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HomeMy WebLinkAboutSEP2014-00019 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 SEPTIC PERMIT APPLICATION .n PROPERTY OWNER Jon Hall �� MAILING ADDRESS 140 Hurricane Ridge Dr. r� Sequim,WA 98382 's'O J� PHONE (360)710-0441 SYSTEM DESIGNER: Michael S.Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 33 Township 30 Range 2W PARCEL#002332015 Subdivision Name V. 3 of Surveys P.92 D vision Block Lot(s) Site address/Directions to site 27 Old Gardiner Rd., Sequim. W. on Hwy. 101, right on Old Gardiner Rd., left on Rajala Rd., right at driveway appriximately 400 feet away, project site is approximately 400 feet down dirt driveway on the left. SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New X Tanks(s)only Private Residential ADU Modification Public X Commercial Expansion Community Upgrade Repair SITE SIZE 4.96 acres SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional W Designate Reserve Area Yes# Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 qal./sq.ft./day Bed Length 204 ft. Trench Width 3 ft. Trench/Bed Depth Varies 24 to 36 in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE OF SYSTEM Pressurized Drainfield 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 future application will be separately judged by the rules and laws in effect at that time. 6/007-1..■ - / Property Owner Signature Date FOR OFFICE USE ONLY 4t/ty PART IAL f �/jC/� E� ASBUILTPD&_ a�/ FIND , A eV:D INSP/PUMP TEST j 1 Sl)`I ��. C ���tS ���.••fff ALL HOLD REQ. MET n1043,(15 nu)I MEd C^✓:) Date 11 i Z I I�{ Fee 1 C4 C) Rec# Lt 11S- Check# 511 Case#SEP I —d Cl _ JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •98368 www.jefferson countyp ub lic health.o rg Phone 360-385-9444 Fax 3bU-:3(Y-448 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP14-00019 Date Received: 02/12/14 Date Issued: 04/04/14 SITE ADDRESS: 27 OLD GARDINER RD Date Expires: 04/04/17 GARDINER, WA 98382 APPLICANT: JON A HALL PHONE: 360-692-1301 140 HURRICANE RIDGE DR SEQUIM WA 983829375 LEGAL DESCRIPTION: S33 T30 R2W TAX 49 PARCEL#: 002332015 Section: 33 Township: 30N Range: 02 W DESIGNER: MIKE DEENEY PHONE: (800)395-7296 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: PRESSURIZED TRENCH No. of Gallons per Day: 360 Type of work: NEW Drainfield Trench Septic Tank Length: 204 feet Width: 3 feet Depth: 24 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 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.: SEP14-00019 1.) H - AS PER WAC 246-272AAND 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 2.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 3.) 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. 4.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 5.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 6.) 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. 7.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 8.) 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. 9.) 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. 10.) 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. 11.) 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. 12.) 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. SEP14-00019 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/4/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING MAR X320157 Designer ,A 7/C If4&L- Permit # SEP i4- oe:De Installer A tFSQvYCC,5 rt 17W, /?,3,s6-12 Parcel # 0622- 33 Z a /S- • Electrician Design Flow 3100 Property Owner //'¢LL Site Address 2 7 ALL' &AeRp/ ' Iz D,l 5 '19/M Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) / 6'Att. Z t? w/ene ',c-GCS.1ou?-GeTF/L- 1? /6 Pump chamber (manufacturer, size) /coo 6'4Z- Screen(s)and/or Pump Shroud (type, location) lw'-h V if ' -r w/B•1 >`Ul3z • Were Tanks tested onsite for water tightness? Ye No Panel Model 4 4304 W /2 1 PG- s5 Timer Model A4,4).0iW0/ / Z- Pump 1 - Man./Model dTZE��o PF3oc' Z! Flow Rate Zeo. / gpm Pump Location (i.e. garage, treatment unit, basement). Bottom of transducer to bottom of tank Z 4,5-'1 Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off- o.9 " On - //'T/mot 3Zs,trc Veto - Z 3,0 Off- 2 38,n,,v ZS_sc Alarm - Z 3, 2" Veto On - 1 MiN 3 Zs Storage Above High Water Alarm 3 39 gal. Veto Off- Z38 r-r/,,-/ ZBs . Dose Counter Reading VG©a-E 5 # gallons/dose 46, Elap. Time Meter Reading /8,-r,,v Pump Throttled? Yes)/ No Dose Drawdown (in inches) 1. 8 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 07/23/14 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 u FEEIz Transport Pipe Size/Sch. 2- I' /7 Size/Sch. l sGf 467 g- /¢ Orifice Diameter l Lateral Size/Sch. Z SG7— G4-4—/4- Barrier Material Fa-r�rz 1-341122IC_ Cover Material/Depth /5 7z Z3" L- 1Z-5--/4- Residual Head (lat.# & ft. Head) 6-0er 41Z 41%)3". lus /"& s1=V2 ;=-Y rU13 /Z- 5-/4- Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean?(j / No If no, what action taken? Mound/Glendon Site Prep. Drainfield Length Zo 4- ft Width 3 ft Depth 04- )a 3!' 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 coe , Autoclear set at 1 doses min-sec. Health Department Inspection issues resolved Yes / No /01f yes how? Users Manual Provided to Homeowner W')`,/ Zeco/z.D 2>2c-(e./- G Date Tank/component Decommissioning Report Attached Yes / No 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). 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