HomeMy WebLinkAboutSEP2012-00075 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368,(360)379-4450 R 41°15
SEPTIC PERMIT APPLICATION ?
Jefferson County Fire District#2 s .
PROPERTY OWNER /-� •
433
MAILING ADDRESS PO Box
Quilcene,WA 98376 - 4;k
+h
Suzanne M 4.1
artin' 1
PHONE ( 360 ) 344-2378 ,. 'DMA 6U@ N : !1
SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304 Q�O b Til 11113
LEGAL DESCRIPTION: Section 24 Township 27N Range 2W PARCEL# 937201059
Subdivision Name Cambell's HW Add'n (tax 38) Division Block 10 Lot(s) 2 & 3
Site address/Directions to site 60 West Rose-Quilcene,WA
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential I New Tank/s only Private
Residential ADU Modification_ _ Public ✓
Commercial _ Expansion_
Community Upgrade
Repair SITE SIZE +/-28027sf
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional ✓ Designate RPsPrve Area it Yes# SOM12-00075
Alternative Redesign No -
SYSTEM DETAILS
Nymber of Gallons/day 240 Soil type 1 (attach soil eval.) Application Rate 0.80 galisq.ftiday
Drainfield Length reserve ft. Trench Width res ft. Trench/Bed Depth res in.
Septic Tank size 1000 ex gal. Pump Chamber size n/a gal.
TYPE OF reserve area designation + bF / tc (tio+ PQrrri+)
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 -c•licatio ill be separately judged by the rules and laws in effect at th t time
l Property Owner Signature Date
FOR OFFICE USE ONLY
PARTIAL ASBUILT FINAL b�I?
INSP/PUMP TEST PUD .V � it/� °
ALL HOLD REQ. MET ¢-5y" L
C� Q 2 � 20.p
Date t 'L.K I t S Fee 25? o�Rec# 5.�✓ Check# ( .Jb o 2- Case#SEP /5 —O 5
rtin�my ,,nth-\T^iTr
forms'.,Suz'',200i SF:A.DOC
Herbert Street-Quilcene
LParcel#937201 055;058;059
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST.,PORT TOWNSEND,WA 98368, (360) 379-4450 4t,
SOIL EVALUATION +
PROPERTY OWNER Jefferson County Fire District#2 +e;
z, ,,
Suzanne L Martin= /
SYSTEM DESIGNER Suzanne Martin ,,,,,„s
LEGAL DESCRIPTION: Section 24 Township 27N Range 2W Parcel # 937201 055/058/05
Subdivision Name Campbell's HW Addition Division Block 10 lot(s) tax 25, 26&38
Date Logged: 12 November 2013 Logged By: Suzanne Martin
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 A \ SOIL LOG #2
r
0 to 56+ in Type 1 ``- ''�-'� 0 to 55+ in
type 1
+ ,
to in. -' c A 1 U to in.
to in. l 'v to in.
to in. - to in.
Anticipated water table n/a in. Anticipated ter table n/a in.
Roots to 56 inches /U' Roots to 50 inches
Health Dept. Comments L=a ii a�”Ith Dept. Comments
;9 i _,
SOIL LOG #3 ■_ ' SOIL LOG #4
0 to 36 i type 1 0 to 48+ 'in, type 1
36 to 48+ in. type 2 ' to i
�n-. ,.,..
to in. `'�N lJOV t o in.
to in. to in.
Anticipated water table ilia in. Anticipated water table n/a in.
Roots to 36" inches Roots to 36" inches
Health Dept. Common s Z Health Dept. Comments
- 5i
SOIL LOG #5 ¶7-± 7-----)41,-- 1 SOIL LOG #6
0 to 60+ in.type 1 0 to 48 in.type 1
to in. to in.
to in. to in.
to in. to in.
Anticipated water table ilia in. Anticipated water table n/a in.
