HomeMy WebLinkAboutSEP1989-00451 Fors" m.k..`,41 U) UN E, fENr, d'Fiii.,I! ,+ Dr.�J aLt ALL 1hi.il..:V.
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JEFFERSON COUNTY HEALTH DEPARTMENT
y,. k .° 802 SHERIDAN AVENUE
c�' 'ii INSTALLER PORT,TOWNSEND,WASHINGTON 9; ti'I RECEIPT NO. e3 9,,
.i. s (206)385-0722
BUILDER SEWAGE DISPOSAL PERMIT ��C2 6'�,TE l� ` � -- "`
JIFF. COUNTY D
HEALTH DEPT
cn
Owner Address Phone d r
9 Y3 ?-":-..e --1- u,�, = x // . 6 8 < 17
Directions for locating site o N m
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70 6-4
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INSTALL NEW SYSTEM❑ REPLACE SYSTEM❑ PARTIAL REPAIR TANK/DRAINFIELDO P -' Z
TYPE OF c i NO. OF SITE L d "'
BUILDING K %a`�uCE BEDROOMS , BASEMENT �v -SIZE /6� Z ac.) co 1
s Previous site evaluation by SOIL TYPE DESCRIPTION n
Health Department 1) -
Yes No X
-_
Depth to maximum seasonal
water table 6 G 'f )
Source of potable water supply 2)
Public >e Private -4
Source type: Drilled well 2
,Dug well p Z
Other 3) x
< z
00 ra
EVERY APPLICANT HAS THE RIGHT OF 0 IW
APPEAL AS PER JEFFERSON COUNTY Z
4)
ORDINANCE 2-77.
73
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SIGNATURE OF APPLICANT
ANY REMOVAL OF OR MAJOR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DDRAINFIELD o m THE INSTALLATIOV OF A
SEWAGE MAY DISPOSAL SITE C. ATI CHANGETIN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING A
SEWAGE DISPOSAL SYSTEM.
PLU`'BING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATESaTHIS pt-
PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT•
for final inspection).
STUB OUT PU�'HING ABOVE FOUNDATION FOOTING, c
Drainfield Length Trench width Trench depth No.lines Tank size C
Soil type and application rate used for design GPD/ft2 -. I- m
COMMENTS: 0
44o0. G-vi e � -k . c - s .t- �x>.\ V 5.
1
i- A . -9 J l I- 10-c;r
Apr
A•PROVED DATE INSPECTED PARTIAL/FINAL DATE n
m
I certify that this system was ' slatted in a manner approved by the Health Department. r-of
IN E 'S SIGNATURE DATE DATE INSTALLED m
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LEGAL DESCRIPTION �ilr,-=-1-4-----SS- A)-, t
COMMENTS:
1. Performance monitoring contract required with PUD #1. Contract required for final
approval of sewage disposal permit. Contact PUD #1 at 385-5800 for information.
2. Recommend installation of low water use fixtures.
N,A 3. Divert all sources of surface runoff from drainfield (foundation drains,
downspouts, etc. ) .
\1 4. Install drainfield in exact area of soil logs.
NN1 5. Remain 100 feet from all wells and all surface waters (including seasonal
drainages).
6. Do not disturb reserve drainfield area; do not build on, drive on , or pave.
7. Drainlines should be installed along natural contours.
8. Drainlines should be installed cross slope.
9. Bottoms of trenches/bed must be level.
v 10. Drainlines must be level.
11. Distribution boxes must be set on concrete pads and water leveled.
12. End caps required on distribution lines.
13. Curtain drain required per instructions.
14. Inspection ports required in absorption bed/downslope portion of fill.
15. Dry season installation required (summer/fall) .
\v 16. The septic tank/pump chamber/closing siphon shall be watertight to prevent
groundwater intrusion.
17. Minimum pump chamber size gallons.
18. Maximum flow per cycle gallons.
19. Owner to provide adequate size pump with audiovisual alarm.
20. Pump to be set on foundation a minimum of 6" above chamber floor.
21. Risers to grade required for septic tank/pump tank.
j 22. Trendies to be installed no deeper than 12" into native soil; 18" of partial fill
(sandy loam) required for cover.
23. Alternating drainfields required.
24. Sand lined trench required.
V 25. Recommend against the use of garbage disposal units (will severely shorten
N drainfield life).
26. Drainfield should be seeded soon after installation to aid in evapotranspiration
of effluent.
27. Certified "as-built" drawing required by installer/designer.
28. Final inspection required by Health Department/Designer.
OTHER:
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12(8/88 MED
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SOIL INFORMATION .
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Owner: € v
I ( ,"
Legal Description: Section 3 (1 Township 3 f Range 70j
Subdivision F.'/ - j- sli
Division Block Lot
Date Logged: / Z-7 ./
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
0 to I / in. L S /r3 to / 7.. in. 2L 5
z.-- to 0 in. - /I, to 66 in. .444 µ
to in. to in.
to in. to in.
Anticipated water table "din. Anticipated water table "'' in.
Roots to ' inches Roots to t0 inches
Soil Log #3 Soil Log #4
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
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
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JEFFERSON COUNTY HEALTH DEPARTMENT !'LT.F. Cc.>
III ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN HEALTH Cap:
Date: l Z/4Z /41 Designer: /4' /'- /I' J . Wit 5O
Legal Description: Section 311 Township 25 / Range / VV
Subdivision Division
Block Lot
Owner: 1∎ I �' pV r c.=L'
Address: il 53 h
►ise Lac:, V ? .Y6 er
I . CALCULATIONS
If for residential use:
Number of bedrooms: 3 x 120 G.P.D. = 1716 d Total G.P.D.
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate 47- G.P.D./ft. squared
(see page 214 of the EPA Design Manual )
DRAINFIELD SIZING:
Absorption area: a (J square feet (Total . GPD -- GPD/ft squared)
Trench or bed width .6 feet
Trench or bed length led lineal feet (sq. ft. -- trench or bed width)
II. APPURTENANCES
Septic Tank Size /c)dO gallons
Pump Requirements (If Necessary)
Elevation differance in feet
Friction loss
Pump capacity should be gpm at TDH
Number of doses per day
Dosing volume gallons
Pump chamber size gallons
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. ' • ...J1.1J.1.4....,U., kAJAJP411 1.11-tILIII 1.11-1 /11,A4A1-...1 Jermit. 0 1-10,.741-
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1,, 75. 1t04, INDIVIDUAL SEWAGE DISPOSAL INSPECTION FORM Date -i...:.......:_-q
APPR _
OVED YES---"-...1 NO ENVIRONMENTALIST . _.,1r.,c-__.3.a.,...._LL.L.z........_
CA e I r",
Address cly-4 3 c.-)-2-) --3 v, ---i-,--\\. --i Owner ak \
I Legal Description 4- Q.k ?-A 7 .7-1\, P t k.:3
Residence -----,1 Commercial II of Bedrooms '."
1. t System Installer
System Designer k.)k \‘DOr--),
SEPTIC TANK
Commercial -.. Non commercial Measurements: L W WD
Construction Material _--x-- Ai-- ? Lig. Cap.iiac
DISPOSAL FIELD ,Jc- c o,i-.('\..z:V. C - ',-\ ■.,,-(
— I
Exc. Depth Q4 Width ' Total Length \C)'\, Sq. Ft. 7y0(T'
Rock Type Depth Under Over
Engineer Design Yes Type Engineer Approval Letter Yes
Well 50 feet from tank 100 feet from leach field
zi .1... Well installed at time of septic system inspection yes No Public Wate
Comments:
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