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HomeMy WebLinkAboutSEP2013-00093 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Michael Dodek MAILING ADDRESS 30525 SE 44t St. AUG 0 1 2013 Fall City,WA 98024 PHONE (360)876-2905 SYSTEM DESIGNER: Michael S. Deeney Designer Phone#: ( 800 ) 395-7296 LEGAL DESCRIPTION: Section 4 Township 29 Range lE PARCEL#921042042 Subdivision Name Division Block Lot(s) Site address/Directions to site West on driveway to 1553 E. Marrowstone Rd., then approx.780 feet to project site. 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 3.5 acres SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes#SUB12-00025 Alternative X Redesign No SYSTEM DETAILS Number of Gallons/day 360 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. 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 ir.."arate judged by the rules and laws in effect at that time. ry--- Property Owner Signature Date '.-i4d 6/ i `t 1 FOR OFFICE USE ONLY ill 1% PARTIAL ASBUILT�tC4• ii/ FIN 4 )1 ` '( APPROVED �- _ y S INSP/PUMP TEST ` &/(fit C act) i�/(Q/2:- ALL HOLD REQ.MET 7-- Fee ± Rec#ig% Check/ Case#SEP 3 -11 3 C:\Data\wpw\Counly&State For msUefferson\Septic Permit Fonms\Glendons\Dodek 921042042.wpd `- JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street •Port Townsend•Washington •98368 www.jeffersoncountyp ub lichealth.o rg Nhone 3ti0-385-9444 Fax 360 •79-4481 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP13-00093 Date Received: 08/08/13 SITE ADDRESS: 1617 E MARROWSTONE RD Date Issued: 04/09/14 Date Expires: 04/09/17 APPLICANT: NEIGHBORHOOD GROUND SERV INC PHONE: 30525 SE 44TH ST FALL CITY WA 980246504 LEGAL DESCRIPTION: S4 T29 R1E TAX 80 WITH EASE PARCEL#: 921042042 Section: 4 Township: 29N Range: 01 E 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: 360 Type of work: NEW 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 S age Systems, codified in JCC 8.15 as amended. This permit may not be renewed. ,4/ 4\ 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.: SEP13-00093 1.) 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. 2.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed by current code. 3.) 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. 4.) H - AS PER WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE SYSTEMS REQUIRE THATA 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 246-272A AND 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 5.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 6.) This system must be constructed by an installer certified by the Jefferson County Public Health Department per state code WAC246-272A-0250. 7.) 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. 8.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) 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. 11.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 12.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 13.) Setback to surface waters- 100' required from drainfield and reserve areas. 50' required from tanks. 14.) H -All portions of the ditch to the south of the Glendon pods and reserve shall be filled in and compacted within 100' of the pods, infiltrative area and reserve areas. 