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SEP2013-00073
Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Debra Katsch MAILING ADDRESS 6101 Panorama Dr. N.E. Tacoma,WA 98422 PHONE (253)927-1750 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 4 Township 28 Range 1 E PARCEL#931500205 Subdivision Name V.34 Surveys, P.8(Basalt Beach) Division Block 2 Lot(s) 5 Site address/Directions to site 121 Quarry Rd., Port Ludlow, WA 98365 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tanks(s)only Private X Residential ADU Modification Public Commercial Expansion Community Upgrade Repair X SITE SIZE 28,681 sf SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes#OTH10-00013 Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 240 Soil type 4 (attach soil oval.) Application Rate 0.6 gal./sq.ft./day Drainfield Length N.A. ft. Trench/Bed Width N.A. ft. Trench/Bed Depth N.A. in. Septic Tank size 1,000(Existing) gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Glendon Biofilter M32 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 be separately judged by the rules and laws in effect at that time. Property Owner Signature Date I i c I=OR OFFICE USE ONLY ' 1//4/ 1 PARTI t A �� / ( 11 ASBUILT 20C.) OC FINA, 71� AP ROVE INSP/PUMP TES-6, r /G4 4I PUD �{(' °I l o (-5-111 ALL HOLD REQ. MET 612Cc4&Y1 GYCS Comp/tit( S�Ca1S tdi fY1 "'`1�''v 7'� 3 7 Rec# ! ��/1y �` Case#SEP Date Fge Check# ���� C:\Data\Wpw\County Si State Forms\Jefferson\Septic Permit Forms\GJendons\Katsch 931500205.wpd JEFFERSON COUNTY PUBLIC HEALTH �Y,t hpzG 615 Sheridan Street •Port Townsend•Washington •98368 www.jeffersoncountypublichealth.org I-none 3ti0-385-9444 rax 3bU-3/9-448/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP13-00073 Date Received: 06/17/13 SITE ADDRESS: 121 QUARRY RD Date Issued: 08/22/13 PORT LUDLOW, WA 98365 Date Expires: 11/22/13 APPLICANT: DEBRA A KATSCH PHONE: (360)779-1989 6101 PANORAMA DR NE TACOMA WA 984221218 LEGAL DESCRIPTION: BASALT BEACH BLK 2 LOT 5&TAX 26,27 TL TAX R(1.59 CH)W/EASE#117872 PARCEL#: 931500205 Section: 4 Township: 28N Range: 01 E DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: GLENDON BIOFILTER-M32 No. of Gallons per Day: 240 Type of work: REP 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 Sewage Systems, codified in JCC 8.15 as amended. This permit may not be renewed. / Jefferson County Envi nmental 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.: SEP13-00073 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 - Installation of 50.4' of culvert is required as per plan. Must be 30' from the drainfield. 3.) 30 ft. setback from culvert to be maintained. 4.) 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. 5.) Contact designer prior to installation for staking of drainfield area. 6.) This system must be constructed by an installer certified by the Jefferson County Public Health Department per state code WAC246-272A-0250. 7.) Dry season installation required. 8.) 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. 9.) 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 10.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 11.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 12.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 13.) 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. 14.) Setbacks to existing and other wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 15.) The site plan received on 6-17-13 was reviewed by the Department of Community Development on 6-8-13 and it was determined the septic permit is exempt from critical area review as it complies with the General Exemption found in JCC 18.22.070 (6) which exempts the following activity: Reconstruction, remodeling, or maintenance of existing structures. This exemption shall not apply to reconstruction which is proposed as a result of structural damage associated with a geologically hazardous area and does not allow further intrusion into a wetland, fish and wildlife habitat conservation area and/or their buffers. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and condition which may be placed on future permits. SEP13-00073 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 8/22/2013 16.) 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. 17.) 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. 