HomeMy WebLinkAboutSEP2014-00126 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Mark O'Neill 2
MAILING ADDRESS 130 Nolton Rd. fi<®/5f
Nordland,WA 98358
PHONE (360)379- 1185
SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296
LEGAL DESCRIPTION: Section 29 Township 30 Range 1 E PARCEL#975900503,504, 505,&506
Subdivision Name Noltons E. Port Townsend(V2 LP P36)&V35, Surveys, P432 Division Block Lot(s) 7,8, 9, & 10
Site address/Directions to site 130 Nolton Rd., Nordland
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New Tanks(s)only Private X
Residential ADU Modification Public X
Commercial Expansion
Community Upgrade X z
Repair X SITE SIZ .3SMM
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional Designate Reserve Area X Yes#tech review
Alternative X Redesign No
SYSTEM DETAILS
Number of Gallons/day 180 Soil type 4 (attach soil eval.) 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 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. 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 pgrmission to build . 'ermanent residence or other structure on this parcel. Any
future application w' sep,. ately j :•ed by h- rules and laws in effect at that time.
__
Prope 0 ner Sig atilt!! Date
FOR OFFICE USE ONLY /
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JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
www.jefferson countyp ub lichealth.o rg
Phone 3bU-33b-9444 Fax MU-.3(9-446
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP14-00126 Date Received: 10/27/14
Date Issued: 12/09/14
SITE ADDRESS: 130 NOLTON RD Date Expires: 05/09/15
APPLICANT: MARK O'NEILL PHONE:
MARK O'NEILL TRUSTEE
130 NOLTON RD
NORDLAND WA 98358-9604
LEGAL DESCRIPTION: NOLTON'S EAST PT BLK 5 LOT 8 W/PTN VAC SWAN ST ADJ
PARCEL#: 975900503 Section: 29 Township: 30N Range: 1E
DESIGNER: MIKE DEENEY PHONE: (800)395-7296
• CREATIVE DESIGN SOLUTIONS
PO BOX 2787
PORT ANGELES WA 98362
SYSTEM DESCRIPTION: GLENDON BIOFILTER-M31
No. of Gallons per Day: 180 Type of work: UPG
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 Envir 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.: SEP14-00126
1.) This permit was issued to correct a violation of WAC 246-272A for an existing system installed
<100' to a well. The permit must be completed within 150 days of the date of issuance, or sooner
if weather and soil conditions allow. Code requires installation within 90 days, however, due to
system type and expected soil and weather conditions, additional time was given.
2.) 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.
3.) H - Prior to final, the existing "D" box must be destroyed as per plan.
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.) Dry season installation required.
6.) 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.
7.) H - Existing tank shall be properly abandoned. It shall be pumped and filled with clean fill.
Documentation to be provided to Health Dept. prior to final.
8.) Original septic permit (SEP78-00341) was permitted for 1 bedroom. This property has a well.
Minimum land area requires one acre for a property w/a well. Current owner wanted to keep the
well, so no expansion to a two bedroom septic system was allowed. If the well gets
decommissioned in the future, and future code allows, this system could be rated as 240gpd.
RMarx.
9.) H - An asbuilt drawing and certification of completion by the designer is required prior to final
approval.
10.) 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
11.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
12.) 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.
13.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
14.) 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.
15.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and
effluent transport lines.
SEP14-00126 Page 2 of 4
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16.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
17.) A Declaration of Restrictive Covenant has been recorded on June 12, 2014 underAFN 584300 for
the purpose of consolidating the lots to allow zero lot line setbacks. The Covenant is strictly for
building and septic purposes only.
18.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed
by current code.
19.) Contact designer prior to installation for staking of drainfield area.
20.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
21.) 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.
22.) 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.
23.) The site plan as submitted with the Septic System Permit application on October 27, 2014 has
been reviewed for consistency under the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to the
approved site plan shall be resubmitted for review and approval by Jefferson County Department of
Community Development.
24.) This approval is for a Septic System Permit only. Any future permits on this site are subject to
review for consistency with applicable codes and ordinances and does not preclude review and
conditions which may be placed on future permits.
25.) MANDATORY MEASURES OF HIGH RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other
approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering lawns and
gardens. Unless catchment water has been treated to meet drinking water standards, there shall
be no cross connections allowed between the potable supply and impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or
gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per
minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors
and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather is
intended to be illustrative of the types of water conservation measures.
SEP14-00126 Page 3 of 4
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26.) MANDATORY MEASURES FOR HIGH RISK SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize DOH-approved
public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of potable
water or an individual well may be used as proof of potable water subject to the following
requirements:
a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a
new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e.,
within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within
100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an
Ecology variance, applicant must provide evidence through a hydrogeologic assessment (relevant
components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that
the subject aquifer will not be degraded by the proposed use of well.
b. Installation of a flow meter.
c. On-going well monitoring for chloride concentration.
d. Submittal of flow and chloride data to the County per monitoring program.
3. If public water is unavailable, a qualifying alternative system may be used as proof of potable
water.
SEP14-00126 Page 4 of 4
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JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
CONSTRUCTION INSPECTION REPORT
For RECORD DRAWING
Designer /W/C14/""q&-t-- '" Y Permit # SEP /4-063/2
Installer /1-7,901Z7-Pd ee17-24/4-s9e Lr9,4/>7- .rf Parcel # 75- ' S3
Electrician Design Flow j80
Property Owner / '
Site Address / ? A/42Z- -1 e2 2>,A,021? , , / 92g 3S
Answer all questions or indicate NA
Tanks, Pumps and Controls Date Insp.
