HomeMy WebLinkAboutSEP2015-00028 Jefferson County Department of Community Development'�'1,
621 Sheridan St., Port Townsend WA 98368, (360)379-4450 1I Zo,S
SEPTIC PERMIT APPLICATION t: l,--
Brian &Jenny Vervynck
PROPERTY OWNER 47 ':F ,,
1420 No Creek Road #2935
MAILING ADDRESS "Suza�eLMartin N y,#�
Mill Creek, WA 98012 bbr r NV-'' !t
EXPIRES vt ti„
PHONE ( 619 ) 823-5947
SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304
LEGAL DESCRIPTION: Section 27 Township 30N Range 1W PARCEL# 965 000 243
Subdivision Name Kala Point#7 Division Block Lot(s) 358
Site address/Directions to site Oak Shore Drive-Port Townsend &q() Qq kS Q 13i---
SOURCE
rSOURCE 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 +/-20498sf
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional ✓ Designate RPSPrve Area Yes#
Alternative Redesign No _
SYSTEM DETAILS
Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.60 gal./sq.ft./day
Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 12-19 in.
Septic Tank size 1000 gal. Pump Chamber size n/a gal.
TYPE OF New conventional trench system for proposed new single family residence
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 ill be separately judged by the rules and laws in effect at that time.
?._..,/,eri
foperty Owner Signature Dote
FOR OFFICE USE ONLY
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PARTIAL 6 �'/7i1 ' y ASBUILT��rC� /TFINAT
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JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublichealth.org
Nnone ibU-38b-9444 I-ax ibU-3/9-4413/
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT#: SEP15-00028 Date Received: 03/11/15
Date Issued: 04/21/15
SITE ADDRESS: 290 OAK SHORE DR
Date Expires: 04/21/18
APPLICANT: BRIAN &JENNY VERVYNCK PHONE:
1420 NORTH CR ROAD#2935
MILL CREEK WA 98012
LEGAL DESCRIPTION: KALA POINT#7 LOT 358
PARCEL#: 965000243 Section: 27 Township: 30N Range: 1W
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
PO BOX 125
CHIMACUM WA 98325
SYSTEM DESCRIPTION: CONVENTIONAL TRENCH
No. of Gallons per Day: 360 Type of work: NEW
Drainfield Trench Septic Tank
Length: 200 feet Width: 3 feet Depth: 12 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.
/°7
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.: SEP15-00028
1.) Kala Point requires a 10' setback to a property line from any construction.
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.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
4.) 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.
5.) 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
6.) 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.
7.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
8.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
9.) 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.
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.) 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.
12.) 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.
SEP15-00028 Page 2 of 2
\\tidemark\data\forms\F_SEP_Permitmod.rpt 4/21/2015
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CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT
Installer: Evan Neville(Shold Excavating) Parcel # 965 000 243
Permit Owner: Brian&Jenny vervynck Permit# SEP15-00028
Designer: Suzanne Martin Design Flow: 360 gpd
Site Address: 290 Oak Shore Drive;Port Townsend,WA 98368
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAL/DAY
LENGTH 200 3' 12-18 1000 gal(Cotton) 3 360gpd
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
Cotton septic tank with risers&tuftite outlet filter installed. Distribution box has been installed with riser&speed levellers. 10'
setback to property lines has been maintained. All the construction practices met or exceed Jefferson county and Washington
State codes, policies and Recommended Standard &Guidance.
Users Manual Provided to Homeowner mailed 28August15 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
� 28 August 2015 5100342
Designer Signature Date License# R+;
6,i 'fir
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i Suzanne L Martin .5 1+
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EA, 2/11/17
., 6 e\oviarabutin Lot area: ±20498sf
Area Soils: Hoypus gravelly loamy sand;0-15%slopes
S iP 1 3 excs ?, Imo'
N87° 58'30"W 100.0' �N
ar
N��� � ������� �� 0 30' 60'
V' NI lir Nr.10' drainfieLd ,' ° reserve area
protection zone- ►� ' ±I200sf :1.+^♦, , SCALE 1"=30 FEET
i o. . ♦ ' now inst :odrtsaLL
now instaLLed '4 y---K
4l ~
distribution box ' ♦ v ,, A ,
-riser & speed .� typical,
LeveLLers instaLLed °� ♦�♦♦� 1
now instaLLed odi, lig
,���,IPsf'�♦A :�
Cotton 1000 gaLLon �� a,
Tx
septic tank wirisers & instaLLed dry weLL
tuftite outlet filter_ -',
ilkMO
3 bedroom
single family
r residence
proposed clean-out ,
(under
constru tions ►
water Line and driveway
10' drainfieLd , I I ` , not instaLLed at the time
protection zone - m 4 of this drawing. Water
Line must maintain
�,�����♦�.� �.`\ / minimum 10' from aLL oss
, _ , components.
