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HomeMy WebLinkAboutSEP2014-00125 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER &RbDtRS, nrC, MAILING ADDRESS 4503 Old Gardiner Road Port Townsend,WA 98368 „Ulft PHONE (360)797-7722 SYSTEM DESIGNER: Michael S. Deenev Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 11 Township 29 Range 1W PARCEL#989500001 Subdivision Name V. 1,BSP, P.31 Division Block Lot(s) 28&29 Site address/Directions to site 415 Port Hadlock Heights Rd., Port Hadlock SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tanks(s)only X Private Residential ADU Modification Public X Commercial Expansion Community Upgrade Repair SITE SIZE 22,409 sf SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluwa_tion Conventional Designate Reserve Area Yes# SEP —290 Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 240 Soil type (attach soil eval.) Application Rate gal./sq.ft./day Drainfield Length N.A. ft. Trench Width N.A. ft. Trench/Bed Depth N.A. in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Service connection to Community Drainfield System (SEP95-00290) 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 se rately judged by the rules and laws in effect at that time. Property Owner Signature Date ( FOR OFFICE USE ONLY L \� PARTIAL (f 7-6../ .Ep ASBUILT LI f O% I di FINAL �`I/I,7 AP ROVED INSP/PUMP TEST iI/Z3/I,c COPXVIA 3, 2-6 tS ALL HOLD REQ. MET 11 Date 101�i I t`-i Fee 2.--Lt Rec# I 4�j 3heck J heck# I Case#SEP 1q z C:\Data\Wpw\County&State Forms\Jefferson\Septic Permit Forms\Tank Only\Broders,989500001,Lot 28&29.wpd JEFFERSON COUNTY PUBLIC HEALTH �SHt.3G'C. 615 Sheridan Street•Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org 1-'hone 3bU-3t -9444 rax .Y30-3/9-4461 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP14-00125 Date Received: 10/21/14 SITE ADDRESS: 415 PORT HADLOCK HEIGHTS RD Date Issued: 12/18/14 PORT HADLOCK, WA 98339 Date Expires: 12/18/17 APPLICANT: BRODERS INC PHONE: 360-797-7722 4503 OLD GARDINER RD PORT TOWNSEND WA 98368-9778 LEGAL DESCRIPTION: PORT HADLOCK HEIGHTS MH PARK BINDING SITE PLAN LOTS 1 THRU 45 PARCEL#: 989500001 Section: 11 Township: 29N Range: 1W DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: SEPTIC TANK TO COM SYS No. of Gallons per Day: 240 Type of work: NEW Drainfield Trench Septic Tank Length: feet Width: 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,'nvironmental 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.: SEP14-00125 1.) Final approval of the sewage disposal permit will be given at the time our office has written notification by the PUD and/or the designer that inspections have been made and the installation meets their satisfaction. 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.) Installer will verify with the system manager, the Jefferson County PUD #1, and the designer for specifications of pump requirements and inspections required by either party. 4.) 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 246-272AAND 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.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 6.) Health Department is to be contacted for a final inspection of the septic tank and pump chamber prior to covering. 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 completion 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.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 12.) Divert all sources of drainage, including roof drains away from septic tank and pump tank areas. 13.) 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. 14.) H - This permit is granted based on the recorded RESTRICTIVE COVENANT combining lots. COVENANT recorded under AFN 511761 15.) 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. 16.) 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. SEP14-00125 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 12/18/2014 17.) 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. 18.) This parcel is within a no shooting area per JCC 8.50. 19.) 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. 20.) This approval is for a septic system only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 21.) The site plan as submitted with the septic system application on 10-21-2014has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan shall be resubmitted for review and approval by Jefferson County Department of Community Development. SEP14-00125 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 12/18/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING 1. Designer /— ICW/P'''G Permit # SEP lq :, c / z j Installer 0v,4A/A'EV/LLE/ Parcel # 90? C-40 dO/ Electrician Design Flow Z © Property Owner R!c///'1,2D ,9 • 'DE72 S Site Address 1/5 l =',27• /r" -G' /4/G>'/4,29 7:5 , ,fz7 f71m12: , ( '.4 g333� Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) /, Z V✓/5/-(Ft'L .s-foo -Z.L57 3-ZS/5* Pump chamber (manufacturer, size) /,4549U G44, 3-0 S-iS' Screen(s)and/or Pump Shroud (type, location) pvi-7-4a V, i 7 ale7Zige fr-74-re.72 3 Were Tanks tested onsite for water tightness? Yes No Panel Model Gj'&'u« $Z Timer Model A/ Pump 1 - Man./Model a12E'''G-e2 PiC Z4:7451/ Flow Rate /4-,7 gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) /z-2>el,Up ,v7-DiFi O rff- ZO On - OFG1 _ Z3 ff Off- ©A/ Zto Alarm - Z9 " Veto On - Storage Above High Water Alarm '-8 3 gal. Veto Off- Dose Counter Reading (o 7 # gallons/dose bO Elap. Time Meter Reading p, l08 f/dv2 s Pump Throttled? Ye / No Dose Drawdown (in inches) 3" FLO4r/���-?`�? ; `Z©l.47ea-Fr;- Pump 2 - Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off- On - Veto - Off - Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) If additional pumps complete this info for each C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 12/01/14 page 1 of 2 Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location 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/Sch. /'Z 5a .e-b 4'0 Manifold Size/Sch. Orifice Diameter Lateral Size/Sch. Barrier Material Cover Material/Depth 4,b Residual Head (lat.# &ft. Head) ®<P4N Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean? Yes / No If no, what action taken? Mound/Glendon Site Prep. Drainfield Length ft Width ft Depth inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Other Aquaworx panel settings: SWarn at , ZBios at , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner Iti/77-/ g "t i>4"-lf '/ma' S Date Tank/component Decommissioning Report Attached Yes / No CE-0 Installer Certification attached/signed Yes /0) ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I certify the information provided above was verified by inspection (with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed (no backfill, except over transport pipes), and final inspection of the completed system(with exceptions as noted, if any). To the extent revealed by these periodic inspections,the system complies with all the conditions noted in the permit as approved by Jefferson County /2-/63-44---- (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 1 �—Z9—l5 5100110 Designer Signat Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 12/01/14' page 2 of 2 m N 21.,,,-' w' I ::': ; CO0��Z 5 A �Z fC U ITI 0 /AB's -p O -�albr�pzA) -0-< -2-"1 V -13 g Ri O� � gal m`t.�.1 r 8r '+ ∎iyi . 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