HomeMy WebLinkAboutSEP2014-00138 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION ;++
PROPERTY OWNER GS Properties No 2 Inc 1,2n
MAILING ADDRESS
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7 CountryClub Drive SW r'If
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P, "��',,
Lakewood, WA 98498 S o2 ' F+.
r„*' Suzanne L Martin �t+
PHONE ( ) yd. [sly IN -'` 4,
E%P1' all IIiS
SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304
LEGAL DESCRIPTION: Section 3 Township 29N Range 1W PARCEL# 994 200 032
Subdivision Name 7th Ave Ac Tr 161; Is co rd rw(Is NW of co rd)+Division Block Lot(s)
Site address/Directions to site 11602 Rhody Drive-Port Hadlock
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential New Tank/s only Private
Residential ADU Modification_ — Public
Commercial ✓ Expansion_ _
Community Upgrade
Repair ✓ SITE SIZE +/-44159sf
SYSTEM TYPE Partial Repair-(tank) ✓ (drainfield) Previous Evaluation
Conventional ✓ Designate RPsPrve Area Yes# SEP85-00097
Alternative Redesign No
SYSTEM DETAILS
Number of Gallons/day ex Soil type eX (attach soil eval.) Application Rate ex qal./sq.ft./day
Drainfield Length 90'ex ft. Trench Width 3'ex ft. Trench/Bed Depth ex in.
Septic Tank size 1000 _gal. Pump Chamber size n/a gal.
TYPE OF Tank replacement for existing septic system SEP85-00097
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.
>i2012-
Property Owner Signature Date I
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forms\Suz\2008 SPA.DOC
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublichealth.org
Nhone itiU-38s-9444 Fax 3tiU-3/9-443(
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP14-00138 Date Received: 12/04/14
Date Issued: 12/12/14
SITE ADDRESS: 11602 RHODY DR Date Expires: 03/12/15
PORT HADLOCK, WA 98339
APPLICANT: G S PROPERTIES NO 2 INC PHONE: 360-379-2954
7 COUNTRY CLUB DRIVE SW
LAKEWOOD WA 98498
LEGAL DESCRIPTION: SEVENTH AV AC TR 161 LESS CO RD R/W(LS NW OF CO RD)&VAC PTN OF 10TH AVE
REST COVT#542147(ENLG BY W 50'OF LOT 160)
PARCEL#: 994200032 Section: 3 Township: 29N Range: 1W
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
PO BOX 125
CHIMACUM WA 98325
SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS
No. of Gallons per Day: Type of work: REP
Drainfield Trench Septic Tank
Length: 0 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.
,e(4( //
Jefferson County E ironmental 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.: SEP14-00138
1.) This permit was issued to correct a violation of WAC 246-272A for a failed septic tank. The permit
must be completed within 90 days of the date of issuance.
2.) The sewage transport line leaving the building is to be replaced and cased in 3034 pvc all the way
to the existing drainfield.
3.) H - Permanent barriers are required along/around primary and reserve drainfield areas to protect
from parking, driving, and other land disturbing activities prior to final. The existing barrier location
at the primary drainfield needs a slight adjustment, and the reserve area is currently not protected
at all.
4.) 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.
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.) 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.) 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.
9.) This onsite sewage system is designed for domestic strength wastewater only. Disposal of any
other waste strength is considered a violation of this permit.
10.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
11.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
12.) 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.
13.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
14.) 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.
15.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
16.) 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.
SEP14-00138 Page 2 of 3
\\tidemark\data\forms\FSEP_Permitmod.rpt 12/12/2014
17.) 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.
SEP14-00138 Page 3 of 3
\\tidemark\data\forms\F_SEP_Permitmod.rpt 12/12/2014
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CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT (Q
Installer: Shold Excavating (Evan Neville) Parcel # 994 200 032
Permit Owner: GS Properties Permit# 14-00138
Designer: Suzanne Martin Design Flow:
Site Address: 11602 Rhody Drive-Port Hadlock,WA 98339
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAL/DAY
LENGTH ex.SEP85-097;90lf;3'wide;24"deep 1000 gal SEP14-0138 n/a
IF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen
Tank Size: n/a
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
Installed 2 compartment, concrete septic tank with traffic rated lid and risers. Risers, clean-out(tuftite) and outlet filter have
been installed. Riser& Speed leveller have been installed. Barriers have been placed.
All OSS Component installation have met or exceeded State and local codes and regulations.
Users Manual Provided to Homeowner mailed 27 Feb 15 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
(DATE) OR THAT CHANGES HAVE BEEN
NOTED AND THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272
26 February 2015 5100342 s4.
Designer Signature Date License# 4& o
i�' Suzanne L Martin .•.