15.) Dry season installation required. 16.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. 17.) Drainlines are to be installed along the natural contours. 18.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 19.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. SEP13-00093 Page 2 of 3 \\tidemark\data\forms\F_S EP_Perm itmod.rpt 4/9/2014 20.) 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. Tanks shall be tested prior to final and documented on the record drawing. 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. SEP13-00093 Page 3 of 3 \\tidemark\data\forms\F_S EP_Perm itmod.rpt 4/9/2014 JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING 1UV 1 0 2014 Designer /L."7 Permit # SEP / 3"Q0C2 Installer /-1.127 K/77 C-2r V. Parcel # z / 04z O 4.Z Electrician Design Flow 3�a Property Owner A-7/Cie/.4 EL 4/< Site Address /�/ 7 G /�r.42izowsro�u� /2 sue_/ "7. 1-ebLr41°/D, (// ri83y8 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) /Ct b)f-L. 2 O/-PP. Q.�FE'��s �ol,>-��)--Fi� l2 j¢ Pump chamber (manufacturer, size)*/Doo 8 -B-M-- Screen(s)and/or Pump Shroud (type, location) f U/`- / / L'L ? /till—*/ /3/o L74r2 g -! Were Tanks tested onsite for water tightness? Yes / No Panel Model Aqa, W',2 /JAG -<Y".7 Timer Model 4J PC9 L c*>4. d F3- 14/---- • Pump 1 - Man./Model ogEi•/lo Flow Rate /8,46' gpm 8_8-1 - Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank 2 /,01/ Float settings (above bottom of tank)/ transducer settings Timer Functions: (above bottom of transducer) On/off- 0,9 On - S�c Veto - �( Off- J ¢rt/l/ Zia Alarm - Z 1,? Veto On - p SSG Storage Above High Water Alarm gal. Veto Off- / Dose Counter Reading e1Dos # gallons/dose z.,G Elap. Time Meter Reading //vti,y' SO 'EG Pump Throttled? es / No Dose Drawdown (in inches) 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 p Pipe 54D�,sc ff Transport Pi a Size/Sch. Manifold Size/Sch. 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 O8 , Autoclear set at /8 doses min-sec. 4 - 7y-2 ,t1 ?11�` px.cg L 1z l o,2 7� Lim s car®a� Health Department Inspection issues resolved3Yes No / NA If yes how? 3 -Neon/ 74 N N/aL 0 re r PG i¢c�D Y�q� L L /b S .5e-el,)? ›, 72.1 A s 2)ci - 6474eS1 Af�® Users Manual Provided to Homeowner WO-7/ /&‘evz-D 27R/tv✓/A-f1, Date Tank/component Decommissioning Report Attached Yes / No /l��/ Installer Certification attached/signed Yes CP 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 4 (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. r 1%7-7-7¢ 5100110 Designer Signature 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 m Qoo = o m > m Z < n �.°o- Sol .. 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O D-i tit nr y v o� m m�� e�sTF�gT'�� o y?�' a• 2m "n o-4 �1 2 0 2 '.2 a , ♦m r" m n W n �2 2OZ i °� N o mk� 0) h an-1i n -1b0 r'21 -`'gib 2� mx CA ∎ 0\0 v_ --..'y W N y C W\m D •,' //'` 3 Nr) n 012 c nti yn c'y v ��Z m =!�:k/// n ntinc, -4 NO 2 '"2 ar' 0" S j4 Z �rr./ , k, '. 201 b On cl, o p 0 �∎ fl7 �6��/i'/ O b 20rni3 02 arm- D 2A n, A s cp A`6 // IAA � 2- 2 y2 co co m N v+ \�N////// r'~l rn1bAr At,) b D2 w y Z 3 bnnn r~iw h Ao a '1'�i'�i0 -ON A N2 r = of V+ Zrr ay '„< N 20 D 0 ' -I -. ® o a.r' r 2 N C' <�4 larr'Aa all a2 C' CD , fit' �� 0 IV = O C') y o Z SOIL HOLE LOGS Page / of ' Designer 7`�7/�/yi96-C: .2:-.