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HomeMy WebLinkAboutSEP2014-00002 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICA N '-PROPERTY OWNER - h 5l4- t't OYl MAILING ADDRESS l la 5 W 1n7a �o Townse,f wfr 93(9' ^ - P • HONE ( 3( 0 ) '505-'1144 .:Qxl-. I o� /TAM MA ?GJre & , 6.01/4�'r� Nn45j-ey- SYSTEM DESIGNER W e II i2amP�trne,() Designer Phone# ( 119001 -0)� { /2- 3 1/3� �J LEGAL DESCRIPTION: Section�J33 Township 30W Range I W PARCEL# 3 J7-"tgv 1 Subdivision Name '"/ A Division Block Lot(s) Site address/Directions to site 3 four(er-e-s /NE Gorner Wy` Pa tr CoYners , SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential New X Tank/s only Private Residential ADU Modification Public X Commercial X( Expansion Community Upgrade Repair SITE SIZE 10•(o >44 SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes# Alternative X Redesign No SYSTEM DETAILS Number of Gallons/daayy�I S Soil I (attach soil eval.) Application Rate 1 • 0 gal./sq.ft./day ` rair ld e th LG 2.-,1 ft/EAT1 Width I O ft. Trench/Bed Depth �p(p in. Septic Tank sife ($(pb gal. Pump Chamber size Igict 10 gal. TYPE of system 56t not 1.4 rwA Bea` ) epD�(,t/LQ Lt -h 1 0� 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 / FOR OFFICE USE ONLY S/ PARTIAL 1/ t1/�3 ASBUILT I 1) FINAL ROV D � INSP/PUMP TEST S I n `�" A1,1 C�� ALL HOLD REQ. MET���C 1.�� /5 Date 1 /241`i Fee tPLOS. OORec# ILUP 2J Check# ��� Case#SEP 11-1 H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend •Washington •98368 www.jeffe rson countyp ub li c hea fth.o rg Phone 36U-38b-9444 Fax 3tbU-3/9-4413/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14-00002 Date Received: 01/02/14 SITE ADDRESS: 63 FOUR CORNERS RD Date Issued: 03/06/14 PORT TOWNSEND, WA 98368 Date Expires: 03/06/17 APPLICANT: JEFFERSON TRANSIT PHONE: 1615WSIMSWAY PORT TOWNSEND WA 983683090 LEGAL DESCRIPTION: S33 T3ON R1 W TAX 98 BND THRU BLA#101626 PARCEL#: 001332009 Section: 33 Township: 30N Range: 01 W DESIGNER: WILLIAM PARNELL PHONE: 360-491-3243 10623 HUNTERS LN. S.E. OLYMPIA WA 98513 SYSTEM DESCRIPTION: SAND LINED BED No. of Gallons per Day: 615 Type of work: NEW Drainfield Trench Septic Tank Length: 62 feet Width: 10 feet Depth: 66 inches Size: 1,860 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 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.: SEP14-00002 1.) NO SUBSTITUTIONS ALLOWED FOR THE SEPTIC AND PUMP TANKS. 2.) This onsite sewage system is designed for domestic strength wastewater only. No floor draind. Disposal of any other waste strength is considered a violation of this permit. 3.) No floor drains are allowed to be connected to this septic system! 4.) BED TO BE EXCAVATED TO 66" DEPTH AND THEN BACKFILLED WITH ASTM 33 TYPE SAND TO 24"AND UP SIDE WALLS AS PER DESIGN. 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.) H - An asbuilt drawing and certification of completion by the designer is required prior to final approval. 7.) H - AS PER WAC 246-272A AND 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 246-272A 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 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.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed by current code. 10.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 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.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 13.) A 30' setback shall be maintained from the disposal component and reserve area to any downslope footing, curtain or interceptor drain or drainage ditch. 14.) 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. 15.) 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. 16.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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. 