The URL can be used to link to this page

Home My WebLink AboutSEP2011-00017 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Gary Peterson MAILING ADDRESS 4883 Upper Hoh Road Forks,WA 98331 PHONE ( 360 ) 374-5354 SYSTEM DESIGNER Ronald Garcelon Designer Phone# 360—681-2202 LEGAL DESCRIPTION: Section 29 Township 27N Range 11W PARCEL# 711-292-004 . Subdivision Name Division Block Lot(s) Site address/Directions to site 5844 Upper Hoh Road, Forks, WA 98331 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tank/s only Private X Residential ADU Modification Public Commercial Expansion Community Upgrade , Repair SITE SIZE—12 acres SYSTEM TYPE Partial Repair- (tank) X (drainfield) Previous Evaluation Conventional X Designate Reserve Area Yes# X (SEP#94-0058) Alternative_ Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Drainfield Trench Length 200ft Trench Width 3ft Trench/Bed Depth 36" Septic Tank size 1,000 gal. Pump Chamber size n/a gal. TYPE OF SYSTEM Tank Replacement for an existing Conventional Gravity System 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 application will b _separately judged by the rules and laws in effect at that time. 4 -212J /if Property Owner Signature Date FOR OFFICE USE ONLY 1 ,3 3/50k PARTIAL ASBUILTeQedi °%6 �' 4 �I FINAL' l APPROVED INSP/PUMP TEST 1X13/1( 61 gt I.5 C ALL HOLD REQ. MET Date 3/2h/ Fee /15.. Rec#t/f7-. f'I Check# /1)7-y Case#SEP )//—1 7 C:\Users\Ron\Documents\Olympic On-Site\Job Folders\2U1O-Jobs\HohRainforestEnt.-lO-UQ/1\HohRainforest- RepairPermit.doc SEWAGE DISPOSAL PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 PERMIT #: SEP11-00017 Date Received: 03/02/11 SITE ADDRESS: 5844 UPPER HOH RD Date Issued: 03/30/11 FORKS, WA 98331 Date Expires: 06/30/11 APPLICANT: GARY PETERSON PHONE: 360-374-5354 CHARLOTTE PETERSON 4913 UPPER HOH RD FORKS WA 983319470 LEGAL DESCRIPTION: S29 T27 Rl 1 W SE NW(E480'OF W1280'OF N1074') PARCEL#: 711292004 Section: 29 Township: 27N Range: 11 W DESIGNER: RONALD GARCELON PHONE: 360-461-3575 PO BOX 3002 PORT ANGELES WA 98362 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. Permit issued to CONSTRUCT,ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY,WASHINGTON Thls 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 8. amended per ordinance no. 06-0719-07. This permit may not be renewed. /J / Jefferson County Environm= tal Health Specialist The property owner is responsible for the accurate location of all prope y 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. HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION. SYSTEM DESCRIPTION: 300-SEPTIC TANK TO INDIVIDUAL SYSTEM No. of Gallons per Day: 360 Type of work: REP Drainfield Trench Septic Tank Length: 0 feet Width: 0 feet Depth: 0 inches Size: 1,000 gallons SPECIAL CONDITIONS APPLY - SEE REVERSE CONDITIONS OF APPROVAL - PERMIT NO.: SEP11-00017 1.) 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. 2.) 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. 3.) 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 246-272A 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 4.) 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. 5.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 6.) H -An asbuilt drawing and certification of completion by the Designer is required prior to final approval. 7.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 8.) 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. 9.) 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. 10.) 