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HomeMy WebLinkAboutSEP2015-00027 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER J `�i� \ F'Y �V J �`�—� rig 17)A 1 1 MAILING ADDRESS ' t( �® GRksg vauEY C.A gsgs PHONE (s SYSTEM DESIGNER ` CS& P team Range Designer Phone ARCEL ��®lfi 1/0A'' o�-�:`I LEGAL DESCRIPTION: Section G uTownshi R 0 9 2015 Subdivision Name SCI4ROED'�'R* t`C,Q SE Division Block Lot(s) I Site address/Directions to site 6424 A R A B I A tS LR N E t ?UT --rou3t45eND SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential 1. New X. Tank/s only Private X Residential ADU Modification Public Commercial Expansion Community Upgrade Repair SITE SIZE 6.60 ? 1S SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evaluation Conventional h Designate Reserve Area Yes#l3TH 15-(o Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 4Q0 Soil type 4 (attach soil eval.) Application Rate .58 qal./sq.ft./day Drainfield Length ,27$ ft. Trench Width .3 ft. Trench/Bed Depth 12-.24 in. Septic Tank size 10 O© gal. Pump Chamber size gal. TYPE of system yITY CONVENTIONAL- 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 r quir 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 sepa ately judged by e rules and laws in effect at that time. Prope FIX wner .ture Date FOR OFFICE USE ONLY / II PARTIAL J/ �t r.D ASBUILT (4 FIN /\I � //`J A ROV D INSP/PUMP TEST 13d'DPa (Q11 ALL HOLD REQ. MET Q Date 3( C I(, Fee i Rec# I 513 Check# ( Case#SEP 5 H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC w�s}I, o` JEFFERSON COUNTY PUBLIC HEALTH 4* 615 Sheridan Street•Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org Nhone 3(50-:3n-9444 i-ax 3bU-:3 19-4413 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP15-00027 Date Received: 03/09/15 Date Issued: 04/22/15 SITE ADDRESS: 520 ARABIAN LN Date Expires: 04/22/18 PORT TOWNSEND, WA 98368 APPLICANT: SHEILA HEJNY PHONE: SHEILA R HEJNY TRUSTEE 20846 RED DOG RD GRASS VALLEY CA 95945 LEGAL DESCRIPTION: SCHROEDER&MCGEE SHORT PLAT LOT 1 PARCEL#: 001064028 Section: 6 Township: 30N Range: 1W DESIGNER: BERNT ERICSEN PHONE: 360-301-0324 293 PINECREST DRIVE PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: CONVENTIONAL TRENCH No. of Gallons per Day: 480 Type of work: NEW Drainfield Trench Septic Tank Length: 275 feet Width: 3 feet • Depth: 12 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 Enviro mental 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.: SEP15-00027 1.) 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. u� t �_ t �; 2.) MAXIMUM TRENCH DEPTH 12 INCHES AT THE E;c9-T END OF THE LATERALS AS THEWESTT r END WILL BE 24" DEEP. 41 / 3.) H - Steel "T" Posts are required at each clean-out in the transport line. Recommend using a double Rfi sweep and separate by 100' 4.) H - EACH CLEANOUT IN THE TRANSPORTLINE MUST BE INSTALLED IN A VALVE BOX. 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.) 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. 7.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 8.) H -An asbuilt drawing and certification of completion by the Designer is required prior to final approval. 9.) 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. 10.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 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.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required and must comply with code at the time of application for use. 13.) Contact designer prior to installation for staking of drainfield area. 14.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 15.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. 16.) 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. 17.) 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. SEP15-00027 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/22/2015 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. SEP15-00027 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/22/2015 CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT INSTALLER J e-f-e g ASS t-FF PARCEL# 001064002. 