HomeMy WebLinkAboutSEP2014-00102Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379 -4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Jeffrev Fish
MAILING ADDRESS 20327 Weald Way St.
Spring, TX 77388
PHONE 281 )_280 - 1406
SYSTEM DESIGNER: Michael S. Deeney Designer Phone #: ( 800 ) 395 - 7296
LEGAL DESCRIPTION: Section 1 Township 29 Range 1W PARCEL # 989400101
Subdivision Name Port Hadlock W.1 Long Plats, P.44) Division Block 1 Lot(s) 1
Site address /Directions to site 100 Curtiss St., Port Hadlock
SOURCE OF SEWAGEIUSE
Residential X
Residential ADU
Commercial
Community
SYSTEM TYPE
Conventional
Alternative X
TYPE OF WORK
New Tanks(s) only
Modification
Expansion X
Upgrade
Repair
Partial Repair - (tank) (drainfield)
Designate Reserve Area
Redesign
WATER SOURCE
Private X
Public
SITE SIZE 12,587 sf
Previous Evaluation
Yes # Tech Review
No
SYSTEM DETAILS
Number of Gallons /day 360 Soil type 3 (attach soil eval.) Application Rate 0.8 gal. /sq.ft. /day
Drainfield Length 150 ft. Drainfield Width 3 ft. Drainfield Depth 40 in.
Septic Tank size existing 1,000 gal. Pump Chamber size 1,000 gal.
TYPE OF SYSTEM Pressure Sand -Lined Drainfield
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 o ain permission to build a permanent residence or other structure on this parcel. Any
future applica n will be separately judged by the rules and laws in effect at that time ___� 1-1 -7 A a
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Property Owner Signature Date
FOR . OFFICE USE ONLY
( PARTIALn L; AS t� Q� FINA
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k� JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street • Port Townsend • Washington • 98368
H/nG
www.jeffersoncountypublicheakh.org
one - - Fax MU-319-448
ON -SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP14 -00102 Date Received:
SITE ADDRESS: 100 CURTISS ST Date Issued:
Date Expires:
PORT HADLOCK, WA 98339
APPLICANT: JEFFREY E FISH PHONE:
MARY ELLA FISH
20327 WEALD WAY ST
SPRING TX 77388 -5422
LEGAL DESCRIPTION: PORT HADLOCK BLK 1, LOT 1(ENLG BY TAX 27) LS TX 26
PARCEL #: 989400101
DESIGNER: MIKE DEENEY
CREATIVE DESIGN SOLUTIONS
PO BOX 2787
PORT ANGELES WA 98362
Section: 1 Township: 29N Range: 1W
SYSTEM DESCRIPTION: SAND LINED TRENCH
No. of Gallons per Day: 360 Type of work: EXP
07/30/14
12/24/14
03/24/15
PHONE: (800)395 -7296
--------- Drainfield-------------- -------------- - - - - -- Trench------------ - - - - -- ----- - - - - -- Septic Tank--------- -
Length: 150 feet Width: 3 feet Depth: 40 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/Environmental 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 -00102
1.) This permit was issued to correct a violation of WAC 246 -272A for installation of a septic system
w/o a permit. The permit must be completed within 90 days of the date of issuance.
2.) Risers are required to grade with secured lids over both compartments and over the outlet of the
septic tank for inspection and maintenance /monitoring. Minimum 20" riser over inlet.
3.) TRENCH TO BE EXCAVATED TO 40" DEPTH AND THEN BACKFILLED WITH 12" OF ASTM 33
TYPE SAND AS PER DESIGN.
4.) 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.
5.) 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- 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
6.) Health Dept. required to observe pressure test with system designer when system fully
installed /complete, 48 hours notice to be provided for scheduling.
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.) All components of the septic system are to be completely protected from vehicular traffic or
mechanical disturbance.
13.) Contact designer prior to installation for staking of drainfield area.
14.) This site has been granted a waiver from WAC 246 -272A and JC Code 8.15 under Jefferson
County Policy 97 -2. The site requires a minimum land area of 15000sq /ft, the property has
12587sq/ft available on the site. Compliance with conditions of the waiver are required, a maximum
of 377gallons of waste water per day can be applied to the site.
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.) 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.