(--► h
r 1 1
♦I
► � — . .a ♦
�
'� t reserve area ' '
'� tfl:1.65sf) ;
� ►'
zc.-0 --- ---- --- ---- ---- k
►� ���♦ :4
- --`- --"---- - _....4.0- _
� 27 August 2015
water meter �--ik - -��- _ _ - JeL . ±350 :''t,
— — ____ i N 87 58' 30"W _.____..100.0' /� I,`•/'a
-------------
fed e of as halt pgKSHORE DRIVE — _ :EX�i$Uz-rPf1%17�R
Brian&Jennifer Vervynck
Septic Site Plan
Oakshore Drive-PT
Lot 358; Kala Point#7
Parcel#965 000 243; S 27;T3ON; R1 W;
SEP 15-00028
June 2015; 125-24
Page 1 of 4; Vervynck;
arcel#965 000 243
JEFFERSON C UNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST. PORT TOWNSEND WA 98368 360 379-4450
%'It
SOIL EVALUATION ('
PROPERTY OWNER Brian &Jennifer Vervynck �9� ' �'
SYSTEM DESIGNER Suzanne Martin 1�)) `�'„
/S Suzan�e LQMart '��.
iL‘
LEGAL DESCRIPTION: Section
EXPIRES
27 Township 3°N Range
Subdivision Name t#7 g 1W Parcel # 965 000 243
Kala Poin
Division Block lot(s) 358
Date Logged: 19 February 2015
Logged By: Suzanne Martin
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 pff
®,
0-22"Yellow/olive brown gravelly medium sand SOIL LOG #2
22-55/60ll Light yellow brown gravelly medium sand
55/60+' 0-15"olive brown gravelly loamy medium sand
Compact medium sand 15-55"Yellow brown gravelly medium sand
some mOttlsoil ' 17 55+' compact fine medium sand
some mottled soils t!.�o�/�_
_ (,.. ,(,,,,zidtr,idotA
Anticipated water table /a in.
Roots to 55 inches Anticipated water table n/a in.
Health Dept. Come Y �� Roots to 55
inches
Health Dept. Comments
SOIL LOG #3
0-8"dark yellow brown gravelly loamySOIL LOG #4
8-50" med. sand 0-19"olive brown loam
yellow brown gravelly medium sand
50-55+"comp ct fine to medium sand
19-60+" 9 medium sand
�-�/ �� yellow brown ravel) medium sand
/Z"r`u ) some compact loamy fine sand inclusions
s some mottled soils present i /
Anticipated water table n/a C� '6�� 1 OAC 6 0 'I
in.
n/
Roots to 46 inches Anticipated water table a
in.
Health Dept. Comments Roots to 60
inches
Health Dept. Comments
SOIL LOG #5
SOIL LOG #6
Anticipated water table in.
Anticipated water table
in.
Health Dept. Comments Roots to
inches
Health Dept. Comments
H:IINFOHLTHISOIL.FRM 1/00
Page 2 of 4;Vervynck;
parcel#965 000 243
ONSITE SEWAGE DISPOSAL i l}
SYSTEM DESIGN I/9 10;
/ 'ice
/5 CO wh• 5> :�tt
4 March 2015 . SuzanneL Martn '•y t
Date = 'Eltusrim IJk... Its
Property Owner Brian &Jenny Vervnyck 4 March 2015
System Designer Suzanne Martin
Legal Description: Section 27 Township 30N Range 1W
Subdivision Name Kala Point#7 Division Block Lot(s) 358
I. CALCULATIONS
If for residential use:
Number of Bedrooms: 3 x 120 G.P.D. = 360 total G.P.D.
•
If for non-residential use, attach calculations used to determine G.P.D.
Soil texture waste water application rate 0.60 G.P.D./ft. squared
(see page 214 of the EPA Design Manual)
DRAINFIELD SIZING:
Absorption area: 600 square feet (total G.P.D. ;G.P.D./ft. squared)
Trench or bed width 3 feet
Trench or bed length 200 lineal feet (sq. ft. trench or bed width)
II. APPURTENANCES
Septic Tank Size 1000 min gallons •
Pump Requirements (If Necessary)
Elevation difference in feet n/a
Friction loss
Pump capacity should be G.P.M. at T.D.H.
Number of doses per day
Dosing volume gallons
Pump chamber size n/a gallons
li:\home\pincntr\infohlth\sewd sn
•
page 3 of 4;Vervynck;
Parcel#965 000 243
III. DRAINFIELD CROSS SECTION
411
: 4 J 11
5,� Suzanne L Martin+++
FIER-
�wwas vnm
/ D
0,/„//g
4 March 2015
a" Dr..w. R.�k
NATIVE SOIL
A
I E �
IMPERMEABLE MATERIAL/
SEASONAL SATURATION
A. Trench Depth 12-19 inches
B. 6 inches of drainrock below pipe
C. 36 inches of vertical separation from trench bottom to impermeable
material/seasonal saturation
D. 5-12 inches of fill (if needed)
E. Trench width 36 inches
NOTES:
The reserve area may require additional treatment
Barriers between reserve area and driveway to protect reserve area from vehicular traffic
DO NOT PLACE EXCAVATION MATERIALS, BUILDING MATERIALS ON EITHER DRAINFIELD AREA
On site fill ok for cover
Pea gravel to be placed in tank hole
10'separation required between home and primary and reserve drainfield areas. 10'separation required between
water lines and all septic components. 5'separation between home and septic tank
ATTACH DETAILED DESIGN OF SYSTEM
Page of 4;Vervynck;
Tank Cross Section - Not To Scale parcel#965 000 243
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
1 ACCESS RISER
I FINISH GRADE
- — V'r —�
111/1/11L 4 �-
r/ — — distribution box
FROM SEWAGE I
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS 1/16"filter
-------------
SEPTIC TANK
(TYPICAL)
SEWAGE DISPOSAL DESIGN
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