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HomeMy WebLinkAboutSEP2015-00072 I Y Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450419 ' + SEPTIC PERMIT APPLICATIONlt i 4.97 PROPERTY OWNER Suzanne Lamon & Frank Samuelson ✓UN '.1,7''tk. MAILING ADDRESS 64 Laurel Street .1 -,- , Port Hadlock,WA 98339 ��/PC1/C,so, `• r ttits une •��4, PHONE ( 360 ) 379-0204/385-1358 ei?, t'' ��5z,,,„` SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304 °xc LEGAL DESCRIPTION: Section 6 Township 29N Range I E PARCEL# 921 063 006 Subdivision Name Tax#24 & ti tax#C1 Division Block Lot(s) Site address/Directions to site 64 Laurel Street-Port Hadlock,WA 98339 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential ✓ _ New Tank/s only Private Residential ADU Modification_ — Public ✓ Commercial Expansion_ _ Community Upgrade SYSTEM TYPE Repair ✓ — SITE SIZE +/-29388sf Partial Repair-(tank) ✓ (drainfield) ✓ Previous Evaluation Conventional Designate RAsPrve Area I Yes# SEP02-00242 Alternative ✓ Redesign No SYSTEM DETAILS Number of Gallons/day 240 Soil type 3 (attach soil eval.) Application Rate 0.60 qal./sq.ft./day Drainfield Length see plan ft. Trench Width rep ft. Trench/Bed Depth mound in. Septic Tank size 1000 gal. Pump Chamber size 1000 gal. TYPE OF Proposed replacing tanks and filter media in ex. glendon system. Extend toe as well 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 assu - you of any other County approvals. For example, it DOES NOT GUARANTEE that you wile+btain permission to build a permanent residence or other structure on this parcel. Any futur- ;ppli, ion will be separatdged by the rules and laws in effect at that time. ,,� 5 2 � t5 Property Owner Signature Dat FOR OFFICE USE ONLY `� I I i 7• 051 PARTIAL{DA � €P ASBUILT awe) / l` t�/ FINA q/15 A'PRO,ED INSP/PUMP TEST HAMS” `ED I' k0\'ilk0 ALL HOLD REQ. MET Date f///() Fee q/ (4 56 Rec# �—C�'•'7 Check# 1 L) t 2 Case#SEP 0 41. C•\Doc��mer* aDd Se*tir-s\SuzArre Marti*i\My Doct*c.ntsmy Bann„mo fG 7.,,,.\mhh9n\J.ffer<=0 cnvi*y\Jeffro forms\Suz\2008 SPA.DOC �40r co` JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 �sri+vaso www.jeffersoncountypublicheakh.org Phone 3bU-:36b-Y444 Fax Jt5U-319-448I ON—SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP15-00072 Date Received: 06/11/15 P. SITE ADDRESS: 64 LAUREL ST Date Expires: 11/17/15 PORT HADLOCK, WA 98339 APPLICANT: SUZANNE LAMON PHONE: 64 LAUREL ST3n-s PORT HADLOCK WA 98339-9720 LEGAL DESCRIPTION: S6 T29 R1E TAX NO.24&TL TX Cl I$' PARCEL#: 921063006 Section: 6 Township: 29N Range: 1E DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224 PO BOX 125 CHIMACUM WA 98325 SYSTEM DESCRIPTION: REM & REP MEDIA-GLNDN No. of Gallons per Day: 240 Type of work: REP Drainfield Trench Septic Tank Length: feet Width: feet Depth: inches Size: 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 age Syst-ms, codified in JCC 8.15 as amended. This permit may not be renewed. C �� c, /271),,,,x �1'� v V 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.: SEP15-00072 1.) All contaminated materials must be placed as designed, limed to kill living organisms, and covered w/a minimum of 6" of clean soil. Designer to verify and certify on the record drawing. 2.) This system must be constructed by an installer certified by the Jefferson County Public Health Department per Jefferson County Code 8.15.120 (9) and state code WAC246-272A-0250 for proximity to a shorline. 3.) 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. 