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HomeMy WebLinkAboutSEP2014-00093Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379 -4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Charles Hartzell MAILING ADDRESS 18304 - 26`h Dr. SE Bothell WA 98012 PHONE ( 360 ) 461 - 6459 SYSTEM DESIGNER: Michael S. Deeney Designer Phone #: ( 800 ) 395 - 7296 LEGAL DESCRIPTION: Section 29 Township 30 Range 1E PARCEL # 021291037 Subdivision Name V.10 Surveys P.103 Division Block Lot(s) Parcel "A" Site address /Directions to site 511 Schwartz Rd., Nordland SOURCE OF SEWAGE /USE Residential X Residential ADU Commercial Community SYSTEM TYPE Conventional Alternative X SYSTEM DETAILS TYPE OF WORK New X Tanks(s) only_ Modification Expansion Upgrade Repair Partial Repair - (tank) (drainfield) Designate Reserve Area Redesign Number of Gallons /day 240 Soil type 4 Drainfield Length N.A. ft. Trench /Bed Width WATER SOURCE Private Public X SITE SIZE 1.73 acres Previous Evaluation Yes # OTH14 -00001 No (attach soil eval.) Application Rate 0.45 gal. /scift /day N.A. ft. Trench /Bed Depth N.A. in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Glendon Biofilter M31 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 futuZea lic ation will be separately judged by the rules and laws in effect at ha time. operty Owner Signature Date FOR OFFICE USE ONLY n 7 PARTIAL I S� C� ASBUILT )?S 7 �J� FINAL APPROVED INSP /PUMP TEST ID t ALL HOLD REQ. MET Date I'Lf.Fee , d Rec # _ S-0S -Y -Check # J 0\V Case # SEP ) q — r. JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend • Washington • 98368 www.jeffersoncountyp ublicheafth.org Phone - - Fax MU-3/9-448 ON -SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14 -00093 Date Received: SITE ADDRESS: 511 SCHWARTZ RD NORDLAND, WA 98358 APPLICANT: CHARLES HARTZELL 18304 26th DR SE BOTHELL WA 98012 LEGAL DESCRIPTION: S29 T30 R1E TAX 39 PARCEL #: 021291037 DESIGNER: MIKE DEENEY CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: No. of Gallons per Day: 240 -------- - - - - -- D ra i n f i e l d-------- - - - - -- Date Issued: 07/09/14 09/19/14 Date Expires: 09/19/17 PHONE: Section: 29 Township: 30N Ranqe: 1 E GLENDON BIOFILTER -M31 Type of work: NEW ---- - - - - -- Trench ----- - - - - -- Length: feet Width: feet Depth: PHONE: (800)395 -7296 Septic Tank--- - - - - -- inches Size: 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 ge 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 -00093 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. 2.) Based on the application dated received 7/9/2014 this property contains an easement for an onsite sewage system to serve the property to the north known as tx 41, parcel number 021291041. The area of the easement shall be protected from all land disturbing activities, parking and driving. 3.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed by current code. 4.) 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. 5.) H- AS PER WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE SYSTEMS REQUIRE THAT 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 BYAN 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.) Health Dept. required to observe pressure test with system designer when system fully installed /complete, 48 hours notice to be provided for scheduling. 7.) This system must be constructed by an installer certified by the Jefferson County Public Health Department per Jefferson County Code 8.15.120 (9) and state code WAC246 -272A -0250. 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.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 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.) Setback to surface waters- 100' required from drainfield and reserve areas. 50' required from tanks. 15.) Dry season installation required. 16.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. The area 30' downslope of the system shall be protected from all parking, driving, construction and other land disturbing activities. 17.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. SEP14 -00093 Page 2 of 3 \\ tidemark \data \forms \F_SEP_Permitmod.rpt 9/19/2014 18.) Any portion of transport line under a driven way is to be sleeved /cased or equivalent. 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. 20.) A screen shall be provided either at the outlet of the septic tank or around the pump or at both locations. A pump shroud is required if only an outlet baffle filter is used. 21.) Dose counter and elapsed time meter are required in the control panel for all system components. 22.) 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. 23.) 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. 24.) 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 -00093 Page 3 of 3 \\ tidemark \data \forms \F_SEP_Permitmod.rpt 9/19/2014 JEFFERSON COUNTY PUBLIC HEALTH 615 SHERIDAN PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT " For RECORD DRAWING Designer Installer Electrician Permit # SEP Parcel # ::::� Z / Z 7 Design Flow 0 4 Property Owner Site Address 5l/ SCr�flrr✓.�i2% Z �D , �/o �l�l�<'p� Lrl�i its' Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) jt5'00 �<�g�•Z.c°c�1i�= `,= �J'����"`�'f Pump chamber (manufacturer, size) Screen(s)and /or Pump Shroud (type, location) 047– L,.A— l i(lA' Were Tanks tested onsite for water tightness? Yes / No Panel Model tl%l��/yt/� ��"� SG Timer Model Pump 1 – Man. /Model D�z�i�e'U ��� Zc455�.Z Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank 7- z <,�51 Float settings (above bottom of tank) / transducer settings (above bottom of transducer) On /off - ®,q-t �! Timer Functions: On - Veto - -z Z Off - Alarm - 2 z Veto On - e.ste—. Storage Above High Water Alarm 3 Z gal. Veto Off - t ¢� -rimer, SZs�c, Dose Counter Reading # gallons /dose Elap. Time Meter Reading /� /��� zd,y� Pump Throttled? Yes No Dose Drawdown (in inches) I If additional pumps complete this info for each Pump 2 – Man. /Model Pump Location (i.e. garage, treatment unit, basement) Flow Rate gpm Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings (above bottom of transducer) On /off - Timer Functions: 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) I If additional pumps complete this info for each C:\Data \Wpw \County & State FormsUefferson\Construction ReportsWlternative sys ASBUILT 2010- 2.FRM.wpd 03120115 page 1 of 2 Pre - Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No JUL 0 72015 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.���141, 4X_�' Manifold Size /SchA 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 atCf , Autoclear set at Z& doses min -sec. i(3 7-0 Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner /jt/��` r' , e' °/z4> A 12, G Date Tank /component Decommissioning Report Attached Yes / No Ka) Installer Certification attached /signed Yes / 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 by these periodic inspections, the system complies with all the conditions noted in the permit as approved by Jefferson County 9' (Permit Approval Date) or that changes have been noted and the system is in compliance with WAC 246 -272. -' 5100110 Designer Signature Date License # CAData \Wpw\County & State Forms \Jefferson \Construction Reports\Alternative sys ASBUILT 2010- 2.FRM.wpd 03/20/15 page 2 of 2 ri D < m Z y 1 O m Z v � o n C,i rP-1 Lo "r m Z I" co V �Vl rri 1 1 '70 � r O N 1 V GI rn � 0 v � � n � r y/ y 11 w® ca I n 0 Da M n to °� C � N CO m� � J o� v o p � A <p 4J J Z ? 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