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HomeMy WebLinkAboutSEP2000-00165 +��:r,xaz+.*Yik4' ;m'".� . .w4.^ e.a>, a :�.u-n«.,k.ao a,��^'€r +av •aa,. �w: ' _r' w�rm..., .r.�,w5aw: A.er+.. Jefferson County Permit Center ,-,,%' :. 621 Sheridan St., Port Townsend WA 98368 (- \,:: 360-379-4450 / \ SEPTIC PERMIT APPLICATION ,�` t PROPERTY OWNER G(L C., WA-L FLouP \ AV 1 k,\r o MAILING ADDRESS {� .0 . 130X 112- '. w� PO It T A Al 6:.C.iS 1 WA, - q 93 GZ- \ -3 F R,� PHONE Area Code ( 3 C 0 ) 4l - 3 `o I a �, tr3 SYSTEM DESIGNER LEGAL DESCRIPTION: Section 4- Township 26 Range \Z 1y PARCEL # 612. - 0c-1 -002 Subdivision Name Division Block Lot(s) SITE LOCATION OF-f OIL. C. lT'I R-0140 1 SOOT -1 OF 1 OU( 4 1 o 9 611 Jr LK To l3--) 5 c-ct--y Z.r.)40 Zip Code TYPE OF IMPROVEM T: Residential ✓ Residential ADU Commercial Community TYPE OF/WORK: New V Redesign Upgrade Repair Partial (tank) (drain f� Ids )1 _emu Expansion Designate Reserve Area �� /' Conventional ✓ Alternative 1 cc�� Drainfield Length 2.2W S ' ft. Number of Bedrooms I r 5-t�-�t te cl. c Trench Width 3 ft. Basement: yes / Trench/Bed Depth t Z in. j" 'Site Size 4- I 59 A}C„ Number of Lines /I-+51e Previous evaluation: yes / ,rte. SEP Tank size I OOO gal. Water Source: private 1/ public Soil type S (ATTACH SOIL EVAL.) Application Rate ©, QS gal./sq.ft./day TYPE OF SYSTEM GrtiziV vj URA I N R IE,(b W ,T(-1 L L Ft 3TA-rl o N --fnfr9zr-tit;9ot_T#ia.t.4—v --4m-f44.Po#+=r-ee,s e_fV THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. . / Signature �•` , Date 7 5-00 OF r FOR OFFICE USE ONLY -t-Am(j.,,, 1,;)/ill.dt■k-1 i rs ,A fikcC 'AV CO PARTIAL,_-) _CI_ o3 7/-2.1/ Y FO A""• ,w RENEWED PRESS/TEST w ONTEMMIM FINAL rI/ ASBUILT 1",e.`4 '' to ko RENEWED . Fire District// Planning District School District Zone Date 1 —6, -CO Fegl 5 Rec # 3 v-GY3 Check # /do S Case # SEP U 0 J h:\home\pincntr\hlthinfo\permitapp.doc 10/97 SEWAGE DISPOSAL PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 (800) 831-2678 PERMIT #: SEP00-00165 Date Received: 07/06/00 Date Issued: 09/07/00 SITE ADDRESS: OIL CITY RD Date Expires: 09/07/03 FORKS, WA 98331 APPLICANT: MARY L PEDERSEN PHONE: PO BOX 353 PORT ANGELES WA 983620056 SUBDIVISION: BLOCK: LOT: T 6 PARCEL#: 612041008 Section: 04 Township: 26N Rance: 12 W DESIGNER: JERRY L JACOBS PHONE: (360)452-4592 221-C S PEABODY PORT ANGELES WA 98362 Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON THIS PERMIT IS ISSUED FORA PERIOD OF THREE YEARS (UNLESS OTHERWISE STATED BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR ONSITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO. 1-83, CODIFIED 8.15 AMENDED PER ORDINANCE NO.11-1115-99. This permit may not be renewed. Jefferson County Environ ental Health Specialist 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 building or sewage disposal plans (including plumbing stubout postion) and/or location of house or drainfield may invalidate this permit unless prior approval is obtained from the Jefferson County Environmental Health Division. ISSUANCE OF A PERMIT DOES NOT PRECLUDE THE APPLICANT FROM COMPLYING WITH ALL OTHER STATE AND LOCAL REGULATIONS. HEALTH DEPARTMENT MUST BE CALLED FOR FINAL APPROVAL. SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH No. of Bedrooms: / No. of Gallons per Day: „38'b 2`{0 Drainfield Trench Septic Tank Length: 267 feet Width: 3 feet Depth: 12 inches Size: 1,000 gallons SPECIAL CONDITIONS APPLY - SEE REVERSE CONDITIONS OF APPROVAL - PERMIT NO.: SEP00-00165 1.) Health Dept. required to observe pressure test, 48 hour notice to be given. 