18.) Setback to surface waters- 100' required from drainfield and reserve areas. 50' required from tanks. 19.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 20.) 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. 21.) 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. SEP13-00073 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 8/22/2013 3 i JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT DEC 0 For RECORD DRAWING - 2014 Designer /t?/cif-T t! tb EE'/VeY Permit# SEP l 3-D©97 Installer/'-1.912t5-'K/724 -A(lzY L.19vj/5-6¢,2, EXGssnV 77/v6 Parcel # '31 S ' Z47 Electrician Design Flow 2'161 • Property Owner J4> E S k"-`r /e''st '- 7' Site Address /Z I Q tIIZL ', X 1 P4912rLf? L 0' v, W4 9g? S Answer all questions or indicate NA Tanks. Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) EXf 5Y/w6 /c 6Se"/ 8% A-A-4E5,ou rz,r7- e.€ 4 -/o- Pump chamber (manufacturer, size) I G4 -. 4 Screen(s)and/or Pump Shroud (type, location) PU/` ', v 1oc r w/&407-0&EF'/GT-/Z' 4-,'2-f4-" Were Tanks tested onsite for water tightness':1CP No Panel Model 6769'4G70/2X / SG Timer Model i9e9a.449olz<- 4-1e3-l14- Pump 1 - Man./Model (19,A- 'C ' -J' S-11 Flow Rate 1Z<5- gpm 4-/D/4 Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank 2 7,4" Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off- c, rj " On - gs�L Veto - z ,8 r' Off- A/ sOc- Alarm - Z-7,0 " Veto On - 8s�� Storage Above High Water Alarm /e-7 gal. Veto Off- /4M/A/ S2�EG Dose Counter Reading (i Doses. 7 Vvor� #gallons/dose /. 7 Elap. Time Meter Reading 2/w/4/ 1 z sr_c_ Pump Throttled? Ye / No Dose Drawdown (in inches) 40.08 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 10/29/13 page 1 of 2 Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No /96-r, 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.1 ¢U Manifold Size/Sch. x-70-1¢ 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 k.7 , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner WI r// Dz4W/A1 Date Tank/component Decommissioning Report Attached Yes / No / Installer Certification attached/signed 41,TP 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 ey these periodic inspections,the system complies with all the conditions noted in the permit as approved by Jefferson County 9-Z 2-/ 3 (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. —17- /4- 5100110 Designer Signature Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 10/29/13 page 2 of 2 Sri CERTIFICATION OF PERF PIPE AND DRAINROCK REMOVAL. Company Certifying Abandonment: Landmark Excavating Phone: j360)179:60.2 Site Address: 121 Quarry Rd., Port Ludlow,WA 98365 Parcel Number: 931500205 Abandonment as required in SEP13-00073 1 I certify that the existing pert pipe and drainrock was removed and backfill placed as • specified in the approved plans under SEP13-00073. • /"/4/- /`f Signature Date /�J. 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ON y O / I CO / r ` � Creative Design Solutions, Inc. X From: Debra Katsch <dkatsch100 @gmail.com> 0 Sent: Friday, November 22, 2013 6:47 AM Michael Deeney Subject Fwd: Fwd: Dug Well Decommissioning Status Mike, Here is the information I received from Jim Tillia regarding the decommissioned well. Is there anything more I need to do? Debra Forwarded message From: Jim Tillia<tilliaj @gmail.com> Date: Thu,Nov 21, 2013 at 7:35 PM Subject: Re: Fwd: Dug Well Decommissioning Status To: Debra Katsch<dkatsch100@gmail.com> They paper work is filed with the county they know it hss been decommissioned they were there. I can send you a well log that was filed with ecology but it shouldn't be required since the county inspects every well that is decommissioned. I thought I sent you already the information from the pump test I will have to run down to the site and see what is still there I might have left something but I don't remember.Your well stabilized at 2.5 gpm but I couldn't get a water level reading past 30 ft, they must have used solid stabilizers on the pump to center it in the well. The only way to get a water level reading would be to fully pull the pump and run the sounder down the well with it. And I don't think it is that important. I would consider adding an extra pressure tank or a small holding tank. If you go with a holding tank have them put a 2 