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HomeMy WebLinkAboutSEP2015-00003 ' ill , Jefferson County Department of Community Development i� . +! 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 ..• b, SEPTIC PERMIT APPLICATION =,.S,"` +, 1-16-15 PROPERTY OWNER Donald Zwernemann 5� M 'k i. Jess 0 Goesatve MAILING ADDRESS CIO O 1_,F=,st- ('-r,s,;e SA t-ce+ ' ..rte :PI `w A"' rte. EYA 12121!16 3 vac r, I-q /0,37 0.7 to 03 PHONE ( 551 ) 404-8374 SYSTEM DESIGNER Jess Godsalve Designer Phone# 360-551-9973 LEGAL DESCRIPTION: Section 33 Township 30N Range 1W PARCEL# 001 333 023 J4N 2 Subdivision Name N/A Division Block Lots) 1 20/5 Site address/Directions to site HWY 20 to four corners road. Address posted "240". SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Tank/s only„ Private Residential ADU Modification Public X Commercial Expansion Community Upgrade Repair SITE SIZE 0.5 acres SYSTEM TYPE Partial Repair-(tank) X (drainfield) Previous Evaluation Conventional X Designate Reserve Area X Yes# 79-00325 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 3/5 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Drainfield Length E`4-'170 ft. Trench Width T*2 ft. Trench/Bed Depth t.tif."36 in. Septic Tank size 1000 gal. Pump Chamber size gal. TYPE of system Existing gravity system. Proposed tank replacement/designate reserve area. 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 fut0 appl. ation will be separately judged by the rules and laws in effect at that time. j-N ,.,r %/1/ Property Owner Signature Date FOR OFFICE USE ONLY (c/ j 0--/Z-0/65--- PARTIAL /21/15- A I t � //s �5-'/ -' � �,b SBU L� � ! FINA 5 APPROVED I INSP/PUMP TEST 16 (\NA' 62 (() .kj-S ALL HOLD REQ.MET O �/ Date 2-) Fee l ►4 Rec# S`'( 9IJ Check# a-I 2. Case#SEP ).--j— �� 3' H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC ¢SON 4 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 �SHl N't- www.jefferson countyp ub lichealth.o rg Phone 36U-3n-9444 Fax 36U-3(9-448 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP15-00003 Date Received: 01/21/15 Date Issued: 02/20/15 SITE ADDRESS: 240 FOUR CORNERS RD Date Expires: 05/20/15 PORT TOWNSEND, WA 98368 APPLICANT: DONALD ZWERNEMANN PHONE: 240 FOUR CORNERS RD PORT TOWNSEND WA 98368-9747 LEGAL DESCRIPTION: S33 T30 R1W TAX#18 (E100')TAX#24 PARCEL#: 001333023 Section: 33 Township: 30N Range: 1W DESIGNER: JESS GODSALVE PHONE: (360) 598-3505 MILLER BAY WATER CO PO BOX 1054 SUQUAMISH WA 98392 SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS No. of Gallons per Day: 360 Type of work: REP Drainfield Trench Septic Tank Length: 0 feet Width: feet Depth: 0 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 En ronmental 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.: SEP15-00003 1.) This permit was issued to correct a violation of WAC 246-272A for a leaking septic tank. The permit must be completed within 90 days of the date of issuance. 2.) Distribution boxes shall be fitted with a riser to grade, constructed of durable materials and a secured lid, adequately sized to allow visible inspection of the liquid level in the box. 3.) 5 ft. setback from house to be maintained. 4.) 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. 5.) 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. 6.) 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 246-272A 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 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.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required and must comply with code at the time of application for use. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 13.) 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. 14.) 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. 15.) 