HomeMy WebLinkAboutSEP2009-00013 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 f� +'•,-
SEPTIC PERMIT APPLICATION `' 1f+1 6/21110
v�&• at
PROPERTY OWNER Harold Moe Construction _trw 5100341 '_'r,
p2' Jess D Godsalve
MAILING ADDRESS 240 Pioneer Dr
Port Ludlow, WA 98365
PHONE ( 360 ) 731-0643
SYSTEM DESIGNER Jess Godsalve Designer Phone# 360-551-9973
LEGAL DESCRIPTION: Section 4 Township 28N Range 1 E PARCEL# 978 900 032
Subdivision Name Olympus Beach Division Block Lot(s) 52,53 f
Site address/Directions to site oak bay to olympus blvd. Site is on right hand side above 204 01 m•us f 1 f 4p
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New X Tank/s only Private
Residential ADU Modification Public X
Commercial Expansion
Community Upgrade
Repair SITE SIZE 18059 sf
SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evuatjgn
Conventional Designate Reserve Area Yes #
Alternative X Redesign X No X
SYSTEM DETAILS
Number of Gallons/day 240 Soil type 4/5 (attach soil eval.) Application Rate 0.45 •gal./sq.ft./day
Drainfield Length N/A ft. Trench Width N/A ft. Trench/Bed Depth N/A in.
Septic Tank size 1000 gal. Pump Chamber size 1000 gal.
TYPE of system Glendon Biofilter 19' x 22.1' install. Redesigned to 2 bedroom based on '09 WW results.
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. 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 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 separately judged by the rules and laws in effect at that time.
Property Owner Signature Date
I
FOR OFFICE USE ONLY
Or I 4 1�s 13 PARTIAL /I /Jq ASBUILT 61 r ul (-7 FINAL /II/2E )
APPROVED INSP/PUMP TEST 6/1/i 3 7 7166 e b\VL'\\ \
� 1 ALL HOLD REQ. MET
Q Q / -
Date u '' � Fee I 15 Rec# I I SIl0 Check# 1 155 Case#SEP 1✓U3
H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC
JEFFERSON COUNTY PUBLIC HEALTH
ys,. w 615 Sheridan Street •Port Townsend•Washington •98368
www.jeffersoncountypublichealth.org
I'hone 3bU-:3tSb-9444 1-ax 36U-3/9-44V
/
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP09-00013 Date Received: 02/18/09
Date Issued: 01/20/13
SITE ADDRESS: OLYMPUS BLVD
PORT LUDLOW, WA 98365 Date Expires: 01/20/16
APPLICANT: HAROLD MOE CONSTRUCTION INC PHONE: (360) 731-0643
240 PIONEER DR
PORT LUDLOW WA 98365-9653
LEGAL DESCRIPTION: OLYMPUS BEACH 52&53 (TAX 119)
PARCEL#: 978900032 Section: 4 Township: 28N Range: 01 E
DESIGNER: JESS GODSALVE PHONE: (360) 598-3505
MILLER BAY WATER CO
PO BOX 1054
SUQUAMISH WA 98392
SYSTEM DESCRIPTION: GLENDON BIOFILTER
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 S a e 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.: SEP09-00013
1.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other
development or a building permit on this site. Compliance with other Jefferson County and
Washington State Codes is required.
2.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed
by current code.
3.) 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.
4.) H - AS PER WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE
SYSTEMS REQUIRE THATA 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.) This system must be constructed by an installer certified by the Jefferson County Public Health
Department per state code WAC246-272A-0250.
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 - Permanent barriers are required along/around primary and reserve drainfield areas to protect
from parking, driving, and other land disturbing activities prior to final.
10.) H -An asbuilt drawing and certification of completion by the designer is required prior to final
approval.
11.) 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.
12.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and
effluent transport lines.
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.) Dry season installation required.
15.) CURTAIN DRAIN CANNOT BE ALTERED OR MOVED WITHOUT THE EXPRESS CONSENT OF
JCPH. The installed curtain drain installed a minimum of 10' upgradient of primary and reserve
drainfields if required. This system approval is reliant on a properly functioning curtain drain.
Modification or lack of maintenance will effect system performance, reducing treatment capacity of
system as permitted and violating permit issuance conditions.
16.) A 30' setback shall be maintained from the disposal component and reserve area to any downslope
footing, curtain or interceptor drain or drainage ditch.