Tank (manufacturer, size, baffles) leeo 'A - /47139reG - ol-2T/-- 7- F�1 � e -lea
Pump chamber (manufacturer, size) lc &44.
Screen(s)and/or Pump Shroud (type, location) .Ut-1I' V'4 ,e 7 W,Bri2>7-1 A-,t 7-4-R
Were Tanks tested onsite for water tightness? Yes / No
Panel Model X141"(:"JaX 1 PG'-SG Timer Model A4(f4 IA20
•
Pump 1 — Man./Model Oee A/C-C, Z130511 Flow Rate )Z 5 gpm
Pump Location (i.e. garage, treatment unit, basement)
Bottom of transducer to bottom of tank 2 2 ,C '/
Float settings (above bottom of tank) / transducer settings Timer Functions:
(above bottom of transducer)
On/off - On -
S .SSG
Veto - 4,9 Off-
Alarm - Z-4-0 Veto On - Qs-Arc
Storage Above High Water Alarm Z4a-4- gal. Veto Off- /4ee riov, < os°ce
Dose Counter Reading /j 5 5 Y1 s s # gallons/dose I, 66,
Elap. Time Meter Reading / rt i Pump Throttled? (Yes)/ No
Dose Drawdown (in inches) 0, O8
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 12/01/14 page 1 of 2
Pre-Treatment Date Insp
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No
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. /( (sue/ 1 ' FM ld S ze/Sch. !//-SC -g—lS
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 4ii° , Autoclear set at Z6 doses min-sec.
Health Department Inspection issues resolved Yes / No / NA If yes how?
Users Manual Provided to Homeowner Wit-,1 Ec'0/2l- L' 41"/ ' ' Date
Tank/component Decommissioning Report Attached No / NA
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 /2 —9 — /4" (Permit Approval
Date)or that changes have been noted and the system is in compliance with WAC 246-272.
S°
—/
5100110
Designer Signature Date License#
C:\Data\Wpw\County&State FormsWeff son\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 12/01/14 page 2 of 2
•
•
CERTIFICATION OF SEPTIC TANK & D-BOX ABANDONMENT
Company Certifying Abandonment: Landmark Excavating
Phone: (360) 379-6652
Site Address: 130 Nolton Rd., Nordland, WA 98358
Parcel Number: 975900503
Abandonment as required in SEP14-00126
I certify that the septic tank and d-box for the above referenced site has been
abandoned to Washington State and Jefferson County requirements.
ignature Date
/ A-ec rAl / j—H044-i/C,.T
Print Name
A COPY OF THE PUMPERS RECEIPT MUST BE ATTACHED TO THIS FORM
C:\Data\Wpw\Construction\Certifications\ST AbandonmenflST&D-Box AbandonmentlO'Neil,975900503,Certification of Septic Tank Abandonment.wpd
9
ENVIRCV:"RECK,
1612 Has7jclas Ave.W.
Port Townsend, WA 98368 539410 '2
Invoice
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ADDRESS ADDRESS
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CUSTOMER ORDER NO. - s's* I SOLD B'Y TERMS F.O.B. DATE
44
ORDERED SNIPPED DESCRIPTION PRICE WM AMOUNT
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ENVIRO CHECK, L.L.C.
1612 Hastings Ave. W
Port Townsend, WA 98368
360-379-9400 SEPTIC TANK OPERATIONAL REPORT
Company Name F P »1 tvirms j L- Date of Service
Technicians signature
Service provided for d
Address \- r- a1- t7t- V-0 boo-pL-k^-'
Phone
Job Address
Last Date Pumped_ c,r Jc_ #people in home —__ #bedrooms U��
SEPTIC TANK
Size of tank It Gallons Compartments: Single Double
Material: Concrete j° Polyethylene Metal Other(specify)
Conditions of septic tank: Good , Poor
Was ground water observed leaking into tank?Yes No
If yes, where was water observed?
Effluent running back into tank from drainfield? Yes No f"
Riser to grade on inlet: Yes No Riser to grade on outlet: Yes No
If no risers,were risers installed? Yes No `S •
Solids in Tank: 1st compartment Scum (top layer) 3 in. sludge(bottom layer) B in.
2nd compartment scum(top layer) in. sludge(bottom layer) , . in.
BAFFLES
Condition of inlet baffle: Good Needs Repair Repaired Material
Condition of center baffle: Good )`- Needs Repair Repaired Material cvry
Condition of outlet baffle: Good/ Needs Repair Repaired Material f
Type of outlet baffle: Unscreened Screened Filtered Material
Cleaned outlet baffle and/or screen: Yes No
PUMP
Does the system include a pump? Yes No If Yes, complete the following
Size of Tank Gallons
Riser to grade: Yes No If n• was ii • installed: Yes No
Material: Concrete of i le.' Metal Other(specify)
Was ground water observed le ki l t• '.nk?Yes No
If yes,where was wat r obs- ed?
Depth of accumulated sludge in e. mp tank inches
Was the tank pumped? Ye No
Recommended additional information
Condition of Pump: Working Not Working Needs repair
Condition of Alarm: Working Not Working Needs repair
Pump cycle drawdown: Inches Time for pump cycle minutes/sec.
Comments: - L v Eo 1 i [ RtaJo 0P,L r_,�
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