4.) The area identified as "Reserve Area" is encumbered by the original drainfield. Future use of this area will require this to be addressed. 5.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 6.) 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. 7.) 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 246-272A 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 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.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 10.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 11.) 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. 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. SEP15-00072 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 9/14/2015 16.) This approval is for a repair to an existing septic system only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 17.) This parcel is within a no shooting area per JCC 8.50. 18.) This project was reviewed and approved as a Shoreline Exemption under JCC 18.25.560(2). 19.) This proposal is consistent with the Jefferson County Code Interpretation date August 29, 2014 for repair and maintenance of legal nonconforming onsite sewage systems. The proposed repair to the septic tank and drainfield is exempt from critical area review under JCC 18.22.070(6) and (21). 20.) The application was reviewed by the Jefferson County staff for the potential presence of Critical Areas under the provisions of the Unified Development Code (UDC). After a Geographic Information Systems mapping review the following Critical Areas were confirmed to be present on the subject property: Fish and wildlife habitat conservation area for marine shoreline, and coastal seawater intrusion protection zone (SIPZ). 21.) VOLUNTARY MEASURES OF COASTAL&AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 22.) This permit was issued to correct a violation of WAC 246-272A for a ponded glendon basin and leaky tanks. The permit must be completed within 90 days of the date of issuance. 23.) The project must comply with the Inadvertent Archaeological and Histroic Resources Discovery Plan for Jefferson County, Washington in the event that any ground-disturbing activities or other project activities related to this development or in any future development uncover protected cultural material. SEP15-00072 Page 3 of 3 \\tidemark\data\forms\F_SEP_Pemiitmod.rpt 9/14/2015 ,• /24::ese'dcAl JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 983 ASBUILT INSPECTION REPORT For RECORD DRAWING tint,. Suzanne Martin Designer Permit # SEP 15- Oif,7s Installer Shold Excavating (Evan Neville) 170 ° t aid, Parcel # 921 063 006 � rad tity Electrician Cascade Electric Design Flow 240 gpd peak 1/pa/ti/ Property Owner Suzanne Lamon Site Address 64 Laurel Street-Port Hadlock, WA 98339 Answer all questions or indicate NA DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) 1000 Cotton, risers, baffles&outlet filter installed 10/24/15 Pump chamber (manufacturer, size) 1000gal Cotton, risers installed, 22 gal/inch 10/24/15 Screen(s)and/or Pump Shroud (type, location) Screen in pump chamber 10/24/15 Screen from previous permit application SEP02-00242 Were Tanks tested onsite for water tightness? C)/ No Panel Model Infiltrator Timer Model Aquaworx IPC previous Pump 1 — Man./Model myers 2nfl51-8e 1/2 (prey pump) Flow Rate n/a qpm previous Pump Location (i.e. garage, treatment unit, basement) in pump chamber/screen Float/transducer settings Inches Timer from bottom of tank- On/off- 19.8 in. Functions: On 7 min Veto - 29.2' in. Off 8:42 sechr Alarm - 29 in. Veto On - 7 .