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
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