HomeMy WebLinkAboutSEP2015-00062 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION ;+T,.
PROPERTY OWNER George Seifert I "dry
MAILING ADDRESS 449 Suzanne Avenue "
,77•• Suzanne l Martin '•,"
+
Shoreview, MN 55126 �` nK 'e
PHONE ( 651 ) 481-1639
SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304
LEGAL DESCRIPTION: Section 27 Township 30N Range 1W PARCEL# 965 000 302
Subdivision Name Kala Point#8 Division Block Lot(s) 402 ((��
Site address/Directions to site Northwest Corner of Pinecrest&Kala Point Drive \'1 1 a e& P r\`-1 r-\(�
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential V _ New V Tank/s only Private
Residential ADU Modification_ — Public V
Commercial__ Expansion_
Community Upgrade
Repair SITE SIZE +/-21591sf
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional ✓ Designate RPsPrve Area Yes# SEP05-00183
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 12-24 in.
Septic Tank size 1000 gal. Pump Chamber size n/a gal.
TYPE OF Conventional Trench system
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.
9_ C
l�/yam//S
Pro rty Owner Signature Date
FOR OFFICE USE ONLY ("
0 PARTIAL 7/1/1.S ASBUILT I•QCt�4 l�/Ir FINAL 101``J +' '
AP""OV D
INSP/PUMP TEST 6 �a'i
1
ALL HOLD REQ. MET
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forms\Suz\2008 SPA.DOC
-- JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypublichealth.org
Phone .360-Jo5-Y444 Fax :3ti0-3f9=448(
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP15-00062 Date Received: 05/11/15
SITE ADDRESS: 1717 KALA POINT DR Date Issued: 06/30/15
Date Expires: 06/30/18
APPLICANT: GEORGE SEIFERT PHONE:
449 SUZANNE AVE
SHOREVIEW MN 55126-2312
LEGAL DESCRIPTION: KALA POINT#8 LOT 402
PARCEL#: 965000302 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.
/ "
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.: SEP15-00062
1.) 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.
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.) 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
4.) 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.
5.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
6.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
7.) 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.
8.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
9.) 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.
10.) 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.
11.) 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.
SEP15-00062 Page 2 of 2
\\tidemark\data\forms\F SEP_Permitmod.rpt 6/30/2015
CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT
4(D5 000 3Oa
Installer: Shold Excavating(AJ Sukert) Parcel # 965 X00 302
Permit Owner: George Seifert Permit# SEP15-00062
Designer: Suzanne Martin Design Flow: 360 gpd
Site Address: 1717 Kala Point Drive-Port Townsend,WA 98368
ABSORPTION AREA:
DRAINFIELD TRENCH WIDTH TRENCH DEPTH TANK SIZE #OF BEDRMS #GAUDAY
LENGTH 201 3' 24 1000 gal 3 360gpd
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
Cotton septic tank was installed with risers and outlet filter
distribution box was installed with riser and speed leveller
construction of this system meets current county and state code, regulation and recommended standard and guidance
Users Manual Provided to Homeowner mailed 27 August 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
27 August 2015 5100342
Designer ignature Date License# 4.
Cllr
f . Suzanne L Martin .;lir
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Page 5 of 5;Seifert;
Tank Cross Section - Not To Scale parcel#965 000 302
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of approved products.)
SECURED LID WITH GAS TIGHT SEAL
1 \If
ACCESS RISER
.SII g.
l FI JSH;GRADE
I — distribution box
FROM SEWAGE
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS maximum 3/16"filter
SEPTIC TANK
(TYPICAL)
GE DISPOSAL DES1Gt
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41?(<4..Jefferson County Environmental Health Dept.
615 Sheridan St.,Port Townsend,WA 98368
SOIL EVALUATION �'P
Property Owner- Mike and Lynn Davenport °� S°I> '41s
System Designer- Soils Applications Inc.Ken Warren ° �d tie
LEGAL DESCRIPTION: Section-_27 Township-30N Range-1W Parcel#965000302
Subdivision: Kala Point#8 Division- Block Lot(s)-402
Date Logged: 05/05/05Logged by: Ken Warren
Include soil textural characteristics and depths at which significant changes occur. Be
sure to include depth where mottling or impermeable layers occur.
SOIL LOG#1 ,/&477
-3" to 0"in. : Duff
0" to 11"in :Loamy Fine Sand
11" to 28"in :Moderate Compact Fine Sand
28" to 60"in :Fine Sand/Medium Sand,Slightly Compact �� /Anticipated water table in.
Roots to 41"inches.
19)
Health Dept.Comments 0.;\
SOIL LOG#2
-4" to 0"in. : Duff4k •
0" to 10"in :Loamy Fine Sand
10" to 60"in :Fine Sand/Medium Sand,Sligh Compact '
Anticipated water table in.
Roots to 49"inches. 0
Health Dept. Comments
SOIL LOG#3
0" to 12"in. :Loamy Fine Sand
12" to 36"in : Fine Sand
36" to 60"in : Moderately Compact,Fine Sand/Medi and
Anticipated water table"in.
Roots to 64"inches.
Health Dept.Comments
scir2aE'55E1 /6r�oFb
YC„e - b5 c5CxD 3o a
Jefferson County Environmental Health Dept.
615 Sheridan St.,Port Townsend,WA 98368
SOIL LOG#4
-3" to 0"in. : Duff
0" to 62'in :Moderately Compact Fine Sand,Medium Sand Pockets
Anticipated water table"in.
Roots to 46"inches.
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