County Department of Community Development 02/29/12
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION •
PROPERTY OWNER- 'Jeff Miller
e.
MAILING ADDRESS PO Box 1171 2
tixavSE .'
zsioNy
Poulsbo. WA 983705
PHONE ( 360 ) 271-1432
SYSTEM DESIGNER Suzanne Martin Designer Phone# 360.554.0224
LEGAL DESCRIPTION: Section 35 Township 28N Range 1E PARCEL# 821 355 058
Subdivision Name Olympic Ridge Estates Division Block Lot(s)22
Site address/Directions to site Olympic Ridge to Fem Gully;Follow FG the horse pasture on right;take small road/grassy drive to left
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE r I Fern
Residential ✓ New ✓ Private
Residential ADU Modification Public ✓
Commercial Expansion
Community Upgrade
SYSTEM TYPE Repair SITE SIZE 2.5ac
Conventional ✓ Partial Repair-(tank) Previous Evaluation
Alternative (drainfield) Yes# SEP07-278
Designate Reserve Area No
Redesign
SYSTEM DETAILS
Number of Gallons/day 600 Soil type 3 (attach soil eval.) Application Rate 0 o 1-0_gal./sq.ft./day
Drainfield Length Z.85 _ft. Trench Width 3 ft. Trench/Bed Depth 24 in.
Septic Tank size S c)C%,_gal. Pump Chamber size n/a gal.
TYPE OF SYSTEM Conventional-
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 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 application will be separate) judged by the rules and laws in effect at that time.
31/C f,
Property Owner Signature ate
FOR OFFICE USE ONLY
Z 5 3/6
PARTIAL-./ f C°7 ASBUILT ae0e I iI�` FINAL 3/36// ..-- id
AP ROVED
INSP/PUMP TEST 75W)s i5
ALL HOLD REQ.MET
Date -2-- Fee ill( Rec# / Check# -5-67 Case#SEP 9—
SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450
PERMIT #: SEP12-00026 Date Received: 03/15/12
SITE ADDRESS: FERN GULLY Date Issued: 04/26/12
Date Expires: 04/26/15
APPLICANT: JEFFREY W MILLER PHONE:
PO BOX 1171
POULSBO WA 983700079
LEGAL DESCRIPTION: OLYMPIC RIDGE ESTATES PARCEL 22 SURVEY 10/178
PARCEL#: 821355058 Section: 35 Township: 28N Range: 01 E
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
SEPTICS BY SUZANNE
PO BOX 125
CHIMACUM WA 98325
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.
Permit issued to CONSTRUCT,ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN
JEFFERSON COUNTY,WASHINGTON
Thls 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, c••ified 8. 5 amended per ordinance no.
06-0719-07. This permit may not be renewed.
Jefferson Coun Environ ntal Health Specialist
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.
HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION.
SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH
No. of Gallons per Day: 600 Type of work: NEW
Drainfield Trench Septic Tank
Length: 285 feet Width: 3 feet Depth: 24 inches Size: 1,500 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL - PERMIT NO.: SEP12-00026
1.) The site plan dated 3-15-2012 submitted for the septic application was reviewed by the
Department of Community Development and it was determined no geotechnical report
was required. Any future permits on this site are subject to review for consistency with
applicable codes and ordinances. A geotechnical report may be required for any future
permits.
2.) 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.
3.) 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.
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.) 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.) Notification of the start of construction shall be faxed or emailed to Jefferson County
Public Health ONE WORKING DAY prior to start.
7.) H -An asbuilt drawing and certification of completion by the Designer is required prior to
final approval.
8.) 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.
9.) 10'separation required between a Water line and all portions of the onsite sewage
system; effluent transport line, tanks, treatment and disposal components.
10.) All components of the septic system are to be completely protected from vehicular traffic
or mechanical disturbance.
11.) Divert all sources of drainage, including roof drains away from septic tank and drainfield
area.
12.) 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.
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.
2 of 2
11/22/19
I:\F_SEP_Permitmodspt
Y
II/A`\ 414
a
CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT'
Installer: Shold Excavating (Evan Neville) Parcel # 821 355 058
Permit Owner: Brian Slayton Permit# SEP12-00026
Designer: Suzanne Martin Design Flow: 600 gpd
Site Address: 151 Fern Gully-Port Ludlow,WA 98365
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GALJDAY
LENGTH 285 36" 24" 1500 gallon 5 600gpd
IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen
Tank Size:
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, 1500 gallon, concrete septic tank and distribution box. Risers, clean-out, speed levellers and outlet
filter have been installed.
All OSS Component installation have met or exceeded State and local codes and regulations.
