HomeMy WebLinkAboutSEP2015-00058 Jefferson County Department of Community Development t
621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 > U'co \� �
SEPTIC PERMIT APPLICATION ��
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PROPERTY OWNER Beverly L. Moore ��js°, ea /�
MAILING ADDRESS PO Box 458 �% °<,„ S �°
Port Hadlock, WA 98339 'S� L
PHONE ( 360 ) 531-0231 °4
SYSTEM DESIGNER Everett A. Sorensen, P.E. Designer Phone# 360-821-9960
LEGAL DESCRIPTION: Section 12 Township 29N Range 1W PARCEL# 962700040
Subdivision Name 9627 - Irondale Acre Tracts Division 3 Block 6 Lot(s) 2
Site address/Directions to site 91 Sweet Home Road (S. on Oak Bay Road, W. on Washington Lane)
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New Tank/s only Private
Residential ADU X Modification Public X
Commercial Expansion
Community Upgrade
Repair SITE SIZE 4.76 acres
SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evaluation
Conventional Designate Reserve Area-7- Yes# SEP15-58
Alternative X Redesign )( Move5 (yenA b^ No
SYSTEM DETAILS
Number of Gallons/day 480 Soil type 3/4 (attach soil eval.) Application Rate `Q0.4 gal./sq.ft./day
Drainfield Length ft. Trench Width ft. Trench/Bed Depth in.
Septic Tank size gal. Pump Chamber�ize - gal. ,, _
TYPE of system Ca ��
� �-1-I UI^1 , _ _ _
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 a-. Apht of entry will be assumed unless the
applicant informs the County in writing at the time of the application that he or sh: ire prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry . 11',..._--'
Appeal —A person aggrieved of a decision of the Health Officer may appeal. Appeals s all 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 apr;. ;tion will e- separately judged by the rules and laws in effect at that time.
�� _ ' • - ,/ 2.0 5-T-f2°15—
Property Owner Signature Date
FOR OFFICE USE ONLY Q
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ALL HOLD REQ. MET
Date 9 �� � Fee Rec# O�? J Check# Case#SEP I 6_
H:\WEB\PDFs\Septic\septicpermitapp2008.DOC
ON
�°` JEFFERSON COUNTY PUBLIC HEALTH
?. " 615 Sheridan Street • Port Townsend •Washington • 98368
www.jeffersoncountypublichealth.org
F'hone 360-385-94-44'Fax 3b0-3/W-2T48 I
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP15-00058 Date Received: 05/07/2015
Revised Date: 10/07/2015
SITE ADDRESS: 91 SWEET HOME RD Redesign Issued: 06/26/2015
Date Expires:06/26/18
APPLICANT: BEVERLY L MOORE PHONE:
PO BOX 458
91 SWEET HOME ROAD
PORT LUDLOW WA 98365
LEGAL DESCRIPTION: IRONDALE AC TRACTS 34& PTN VAC ROOSEVELT ST ADJ
PARCEL#: 962700040 Section: 12 Township: 29N Range: 1W
DESIGNER: EVERETT SORENSEN PHONE: 360-821-9960
STREAMLINE ENVIRONMENTAL, INC
715 GRANT STREET
PORT TOWNSEND WA 98368
SYSTEM DESCRIPTION: CONVENTIONAL TRENCH
No. of Gallons per Day: 480
Drainfield Trench Septic Tank
Length: 200 feet Width: 3 feet Depth: 24 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 Sys y odified in JCC 8.15 as amended.
This permit may not be renewed. j
Jeffe son County Env' onmental Health Specialist
This permit with conditions must be onsite during all pha es of construction
HEALTH DEPARTMENT MUST BE CONTACTED FOR FINAL INSPECTION.
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL - PERMIT NO.: SEP15-00058
1.) Maximum trench depth is 24." If a pump is needed to meet this requirement a redesign is required
by the designer.
2.) 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.
3.) 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.
4.) 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
5.) 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.
6.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
7.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
8.) 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.
9.) 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.
10.) Contact designer prior to installation for staking of drainfield area.
11.) 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.
12.) 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.
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.
Page 2 of 2
\\tidemark\data\forms\F_SEP_PermitRedesign_nw.rpt 10/7/2015
CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT °b
INSTALLER Evan Neville, Shold Excavating PARCEL # 962700040
BeverlyL. Moore SEP15-58 '`)/,/..r-car, --.8<, f
Permit Owner Permit # n sa Os
ABSORPTION AREA: 1 000 t120 �;C`
DRAINFIELD TRENCH TRENCH TANK #OF #(� 0
LENGTH 200 ft WIDTH ) ft DEPTH 24" SIZE Gals BEDRMS 4 DAY ti °0
Tank Shroud/ t.7/e.
IF PUMP AND PUMP CHAMBER REQUIRED: Size Screen
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
I CERTIFY THIS%NITE SEWAGE SYSTEM WAS INSTALLED AS DESIGNED, PER PLAN APPROVED 6/26/15
October 16, 2015
naTF
-+N84-746 R-SIGNATURE DATE INSTALLED
Designer
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Septic System As-Built Sheet 2 of 2
Drawn By: Everett A. Sorensen, P.E. Site Plan Eastern Detail
Streamline Environmental, Inc.
715 Grant Street; Port Townsend, WA 98368-2405 Beverly L. Moore's Property
360-821-9960; everett@streamlineenv.com 91 Sweet Home Road
October 22, 2013 Port Ludlow, WA 98365
STREAMLI/VE Parcel Number 962700040
ENVIRONMENTAL
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