"'i 515r F NEW' +t
EXPIRES RI I/15
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Page 1 of 1;GS Properties;
Tank Cross Section - Not To Scale parcel#994 200 032
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
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SEDIMENTS maximum 1/16"filter
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Randy Marx
From: Randy Marx
Sent: Tuesday, December 02, 2014 10:34 AM
To: 'Suzanne Martin'
Subject: RE: SEP85-00097
Show df protection for reserve area.. show existing transport line and your tie in, OR is it all new? If all new then say
that. If you are installing a complete new transport line then call for a riser on the d box. You need to state the current
status of the entire system, WE DON'T ISSUE A PERMIT IF THE EXISTING IS FAILING, so need to state, ALWAYS!!!!
Words are cut off..
Randy Marx
Always Working For a Safer& Healthier Jefferson County
360 385 9402 ><((((°> ><{{{"> ><((((2> ><((((2> ><{{{">
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Septic Permits Online (Link) Environmental Health Web Site (Link)
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended
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Original Message
From: Suzanne Martin [mailto:septicbysuzanne@gmail.com]
Sent: Monday, December 01, 2014 2:34 PM
To: Randy Marx
Subject: SEP85-00097
Good Afternoon Randy,
Here is a copy of the revised plan.
I have a message for Linda Sather on her answering machine about pumping and filling the septic tank asap/today.
In addition i have spoken with Dave Sather(brother) about the abandonment of the ex. septic tank. He indicated that
he is going to ring Tim Johnson and see if that is covered in the estimate and get it done. Dave had told me that
Goodman did pump it when this first had occurred and that there is soil in the bottom of the tank.
Thank you, slm
"The greatness of a nation and its moral progress can be judged by the way its animals are treated." --Gandhi This should
be applied to individuals as well
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' ' ' '' THIS PERMIT WILI EXt'IPE ONE YEAR FROM DATE ISSUED APIPUCATION ,,...,xlvDseye (2 --cycli
, FOR RENEWEL FOR ONE YEAR WITHIN 30 DAYS P:" -'' DORAV C t,X N • .fr , ': , -
. '
JEFFERSON COUNTY HEALTH OEPARY114NT ..•
tO,n
' 802 SHERIDAN AVENUE
1' v
INSTALLER PORT TOWNSEND, WASHINGTON 9836wii0RECepPi NO. (7(
(206)385-0722 CO‘iS ,
BUILDER of' *iii' 4
1 Iva -
, . SEWAGE DISPOSAL PERMIT kotf.PA- ..-..—---/C.....—,-............,.
• Submit In Duplicate
,.....c 1 ,?_, - e_...• 4 tr-- e(f ou...dertf, I ' .13S--
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Owner -
Address Phone
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Directions for locating sltec7) I --'.
11(402- i-tio7D
DY E. ....
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INSTALL NEW SYSTEM 0 REPLACE SYSTEM Vf•----PARTIAL
REPAIRTANKO,AINFIELD • 8 cn :
...
TYPE OF Se-r I./ice NO. OF is ' 4 2_ *ge-..--si- P-498 WO SITE t-.) •
BUILDING C.64.irCIA BEDROOMS 4 I' BASEMENT Al -SIZE
Previous site evaluation by 1SOIL TYPE DESCRIPTION ir
Health Department —
—"--
lk1.7. b,eQc..;,..,c
Depth to maximum seasonal
water table ii-9P
\ 3
Source of potable water supply 2)--..;\
V
.e„C',..- ._ Public ---- Privatef`4
-1-44,---e) -,
Source type: Drilled well , 3j-‘4341-"ga ,•14,-..--SC--`-e•- it i
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sDug well /*-Ia-4-t.A.)tecti- "i 2
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, iroi 1,-1
EVERYtAPPLICANT HAS THE RIGHT OF I 11 -36 C1- .e• ,,k1.-- til-e-/ - 0 ki
Z t'\
APPEAL AS PER JEFFERSON COUNTY ---1.,
ORDINANCE 2-77. 4) S) a-- - 4 cv..ety %.4.,,J-kV-A,...,.‘- (1' .
1 ,
31-31s -)>a,-14k 3
tkiNATURE OF APJA,12,AtidT—
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REMO OF OR MAJOR DISTURBANCE OF SOIL IN THE PROPOSED OR APPROVED DRAINFIELD 0) C
AREA MAY CREATE SITE CONDITIONS THAT ARE MACCEPTABLE FOR THE INSTALLATION OF A r r
SEWAGE DISPOSAL SYSTEM. ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING 8 ----
PLUABING STLIBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS c---`
r
PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept.
for final inspection). STUB OUT PL mi.' -G ABOVE FOUN ION FOOTING, t
C'
Drainfield Length 1L) Trench widt 3 . rench dep . 11" o.lines :i`" Tank size 1401'47 'Z'
[
Soil type and application rate used for design GPD/ft2- - e- -
COMMENTS: '.-.,42k c3,1,-6v-k ,\.‘ed,• ,44,-vv,e-... 0 r
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, 44;‘). 0‘4 ti. C--04...40‘•
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IL
API" o'vED DATE INSPECTED PARTIAUFINAL DATE 1--
I
certify ipa this sysle as iii?ailed in a manner approved by the Health Deparlment _,J
IN - LIAR'S IGNA URE DATE DATE INSTALLEDt
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