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HomeMy WebLinkAboutSEP2013-00040 Jefferson County Department of Community Development 621 Sheridan St.,Port Townsend WA 98368,(360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER JOHN DRAKE & KELLY KORTEKAAS 4p MAILING ADDRESS 272 ELK RUN ROAD 1•I n1; COTTONWOOD, IDAHO 83522-5246 PHONE ( 208 ) 839-2343 SYSTEM DESIGNER NATHAN N. CLEAVER Designer Phone# (360)598-6546 LEGAL DESCRIPTION: Section 19 Township 30N Range 1W PARCEL# 001-195-126 Subdivision Name Division 5 Block Lot(s) 6 Site address/Directions to site 0 DISCOVERY RIDGE ROAD, PORT TOWNSEND .--1: &)3 �Scove.r SOURCE OF SE AGE/USE TYPE OF ORK d `'�`8 WATER SOURCE Residential New Tanks only Private i Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 222,156+4- SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evalo tiotl Conventional Designate Reserve Area Yes#`SCP01 -00113 Y Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 5 (attach soil eval.) Application Rate 0.4 galJsq.ftJday Drainfield Length 58.5 ft. Trench Width 32.55 ft. Trench/Bed Depth NA in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE of system PRESSURE MOUND , 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 application will be separately judged by the rules and laws in effect at that time.A 9//v1-\' Property Owner Signature /�p M `ate FOR OFFICE USE ONLY" U l , e 301 ) y 1` � PARTIAL ASBUILT 8CvA i/IGo r,1 q"W/t.-- APP OV-ED" J INSP/PUMP TEST 1/ /iS RA) p-wd i3//S`i ALL HOLD Q.MET L f � ll' W /.60444( CJbsnjl r� 4/ Da /ji` Fe _, Rec#/47/-- --1�'t Check# 7 )/5 Case#SEP U ._ I _:.:I, i v„ep�i__permitapp 2008.DOC 4 S R JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •93368 www.jeffersoncountypub licheatth.o rg "Ph'ohe 360:385:°g'44'4 Fax°�3'6 :379 448 _.__.....______.........e_____. ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP13-00040 Date Received: 04/10/13 Date Issued: 05/17/13 SITE ADDRESS: BLUE SKY DR Date Expires: 05117/16 PORT TOWNSEND, WA 98368 APPLICANT: JOHN W DRAKE PHONE: 503-593-9135 KELLY K KORTEKAAS 272 ELK RUN RD COTTONWOOD ID 835225246 LEGAL DESCRIPTION: DISCOVERY BAY RIDGE DIV V PARCEL 6 SUBJ TO CC&R OF RECORD V660P426 PARCEL#: 001195126 Section: 19 Township: 30N Range: 01 W DESIGNER: NATHAN CLEAVER PHONE: 360-598-6546 NATHAN CLEAVER SEPTIC DESIGN 1990 KIMBALL ST. NW POULSBO WA 98370 SYSTEM DESCRIPTION: MOUND No. of Gallons per Day: 360 Type of work: NEW Drainfield Trench Septic Tank Length: 58 feet Width: 33 feet 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 vironmental 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.: SEP13-00040 1.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 2.) 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. 3.) Dry season installation required. 4.) Contact designer prior to installation for staking of drainfield area. 5.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 6.) 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 7.) 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. 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 conpletion by the designer is required prior to final approval. 10.) 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. 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.) 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. 13.) 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. 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. 15.) This system as designed and approved is sized for only one single family residence. It is not sized for an Accessory Dwelling Unit (ADU). The minimum daily design flow per residence is 240 GPD. 16.) The project shall adhere to the Best Management Prabtices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall addf'ess permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. SEP13-00040 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 5/17/2013 17.) The site plan dated 4-10-13 submitted for the septic application was reviewed by the Department of Community Development on 4-29-13 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. SEP13-00040 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 5/17/2013 a . ° JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN. PORT TOWNS D} A g1 ASBUILT INSPECTION REPORT For RECORD DRAWIf ''( 4. Designer >r*..,`_ ��, � A AJ CIEM/ & Permit# SEP i3—e ,. {� Installer L ebJ Jo S CX� °t Parcel # Mt—kct S-126'r� Electrician AA.R,.pN R ' NseS � Design Flow , Property Owner J 4tj"bQA 1 ko ekA Site Address 803 Thscoverej Qtoc‘E tZ,Ot c , Portr'tvv lt4.S Nt) Answer all questions or indicate NA Tanks, Pumps and Controls DATE INSP. Tank (manufacturer, size, baffles) i"" i Pump chamber(manufacturer, size) PreguSiSokik 'UMW.) `jOoo ( AA .. Screen(s)and/or Pump Shroud (type, location) 't"DUqu Ti IE 'WF-4 c.l+cacrxlc.. 