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. SEP15-00003 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 2/20/2015 15), **' CONVENTIONAL SYSTEM AS-BUILT INSPECTION REP 9ATer 1248, viron,�nl CO j' Installer: Donald Zwernemann Parcel # 001 333 023 /yAa- Permit Owner: Donald Zwernemann Permit # SEP 15-0003 rh Designer: Jess Godsalve-MBH2O Design Flow: 360 GPD Peak Site Address: 240 Four Corners Road-Port Townsend ABSORPTION AREA: DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAL/DAY LENGTH 170 24" 36" 1000 3 270 IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen Tank Size: Float Arrangement High water float—distance to top of tank/emergency storage Dose drawdown (#of inches) #Gallons/Dose Timer/Dose Counter info Pump Size/Manufacturer COMMENTS (inspection notes, changes from design or deficiencies installation)Attach additional sheet(s)if necessary Existing drainfield SEP 79-325. Septic Tank install and D-box riser only. Users Manual Provided to Homeowner N/A Date ATTACH ASBUILT DRAWING signed by Designer or stamped/signed by a Licensed Professional Engineer I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY 1-21-15 (DATE)OR THAT CHANGES HAVE BEEN NOTED AND THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272 10-12-15 5100341 ,,'/ Date License# .7 /vy z{ 10-12-15 t>3' S 12/21120+6 ) ® � ^ ��/ OCT/ . `� e �20co rr, e �f o sot) _ ^ a ��tZ��Y | \ �/ E a ca | ; : � / Zi , �o ��\ �= �� � a \ G � §a 22 � \ -0( k/� ® 9 (0 D- 0 Gk P 2 _ 2$ ®m e �R 7 , / �� �- y \ED 1 ¥ � \ I i % s 85 L \ a 1 ƒ I \/ no I 2 K & £ L , - | 7 - -� Z 2 ~ Z 1 - - - 1- -1/1j - - - _ S s E { 6 . -200'+1- 1 a / - 0 71 2 p ? 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SECURED LID WITH GAS TIGHT SEAL a� 1 ACCESS RISER 1Af y�`G jQ f 1 f 1 FINISH GRADE �jr / / FROM SEWAGE SOURCE FLOATING MAT APPROVED EFFLUENT FILTER SEDIMENTS SEWAGE ved DI S Appro or SPOSAL Co struction DE IGN Date Zwernemann Parcel#001 333 023 240 Four Corners Road JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 SHERIDAN ST., PORT TOWNSEND ,WA 98368, (360) 379-4450 -f' �'h- -16-15 if`.':f SOIL EVALUATION 4 ' �'�.`'' Jess D Godsalve t PROPERTY OWNER Donald Zwernemann ".r Al nn -r NPA'•• ++ FxM. 12/27/2016 SYSTEM DESIGNER Jess Godsalve- MBH2O 33 30N 1 W 001 333 023 jAN 21 ?Of LEGAL DESCRIPTION: Section Township Range Parcel # 5 Subdivision Name Division Block Lot(s) Date Logged: 12-27-14 Logged By: MBH2O 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 7 ' SOIL LOG #2 0 to 6 in. Dark brown sandy loam \L 0 to 12 in,dark brown sandy loam 6 to 22 in. Lt gray/brown silt loamt med.blocky) \k 12 to 18 in grey silt loam(med.blocky) 22 to 50+ in. Grey/brown gravelly med.sand 7\�\ 18 to 48 in. grey gravelly med.sand to in. to in. Anticipated water table >50 in. Anticipated water table >48 in. Roots to 36 inches Roots to 36+ inches Health Dept. Comments Health Dept. Comments ii(AceeW G `� 7�— /caul Rio SOIL LOG #3 SOIL LOG #4 to in. to in. to in. to in. to in. to in. to in. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments SOIL LOG #5 SOIL LOG #6 to in. to in. to in. to in. to in. to in. to in. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments H:\INFOHLTH\SOIL.FRM 1/00 4.. z JEFFERSON COUNTY HEALTH DEPARTMENT 1 802 SHERIDAN AVENUE lL INSTALLER Few_- E-4. - 4 -; PORT TOWNSEND,WASHINGTON 98368 RECEIPT NO. 7 97, V (206) 385.0722 BUILDER DATE 4--1 g---7�f' SEWAGE DISPOSAL PERMIT .tea fl Submit in Du licate ! 7 /37`-3 B©A 3/5i T �^'P0A1 /Ac RE ! 1 _ ^. 2_ ___ j . /vim S FS- /..47 Owner ` / ddre s Phone m l a .�.�,.�. › FRonz f�Rr AL/6 �,�spa•p - (,� ,� ,� :�, d, .c ,Jl Directions for locating site r Y-"'""�`" " t . 1 gt_,C g`6 , ,.., - .ax., o w xi INSTALL NEW SYSTEM ❑ REPLACE SYSTEM ❑ PARTIAL REPAIR IX TAN DRAINFIEL v Lyi _{ O TYPE OF NO. OF SITE BUILDING bw /4/z:(-. BEDROOMS BASEMENT .SIZE/4_ 6.--r..4.4:._ c Cl) DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING w 0 t SOIL LOGS - \;171-'1-- < O is,, �` z z -4 O o z Fn 0 z (),,l 0 3) D z Dig two holes per site. (min.) ' W O 4' deep-2' dia. -50' apart & flag APPLICANT /L x'77 Cam"" ��� e�'Zt'1"C O m ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL IS OBTAINED F•Iw . . L . Lw u ► _a 6 ' ---- g 0 Drainfield Len.th / 70 ! Width d De.t 3' d4} # Lin-s C Tank Size Gal. c COMMENTS: (TWO COMPARTMENTS) . \ i g APP•∎VED ATE l INSPECTED PARTIAL/FINAL DATE I ce • J that this system was installed in a manner approved by the Health Department. / 7 v`` ? 7 INSTALLER'S SIGNATURE IV DATE DATE INSTALLED r - JCF+J/1°78 I . . ,...,1,...... .. . . ill , Co 1? cl. I . . 1 151 2S1 1 1 , . , ID 1 3 1 ....1 1 i Q, 1 „..._. , .7. „ ,..,,, 104 1:5 e.‘t -"---lg.a..:st,a 61 Ce. . "-I-4) ' .' 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