2.) MAXIMUM TRENCH DEPTH 12 INCHES 3.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 4.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. 5.) 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. 6.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 7.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. 8.) Drainlines are to be installed along the natural contours. 9.) Contact designer prior to installation for staking of drainfield area. 10.) Any portion of transport line under a driven way is to be double cased or equivalent. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 2 of 2 is\F_SEP_Permit.rpt • 11/22/99 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING Designer /`-'7/cN."14 z.-- P°' Permit # SEP DQ-.1d-.5- Installer/2/48eAoti,v /a y/Ga,Q,eecT<ovvs asap R...s.56e,'Cirs Parcel # 2 4-/ 4108 Electrician Design Flow 04-0 Property Owner Gsc 7,2 Site Address /09 `l c'/Z- / ®/ 5 , l.Yiq 9'6'33/ Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles)/040 &f 4. 2 ConIP. Vve,43,<7.c-z S 444:9 eirG Er o,-3-1 ¢ Pump chamber (manufacturer, size)t teet, 6 4L _ liv-3-/¢ Screen(s)and/or Pump Shroud (type, location) Pao'--,P. i iz-pw J) Z-7 -IS Were Tanks tested onsite for water tightness? Yes / V� Panel Model 114,49-9 1 }c` /PG-zs Timer Model s94919-,'W X Z-23-15- Pump 1 - Man./Model EX/.. ICU/-t i`-iil"•e40 ' t U.vkuowVFlow Rate z4,8 gpm Z-Z3-i Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank z 3.?" Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) O n/off- 0,9 /' On - • Veto - z 5,4 ii Off - 2 , Alarm - Z 5-..9" Veto On - Storage Above High Water Alarm Z 7 7 gal. Veto Off- Z E3 Dose Counter Reading rt 9 /G96 c/Dos 5 # gallons/dose 7_4,,7 Elap. Time Meter Reading 4h`k.s Pump Throttled? Yes m Dose Drawdown (in inches) /, Z 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 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 xeik Transport Pipe Size/Sch. Z ez•11.5.5 Zoo Manifold Size/Sch. 2-23-/,s- Orifice Diameter Lateral Size/Sch. Barrier Material riz-"4(6'G2 S ./e/%1%r'a S Cover Material/Depth h/1)'-o 9//54. Pe G S Z-2 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 / 78 ft Width 3 ft Depth l z 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 ,7 , Autoclear set at z doses min-sec. 5/Z 6 1:>6.2 Reco2D5 P�ae ��caB5 /A/c, 7°G,StAjS Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner W/7 '/1 r2 col '- 4)12e9t i6, Date Tank/component Decommissioning Report Attached Yes / No /i Installer Certification attached/signed Yes / 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 -7-60 (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. 457 Z-z l5" 5100110 Designer Sign 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 N v .'fl °m 2 XI m a s ao Z c a . 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' --01. % n43\--a C,LN i oy\ . - ii\Ov i'{\r . 