� in Storage Above High Water Alarm 435/635 gal. Veto Off- 6:31 sec®hr Dose Counter Reading 17073 doses # gallons/dose per gpt gal. Elap. Time Meter Reading 00431:03:381 minEr Pump Throttled? YesNo Dose Drawdown (in inches) n/a in. Pump 2 — Man./Model n/a Flow Rate qpm Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Timer from bottom of tank- On/off - in. Functions: On sec/min Veto - in. Off- sec/min/hr Alarm - in. Veto On - sec/min Storage Above High Water Alarm gal. Veto Off- sec/min/hr Dose Counter Reading # gallons/dose gal. Elap. Time Meter Reading min/hrs Pump Throttled? Yes /No If additional pumps- complete the info in this table Dose Drawdown (in inches) in for each and attach. Other Timer functions & settings (e.g. override on/off) 06900 veto doses;ZB-06; Autoclear 22 dose; 02975 events; ID=00-07-0235 H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 A, Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location n/a Sand Fill met design spec? Yes / No ATU (manufacturer, model) n/a Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes / No Drainfield Transport Pipe size, schd, diameter prey install 1" Manifold size/schdPre install 1"sch 40 10/26/15-confirmed Orifice size 1/8 Lateral Size/schd n/a Barrier Material jute Cover Material/Depth 0 Residual Head (lat.# & ft. Head) pods balanced The laterals/pods were balanced 0 / No Source/Manufacturer of Drainrock/Gravelless chambers cotton Drainrock Clean? Ye / No If no, what action taken? Mound/Glendon Site Prep n/a Drainfield Length 14 ft Width 18 ft Depth n/a inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary existing header 1"transport line, 3/4" ball valves, 1" lines to Glendon Pods;w/disconnects .1.) All contaminated materials have been disposed of on site as per plan and requirements. 6.) H-Tanks have been abandoned, see abandonment certification and pump out receipt •Existing components that have been utilized for this have been noted on the as built form. the transport line was only verified at the pump chamber and at the header. New riser installed on header. Health Department Inspection issues resolved Yes / No /0 If yes how? Users Manual Provided to Homeowner mailed Date /6 t5 Tank/component Decommissioning Report Attached es / No / NA Installer Certification attached/signed �e / No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY TUE 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 T1-t:E SYSTEM IS IN COMPLIANCE WITH /WAC 246-272. "f�,�.� j ,, C411 C 5100342 �� Date License # 5t0Zc :o'4 Designer Signature SuzanneLMa . ., Ewrtes 2/11/17 H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 0 -100 o, CD o CD 10 °' .moo Q, _in 1::1 h3 a = 0 Il = — 3 = < O o -1 -3 d n, 3. CT n/) CD 0, CD n C ,— n �OCD - I p, a -3 0. O 0- "0 rla n 0 , C 0 CD i+ c D nCDd a CD d O c -0 _1, 4CD n, N — Q 3 c- 0O 0 C 0 0 O Cn C I+ -< ON c - C.p (-71 a .-1- 3CD 0 ,fi�G CD O0. N �' CD a CD Cu f-r `+ C- CD (1 n Cu 04 -3 Q,7 d CD N O CD 3 \ 7CD r �,n, Dd d 7 7- TA • • i.. i ‘ - .. : i : . . . . . .: . V ==r At�ih, y Tapir �� �` �► �rl�as�M�Noff • 1 ,t '4 * „, t tff f ff iff f i f -may--mo ,� 4-IJ . . t ♦� ; rippriur 4tr , , . ''''' , r,” ...., , 4411k* i m.„:,.,„/„. , ( C:°cp..; , ,r 1 .. 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Phone: 360-385-9444 FAX: 360-379-4487 EMAIL: septic@co.jefferson.wa.us PERMIT OWNER Suzanne Lamon SITE LOCATION 64 Laurel Street-Port Hadlock, WA 98339 PARCEL NUMBER 921 063 006 ©SEP NUMBER 15-00072 INSTALLER Shold Excavating CONTACT PHONE 385-0480 DATE FOR INSPECTION SYSTEM WILL REQUIRE PRESSURE TEST - YES please NO *The designer is required to complete a pre-cover inspection of all systems. Please contact the designer prior to beginning construction to schedule installation inspections and pre-construction meeting if required per the permit or designs specifications. 