HomeMy WebLinkAboutSEP2014-00046 Jefferson County Department of Community Development
621 Sheridan St.,Port Townsend WA 98368,(360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Richard gurleigh
MAILING ADDRESS 4703-46th Ave.S.W.
Seattle,WA 98116
PHONE (206)909-8204
SYSTEM DESIGNER: Michael S.Deeney Designer Phone# ( 800 ) 395-7296
LEGAL DESCRIPTION: Section 8 Township 29 Range 1W PARCEL# 901081016
Subdivision Name V.1 of Short Plats,P.6 Division Block Lots) 2
Site address/Directions to site 23 Madrona Beach Dr.,Port Townsend,WA 98368
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New Tanks(s)only X Private X
Residential ADU Modification Public
Commercial Expansion
Community Upgrade
Repair SITE SIZE'25,509 sq.ft.
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional X Designate Reserve Area Yes#SEP79-31
Alternative Redesign No
•
SYSTEM DETAILS
Number of Gallons/day 240 Soil type n,a. Application Rate n.a. gal./sq ft./day
Drainfield Length n.a. ft. Trench Width ma. ft. Trench Depth n.a. ;,in.
Septic Tank size n.a. gal. Pump Chamber size 186 gal.
TYPE OF SYSTEM Sewage Lift Vault connection to existing septic tank installed under SEP79-00031
By signing the application form,the appiicantiowner 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 attomey'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 requir:.0 or notice. Inspections shall occur during regular business hours. Initial here if you require
notification before entry -`fir Appeal —A person aggrieved of a decision of the Health Officer may appeal.
Appeals shall be submitted to a 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 e se•ara-a - ju•-,.. by the rules and laws in effect at that time.
/ 'er
Property • ner Signature at
I oa/ FOR OFFICE USE ONLY S D J -
�!17 PARTIAL ASB • X1/5 �,� / �l
UILT C[) FINA,I����y /5
APPROVED �,/
INSP/PUMP TEST 7/4/l5' ), 1
ALL HOLD REQ.MET II ''
Date I. t I I`i Fee 210 CC Rec# C D Check# 17 Case#SEP I`1 -0 4
Clilet Iiy $ IQy Q.I7 cr5l
°tIt a (l .I i (V4, �� i3-e-0.
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t JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
-Syll f tii+ ~
www.jeffersoncountypublicheakh.org
Phone WU-:it b-9444 Fax 3bU-3(9-448/
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP14-00046 Date Received: 04/21/14
SITE ADDRESS: 23 MADRONA BEACH DR Date Issued: 12/08/14
PORT TOWNSEND, WA 98368 Date Expires: 03/08/15
APPLICANT: RICHARD F BURLEIGH JR PHONE:
SUSAN H BURLEIGH
4703 46TH AVE SW
SEATTLE WA 981164405
LEGAL DESCRIPTION: BARRETT SHORT PLAT LOT 2W/TL FRTG&TAX RR-14
PARCEL#: 901081016 Section: 8 Township: 29N Range: 1W
DESIGNER: MIKE DEENEY PHONE: (800)395-7296
CREATIVE DESIGN SOLUTIONS
PO BOX 2787
PORT ANGELES WA 98362
SYSTEM DESCRIPTION: PUMP CHAM TO INDIV SYS
No. of Gallons per Day: 240 Type of work: MOD
Drainfield Trench Septic Tank
Length: feet Width: feet Depth: inches Size: 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-Si Sewage Sy to s, codified in JCC 8.15 as amended.
This permit may not be renewed. \ d,
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.: SEP14-00046
1.) H - Risers shall be installed over existing pump chamber to drainfield and distribution box.
2.) H - The presence of the divider wall in the septic tank shall be verified. If there is no wall and it
cannot be replaced the tank shall be replaced with a compliant 2 compartment septic tank.
3.) H - Existing tank shall be properly abandoned. It shall be pumped and filled with clean fill.
Documentation to be provided to Health Dept. prior to final.
4.) H - Permanent barriers are required along/around drainfield areas to protect from parking, driving,
and other land disturbing activities prior to final.
5.) 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.
6.) This permit was issued to correct a violation of WAC 246-272A. The permit must be completed
within 90 days of the date of issuance.
7.) 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 246-272A 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
8.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
9.) This system must be constructed by an installer certified by the Jefferson County Public Health
Department per Jefferson County Code 8.15.120 (9) and state code WAC246-272A-0250.