6,)o,. &ro t,,,p ,(3•(\st, er 0 00 -' / ,. . ------- 1 f .-- ---- , '1 \ \ ------- /V .. ■ A A■Ta. 4 •••-Alh' 6,c_ 1 , 0 c.- -V.6 __... ...,, ‘ v\isz_46 .D. ov-r• s• 7•c_-\-‘7,N. 0T\ __.---_o,c,,N 7 \77Q_• ••Ve;-•-• _•---6-ry\.• 17,eit.9 Actions: A x‘ Randy Marx From: Creative Design Solutions, Inc. <mike @cds4you.com> Sent: Tuesday, February 10, 2015 11:36 AM To: Randy Marx Subject: Final Inspection, SEP00-00165, Parcel Number 612041008, 1099 Oil City Rd., Forks Hi Randy, Subject: SEP00-00165, Parcel Number 612041008, 1099 Oil City Rd., Forks I've did a substantial amount of work for the owner of this property last June, 2014. They have apparently taken care of all of the punch-list items I sent to them and are ready for a final (email notice from R.J. Services in December 2014). However, they are past due on my invoice for the services I provided last June. If another designer or engineer contacts your office regarding getting this system finaled, could I trouble you (or whomever in your office is addressing the final) to ask that designer or engineer to give me a call before proceeding? Many Thanks, Michael Deeney Creative Design Solutions, Inc. 800-395-7296 www.cds4you.com /1-3/ 15. 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'4,Y I 0 O .,,.�'� 6 OI N a ell I Z 2 y \' f-��cJO�y�\ , 1' — 1\11.6A-L- rl 5U(,C-D to(o GQNO • AOPtM 137 5 ( ` O LO t plc G-f- ou3 0 md- 7 i4w`( l v ( JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN ST SOIL EVALUATION PORT TOWNSEND WA 98368 (360)379-4450 PROPERTY OWNER GR.E.,c LUA.LprznU' SYSTEM DESIGNER J it,c,1 L ,Je4C.o3S LEGAL DESCRIPTION: Section - Township 2 7 Range 12 Parcel # C, (2.- O4-f -OO Q Subdivision Name Division Block Lot(s) Date Logged: r'vlp„i 23 - OC) Logged By: G41,A1 L . J+zi-(..043-S Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. • SOIL LOG #1 SOIL LOG #2 O to 27._ in. y6.,tii ri.oc S O to 12 in. ( z., 5.L, 22 to Co in. PtNc._ Spouo lZ to 36 in. 51L, -F-,,,m. S. to in. , .:,.,,___.w.., to 36+ in. V,,Ca2, C4�at�5GS. to in, ?..`__-_---� u4; to in. Anticipated water table 66r in. U� o Anticipated water table 36 in. Roots to inches . 1 �.' Roots to �( inches . Health Dept. Comments co o Health Dept. Comments SOIL LOG #3 �`�f o SOIL LOG #4 O to t7 in. \ n.. 11, �, S, r---'^� W 3 � c,i D to Q-r/ in. pg. i3/L, S,crL, l7 to 4Z in. bn., S, - _. .._, Q-9 to G S in. Can., co,brus . S, ct-L to 60 in. YWCAT, '5-ikZ,S to in. to in. to in. Anticipated water table ` 5+in. Anticipated water table 'O in. Roots to 4s 11 inches Roots to 4.4 a inches Health Dept. Comments Health Dept. Comments SOIL LOG #5 SOIL LOG #6 0 to 34. in. Qtt,, S,�rC„ to in. 34- to q- ' in. 'Flue . S , to in. to in. to in. to in. to ire. Anticipated water table (01-in. Anticipated water table in. Roots to 3A- inches Roots to inches Health Dept. Comments Health Dept. Comments H:\\\INFOHLTH\SOIL.FRM • 05/25/2000 11:56 :3604521.385 JACOBS INC PAGE 03 is { t\g) - 4: `''' low � ,s \\''''7,3,,3 E N„...f ,4\31X r\A 1 '"WC 01\rivii r‘ j;4k 1 irl 1-,..wk-i—4- — __-_. -- -----7/11,,,_ 6D ; °72 " I \di. ZULLe ON)G 4 ,-ra. W \ AP- ;9 7)( - ccul49:‘74.'4, E. cY ci I— a L ._— i / :.) 