SEP09-00013 Page 2 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 1/20/2013
17.) All components of the septic system are to be completely protected from vehicular traffic or
mechanical disturbance.
18.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
19.) 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. Tanks are to be tested for watertightness
and documentation provided in the record drawing submittal.
20.) Dose counter and elapsed time meter are required in the control panel for all system components.
21.) 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.
22.) 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 20,000sq ft for a Type 5 soil. 18,059
square feet are available on the site. Compliance with conditions of the waiver are required.
23.) 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.
24.) 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.
25.) This approval is valid only with a connection to an approved public water supply.
26.) 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.
SEP09-00013 Page 3 of 3
\\tidemark\data\forms\F_SEP_Perm itmod.rpt 1/20/2013
P / '4
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
ASBUILT INSPECTION REPORT For RECORD DRAWING
Designer Suzanne Martin Permit # SEP 09-00013
Installer Ericsen Excavating Parcel # 978 900 032
Electrician Cascade Electric Design X7.1 z240gpd peak
Property Owner Dwight DeSilva
Site Address 196 Olympus Blvd-Port Ludlow dUN
ale ®tQ
Answer all questions or indicate NA 4 ' t <°1,5
Tanks, Pumps and Controls n�e/71- ,h,nfj, INSP.
Tank (manufacturer, size, baffles) Cotton, risers, baffles&outlet filter installed ed/tb 5/28/15
Pump chamber (manufacturer, size) Cotton, risers installed, 22 gal/inch 5/28/15
Screen(s)and/or Pump Shroud (type, location) shroud in pump chamber 5/28/15
Were Tanks tested onsite for water tightness? ED/ No
Panel Model Infiltrator Timer Model Aquaworx IPC 5/28/15
Pump 1 — Man./Model liberty 252 Flow Rate gbt gpm 5/28/15
Pump Location (i.e. garage, treatment unit, basement) in pump chamber
Float/transducer settings Inches Timer
from bottom of tank- On/off- 19.9 in Functions: On 5 EZIlat min
Veto - 28.4 in. Off- 8:23 sec�hr
Alarm - 28.2 in Veto On - 5 emin
Storage Above High Water Alarm +395 gal. Veto Off- 6:18 sec in hr
Dose Counter Reading 133 dose/23 Vdose # gallons/dose per gbt gal.
Elap. Time Meter Reading 00;18:00 min hrs Pump Throttled? Yes No
Dose Drawdown (in inches) gbt in A/C 22 doses; ZB-08; 342 events 5/28/15
Pump 2 — Man./Model n/a Flow Rate gpm
Pump Location (i.e. garage, treatment unit, basement)
Float/transducer settings Inches Timer
from bottom of tank- On/off - in Functions: On sec/min
Veto - in Off-- sec/min/hr
Alarm - in. Veto On - sec/min
Storage Above High Water Alarm gal. Veto Off- sec/min/hr
Dose Counter Reading # gallons/dose gal.
Elap. Time Meter Reading min/hrs Pump Throttled? Yes / No
If additional pumps-complete the info in this table
Dose Drawdown (in inches) ;;in for each and attach.
Other Timer functions & settings (e.g. override on/off) ZB-08 Autoclear 22 dose;
I D=05-08-2013
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2
Pre-Treatment Date Insp
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No
Sandfilter Basin size/location n/a
Sand Fill met design spec? Yes / No
ATU (manufacturer, model) n/a Alarm tested Yes / No
Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes / No
Drainfield
Transport Pipe size, schd, diameter 2" pvc sch 40 Manifold size/schd 2"pvc sch 40 5/28/15
Orifice size n/a(1"pvc in pump chamber) Lateral Size/schd 1" pvc sch 40 5/28/15
Barrier Material jute Cover Material/Depth mound 5/28/15
Residual Head (lat.# & ft. Head) pods balanced 5/28/15
The laterals/pods were balanced E) / No 5/28/15
Source/Manufacturer of Drainrock/Gravelless chambers n/a
Drainrock Clean? Yes / No If no, what action taken? n/a
Mound/Glendon Site Prep yes 10/27/14
Drainfield Length 22 ft Width 19 ft Depth n/a inches
Caps for measuring residual head stored (location) n/a
COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional
sheet(s) if necessary .
.4.) H-O & M Restrictive Covenant#586939
9.) H-Berm along North property line prevents traffic from entering primary&reserve areas and downslope
propection zone.
Health Department Inspection issues resolved Yes/ No / NA If yes how?