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 of 2 11/22/19 I:\F_SEP_Permitmod.rpt CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT INSTALLER Iv S-&i ii t (e_S PARCEL # 7/(— 2g 2 —CO 9 Permit Owner 6 a r ti 114:-e iSCI. Permit # //- 000 17 ABSORPTION AREA: 0 DRAINFIELD , TRENCH , TRENCH . , TANK #OF -7 #GAL/ LENGTH issi5r-, /7 WIDTH firth rt 1/6 DEPTH t i ' SIZE /w.,) BEDRMS ..., DAY &Tank d, Shro d/ IF PUMP AND PUMP CHAMBER,REQUIRED: Size ,fi,/ Screen Float Arrangement /V4 High water float-distance to top of tan emergency storage It/ 4 Dose drawdown (#of inches) it) A- 7 #Gallons/Dose it/A ,c9 1. Timer/Dose Counter info /17/4 Pump Size/Manufacturer I CERTIFY THIS ONSITE SEWAGE SYSTEM WAS INSTALLED AS DESIGNED, PER PLAN APPROVED nATF INSTALLER SIGNATURE DATE INSTALLED ii llti ),,/ s4 ( r o (A-1- k-i- 61-M1,e c 1-e•-eAn • --rio's v1/4A5( `-- rfavve ////°/"/ . 14 • fa • •• ..„,. 1.r .. . ton, it , 1 51&;361 CAPM.0 doT —tiC1, ,,:t '"`:1(-t i'' w. Exr+tEs: 09/04/20/6, DAM /1 /11 1/9 Olympic On—Site RECORD DRAWING Job" 10-0071 Property Owner: Gary Peterson Parcel # 711-292-004 . Designer: Ronald Garcelon Date Inspected: 10/31/2014 Installer: RJ Services Permit SEP# 2011-00017 JNti Ip �� E ° ISM` I 1 1 I 5 1 ScaIe:. "=40' — - - I �10' 20 60' ,_ - ■ FENCE 1 ' n , / 1 i , I II ' i PROPOSED . 1 l 20' x 20' I I I WELL HOUSE 1 EXISTING WELL I I I I 1 , I I ,-� o I /0 1I I i I I j `;BEDRNC\ci` PROPOSED 2"0 � �° NEW 1,000 GALLON L , SFROOM i WATER SERVICE TANK j JJfSEP11C ., GRAINFIELD 1 III ...,. .2' � / OIN I I RESfR/1f gRE4 DEC �� SSIONED \ I I I \ I \ j a 1I I a Ni I Q (NI i I I � II I I / .T-C(17 0-• Q- 1 C - a.1 I .►,. t.;11,:I t. ir�':.x R 1 /.:-- fie, 1 �v i o`er u , v�?c o1a 11 I I 3 - Lic._I::FI LiEc>?t7Nci? It I EXP RES: 09/04/2Q/6, IDATE; ////Z //y I certify the information heron was verified by inspection and the system installation appears to have been completed in accordance with the approved design except for the changes made during installation as noted above and on the reverse. Designer's Stamp and Signature: oc:,. Check one: '‘cfla INSTALLATION START NOTIFICATION DATE SENT (,,,,, IPRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT This form shall be faxed or emailed ONE working day prior to starting construction OR a minimum of 48 hours prior to pressure/pump test Jefferson County Public Health - Environmental Health Dept. Phone: 360-385-9444 FAX: 360-379-4487 EMAIL: septic@co.jefferson.wa.Us PERMIT OWNER ( 4/ /4" 010 SITE LOCATION 5-5 chimt /44 it T4 ft/IX n331 PARCEL NUMBER 7/1 q 2 - SEP NUMBER 5014/7- v/& y S e, /7-6to INSTALLER CONTA T PHONE g(- 2 2.6 2 DATE FOR INSPECTION SYSTEM WILL REQUIRE PRESSURE TEST - YES NO *The designer is required to complete a pre-cover inspection of all systems. Please contact the designer prior to beginning construction to schedule installation inspections and pre-construction meeting if required per the permit or designs specifications. Jefferson County Staff Only:: MONITORING AGREEMENT MAILED DATE/INITIAL4\\11 PRESSURE TEST SCHEDULED F ()) ,1fit/\illiew I\ 5 \kN 0\ 0 \A., tst, D\ pryyk, 6 . \\ .1 asAA) P,, ) 1/ 0- • Idu ' iiy\A Otilia.$141"41)04Apti9.‘1/1/1/44/tilk ,\ .; • pp.13/` aft ci,At/Qk5-cuPitv Olympic Hoh Rainforest Ent.,LLC. Wastewater System Design&Inspections 10-0071A Repair Tank Placement Assumptions/Calculations Hoh Rainforest Enterprises,LLC. /Parcel# 711-292-004 An Evaluation of Existing System was performed on 1/06/2011 for the purpose of obtaining a building permit for another project located on this parcel. The residence is currently vacant and has been vacant since September 2010. During the inspection it was discovered that the septic tank is leaking and needs to be replaced. Septic Tank Sizing For this existing 3-bedroom single family residence: Decomission the existing leaking 1,000 gallon septic tank(Pump/Crush/Fill). Install a new 1,000 gallon two-compartment concrete septic tank. . ce aft , IJV IICEF.SED DESIGNER if .