17.) This approval is valid only with a connection to an approved public water supply.
SEP14 -00102 Page 2 of 3
\\ tidemark \data \forms \F_SEP_Permitmod.rpt 12/24/2014
18.) 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.
19.) The site plan as submitted with the Sewage Disposal Application on July 20, 2014 has 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 dated September 10, 2014 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
20.) This approval is for an on site sewage disposal 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.) This parcel is within a no shooting area per JCC 8.50.
22.) 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 -00102 Page 3 of 3
\\ tidemark \data \forms \F_SEP_Permitmod.rpt 12/24/2014
JEFFERSON COUNTY PUBLIC HEALTH 615 SHERIDAN PORT TOWNSEND WA 98368``
CONSTRUCTION INSPECTION REPORT Ak
For RECORD DRAWING
Designer C *0*ff e- Permit # SEP o.Z
Installer 4i,`7it/ /VZ'yl4 L F— Parcel #
Electrician Design Flow c-
Property Owner
Site Address 1042 G viz T'/ S.S s? ; , T -�a�7" ry '�G�c� , L'V'4 98 33Q
Answer all questions or indicate NA
Tanks, Pumps and Controls Date Insp.
Tank (manufacturer, size, baffles 10a,57 Z �o��� tas�y- 'irl�C �rGET iz7'�?� 3 -ZS -t$
Pump chamber (manufacturer, size) /000 7-Z5- /S
Screen(s)and /or Pump Shroud (type, location) Y.1rf41G7- wl 31Drl�BE Were Tanks tested onsite for water tightness? Yes / No
Panel Model fIQu.9 S01 Timer Model A4'604
Pump 1 - Man. /Model 0 SDo Flow Rate 3 3 gpm 4 -2 3 -/S-
Pump Location (i.e. garage, treatment unit, basement)
Bottom of transducer to bottom of tank
Float settings (above bottom of tank) / transducer settings
(above bottom of transducer)
On /off -
Float settings (above bottom of tank) / transducer settings
(above bottom of transducer)
On /off - O. 9
Timer Functions:
On - ! ��i.u. l 3
Off -
Veto -
Off - 3 ¢75 c
23 88
Alarm - Z 3 .G "
Veto On - ll rlAl,
# gallons /dose
Storage Above High Water Alarm gal.
Veto Off - 3,y25 78rr,.v, 7 ��
Dose Drawdown (in inches)
Dose Counter Reading
# gallons /dose 469
Elap. Time Meter Reading Zqj ? „v 7src
Pump Throttled? Ye / No
Dose Drawdown (in inches) /. 6
Pump 2 - Man. /Model
Pump Location (i.e. garage, treatment unit, basement)
Flow Rate gpm
Bottom of transducer to bottom of tank
Float settings (above bottom of tank) / transducer settings
(above bottom of transducer)
On /off -
Timer Functions:
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
CAData\Wpw \County & State Forms \Jefferson \Construction Reports\Alternative sys ASBUILT 2010- 2.FRM.wpd 12/01114 page 1 of 2
x
Pre- Treatment I,e�y
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 Yids " / No
Disinfection Unit (manufacturer, type, model)
Date Insp
Independent Alarm Yes / No
Drainfield
Transport Pipe Size /Sch. Z scf ¢U Manifold Size /Sch. Z /SC,�{ ¢1:5) 3 -z J -ls
Orifice Diameter %3 Lateral Size /Sch. sc ff- 40
Barrier Material Cover Material /Depth /3"5Z
Residual Head (lat.# & ft. Head) 5 �-� ��, 1-�' LG Z i1 iS ¢ -Z 3 -1 s--
Source /Manufacturer of Drainrock /Gravelless chambers
Drainrock Clean? 1C / No If no, what action taken?
Mound /Glendon Site Prep.
Drainfield Length /5-0 ft Width 3 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: Swam at , ZBios at0, Autoclear set at 1 doses min -sec.
Health Department Inspection issues resolved Yes / No NA If yes how?
Users Manual Provided to Homeowner wZ �y R'5 0A 1�/2� L4/ lo S Date
Tank /component Decommissioning Report Attached Yes / No /
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 (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 /Z- Z 4 — l 4f- (Permit Approval
Date) or that changes have been noted and the system is in compliance with WAC 246 -272.
f
e,.