Users Manual Provided to Homeowner mailed 30 Mar 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
NOTED AND THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272
26 March 2015 5100342
Designer Si nature Date License# h'4;
l j �\4 td,
./ 51042 '
42 PIl
Suzanne I Mann
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Page 4 of 4;Miller;
Tank Cross Section-Not To Scale Parcel#821355058
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
1 ACCESS RISER
\ f FINISH GRADE
n _
/ — — = to distribution box
FROM SEWAGE
/, Elms
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS maximum 3/16"filter
SEPTIC TANK
(TYPICAL)
sE1,vir\GL DISPCSAI-DESIGN
Approve' or onstruct;on
ft
pate
Page 2 of 4; Miller;
parcel#821355058
ONSITE SEWAGE DISPOSAL
SYSTEM DESIGN
Suzanne L Martin �,,
Date 29 February 2012 - ru x'
Property Owner Jeff Miller
29 February 2012
System Designer Suzanne Martin
Legal Description: Section 35 Township 28N Range 1 E
Subdivision Name Olympic Ridge Estates Division Block Lot(s) 22
I. CALCULATIONS
If for residential use:
Number of Bedrooms: 5 x 120 G.P.D. = 600 total G.P.D.
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate 0.70 G.P.D./ft. squared
(see page 214 of the EPA Design Manual)
DRAINFIELD SIZING:
Absorption area: 857 square feet (total G.P.D. :G.P.D./ft. squared)
Trench or bed width 3 feet
Trench or bed length 285 lineal feet (sq. ft. trench or bed width)
II. APPURTENANCES
Septic Tank Size 1500 gallons •
Pump Requirements (If Necessary)
Elevation difference in feet n/a
Friction loss
Pump capacity should be G.P.M. at T.D.H.
Number of doses per day
Dosing volume gallons
Pump chamber size gallons
H:\home\pincntr\infohlth\sewd sn
page 3 of 4;Miller;
parcel#821355058
III. DRAINFIELD CROSS SECTION
svrann.l"eNn III
29 February 2012
D I WF I/L
a" Drat« R•4c
NATIVE SOIL
A
IMPERMEABLE MATERIAL/
SEASONAL SATURATION
A. Trench Depth 24 inches
B. 6 inches of drainrock below pipe
C. 36+ inches of vertical separation from trench bottom to impermeable
material/seasonal saturation
D. 0 inches of fill (if needed)
E. Trench width 36 inches
NOTES: Septic tank must have max. 3/16"outlet filter installed
Reserve area may required additional treatment.
If one tank is utilized, it must be a minimum of 1500. If the proposed three bedroom home is the
only structure utilizing the septic tank than a 1000 gallon tank shall be appropriate.
ATTACH DETAILED DESIGN OF SYSTEM
- page 1 of 4;Miller;
parcel#821355058
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST..PORT TOWNSEND,WA 98368, (3601 379-4450 /����',,
SOIL EVALUATION r ,
r
r
i Suzanne L Mahn
, #4 twirsisrmar
PROPERTY OWNER Jeff Miller
29 February 2012
SYSTEM DESIGNER Suzanne Martin
LEGAL DESCRIPTION: Section 35 Township 28N Range 1E Parcel # 821 355 058
Subdivision Name Olympic Ridge Estates Division Block Lot(s) 22
Date Logged: 30 May 2007 Logged By: S. Martin
Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth
where mottling or impermeable layers occur.
Primary Drainfield Area: Primary Drainfield Area:
SOIL LOG #1 Type 3 soils;0.80gpd/sf SOIL LOG #2 Type 3 soils;0.80gpd/sf
0 to 12 in. Light yellow/brown fine sand 0 to 31 in.Yellow brown fine sand
12 t0 24 in.Light grey fine sand 31 t0 48 in.Yellow brown medium sand
24 to 27 in.Gravelly mottled medium sand 48 to 60+ in.Yellow/brown fine-medium sand
27 to 45 in.Light yellow/brown fine-medium sand to in.
45-60+ Light yellow/brown
Anticipated water table n/a in. fine-medium sand Anticipated water table n/a in.
Roots to 6 inches Roots to 50 inches
Bands of mottling not due
Health Dept. Comments to water table-appear at Health Dept. Comments
soil changes
SOIL LOG #3 Reserve Drainfield Area: SOIL LOG #4 Reserve Drainfield Area:
Type 4 soils;0.60gpd/sf Type 4 soils;0.60gpd/sf
0 to 39 in. Y/b gray.f s;comp.in areas;fill in areas 0 to 2 in. Dark brown sandy loam
39 to 51 in. Dark brown organic debris 2 t0 27 in,Yellow brown slightly compact fine sand
51 to 60+ in. Yellow brown fine sand 27 to 60+ in.Yellow brown fine-medium sand
to in. t-7 to in.
Anticipated water table n/a in. 0 Anticipated water table Ilia in.
Roots to 12 inches
'mot tA--- D Roots to 24 inches
Health Dept. Comments 1;,--1/0 Health Dept. Comments
SOIL LOG #5 LOG #6
';41kli".1.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
. , . i ttt
1 June 2007 „���t •
I4 I ytt
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT : . e ?.4ttt
621 SHERIDAN ST.,PORT TOWNSEND ,WA 98368, (360) 379-4450 ..-.' •.,,nett
. %."'A t
! i 510 42 `tt
SOIL EVALUATION Suzanne L Martin .?7 tt
EXPIRES 7111/08
PROPERTY'OWNER Michael Ehlhardt
SYSTEM DESIGNER Suzanne Martin - MBH2O
LEGAL DESCRIPTION: Section 35 Township 28N Range 1E Parcel # 821 355 058
Subdivision Name Olympic Ridge Estates Division Block Lotts) 22
gg 30 May 2007 S. Martin
Date Logged: Y Logged By:
Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth
where mottling or impermeable layers occur.