Roots to 48 inches Roots to 39 inches
Health Dept. Comments Health Dept. Comments
H:UNFOHLTHISOILFRM1/00 r s
Cv\)C4,..) C t• 1 1 i '}' ")--% a i' ' \\'''',\V ', ,,/\:,-,,,,,,/***,)
r/ /7
1
C- 1
0.1 -4,
7 0
O
— 3 c N cD
O ` m n X
• N
• Ti J_ I °
�d o O cD 7 O
C O 3 .+ O X
CI 3 ,--•
CJ O
c- co 1 d
O
00 0o CD d CD 4,
d N X CD CD-0 -• 7
_,• N O X
a D, .•r CD
7 CD I 0 • .-4
CD CD
X Q CD ,-r CD a CD
O a .. c-
CD
O CO C A
N ex. (Irk/-
X
I* N C.4=:0 11 X
•%'iii
'-..,./.
N 1 t '••
t't 1
s
i CD :, L N
o
N
, ♦ ♦! : CD:; ::■ �4SIiP: h'w d CD::i:i0 'E o
.:::::::::::': ;-:,:,,.:: '771'::::::::::::: ___ 1!.!2!!:: 2
'''''t r, A 0 i ---,,...„. ., ..., • jr
... _ i,...,:.:„.„.„.,.i.,,,:;:,..„,,,,,.i.•,
j
1 4 7 N Pco-i
co
w
lo cl.
o C .. -I _
O
E' Z
V
..I°
23
X m X 6` N
s• C1 ea iJ = Qi O C3' CO C7 CD -i CD
-5 -, CD < NNIcr o ? ? = a -i. X ?
CD (D .-1.. .-1-i N rr CD CD 0 .-4- 0, 0 -,
9 C co
`Z d - CD .•+ 3 o C,d O CD CD -1 O ?Oo m d
O O d d -1 O O X • CD (-(' CD O. I•-r '+ • 7 7 O 7
-. + .+ 7 7 O. CD CD 3 N
CI)
- CD co 7 -• h h d 7 7C' 71 O fD �` '� fD K �, O
.•+ N -7 -7 -1, h N - O 0, X Q 1 Cr ?CCDD n d N � CD (0-.
n0 � 3 co o. 0 =oci a 7 N �01� (1)00 n, + ���0 T 1.
- D = 0 '- = = • -, CD n X;` 0 N ll 7 ' O 3 -. ..i, 7
0 ,1- NcD �Nrn ?,nor~ o, fa �+ � � � °+
1IIHI
? CD 7 d ' n 0?i CD r+ 7 .-r O N 7 ,� -..
d a co O 7 c O O O I �, O. 7 0 co 7 0 .�� O O
N '� N -• _. x nCD Q .+ 7 7•n�• Q-1. 7 CD ..
CD O CD 0) C)Odf'..... CI'•• 77) 0. 0NCI
n n ° � ? rnN
= u c QCn , �o �
CD
O L ho O CD N O .+ ,+ N CI, j
.. o� r+rn � 7� ° CD .+ o o a a
:
v ° C < < CD
x0na D CD = .
, - .. ,
4.11�a N
K \/ .,\\\ N 0 CD w N Crn < - O• Q a. ? co?C0n- rnD N (-, x 7
'I - 0 -
• oocv N NC
ti D CD •0, .+ COD C -n 01 0 CD +7 7
1 D
N .+ CD CD .+00 CO s-
? n CD D$ \\\ m n N j n W.% D C
/z. S r�
C
/dr NN
3, �J... A V n
/l ,.
Jwl
-.1-
O O CD I-
-1
c n
X (n CD � �` ^ 0 - 00 0.
CD r_ `.. 0 0 •, -,Cn_cNn -a a -1- N N � Q D 3 7 a.. CD
1\1 CL. N � mO = r• r = N (<D ..
rn ' 1 om7 co m oaf, t— o
N °, cN Nn - N -< cc
co c- .Z70 0 N S.
� •• UI V) CD a -• �� O O � d N
.. (n tG. C1 �1 r• W
'.1 3 O -7 m° 7° 7 1°
N N .7 (D Q Q v
1.. # N r— 0 -! (D 7 ca, O
r~ 1 B
-. Nom * ? c - �° CD
a°iC> > n - N • c
N CD rt () CD N I 00* 7 +.e 2 p -
o �•' W et
am C
,< o
N
CD
N