10.) 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.
11.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
12.) H - A Record Drawing and certification of completion by the designer is required prior to final
approval.
13.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
14.) Setback to surface waters- 50' required from tanks.
15.) Pump chamber shall be water tight be on the WA state approved list. It shall be equipped with a
control panel outside within line of sight of the pump chamber. The panel shall have an audio and
visual alarm, a cycle counter and a riser to grade. It shall be UL listed and meet L&I requirements.
16.) A screen with no greater than 1/8" openings shall be provided at the outlet of the septic tank to
protect the drainfield from excess solids.
17.) 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.
SEP14-00046 Page 2 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 12/7/2014
18.) Permit records show that the well is less than 50' to the drainfield and was drilled after the drainfield
was permitted and installed in violation of state code. No further building permits shall be approved
until corrections are completed. Connection to public water is available and the well would need to
be decommissioned.
19.) 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.
20.) The revised site plan as submitted with the Tank Only application on September 19, 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 approved site
plan shall be resubmitted for review and approval by Jefferson County Department of Community
Development.
21.) This approval is for a Tank 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.
22.) The proposal has been reviewed under JCC 18.25 Shoreline Master Program and is exempt under
JCC 18.25.560(8).
23.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the
County GIS map. There are voluntary and mandatory measures identified in the Jefferson County
Seawater Intrusion Policy(Resolution 61-02, effective September 23, 2002) that apply to well
drilling proposals and building permit applications on existing lots of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but
no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet.
24.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other
approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering lawns and
gardens. Unless catchment water has been treated to meet drinking water standards, there shall
be no cross connections allowed between the potable supply and impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or
gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per
minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors
and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather is
intended to be illustrative of the types of water conservation measures.
SEP14-00046 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 12/7/2014
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
CONSTRUCTION INSPECTION REPORT
For RECORD DRAW1°NO 201 /✓rr ., rt
Designer/`- /cf/�JEL l��� ' 5 Permit # SEP /4-e).004 ,
Installer D/ Si/oGl>/ cawr Ae 77/web Parcel # g.0/ D8 / 01(0
Electrician Design Flow 0.10
Property Owner /2l
Site Address z 3 /---40g..2/2aA I'9 B e i i C f/ p'?..,, / .e") 77-00//1/.5 It , (oc'rief 923 3&'a'
Answer all questions or indicate NA
Tanks, Pumps and Controls Date Insp.
Tank (manufacturer, size, baffles)
Pump chamber (manufacturer, size) /(O 644. 47?2Fi+.ic-0 PO/- vAy/GT 3-75=1
Screen(s)and/or Pump Shroud (type, location)
Were Tanks tested onsite for water tightness? ♦ZINP No
Panel Model 4:71?e vcp A 1 c T Timer Model 3-z 5-15
Pump 1 - Man./Model G 18E"e) T GAD Flow Rate gpm 3-ZS-/5
Pump Location (i.e. garage, treatment unit, basement) S'w'9d' Z//">1444047 R�rsll
Bottom of transducer to bottom of tank
Float settings (above bottom of tank) / transducer settings Timer Functions:
(above bottom of transducer)
On/off - Z 2 ti On -
Veto - Off -
Alarm - Z9 Veto On -
Storage Above High Water Alarm /O& gal. Veto Off -
Dose Counter Reading 4 lg # gallons/dose 1 S
Elap. Time Meter Reading Pump Throttled? Yes
Dose Drawdown (in inches) 7, if
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 11/02/11 page 1 of 2
Pre-Treatment Date Insp
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No +, 4; t ,t
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 ScH ¢Q Manifold Size/Sch. 3-25--/S
Orifice Diameter Lateral Size/Sch.
Barrier Material Cover Material/Depth
Residual Head (lat.# &ft. Head)
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.
rreP S/Y4,G I>
Health Department Inspection issues resolved Yes / No If yes how?
Users Manual Provided to Homeowner V/i7 '/ .''''"rw/iv& Date
Tank/component Decommissioning Report Attached Cr)/ No / NA
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 - $-/4 (Permit Approval
Date)or that changes have been noted and the system is in compliance with WAC 246-272.
5100110
Designer Signature Date License#
C:\Data\Wpw\County&State For " efferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 11/02/11 page 2 of 2
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