18.) This approval is valid only with a connection to an approved public water supply. SEP14-00002 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 3/6/2014 19.) 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. SEP14-00002 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 3/6/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA383 0' �� �yjf j`- ASBUILT INSPECTION REPORT For RECORD DRAWIN�C`�'�.o �°r,�. �'�r Designer % 'C 9 '.A i1_�Iv rr ?R12�tci_L Permit# SEP Li 00�Z/it.°/ x'11 Installer 15 5 xc:A-VA iix1C& 1T1&,- Parcel # ©0i 3"32009 Edith Electrician 0 L LOIN 1 Design Flow 6 15 6) p(D Property Owner -Z 1T .87,oy 'I-now 5/7 Site Address 6 3 FAQ C.ogive=Q5 ROAD / rr`T `7'e,,Z'A,/5G- o, C�4- Answer all questions or indicate NA q�J6.6 DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) LoTtoN Q-c'.ei l _M\X I I SOO i 'OM t: 41124,5" Pump chamber (manufacturer, size) "a.N IAi Lt 4 1 Z.OGO gi7.4115 Screen(s)and/or Pump Shroud (type, location) IL)r-. ITE t-F Lj - 46 ill agic /8" `%f Izd U0 set is T19-4/4 Were Tanks tested onsite for water tightness?0 1 No Panel Model ("cLeKcti oce"tz° mm 9 . .1.: Z.i) me iZL Timer Model 4nk..9P 'AI V_Zflm L. iniiih5— Pump 1 — Man./Model L%2, �i{--6/i P�3c Z.0 a)FlowRate j qpm tl/Zih S' Pump Location (i.e. garage, treatment unit, basement) CJV,r,p CA\--PcnvbC.=rt. `TA-NIC Float/transducer settings Inches Timer a 1 from bottom of tank- On/off- 0/ 9 ! in. Functions: On 6 tt rt,min Veto - " -30i5 in. Off z 1 q sec/min Alarm - 5 k in. Veto On - - et 0,min Storage Above High Water Alarm 1223 gal. Veto Off- '2, , q sec/mine Dose Counter Reading I 1 # gallons/dose . 4/gal. Elap. Time Meter Reading y �hrs Pump Throttled? Yes Dose Drawdown (in inches) / It in. Pump 2 — Man./Model Flow Rate qpm 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 Dose Drawdown (in inches) in. If additional pumps-complete the info in this table for each and attach. Other Timer functions & settings (e.g. override on/off) H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 oft Pre-Treatment NOH-,>, t , Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No 0�%se 'f Sandfilter Basin size/location 2■k Sand Fill met design spec? Yes / No '`. J ATU (manufacturer, model) �`° Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe diameter schd, /,, size, , 1� `cN i �Q�; Manifold size/schd /5?? 5c4 Z9 Orifice size 1 "� Lateral Size/schd /"Q3i 5C/1 90 Barrier Material G 7ex-r!t_F &he Cover Material/Depth 29 h z fS Residual Head (lat.# & ft. Head) ,4t,t- LTc ,ft($ ?Z. !1 . The laterals/pods were balanced 4/ No 4121-0 Source/Manufacturer of Drainrock/Gravelless chambers CCTTrc,4 / Mt,)C Drainrock Clean? / No If no, what action taken? Mound/Glendon Site Prep Drainfield Length 31 (X Z ) ft Width 10 ft Depth 66 inches Caps for measuring residual head stored (location) (110 12-0 COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Health Department Inspection issues resolved Yes / No Of yes how? Users Manual Provided to Homeowner 7:r - 7/2 - 5/T/40 5/13/6 �r & k-►c,_lT r}?m/ !Z u t Date Tank/component Decommissioning Report Attached Yes / No / A Installer Certification attached/signed 1/ No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VEj IFIw BY INSPECTION, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY 516 Z°15(DATE) OR TEAT CHANGES HAVE BEEN NOTED AND THE SYSTEM I N COMPLIANCE WIT}E WAC 246-272. .5/J 2 1 — Designer Signature Date License# H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 oft 0 +-- STATE ROUTE 20 @ - N 03'30'25"E — - R 640.14 --'° a /ZS I / 1 / �� 0 ■71 L IArei ,, ----- CI : tIi -- N �° �r,!,': _ 0°o ■ i. tt, r — _ [ 1; ___. _,e2/ / 7 1 � _ i ) , - _ [--__) , , ,„ i______ ) / i , _. , , 7.se i 5' 0 S 0255.95 W H _ .�-HiliiI . 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