8' Permit Owner s ht.I I a N t3 11 Permit # Is - L7 ABSORPTION AREA: DRAINFIELD TRENCH TRENCH „ TANK #OF #GAU LENGTH .275 WIDTH 34 DEPTH /.-- 2 4- SIZE 1 600 BEDRMS 4 DAY 4.g o Tank Shroud/ IF PUMP AND PUMP CHAMBER REQUIRED: Size Screen Float Arrangement High water float-distance to top of tank/emergency storage Dose drawdown (#of inches) #Gallons/Dose Timer/Dose Counter info .. Pump Size/Manufacturer --- 1 CERTIFY THIS ONSITE SEWAGE SYSTEM S INSTALLED AS DESIGNED,PER PLAN APPROVED - -- 6,e,6„...÷ �6./4 ' G - IS l� DATE APPROVED Designer SIGNATURE DATE Tren Ch atiA a y� " o n e as+ •end. o�' c�ray n�eAcl. � 1;. o r, ui es f dn ci, 1600 661. TOAk Ins+a.11cc . Ou,-I- k+ ba-f Ie fns-all•ece. . if 1/ bee tr (ached, 1 LC.orcL brau)ln Manual pity\ +o Robt `betieb.e,r 6- u. 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Y Yy L Y/ .yl 4 l k V:, Y Y s" Sf-1 S S�' x ;-,V 4� End Trench "D° Box 4"ASTM D2729 KM p'ASTrt 303y To Drainfield >t(om Tanit (Solid) ,;A-....;:•,;!.,,t,.!, ..:X per x: 314"to 11/2" O y Clean Drainrock Ky . w ry r r, • «., .1 6"Mtn.Under Pipe rn z o z i M Oa ° r'' - � ��ff I s s C~.hoc ' st.7 rn Ay- � c.trl i : ,/ '! 5100259 i .d.BERNT PAUL ERICSEN + pt E IR S 0 '11 Ir 3-44'l7 . 1 0,ki, S \ . 40 dO 00 i 3� � �. it t,a,5 2 I , Sheila Hejny q� °f �� ° `^ Liuea 001064028 ti�91 :�``` , A .S '5100259_ f ,.i ,/ i. SERNT PRUC EicSEN*%. #a Project Description ,.' ****c Aso'• 'NE • + Install 4 bedroom conventional trench septic system. `"`��a�1-S wr 1 ����awi, rtrs ��r� 4-q a4 Septic Tank Install 1000 gallon two compartment septic tank. Install water tight risers to grade on all tank lid openings. Install outlet baffle filter ( Orenco FTiP 0418 —W ) or equivalent. Tank to be set on 6" of"Pea Gravel". Fill with u���ter prior to "Designers" inspection. J�"'"��// , \toccw12- Bdlryg,,,,,,- Transport Lines Install 4" 3034 sewer pipe from buil ' g stub out to septic tank @2% minimum grade ( install C. 0. s to grade eve 0' as needed, mark with steel fence posts) and from tank to "D" box @ 1% min. Double case any portion of transport line under driveways with 6" ASTM 3034. "D" Box Install 6 hole "D" box on poured in place concrete pad on undisturbed soil with 24" Diameter riser to grade. Install speed-levelers and water level prior to designers "as built" inspection. Drainfield Install 5 ( 55' x 3') laterals as shown on plans. Install inspection ports ( inside 6" round valve boxes ) with risers to grade within 5' of each end of lateral ( Gravelless Chambers ) Install straight tees 10' from beginning and at end of each lateral ( Gravel Trenches ) If Gravelless Chambers used install Digger's 20 Gauge, Hot dipped galvanized wire mesh with 3/4" hexagonal openings over entire trench bottom under chambers. Trench depth 12 - 24" ( 12" minimum on west end of drain lines — see note on drain field drawing ) Water Lines Maintain a minimum of 10' separation from septic components. No crossings allowed. Maintain 50' minimum setback from well to septic transport line. Inspections Designer needs to be contacted for a pre-construction meeting prior to construction to discuss details and to set up schedule for inspections. Designer is responsible for submitting "Record" drawing, and must be called prior to backfilling system. Cotruction Notes 1. The work described herein consists of General ns construction of an on-site wastewater 1geab a and experienced in the 2. The contractor shall be this type of wastewater system and shall hold a valid certificate,c ns construction of Yp from Jefferson County Division of Environmental Health. "Approved" be on site during construction. 3. If during the installation of the system the contractor finds soil l conditions that may lead to premature failure of the system,f ed Such soil may n terminated immediately and the designer notified. acted soil, bedrock or excessively include groundwater, fill, clay, highly permeable soils. 