1 ,&,...._ ....., / ,cty< \. STU wk's Lb(1 1..j( 1 j C,' 114144 I I .. LL 1 s RECVEP i MAY25 5`1 JEFF. CQUN Y HEALTH DEPT. 05[25/2003 11:56 3604521335 JACOBS INC PAGE 04 • • -:- DATE: MAY 23, 2000 CUSTOMER NO: 200267 SOILS TEST PIT LOG FOR Greg Waldroup PREPARED BY: JACOBSWCc. 221-C South Peabody Port Angeles,WA 98362 (MO)481-4592 PRESENT ON SITE: MICHAEL BOARDMAN -JACOBS, INC. JERRY JACOBS -JACOBS, INC. GREG WALDROUP PARCEL# 612-041-008 TEST DAII: 05-17-2000 TEST PIT#1 c (+7 0-22 INCHES VERY FINE SAND 4`441 22-60 INCHES FINE SAND ' (4e TEST PIT#2 0-12 INCHES BROWN SANDY LOAM 12-36 INCHES BROWN FINE SAND Pak 364 INCHES VERY GRAVELY COARSE SAND(WET) C) ROOTS TO 36 INCHES TEST PIT#3 0-17 INCHES BROWN VERY FINE SAND 17-42 INCHES BROWN FINE SAND 42-60 INCHES MOTTLED FINE SAND(BLUE) ROOTS TO 45 INCHES TEST PIT 004 0-49 INCHES DARK BROWN SILT LOAM / 49-65 INCHES GRAVELY COARSE SAND -.7 0\4I, TEST PIT#5 0-49 INCHES BROWN SILT LOAM / 34-45 INCHES BLUE/GRAY FINE SAND J RECFIVED ROOTS TO 34 INCHES MAY 2 5 2000 • ito-, (..uuNTY HEALTH DEPT. • 591110 PGS : 2 Coy 05/05/2015 03,25 PM $73,00 JEFFERSON TITLE CO INC Jefferson County WA Auditor's Office - Ross Ann Carroll, Auditor When Recorded Return To: ®III 'ir ��Iik , l'A ik lillri�';'li ` 'i�V 111111 Name: Jefferson County Public Health Address: 615 Sheridan City: Port Townsend,WA 98368 Restrictive Covenant Regarding Monitoring of On-site Septic Syst• ii THIS AGREEMENT is made this date April 02,2015 by and between b : ON,his/her heirs and assigns("GRANTOR(S)")and Jefferson County Public Health("GRANTEE' ) 9 kit obcAC CAESAR. 4AP4 Public y _ WHEREAS, OSCAR TUAZON 11) C'j" -Pt e-L Kk,..,_. b/rE CIcLI Alf Xie°C 1 is/are the owner/s of a certain tract of land particularly described as fo t Ws: PARCEL NO. WHERE SEPTIC SYSTEM IS LOCATED: i Parc-1#.612041008 LEGAL DESCRIPTION(S): Section: 4 Township 26N Rar e.„.1 S4 T26 R12W TAX 6 ADDRESS OF RESIDENCE SERVED Of assigned) 109 IL ITY RD and, N} WHEREAS,a sewage collection,treatment and disposal' : deicribed in case#SEP00-00165 has been installed thereon,:and ( i'\ ( J WHEREAS,the residence or facility at the above��bed\prop ,including all parcels associated with said case, utilizes an onsite sewage system which requires re la(mItintenance and monitoring for the life of the system. Monitoring is required to be performed by a 'erso i autfio ze i by the Public Health Department,and WHEREAS,the Owner is require Jeff= c.,___4/\o ty i'ublic Health Department,as per WAC 246-272A through Jefferson County Code 8.15 to• e a • ogram ft periodic monitoring to assure the continuous and satisfactory operation and maintenance of th. s s em, =r d NOW THEREFORE,in o it r ion , the premises and the mutual promises and covenants hereafter set forth,the parties hereto agree as f. to . 1. Construction 0 er ':• constructed and installed a sewage collection,treatment and disposal system together th app e t facilities whose capacity and design are satisfactory to the Jefferson County Public Health De• • a ' e plans and specifications for this construction have been approved by the Jefferson CotultysQublic.H Ith Department prior to construction. 