5100110
Designer Signature Date License #
CAData \Wpw \County & State FormsWefferson \Construction Reports\Alternative sys ASBUILT 2010- 2.FRM.wpd 12/01/14 page 2 of 2
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SOIL HOLE LOGS
Page i of /
Designer f� > k 1>�/� mil' Date
Property Owner /Buyer -� ���' ��1�6,� Parcel #
t
Projects /b�-!�L1�'? '/ G Sec(Twp -Rng)
HOLE
NO.
w
O
z
TYPE
OF
DEPTH
z
w
CO
F=
ui LO
m w
zz
SYSTEM
(Inches)
H
v
TEXTURE
APPL.
O
H o c
F-
O
I-
RATE
(gpd /sq. ft.)
w _�
Q a -
OBSERVED
Co
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U
O
O
D:
z
F71G�
N
Zo
& 5 G
.
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LEGEND - SOIL HOLE LOGS
TYPE OF SYSTEM
Conv
Conventional Drainfield
Note: The type of system underlined is the
CPF
Conventional Drainfield - Partial
Fill
type of system currently indicated by
P
Pressure Distribution Drainfield
the soils. Wet season evaluation
PPF
Pressure Distribution Drainfield
_ Partial Fill
and /or effective curtain draining may
PSL
Pressure Distribution Drainfield
- Sand Lined
allow revising the type of system.
PDT -
Pressure Distribution Drainfield
- Deep Trench (Sand Lined)
M
Mound
SF
Intermittent Sand Filter
SF -M
Mound With Intermittent Sand Filter Pretreatment
NS
No System Possible
WSE
Wet Season Evaluation
MOTTLING
Examples
VF Very Faint
F Faint
F -D
Faint to Moderate
D Distinct
P Prominent
STRUCTURE
Examples
L
Loose
MC-C
Moderately Compact to Compact
Sc
Slightly Compact
MC /CEM
Moderately Compact & Cemented
MC
Moderately Compact
S -Cem
Slightly Cemented
C
Compact
S -Mas
Slightly Massive
CEM
Cemented
MAS
Massive
BLKY
Blocky
TEXTURE
APPLICATION
(APPL) RATE
S
Sand
R Unusable Restrictive Layer
LS
Loamy.Sand
SL
Sandy Loam
L
Loam
SiL
Silt Loam
Si
Silt
SiCL
Silty Clay Loam
Sic
Silty Clay
CL
Clay Loam
SCL
Sandy Clay Loam
Sc
Sandy Clay
C
Clay
Textural Qualifiers
Examples
F
Fine
VG F -M S
Very Gravelly Fine to Medium Sand
M
Medium
F SL
Fine Sandy Loam
C
Coarse
G
Gravelly
VG
Very Gravelly
EG
Extremely Gravelly
Cob
Cobbles
Version 11/14/07
CAData \Wpw\Soils\Maslers\Soil Hole Logs .wpd
12-
ox
jel,
ce
i
�,;ON < _.
w v
Date 4/30/14 Additional Information Routing Sheet
REQUIRED - check at least one item in section #1 and #2
#1 This is being submitted for the following reason
#2 Submitted for the following Application /s or Case
# of Copies
Redesign /Revision
Septic Case (SEP)
3
X
Technical Assistance (1 copy)
Building permit (BLD)
7*
Record Drawing (1 copy)
SPAAD
4*
Monitoring Inspection Site Plan (1 copy)
Subdivision (includes BLA)
7*
Renewal
Other -state case type
7*
Other (provide detail)
*If Submittal is larger than 11" X 17" submit 4 copies of those sheets
Requested by 1C Staff Randy Marx -;
Submitted by: Michael Deeney, Creative Design Solutions, Inc. Phone 800 - 395 -7296
XCheck included? $67
u�
Regarding: Parcel Number 989400101
Address 100 Curtiss St., Port Hadlock, WA 98339
Case Number SEP 05 -00197 Case Number BLD 99 -00343
Other Case Number /s SOM05 -00197
Comment:
This Tech Review will be for digging soil holes and locating the existing septic system disposal components (would
like to backfill same day).
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