> k F Date t-(t- (_Z_ 2( q-24-1 2 Property Owner/Buyer r--//c/Yr9g6 Parcel# `7 2( og Z. ool- Oir--Z Project J°P l . 5 I)"mil /l45 sEL Gv7- Z Sec(Twp-Rng) A/t,v -6 z f ) HOLE w CD 0 z TYPE w U) w co OF DEPTH z m w zz SYSTEM (Inches) 7 U TEXTURE APPL. �O o L I-- F- D RATE 2 (X w OJ DATE O �-: )> (gpd/sq. ft.) fw- Q cii OBSERVED co �� 5 ) H Q o_ /6 Ce o f//3J o Z CK z /4 24 .s-z._ -,,,• L- 5c0-I S .e,.6 2-7 ?Z Fa P-P -4,_. c, e- 15-t ca _& ZS cv c cr/ . -t.. V--c, ' s D y 3 7 lz' . '2 Z-G z 7 le �G o,.6 '�7- l8 >1 e 45 p_ G 5L 1hc7 4S f -p,z z¢ ,.., .r'' - r �. , ICI SCL 1 It IL. /1 t z 3 4 ZG a sG o-lo Z6 >zo 5 4 y C -, U ' 4. ' ''.C) s I2 Z t& 6, S-Z- IC- '. @' go �7 F e L cD il'I '''S 3 � /r1 pct- t0� a y ll� 1/ z-g Z IS �� x`40- l l -1- �,�_ lb / • L Ls '3 �sL L C 4157 �, 12 ma- e„,�4 I � 'kV i-)/1'C ,`SC _ z-� 0 iv-37 p l till ✓ Z. (0. -- ZO Si-- e, 4 >3-& qi--z4--)Z 4 ' roc-G SG t ,,z-P 4-2 2 6 z-2 ,� SOIL HOLE LOGS Date 9t-/ -(Z , - 4-( � Parcel# 2/ " Z oco/ 4 Page Z of Z Owner/Buyer/-7i6-hefrit L .2›.='1>€,L!' f j2 S/y21 lz6� 2,sz__1 ' 'P-z HOLE w 0 NO. 2 z_ O F- u) TYPE C9 w O OF DEPTH z F- APPL. co CO W N SYSTEM (Inches) j TEXTURE RATE ~ 0 I- O (gpd/sq.ft.) O w Q DATE OBSERVED ~O U O z Q Z 74 /, :SG sL °•Co /4 > zB .-24--/Z 4.2_ ;j 6 me-- G sL to L S Li,z 5�1 Pik' cp`t`gY' G SL YO L-5- lZ Z-3✓ • 2 g/4 Z4 G s" e,e, z ! >z 4O 17- Mc---( SL y , L - O.? i-l0 Z . zoo; s 0.& 20 -Zg -24-! z 3 ) 1?--".- ' etc-c 5L, ,ro L S ,3 ,. 3 / �U }- !o?4 ' G .5'1- y-Q L S /2 l Z /0/9 1-7 b sL .& l& > 5,.' 4 ir/m r ---1,_ po 4 S 12-- A, fir'f 3 C:\Data\Wpw\Soils\Masters\Soil Hole Logs.wpd LEGEND -SOIL HOLE LOGS TYPE OF SYSTEM Cony Conventional Drainfield Note: The type of system underlined is the CPF Conventional Drainfield - Partial Fill type of system currently indicated by P Pressure Distribution Drainfield the soils. Wet season evaluation • PPF Pressure Distribution Drainfield-Partial Fill and/or effective curtain draining may PSL Pressure Distribution Drainfield-Sand Lined allow revising the type of system. PDT Pressure Distribution Drainfield-Deep Trench (Sand Lined) M Mound SF Intermittent Sand Filter SF-M Mound With Intermittent Sand Filter Pretreatment NS No System Possible WSE Wet Season Evaluation MOTTLING Examples VF Very Faint F Faint F-D Faint to Moderate D Distinct P Prominent STRUCTURE Examples L Loose MC-C Moderately Compact to Compact SC Slightly Compact MC/CEM Moderately Compact&Cemented MC Moderately Compact S-Cem Slightly Cemented C Compact S-Mas Slightly Massive ' CEM Cemented MAS Massive BLKY Blocky TEXTURE APPLICATION (APPL) RATE S Sand R Unusable Restrictive Layer LS Loamy Sand SL Sandy Loam L Loam SiL Silt Loam Si Silt SICL Silty Clay Loam AUG 0 ] 2013 • SiC Silty Clay CL Clay Loam SCL Sandy Clay Loam SC Sandy Clay C Clay Textural Qualifiers Examples F Fine VG F-M S Very Gravelly Fine to Medium Sand M Medium F SL Fine Sandy Loam C Coarse G Gravelly ' VG Very Gravelly EG Extremely Gravelly Cob Cobbles Version 11/14/07 C:\Data\Wpw\Soils\Masters\Soil Hole Logs.wpd