%%% % 11�1011114111111•11Wit EXPIRES: 09/04/2011 DATE: 0Z/2z/1( r-1 w 0 bz ct a P.O.Box 3002 ♦ Port Angeles,WA 98362 • Phone(360)681-2202 ♦ olympiconsite @q.com I NOTES/DISCLAIMER: N 1. THE LOCATION OF CERTAIN SITE FEATURES AS SHOWN ON THIS PLAN ARE APPROXIMATE ONLY, NO SURVEY WAS PERFORMED IN CONJUNCTION WITH THIS DESIGN. THE SYSTEM INSTALLER SHALL VERIFY ALL DISTANCES AND MUST OBTAIN THE ASSISTANCE OF THE DESIGNER TO STAKE OUT THE LOCATION OF THE DRAINFIELD. 1 2. APPARENT PROPERTY LINE INFORMATION TAKEN FROM SOURCES BOTH PUBLIC AND PRIVATE. PROPERTY OWNER INDICATED VV _ r�.: LOCATION OF APPARENT PROPERTY LINES IN FIELD. APPARENT PROPERTY LINES ON THIS PLOT PLAN DO NOT REPRESENT A r I SURVEY OF PROPERTY LINES NOR ARE THEY INTENDED TO BE USED FOR ANY OTHER PURPOSE THAN THE LIMITED SCOPE OF THIS ON-SITE WASTEWATER TREATMENT SYSTEM INSTALLATION. 3. THIS SYSTEM IS NOT TO BE INSTALLED UNLESS THE APPROVED PERMIT AND DESIGN DOCUMENTS ARE PRESENT ON SITE. THIS I INCLUDES ALL SYSTEM DRAWINGS AND SPECIFICATIONS. S I 4. SOME SITE FEATURES ON THIS DRAWING PROVIDED BY OTHERS. Scale: 1"=3o' O' 10' 20' 50' I I - I FENCE 1 ,; ,fr rt I x =!t/r f vo, I rt`! a°°e 4 I -�r :i 3,00361 It% , y d\`y �q�` v been i _1,, LICENSED DESIGNER.C ,# � S`\�i t e $y, I 09,04,204 >a►>b aZ,z�,�, °o °\\et wed 01 C' V0 ska't. i I IeV� eCS°�CcA PROPOSED x �e 20' x 20' I 1 WELL HOUSE x I EXISTING WELL ii I 1 x ` X00 I R X \� /411. , I 0 II X / ` \ I x / i -312:7:177"11/-0C-:-. 3 BEDR�c \c/\ PROPOSED 2"0 / / ' I 1,000 GALLON '-, S1, ° / WATER SERVICE x a <„�,� NEW 1, R / ° SEPTIC TANK _ EXISTING ,': . q -l1 , ' 3 - - - � DRAINFIELD I ;, . . ys ,. , I • w 't CLEAN Csi • a PROPOSED N i --k OUT \ 100+% RESERVE AREA RE EXjST��c -"��"" �" (PROPOSED CABIN RESORT) N I ERVE DECOMMISSION O x 4R4-4 D-BOX (P/C/F) (INSTALL RISER) ( x \ i _____,/� 1 I X _—i Lc) _____ I � x SEWAGE DISPOSAL_D SIGN .... / NI x 'S IDate x C� I Q I 3 _Lj4 / x �� I x ( I ^ -/ 1 I 1 x i II ...c. OLYMPIC ON-SITE PETERSON 2/15/2011 2 �� , SITE PLAN VIEW 10-0071A of P.O.BOX 3002 PORT ANGELES,WA 98362 711-292-004 Rev. / 3 F\-; rri (/) --- 4-) z rri 31, C2) -o 0 0 -0 A3 —I 0 -0(.) rri r\) Z (7/ r r)r.-CU IZ:Z1 1 11 3 ,A >1. (i) -TI ---1 r— -0 (2) rn z Z r-r- Ill XI C;) — o (i) la)CO 0'-'' — >b . 11.6' MINIMUM (7) 1-11-14" • co r- rri r- -0 rri < c -r1 51+111- (J) rri rT1 r- Z (r) I/\L. CI) z SEWAGE DISPOSAL DESIGN 24" srl Val ) AMMMINI e 1111 CO 1.0 -ri r--0 -'1 rr1 1.> 0 Zqb r- 0 0 N r- rrl 0 6 ED(-) (/) z (I) rri rr1 rrY r- (J) cp r- <3 C/) z — 0 z r- r- 0 II g 111 C.)./k it $ ,rn 2• • mz ..., •z „go • 4IP4b itb4b OLYMPIC ON-SITE PETERSON TANK 2/15/2011 3 DETAIL DRAWINGS 10-0071A Rev. OF P.O.BOX 3002 PORT ANGELES,WA 98362 '7'71-292-004 / 3} N li W -fir; E S 0' 100' I iI____-._ ____-_ , 1 I 1 I I I I ii I I 1 I i 1 1 1 I I PRA I 20'x20 WELL HOUSE 1 o cosmic I I I ■ 1 I s P11- 11 ''' 111 o . 1 1 a - ri 1 II n c MON • -=moo �p ►ac s e� y �" �-°m d1n9 site, dnv �,has been 4. .. > buts u�en , 1 ,J .M N�ether aPp a�coved►by reviewed pr�p� stall. P, oura\v ,etterspn 1 I I_ PROPOSED I I n 1 «+RE I) I Api______ cam` /4// ' -- s A 51e■ SP-P //- 6 N 1 • 1 I _,0„...... iti.i t 1 . Cit.gi• . A 07-4 in El . 4111111/47111, 1 nru Apit,LT 1 e' I ir GRA Via i PARKING I 1 s'caws WALKWAY 1 I 444_ t ' r-__ ___. wt ' ® ON 010 - ST.?WOW i tr•CULVERT F,asnHC a e►��ri'��I 177 --i-- --•+ - - - - / aN �/ I-PER H O H ROAD -----��_-�� = I ��,Ix s g1 ASPHALT APPROACH eI 0:ROHM D A. CAARea0N,g1 vI LICENSED DESIGNER 1��11111111\11r�,/ EXPIRES, Q9/04/2Q1 b DAIL 02/2L/11 NOTE:SOME SITE FEATURES ON THIS DRAWING PROVIDED BY OTHERS OLYMPIC ON-SITE PETERSON 2/15/2011 1 //) „‘;,,„ ��r. SITE OVERVIEW 10-0071A 2/1 °F 3 P.O.BOX 3002 PORT ANGELES,WA 98362 711-292-004