gpm flow restrictor on the well then you won't have to worry about drawing the well down. Ill look and write up my findings in a report for you. If your septic guy wants a copy of the well log let me know and I will email you one -jim tillia On Nov 21, 2013 7:24 PM, "Debra Katsch" <dkatsch100@gmail.com>wrote: Hi Jim, I'm following up with you on the status of the decommissioned well from October at Mats Mats Bay. Please see the note from Mike Deeney, below, as to what he needs to complete the septic installation. Were you able to complete the testing of the active well? I noticed some tools left in the pump house about 6 weeks ago and assumed you were still working on it. My friend informed me that the pump house door is still ajar and the tools still there. Having a report on your findings is important to include in the property records, and will also let me know if I need to take further action regarding maintenance or improvements. 1 Thank you, _,� Debra Katsch $ Forwarded message From: Creative Design Solutions, Inc. <mike@cds4you.com> Date: Thu,Nov 21, 2013 at 2:59 PM Subject: Dug Well Decommissioning Status To: Debra Katsch<dkatsch100@a,gmail.com> Hi Debra, What is the status of decommissioning the dug well? I will ultimately need the appropriate paperwork from the company performing the decommissioning for submittal with the septic system Record Drawings, Construction Inspection Report, and O&M Manual. Thanks, Michael Deeney Creative Design Solutions, Inc. 800-395-7296 www.cds4you.com 2 " \ I / 0) ZO U 3 y / Zee o m ceU�� 1 Q� V I / I � OcYU .JS. Ozw O u W " z ZmW .i V/ 6 < • Wv I O°o�o °mya =� a u' 2' t G 0o o � a, 03� CO � < �co W U e O ce W m n . (n,w . 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N do CD, it 11,,_ a/ 0 /� �� � s— a need wo`' l'i / N Z z xo xJ = 'TFiti--- �''pV�/n q6 e7: - men Z n � 010 0\m • ,w •.� //�\ L/ne w�' c n �In � : � N Z Q. oN, m i t• di � / �o�i"ovaiz�o 0 3 '��Yi� ° Z O cn' �♦ m Z\...•. 2Wa0�� I11(3øI?i4 ::::, rJ!J 0 F //� ��� Z I 1 �A o °li(.4 �y I �1k � O�c�o A2 O_2 T �2 ° Cl)O / 1 �2a0=0222 ~ n k C I ao ' oa°OAL'II Q 0 rr ^^ W ,a c� O`� O $ z I r g2 w °%g zy mo 6 • • ON w o° I -1 or ■► "ci2r�ysi,°,A Ez,� J G� b7 trl -'1� I1�1 �. =n a�ICO�cnvm O], CD W ( dab_ 30' a cn�J) o Z 2ozi:i''i'; j;t1r: ' ; W.'d'° ca \ 1:73 op rrl 02 I — --- ` 4s�f co t 2 r) C c� C - y —1 9 \ O V .p> ti �� I �......: EIfISF(NG DECK G �'� (� r __ I I y O li (�j1 = I �,� EXISTING RESIDENCE O v (121 QUARRY RQAD) C f� . cn �1 _ U1 ....•'2 / G r:::;,!7z.,.:7:',.,-,,:;,;:t:..r.i.,:,,,,,06,.....,:, , \ rn 0 4, k. p/CO N / CS R -- I r r� 1:19.' O K C 1-t I )61(,) �k r m / O m o) Vii' r ul m1 O Li) : - ;(_(1:..D m ^� OC'l 99.99' 1 ' ,,,,,,:z::::::::,,., (_--irs !L:til- 1 .. . '4--:I.....K';:.i7,;.':;'..:,7.::::.:,;::::,,.,',,::•:':,*..\:.'.'.'.'.:.e;!.,,,/r...,:,,.:,,:."..;.:,i',r,;'.,.,,,,.::,,:..,,'..,):C'',:.,,.,'...,(:'.,::.':,;.,..,:,:,,,'::.:.'.::'a1:..‘'.i.."im.;:i,...ii,j,,.. �. ,� ENDOL NE ROAD og N�dB�s C 0�' o NORT o o k \\14'21 `' cn c �� �za Z � \ _: R 1,C K CO W oti \� I j I ,.s , � 7, 0�s 20' 20' , s • I — \ K �O• j�j x Ste, o. D :; y1� � . ® y . c i _ X90• 9 ym — ,,, * t 1 . 1 s V'' yi SD vm _ _ — — 21� ao i s mt m V ` o v0 a al p � y • z 00= ii m �� I cum �.:, ■c''' m i1 v, • 0 �' Z ,99'V9 ;,_ ::'''-„:„„::‘,.:„.1:';',;,:il.:.,',„"' a a ., V� e !;!:i:O \ * �pa� D �7 r 6 �� i C ,-- / * ° x* x o i ^' w Oi�![1z�1["' u!!�!}:.;;':`: ... .. _� - —m :A 2 ...... .... O 2 N n, n N .,..(N% r' s--:p:,dtor..,rn..:..:..:,?:iS; i![iii?ii;E ::.;it:`i:i?i:::i N y / 2.-:I. rr+�0 -i�0 a�vmi� A A rn c� o a 0 Z u9 CD NORTHWESTERN TERRITORIES, INC. 717 SOUTH PEABODY STREET,PORT ANGELES,WA 98362 __ Engineers III Land Surveyors■Geologists \ ' Construction Inspection a Materials Testing $ (360)452-8491 1-800-654-5645 FAX 452-8498 E-Mail:info @nti4u.corn ry �proV�D�SpO NTI :0'>Vor SqL ttc, wwenti4u.com p 4ctio ry y dt. n August 20, 2013 Jefferson County Health Department 615 Sheridan Street Port Townsend, WA 98368 Subject: Glendon Biofilter M32 Elevated Containment Vessel for Parcel Number 931500205 Gentlemen, This letter establishes the appropriate criteria for placement of fill inside and outside of the Glendon Technologies Inc. M32 Biofilter elevated Containment Vessel (hereinafter referred to as M32), with a 30 mil