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OQa C fl P O,2 V \ page f 41, amon; Tank Cross Section-Not To Scale par 1 063 006 (For illustrative purposes only, actual tank configuration'may vary,tanks must be on list of appror ucts.) SECURED LID WITH GAS TIGHT SEAL /C�4, " . ,\ ,^'".• 'i.t, , ACCESS RISER O) -0, <Zl =a FINISH GR (,` h ��9 �. ('°'f.' �mil ® i__, " l TO PUMP °- CHAMBER FROM SEWAGE SOURCE FLOATING MAT t APPROVED EFFLUENT FILTER r,,p't % SEDIMENTS 1/16''filter must _____________ be be installed At/I--'- Nt- Q�`ll a SEPTIC TANK (TYPICAL) SECURED LID WITH GAS TIGHT SEAL THREADED UNION ACCESS RISER SERVICE FINISH GRADE \� 1 VALVE* FROM SEPTIC ' 1111111 ®_ I —►TO DRAINFIELD J TANK LJ — 180 ■ EMERGENCY STORAGE ANTI SIPHON HIGH WATER ALARM LEVEL VALVE' � 180 f Aquaworx Transducer NORMAL TIMER OFF LEVEL WORKING VOLUME I ENCLOSED PUMP SEDIMENT SHROUD* ( CHECK VALVE"'1$" SEDIMENTS ,1SUBMERSIBLE i CENTRIFUGAL PUMP PUMP CHAMBER (TYPICAL) *AS NEEDED • Page 'of IP,Lamon; ` Parcel#921 063 006 • • s Effluent PumpsOrenems° Incorporated 1-800-348-9843 100 Effluent Pumps 90 PEF150 PEF, PKP Series 1/3 hp to 1-1/2 hp 80 [PEF 1001 t w. V ..... d e 60 p PEF75 H CO = 50 0 .E - co PEF 50 GI 40 i effluent pump 30 V 20'of head 10 PKP 350 PEF 3371 0 ° f f f 0 10 gpm 20 30 40 50 60 70 80 90 Net Discharge,gpm NDW-PC-PEF-1 Rev.5.0,©9/04 Page 1 of 1 tom. III. DRAINFIELD CROSS SECTION fi 510 t D I FILL i / 8 May 2015 (.. R" Dr‘ift Mack NATIVE SOIL A � E � IMPERMEABLE MATERIAL/ SEASONAL SATURATION A. Trench Depth mound inches B. n/a inches of drainrock below pipe C. 18 inches of vertical separation from trench bottom to impermeable material/seasonal saturation D. mound inches of fill (if needed) E. Trench width 21' new inches ex. pump currently works well. the calculations are for in the event it fails. Currently the system is controlled by Aquaworx control panel which is to be retained. The existing transport line is existing and was repaired within the last 5 years and still has integrity. The existing water lines and water fixtures are not within 10'of the drainfield proposal nor existing drainfield components. .. N y ATTACH DETAILED DESIGN OF SYSTEM Page k of 42, Lamon; Parcel#921 063 006 ONSITE SEWAGE DISPOSAL .T ,, SYSTEM DESIGN I/',+ ` S^ :c .. '' �h5 1:....q,Martin �,�� Date 11 May 2015 '71/ s* Suzan Lt, "i N titst 7 N •' f )I .F"!fit ( F �' EXPIRES vlIn7 (� ~ (�Oi - 9May2015 Property Owner Suzanne Lamon& Frank Samuelson rl��l�r; System Designer Suzanne Martin '4:,. �;:�. Legal Description: Section 6 Township 29N Range 1E ,, Subdivision Name Tax#24&tl Tax Cl Division Block Lot(s) I. CALCULATIONS If for residential use: Number of Bedrooms: 2 x 120 G.P.D. = 240 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: 400 square feet (total G.P.D. :G.P.D./ft. squared) Trench or bed width 21 feet Trench or bed length 4' new lineal feet (sq. ft.!trench or bed width) II. APPURTENANCES Septic Tank Size 1000 min gallons • Pump Requirements (If Necessary) ex. pump; caic only if needed Elevation difference in feet 14 Friction loss 3 Pump capacity should be 10 G.P.M. at 20 T.D.H. Number of doses per day per gbt Dosing volume per gbt gallons Pump chamber size 1000 min gallons H:\home\pincntr\inf ohlth\sewd sn