1. Any the inconsistencies, errors, or omissions that, in the opiiem shf I be installer, would compromise the quality of the wastewater system to the designer prior to ll construction.i rn gravel and compacted. All gravity 1. Backfill in traffic areas shall P PP pipe shall be pipe shall conform to ASTM D 3034. All gravity and debris and sharp bedded, using native or imported material free o objects. sed soil shall be seeded and mulched prior to the final inspection. Seed shall be spread at an approximate All expo roximate rate of 10 lbs. per 5,000 q 3. The installer shall be responsible for constructing the system eacoc edit ono plans and conditions of permit and shall be responsible ble for operating and P _ and function for one year. The owner ,n accordance with WAC 246-272A-0270. maintaining the wastewater system 4. Any pp chan es, substitutions, or deviation from these plans shall Health approved by the designer and by the Jefferson County Environmental Department. from tanks 5. The installer shall grade to divert all surface water runoff away and drainfield/reserve areas. be inspected by the designer prior to 6. The bottom of the trench or bed may placing drain rock and shall not exceed +/- Y2" from level. Place filter fabric over drain rock prior to backfilling. 7. Se tbacks to all known water lines shall be a minimum f 10'. nclossi g of water lines with any septic component shaH allowed, Departmen except septic design approved by Jefferson County ealth 8. Setback from the house foundation wall shall be 10'to ted sewer pipes. drainfield, 5' minimum to tanks and nd Br e to be used. Water saving appliances, fixtures, a p act ces a 9. Th e septic and pump tanks, drainfield and reserve areas are to be protected from vehicular traffic or mechanical disturbance 10. The designer is to provide the as-built and letter of certification. 11. This system has been designed in accordance with WAC 246-272-A- 0270 and the most current Department of Health "Recommended Standards and Guidelines for Pressure Distribution Systems," and has been approved by the Jefferson County Health Department. Nevertheless, negligence or improper action on the part of the users could result in the premature failure or malfunction of the system or its components. iii JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 0 J . 621 SHERIDAN ST. PORT TOWNSEND A •83.8 360 379 • ..e, aQ wn t7', SOIL EVALUATION t,,, �" ' X40 • S ,, PROPERTY OWNER SHE 1 LA N E J NY f p' 'u' •+>4.. s ro1 G S' r_s: " ": =',..41� ±SYSTEM DESIGNER E R ( C S E N V ES I N .0",. �!'°�•..•,,..1••'•`., LEGAL DESCRIPTION: Section 3-N 1I� (� Township,�N Range (UQ Parcel # ��1�(� 4©�g Subdivision Name Soi R O ETDER i M(66E- Division Block Lot(s) I Date Logged: ,2_ - 17 - 15' Logged By: 15 ER N T ERR (C S e N 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 # A SOIL LOG #' 13 O to 3 0 in. 3R LS/F IU S t I t T4 0 to 9 in. tit . LS -fib 36 to +6 in. TN FN 5,47) T'Lf- 9 to /y. in. TN L S s (?. i T 4 . 45 to ']1 in. TN FN-IhEb SO T 3/4 2.(I- to 4.. in. G• V FN -CRS SAID to in. 41 to 5 4- in. CRS SNl) T ,/ Anticipated water table-7.71 in. Anticipated water table 79/Lin. Roots to 448 inches _ Roots to Co inches Health Dept. Comments p Health Dept. Comments ) SOIL LOG # C SOIL LOG #• D D to 12. in. j'37? L S Tq- 0 to 1t in. BR L3 Tit 11 to 30 in. TN LS 4 GR T& 1I, to 55 in. TN GRV FN-- CRS 50r 30 to D. in. T 1 GRV. FN - CRS S14 55 to 7), in. SLT (fPT'> FN- MED StOil6R. to in. to in. _ Anticipated water table 77Z in. Anticipated water table?72_in. Roots to &O inches A. Roots to 6S inches Health Dept. Comments qR 00 Health Dept. Comments ROHM ey. °�s SOIL LOG # E �NT44 h, SOIL LOG # F 0 to q in. TB L.S T4 ,.....q;,.i 0 to T _ 12 in. P?R LS Li to d2.. in.TN N (A £ ( R Ti 11 to 114 in. TA) FN 5Nb _ 74 .2. - to 74 in. TM FM- M El) SAJb t 4R. T314 414 to 7(0 in. T111 FIJ SND 4 6R. T3 4 to in. to in. Anticipated water table>74 in. Anticipated water table?7(o in. Roots to (o0 inches Roots to CO inches Health Dept. Comments Health Dept. Comments H:1INFOHLTHISOIL.FRM 1/00