)\_ tki)t
Users Manual Provided to Homeowner I DateJ i ylr
Tank/component Decommissioning Report Attached es / No / NA <■e-
Installer Certification attached/signed ge / No
ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer
I CERTIjr' THE INFORMATION PROVIDED ABOVE WAS VERIFIED 13Y INSPECTION, Tq-tE
SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY
(DATE) OR THAT C1fANGES HAVE BEEN NOTED AND
THE SYSTEM IS IN COMPLIANCE WIT}f WAC 246-272.
ZThia q f c 5100342
Designer Signature Date License# - Suzanne 2 •�+++
It sot%i N .:. ++
F wIPFS 2/11/,1
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2
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System System Owner: Dwight DeSilva JON
SEP09-00013; �e f� -, '''
Parcel #978 900 032 *III peps.a
Site Address: 196 Olympus Blvd-Port Ludlow `i-k, ;
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(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
IACCESS RISER
f_-±__ - _ 4/ ),,,, _ __ , FINISH GRADE
r \ / H , -
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TANK Ill d I,' l
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' EMERGENCY STORAGE i 1 ANTI SIPHON
VALVE
HIGH WATER ALARM LEVEL
240 Gallon Aquaworx Transducer
NORMAL TIMER OFF LEVEL WORKING VOLUME Assembly
rt
ENCLOSED PUMP
SEDIMENT SHROUD* CHECK VALVE*
1$" I _ -
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PUMP CHAMBER
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*AS NEEDED
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EXPIRE 12/27/10
Performance (Utt1 fl IOO Wholesale Products Page: 6370-1
Data Section: Performance Data
Dated: January 2001
RPM: 3450 Discharge: 2" Solids: 3/4"
Note: Installer may substitute with a different
size and/or brand pump provided it meets
applicable electrical requirements and is
design for use with wastewater.
NINO
"� SHEF50
D
SHEF1 00
30— 100
24— 80
SHEF100
60 /W Z
=
SHEF50
= 12—�40
6 — 20
10'TDH
0 _ 0i
Capacity-U.S. G.P.M. 0 20 40 60 80 100
Liters/Second 0 2 4 6
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510 341 1
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0(PIRES 12/2740
The curves reflect maximum performance characteristics without exceeding full load(Nameplate) horsepower.All pumps have
a service factor of 1.2.Operation is recommended in the bounded area with operational point within the curve limit.Performance
curves are based on actual tests with clear water at 70° F.and 1280 feet site elevation.
Conditions of Service:
GPM: 3 TDH: 10' HYDROMATIC®
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SEWAGE DISPOSAL DESIGN
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JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT .'y, +
621 SHERIDAN ST., PORT TOWNSEND ,WA 98368, (360) 379-4450 %? .+►,- •21/10
,+fy
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SOIL EVALUATION s o i•
Harold Moe Construction -- JessDGodsaf4 ''.°,l
PROPERTY OWNER --um 5nr..� � ++
EXPIRES 12/27/10
SYSTEM DESIGNER Jess Godsalve- MBH2O
LEGAL DESCRIPTION: Section 4 Township 28N Range 1E Parcel # 978 900 032
Subdivision Name Olympus Beach Division Block Lot(s) 52.53
Date Logged: 5/24/08 Logged By: MBH2O
Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth
where mottling or impermeable layers occur.
SAIL LOG #5 SOIL LOG #6
0 to 12 in. dark brown loam 0 to 8 in.dk brn to
12 to 16 in. It brn mottled silo-strong blocky 8 to 15 in. brn silo-strong blocky
to 16 in. restrictive - 15 to 19 in. grey mottled sandy silo-mod blocky
to in.mott 12+ to 19 in, restrictive
Anticipated water table`^tee in. Anticipated water table wwe in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #7 SOIL LOG #8
0 to 14 in. dk brn silo-moderate blocky 0 t0 2 in. dk brn sandy loam
to 14 in. restrictive 2 to 12 in. brn silo-strong blocky
to in. to 12 in. groundwater
to in. to in.mottled 2+
Anticipated water table vvwe in. Anticipated water table wwe in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #9 SOIL LOG #
0 to 5 in.dk brn to to in.
5 to 12 in. brn to to in.
to in, to in.
to in. to in.