2,,q14w1'tot� r•, "n f* eurtet- •aA L& or sera,T At.NG,, Pw 4p sUaoaIa 1$ Were Tanks tested onsite for water tightness? Yes / No A Panel Model 0.VAW oprk tee.-50.3. Timer Model .S Ft-E.2.0%5 Pump 1 — Man./Model la /FL.tolM Flow Rate �(o gm 2.1.* 2�o13 Pump Location (i.e. garage, treatment unit, basement) t P1A -1 Float/transducer settings Inches Timer from bottom of tank- On/off- in. Functions: On IS .0imin Veto - 3-4..k in Off- 2,,, sec/min,tQ Alarm - 3 t in Veto On - 24 Storage Above High Water Alarm 33$ gal. Veto Off- Z sec/min, Dose Counter Reading 01‘50/000.32. # gallons/dose 22.5 Elap. Time Meter Reading ZO m gal' g VI t y •. in/hrs Pump Throttled? Yes M Dose Drawdown (in inches) 3 3/' " g in. Pump 2 — Man./Model Flow Rate CI Dm Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Timer from bottom of tank- On/off in. Functions: On sec/min Veto - in Off- sec/min/hr Alarm - in Veto On - Storage Above High Water Alarm sec/min gal. Veto Off- sec/min/hr Dose Counter Reading #gallons/dose gal Elap. Time Meter Reading min/hrs Pump Throttled? Yes / No Dose Drawdown (in inches) in If additional pumps-complete the info in this table for each and attach. Other Timer functions & settings (e.g. override on/off) �.rezo-- "A` 1 A u't'v Ctc.trl. : Z. Doses H:1 WEB\ONSITE1Asbuilt_Report_Form.doc 04/28/10page 1 oft F . Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes/ No Sandfilter Basin size/location Sand Fitt 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 2",Sc1#4D Manifold size/schd 2u,sc�k#40 2 ',twig,pt3 Orifice size Ye" Lateral Size/schd 1" 40 ' ArS4 2Ot Barrier Material Fries-Vac Cover Material/Depth WA / l2.--1€5" 5 Pee.zo15 Residual Head (lat.# & ft. Head) V2.5' is-T t r 5 FETI>2ONS The laterals/pods were balanced / No 5 Fes2IO11S Source/Manufacturer of Drainrock/Graveness chambers CONIcI EOt(ukt)t Drainrock Clean?Q/ No If no, what action taken? Mound/Glendon Site Prep �►'00© ____ AM Drainfield Length SS.S ft Width 32..•SS ft Depth /44 inches Caps for measuring residual head stored (location) NW .!A\uGle"( COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Health Department Inspection issues resolved Yes / No/ NA If yes how? Users Manual Provided to Homeowner . :(1- Date X/0//.5 Tank/component Decommissioning Report Attached Yes / No / NA 9 p 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 APP ROVED by JEFFERSON COUNTY 5/l,, 73 (DATE) OR THAT CHANGES HAVE BEEN NOTED AND ES 0 PLIANCE WITH WAC 46-272. ..di dili -2 (0 t' 5/00257 Designer Signature Da e License# H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 ° ° ° r- -4 n D . D X ---1.I N D F., 0 z W z o m m z - Q 03 .-5 -c g so ��oa� deJ �/ i I m <. 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O cQ (�D r* a) r O s X * C o o 3 - W Q (D °+ 0 + CD cQ rt O o 0 cn u, c CD X Q =' D = (D r+ CO__. x co co r 1 Q \ v rte+ *k �G 0 -° S rrt \ 0_ v 2 v v O. W = II 0 0 v M- -i O O p n cn Q 0 0 C c\ O iy n > + CD ccDn r+ (n \ DD m (C 0- 00 O °• N N V) V. r-r - - N - v Ni .A.) Cn Ni -, (n V) Ni -� W r--' ) — v c' CD - p' 1 Ni Ni Ni s WO M- �- O = 6- I I O' (7 2 p W O cn = -r, c9 .� W r Ui O oo • O OOv : ( rte, n oCO °' 3 cn r* aD ti iv r• II Q, (-: p _ O -r _ Cr v, 0 O - O O • c U, r oo I a' EcE11 V E 15 JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN ST SOIL EVALUATION L PORT TOWNSEND WA 98368 �4 18 (360)379-4450 JEFFERSON COUNTY PROPERTY OWNER — i 'F C, MUNITYDEyELOPMENT J�.� rrcaJc @� mss_ - _. 6 SYSTEM DESIGNER Dcxv I d iTe n sen PE LEGAL DESCRIPTION: Section 1 9 Township 30 Range 2W/ Parcel #0 0119512. G Subdivision Name 01 SGovp_Jr. F91doe LLG Division 5 Block Lot(s) C J ' Date Logged: 1 -10- 0n Logged By: Day I d Je ns e.r) 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 O to I E. in. Brn, So., Lrn , n to 1 3 in. 8rn, Sca, L.rn , 12 to 31 in.Gr\{, Brn,S1, Lm, 13 to j ( ) in. G rri , C3r, Si , Lrn , to in. to in. to in. to in. Anticipated water table'2.1--1'in. Anticipated water table}2y- in. Roots to 3 0 inches Roots to 3 5 inches Health Dept F eat r∎i, Health Dept. Comr�•ie t PeP* 6' 047 21-7f 9- 05) 6 5 i 334' SOIL LOG #3 SOIL LOG #4 o to 13 in.arn ,Sa, Lrn , Q to l2, in.Brn, Sa,Lrn , i3 to3G in.Gry , Brn, 5, , Lrr, , • is to3 5 in.Gry Brn, S1, Lrn , to in. to in. to in. to in. Anticipated water table>21-I-in. Anticipated water tabled-{in. Roots to 3 9- inches Roots to 3 0 inches - Health Dept. Comments Health Dx4me&s 4P° � no Wa--e r in holes �{ � L cdDR ,5, v151-F 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. Comments H:\\\INFOHLTH\SOIL.FRM