�S C Primary Drainfield Area:
Primary Drainfield Area: Type 3 soils;0.80gpd/sf
SOIL LOG #1 Type 3 soils;0.80gpd/sf —41.-61 t4 SOIL LOG #2
0 to 12 in. Light yellow/brown fine sand 0 to 31 in.Yellow brown fine sand
t0
12 24 in.Light grey fine sand A6. k 31 to 48 in.Yellow brown medium sand 24 to 27 in.Gravelly mottled medium sand c )
n6 S Yellow/brown fine-medium sand
//(���-y 1�S 48 to 60+ In,Yellow/b
27 to 45 in.Light yellow/brown fine-medium sand to in. �' W
45-60+ Light yellow/brown )10154'
f
Anticipated water table n/a in. \-\,2,- , zj, Anticipated water table n/a in. ��1l
p fine-medium sand ^
�a1 �S r1 Roots to 50 inches
Roots to 6 inches
Bands of m%inh not due
Health Dept. Comments to water table-appear at Health Dept. Comments
soil changes
Reserve Drainfield Area: SOIL LOG #4 Reserve Drainfield Area:
SOIL LOG #3
Type 4 soils; 0.60gpd/sf Gt A
0 to 39 in. Y/b gray.f s;comp.in areas;fill in areas ,,,LA 0 to 2 in. Dark brown sandy loam
39 to 51 in. Dark brown organic debris
2 to 27 in. Yellow brown slightly compact fine sand
51 to 60+ in. Yellow brown fine sand 27 to 60+ in Yellow brown fine-medium sand
o
to in.
to in. -n rw4rA I,
Anticipated water table nia in. _ Anticipated water table n/a in.
Roots to
12 inches Roots to 24 inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #5 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
1,- Health Dept. Comments Health Dept. Comments
r - �� ) H:IINFOHLTHISOIL.FRM1/00
1t1
1 June 2007 = � 11
ONSITE SEWAGE DISPOSAL ,
SYSTEM DESIGN
i N
i 5 042 '41
Suzanne L Martin •. 11
Date 1 June 2007 EREg z,,,oe
Property Owner Michael Ehlhardt
System Designer Suzanne Martin -MBH2O
Legal Description: Section 35 Township 28N Range 1E
Subdivision Name Olympic Ridge Estates Division Block Lot(s) 22
I. CALCULATIONS
If for residential use:
Number of Bedrooms: 4 x 120 G.P.D.. 480 total G.P.D.
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate 0.80 G.P.D./ft. squared
(see page 214 of the EPA Design Manual)
DRAINFIELD SIZING:
Absorption area: 600 square feet (total G.P.D. ;G.P.D./ft. squared)
Trench or bed width 3 feet
Trench or bed length 200 lineal feet (sq. ft.4.trench or bed width)
II. APPURTENANCES
Septic Tank Size 1000 gallons •
Pump Requirements (If Necessary)
Elevation difference in feet n/a
Friction loss
Pump capacity should be G.P.M. at T.D.H.
Number of doses per day
Dosing volume gallons
Pump chamber size gallons
H:\home\pI nc ntr\i of ohlth\s a wd s n
` JEFFERSON COUNTY PERMIT CENTER
621 SHERIDAN ST .SOIL EVALUATION
PORT TOWNSEND WA 98368
(360)379-4450
PROPERTY OWNER M[c‘y}ej �P--- /4 40c/
SYSTEM DESIGNER �� 77,-c)Atf/4Sqti
LEGAL DESCRIPTION: Section 3 7 '^Township 2&( Range Parcel # g2(- 3$5-D S—S
SubdivisionName Gy rp? M-/, Division Block Lot(s) 22
Date Logged: /—// q S--- Logged By: Lam/ 7Zoir,Asoa
Include soil textural characteristics and the depths at which significant changes occur. Be sure
to include depth where mottling or impermeable layers occur.
SOIL LOG #1 SOIL LOG #2
c) to 2c in. 4_ 5 ____L)_to 2,_2 in. 4s
2 to ---2?, in. ;, Me," 5 Ito 72 in. _ {a ,1 c / 6
to in. to in.
to in. to in.
Anticipated water table 7Z in. Anticipated water table 72in.
Roots to 20 inches Roots to `6 2, inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #3 SOIL LOG #4
D to ay in. Zs Q to 3eD in. ,c Ad 5
2cto72 in. ,„, 7 , /h,c13 3/ to (- O in. L5
to in. 4--ll to 7?, in. F ,a Ned I5
to in. to in.
Anticipated water table 72_ in. Anticipated water table 7Z in.
Roots to 7 Z inches Roots to 55 inches
Health Dept. Comments Health Dept. Comments
•
r
SOIL LOG #5 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. Comm nts
H INFOHLTf H1SOIL fRM 't _� _ ( _(7 .
v Ci-\�)r k_. / "\ �