Anticipated water table uvwe in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:\INFOHLTH\SOIL.FRM 1/00
e tttt
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ONSITE SEWAGE DISPOSAL
SYSTEM DESIGN 6/21/10
ci.' 5100341 ' °
j.'' Jess D Godsalve '7ttf
EXPIRES 12/27/10
Date 6/21/10
Property Owner Harold Moe Construction
System Designer Jess Godsalve-MBH2O
Legal Description: Section 4 Township 28N Range 1 E
Subdivision Name Olympus Beach Division Block Lot(s) 52,53
I. CALCULATIONS
If for residential use:
Number of Bedrooms: 2 x 120 G.P.D. = 240 total G.P.D.
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate 0.45 G.P.D./ft. squared
(see page 214 of the EPA Design Manual) •
DRAINFIELD SIZING:
Absorption area: N/A square feet (total G.P.D. 4 G.P.D./ft. squared)
Trench or bed width N/A feet
Trench or bed length N/A lineal feet (sq. ft. trench or bed width)
II. APPURTENANCES
Septic Tank Size 1000 gallons
Pump Requirements (If Necessary)
Elevation difference in feet 3
Friction loss 1
Pump capacity should be 3 G.P.M. at 10 T.D.H.
Number of doses per day per GBT
Dosing volume per GBT gallons
Pump chamber size 1000 gallons
H:\home\pincntr\inf ohlth\se wd sn
Design Manual for Glendon®
BioFilter Systems in Washington
Construction Notes, and Disclaimers
The following construction notes and disclaimers are binding upon the septic designer, the installer, and the
owner or grantor of the property on which the septic design is accomplished. No substitutions can be made
without the designer's approval. The construction notes assume that the designer is not a licensed surveyor.
1.This site map does not represent a survey nor does it purport to show all easements or encroachments, if
any. If easements are not shown, it is the responsibility of the owner and the owner's liability.
2. The location of this drainfield is based on the owner or the owner's agent locating property lines and
corners. If those boundaries are not accurate, the designer is not liable for mistakes in location of primary or
reserve drainfields on the design. Easements not shown on design or on the plat map included with the design
are the sole responsibility of the owner. However,the designer must make a good faith effort to accurately
locate drainfield areas according to these instructions and, as circumstances permit,the preferences of the
owner.
3. All surface water must be diverted away from drainfield area. Insure that final grading of drainfield area
directs water away from the drainfield.
4. Prepare the site and install the units during dry conditions so equipment does not damage the structure of
the soil in the absorption area. Use of tracked machinery is strongly recommended on Glendon®sites.
5. This system is not designed for use with a garbage disposal installed in the building(s)served. Use of a
garbage disposal in a Glendon®system will require a larger than normal septic tank and additional expense in
pumping fees due to the markedly increased quantity of solids in the septic tank.
6. The property owner is responsible to fill soil logs after final approval of the design.
7. No burning on drainfield area.
8. No vehicular traffic on drainfield area allowed.
9. This system requires a proper degree of maintenance by a Glendon®licensed technician. Certification,
design and installation does not necessarily guarantee trouble-free operation.
10. No septic additives are to be used.
11. The property owner is responsible for damage done by landscapers.
12. Curtain drains may be required at time of installation even though not shown on design.
13.The owner/grantor acknowledges having read the above construction notes and disclaimers and agrees to
abide by the content.
Code of Good Practice for Glendon®Designers:
1. When considering locations for Glendon®units,try to locate them so they are not too noticeable.
2. Staking out the Glendon®is a good practice so the Health Department can see the actual location, and the
installer knows exactly where they are to be installed.
3. It is important to see where surface runoff from the adjoining property may be coming, and,if necessary,
install a curtain drain to protect the area with the Glendon®units. Avoid installing Glendon®BioFilter units
in swales.
4. On tight soils (low permeability), surface runoff can be a major factor, and a swale or berm can be
effective to divert surface water from flooding the area.
5. When designing curtain drains at property lines, check for roots for mature trees on the other side of the
property which must be avoided.
6. Curtain drains should not be installed against the slope so they become too deep.Also, sometimes you can
be in the shallow aquifer.
Extreme Cold Weather Climates Excluded
Application of Glendon®BioFilter Models M3 and M31 is limited to areas with climates exhibiting an
annual accumulation of 6000 heating degree days or less. Glendon®BioFilter Technologies has research
sites in planning that will extend this range of applicability. Designers who wish to use Glendon®BioFilter
systems in areas colder than 6000 heating degree days should contact Glendon®to discuss their specific
Copyright Glendon BioFilter Technologies,Inc.2003. All rights reserved.
WA Design Manl 122003.doc