2. Own: e bilities: a. M.,. .' all Co nents as accessible and unobstructed to the surface.Non-accessible or obstructed •mpoi en of be serviced and may result in a violation of permit requirements. b. t:iI th tern consistent with producing residential waste strength effluent. c. •• • and maintain the system in accordance with conditions of the permit and Jefferson County Code ��� Page 1 of 2 ' VV I I IV I CijG L VI L 1 IV:WV1 LW 1V Vs 1 IVI • • 3. Attachment:n If box checked this septic system contains a proprietary device that requires Attachment#1 ti ee -+notice for Maintenance and Monitoring of a Proprietary Onsite Sewage System Device be recorded with this document. 4. Schedule: The Owner shall 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. 5. Reminder:The Jefferson County Public Health Department shall provide a reminder of re4 lred monitoring.The lack of receipt of said reminder does not relieve the property owner from complian�e with the monitoring schedule pursuant to Jefferson County Code. r ----`, 6. Records:A report of each inspection conducted shall be submitted to the Jefferson CountyPublic ealth Department within 30 days of completion of the inspection. Such records shall be open tQthe inspection f the Owner. (✓ tY agrees 7. Liability:The Grantor a ees to relieve Grantee,its agencies,divisions,officers, gen ,!=and employees of any liability,damages,judgments,claims or other expenses that might ari s a rresultof t e,inspections required by this agreement. _II N,i 8. Fees:A fee as set forth in the Jefferson County Fee schedule aandadop d�e Bbard of County Commissioners shall be paid upon submittal of each inspection report.,% 9. Terms:This agreement shall remain in full force and effect u til the date\of notification to the Owner by the Jefferson County Public Health Department that the Owner`s wer System)has been intercepted and connected to a general sewer system. 10. Amendments: This agreement shall not be modified except NJith the a ress written approval of the Environmental Health Department of Jefferson CounN- 11. Penalties: Non-compliance with monitoring and'inspection requirements is a violation of Jefferson County Code and shall be subject to enforcement as described in aid codes.The County shall have the right to enforce and compel compliance with this coven meludingaal'remedies available at law and equity. The County shall have the right in any such proceeding,t o re'coverits attorney fees and costs. 12. Venues: Venue for any action hereundershall be In 4etf frsron County,Washington. If any term or provision of this agreement is in whole or par held invalid or unenforceable by any court of competent jurisdiction,the remainder of this agreement hill continua in full force and effect. 13. Life of Covenants and Binding Effeect;7All ofthepromises,covenants,terms and conditions of this agreement shall bind the parties to this{'agreement and the successors and assigns of the respective parties here s AND . e dee -d to 1 w■ th laridJ 2 ' ..rr'�1N �a. ,.:- .11et. s ►i Ald. Owner Acknowledgment: ', SUBSCRIBED AND ! '• to heft,' me this 1 day of 5 ,2015 Notary Signatfr. , , f J,. Notaryptiklli 7P / for the State of 4� ,r i. .2 I . i r g in�._._.�'- !7/,., 1. i commission expire-. . d • page 2 of 2 !10 JAMES PAIRICK�wFON L1 ' , le N___/ W COOK EXPIRES PK 2018 \ltidemarkidatalfomts\F_SEP_monitaring_agree_ 4/2/2015