PVC liner using a containment vessel as specified in the Glendon Biofilter Containment Vessel Plan, Section & Notes signed January 10, 2010, by Damon D. Van Den Top, DVDT Engineering, Inc. (see attached), and installed as shown on Sheets 3 and 6 of the septic system design for Parcel Number 931500205 signed May 17, 2013, by Michael S. Deeney, Creative Design Solutions, Inc. Backfill around the elevated M32 Containment Vessel shall be considered satisfactory for meeting the requirements of Jefferson County Health & Human Services Environmental Health Division Policy Statement Number 01-01 (see attached): 1. Natural grade shall not exceed 45% cross slope for the area of placement of the M32 Containment Vessel and required surrounding fill. 2. All organic material shall be removed from the existing grade prior to placing fill outside the M32 Containment Vessel. 3. For any portion of the bottom of the M32 Containment Vessel to be above grade, a leveling grade of ASTM C33 sand shall be placed on the native grade (after removal of organic material) and water settled. 4. Fill outside the M32 Containment Vessel shall consist of"Cover Sand" as specified by Glendon Technologies, Inc. and shall be placed with a finished grade not to exceed 1 foot of height (vertical) for every 1.43 feet of run (horizontal). This 1:1.43 slope (35°) may commence at a point above and outside of the outside edge of the Containment Vessel as specified by Glendon Technologies, Inc. At a minimum, this fill shall be placed in 8" to 6" lifts compacted to 80 - 85%of optimum density (equivalent to "walking-in"the fill). Jefferson County Health Department August 20, 2013 Page 2 5. Material shall be place inside and outside the M32 Containment Vessel at the same rate (maintain equal elevations) in order to evenly distribute the loading on the Containment Vessel. Monitor compaction activities to avoid deflection of or damage to the containment vessel. 6. The top of the Containment Vessel shall not exceed 6 feet above natural grade at any point around the Containment Vessel. 7. All finished grades to the sides and over the top of the M32 Containment Vessel shall be planted with drought resistant non-intrusive grass or other shallow rooted, non-intrusive drought resistant vegetation (see www.glendon.com for lists of acceptable vegetation for M32's). This letter has been prepared exclusively for Creative Design Solutions, Inc.for their use in the septic system design incorporating an M32 Containment Vessel for Parcel Number 931500205 and as specified on Sheets 3 and 6 of the above described septic system design. Our services have been executed in accordance with generally accepted professional engineering principles and practice. NTI Engineering & Land'Surveying ff glA• F ti o was 40 0 X 4, r 7 F ,, a 4.rte., � r,-. Robert A. Leach, PE, MBA 4°�of 37 `r,- k. f °"" Project Engineer �0,� 4, 13772 R�° 4 Fs%/VAL E�G� 08-20-13 attachment: Policy Statement No. 01-01 H:11 Work Files\CDS-Containment vessellAug 20131Glendon at PIN 931500205.wpd 11111111111 111111 1111 111 54 Page: 1 of 2664 2 04/29/2009 03:46P When Recorded Return To: Jefferson County ALId FIRST AMFRTCAN TTTIF COV 4A 0M Name: Jefferson County Public Health Address: 615 Sheridan City: Port Townsend,WA 98368 Restrictive Covenant G 13 ? Regarding Monitoring of On-site Septic System THIS AGREEMENT is made this date April 19,2009 by and between DENNIS PJOHNSON,his/her heirs and assigns("GRANTOR(S)")and Jefferson County Public Health("GRANTEE") WHEREAS, DENNIS PJOHNSON Pf"1C50If',$L Unger& i+TNC f 7-7ler 6$p1)TG O P is/are the owner/s of a certain tract of land particularly described as follows: DemAmie 4 S co r-T &E deAS•,a.a PARCEL NO. WHERE SEPTIC SYSTEM IS LOCATED: Parcel#: 931500205 LEGAL DESCRIPTION(S): Section: 4 Township 28N Range OlE BASALT BEACH BLK 2 LOT 5 &TAX 26,27 TL TAX R(1.59 CH) ADDRESS OF RESIDENCE BEING SERVED (if assigned): 121 QUARRY RD and. WHEREAS,a sewage collection,treatment and disposal system,as described in case#SEP09-00020 has been installed thereon,and WHEREAS,the residence or facility at the above described property,including all parcels associated with said case, utilizes an onsite sewage system which requires regular maintenance and monitoring for the life of the system. Monitoring is required to be performed by a person authorized by the Public Health Department,and WHEREAS,the Owner is required by Jefferson County Public Health Department,as per WAC 246-272A through Jefferson County Code 8.15 to implement a program for periodic monitoring to assure the continuous and satisfactory operation and maintenance of the sewage system,and NOW THEREFORE,in consideration of the premises and the mutual promises and covenants hereafter set forth,the parties hereto agree as follows: 1. Construction: The Owner has constructed and installed a sewage collection,treatment and disposal system together with appurtenant facilities whose capacity and design are satisfactory to the Jefferson County Public Health Department. The plans and specifications for this construction have been approved by the Jefferson County Public Health Department prior to construction. page I of 2 • 542664 Pare: f 2 @4/29:2240300 9 0346P 2. Owners responsibilities: Jefferson County Aud FIRST AMERICAN TITLE COV 00 a. Maintain all components as accessible and unobstructed to the surface.Non-accessible or obstruct components will not be serviced. b. Utilize the system consistent with producing residential waste strength effluent. C. Operate and maintain the system in accordance with conditions of the permit and Jefferson County Code 8.15. 3. Schedule:The Owner shal I have their sewage system inspected by a person authorized by Jefferson County Public Health in accordance with the schedule set forth in Jefferson County Code as adopted and hereinafter amended.For some proprietary products registered with the State Department of Health,the inspector must also be authorized by the device manufacturer. 4. Reminder: The Jefferson County Public Health Department shall provide a reminder of required monitoring. The lack of receipt of said reminder does not relieve the property owner from compliance with the monitoring schedule pursuant to Jefferson County Code. 5. Records: A report of each inspection conducted shall be submitted to the Jefferson County Public Health Department within 30 days of completion of the inspection.Such records shall be open to the inspection of the Owner. - 6. Liability:The Grantor agrees to relieve Grantee,its agencies,-divisions,officers,agents,and employees of any liabi lity,damages,judgments,claims or other expenses that might arise as a result of the inspections required by this agreement. 7. Fees: A fee as set forth in the Jefferson County Fee schedule and adopted by the Board of County Commissioners shall be paid upon submittal of each inspection report. 8. Terms: This agreement shall remain in fu II force and effect unti I the date of notification to the Owner by the Jefferson County Public Health Department that the Owner's Sewer System has been intercepted and connected to a general sewer system. 9. Amendments: This agreement shall not be modified except with the express written approval of the Environmental Health Department ofJefferson County. 10. Penalties: Non-compliance with monitoring and inspection requirements is aviolation ofJefferson County Code and shall be subject to enforcement as described in said codes.The County shall have the right to enforce and compel compliance with this covenant,including all remedies available at law and equity. The County shall have the right in any such proceeding to recover its attorney fees and costs. 1 I. Venues: Venue for any action hereunder shall be in Jefferson County,Washington. If any term or provision of this agreement is in whole or part held invalid or unenforceable by any court of competent jurisdiction,the remainder of th is agreement shall continue in full force and effect. 12. Life of Covenants and Binding Effect: All of the promises,covenants,terms and conditions of this agreement shall bind the parties to this agreement and the successors and assigns of the respective parties hereto AND are deem ru with the land. � .. _ _,Owner _ _,Owner AS PERSONA I? 7 7 fVF 2 19 657 JL` of T6-si /o 4- Sce?7 atCA541,0 Acknowledgment: SUBSCRIBED AND SWORN to before me thiV day of Aeir;1,20_09 Notary public in and for the State of Washington, residing' P s�b Washington. ��� t� s1► My comm issi expires 1—�3—U� e /, 7. page 2 oft :" 3 F_SEP_monitoring_agreement, 8-21-08 7.6 I P`'or az: