HomeMy WebLinkAboutSEP2015-00043 Jefferson County Department of Community Development 4io�.,
621 Sheridan St., Port Townsend WA 98368, (360)379-4450 .,,
SEPTIC PERMIT APPLICATION �al,�° ►���4a�/
Theodore Lundquist Jr
PROPERTY OWNER
352 Elmwood Lane %� ��` �"'�
MAILING ADDRESS 510 2 •!+
Suzanne L
Oceanside, CA 92504-5409 s !+,
EXP1 2/1
PHONE ( Ito ) '- 22 2:3 &//) 3 )0 370 t 7/`to 1-1xeli
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SYSTEM DESIGNER Suzanne Martin Designer Phone# 990-3304
LEGAL DESCRIPTION: Section 13 Township 30N Range 2W PARCEL# 940 800 061
Subdivision Name Cape George Village Division 4 Block Lot(s) 65
Site address/Directions to site 41 Dennis Blvd-Port Townsend,WA 98368
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential ✓ _ New I Tank/s only Private
Residential ADU Modification_ _ Public it
Commercial 'Expansion_ '_
Community Upgrade,
Repair SITE SIZE +/-14201sf
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional Designate RAsPrve Area Yes# SEP80-00037
Alternative ✓ Redesign No . _ OIH 15-011
SYSTEM DETAILS
Number of Gallons/day 360 Soil type 3/4 (attach soil eval.) Application Rate 0.60 qal./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 1000 gal.
TYPE OF pressure 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.
LW
L r
Pro•:rtyr i ture Date
FOR OFFICE USE ONLY / /(PARTIAL 10/11/16 Er) ASBUILT 10.3/1 itO FI /, s
A OVED
INSP/PUMP TEST f O/t7/1, PUD/01)9/15 g.b
ALL HOLD REQ. MET
Date Z1 L Fee 5 Rec# ) L a Check# Z-C1 Case#SEP / 'L 4
C•\Docs erts and Sittings\Suzann= Martin\My Dor-»merts\my Tann=\ 'b1,2o\Jeffers^n County\JeffCo
forms\Suz\2008 SPA.DOC
- 5�� f�` JEFFERSON COUNTY PUBLIC HEALTH
4 H615 Sheridan Street•Port Townsend•Washington •98368
www.jeffersoncountypubGchealth.org
I'hone 3bU-3tis-9444 i-ax 3bU-319-4411
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP15-00043 Date Received: 04/02/15
Date Issued: 06/09/15
SITE ADDRESS: 41 DENNIS BLVD Date Expires: 09/09/15
PORT TOWNSEND, WA 98368
APPLICANT: THEODORE LUNDQUIST JR PHONE: 360-379-6441
91 ELMWOOD LN
OCEANSIDE CA 92054-5409
LEGAL DESCRIPTION: CAPE GEORGE VILLAGE DIV 4 LOT 65
PARCEL#: 940800061 Section: 13 Township: 30N Range: 2W
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
PO BOX 125
CHIMACUM WA 98325
SYSTEM DESCRIPTION: PRESSURIZED 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.
,/(7.7
Jefferson County Environ -ntal 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.: SEP15-00043
1.) This permit was issued to correct a violation of WAC 246-272A for the repair or installation of
drainfield components without a permit.. The permit must be completed within 90 days of the date
of issuance.
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.) 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.
4.) 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.
5.) This system as designed and approved is sized for only one single family residence. It is not sized
for an Accessory Dwelling Unit(ADU). The minimum daily design flow per residence is 240 GPD.
6.) 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
7.) Health Dept. required to observe pressure test with system designer when system fully
installed/complete, 48 hours notice to be provided for scheduling.
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.) 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.
13.) 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.
SEP15-00043 Page 2 of 2
\\tidemark\data\forms\F_SEP_Permitmod.rpt 6/9/2015
i �&fin
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98 ?1(4?-
ASBUILT INSPECTION REPORT For RECORD DRAWII , (: �cf �02,,r5s
Designer
Suzanne Martin Permit # SEP 15-0004 �IL>�, �
Installer Ericsen Excavating (Toby Killam) Parcel # 940 800 061 ti�,�
Electrician Cascade Electric Design Flow 360 gpd peak
Property Owner Noah Middleton
Site Address 41 Dennis Blvd
Answer all questions or indicate NA
DATE
Tanks, Pumps and Controls INSP.
Tank (manufacturer, size, baffles) 1000 Cotton, risers, baffles &outlet filter installed 10/22/15
Pump chamber (manufacturer, size) 1000gal Cotton, risers installed, 22gal/inch 10/22/15
Screen(s)and/or Pump Shroud (type, location) shroud in pump chamber 10/22/15
Were Tanks tested onsite for water tightness? ED/ No
Panel Model Infiltrator Timer Model Aquaworx IPC 10/22/15
Liberty280 38.5 10/22/15
Pump 1 — Man./Model Flow Rate qpm
Pump Location (i.e. garage, treatment unit, basement) in pump chamber
Float/transducer settings Inches Timer
from bottom of tank- On/off- 21.4 in. Functions: On 1:10 sec 430
Veto - 33.9 in. Off 240 sec/ehr
Alarm - 33.7in. Veto On - 1:10 sec®
Storage Above High Water Alarm ' 335/534 gal. Veto Off- 180 sec/6/hr
Dose Counter Reading 2 dose/4 veto dose # gallons/dose 44-45 gal.
Elap. Time Meter Reading 0:11:16 mina Pump Throttled? YesNo
Dose Drawdown (in inches) 2 in.
Pump 2 — Man./Model n/a Flow Rate qpm
Pump Location (Le. 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) ZB-OA;Autoclear 40 Seconds;
ID=05-08-2013; 35 events
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 oft
'r .
, ,
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 2"pvc sch 40 Manifold size/schd 2" pvc sch 40 10/22/15
Orifice size 1/$ Lateral Size/schd 1"pvc sch 40 10/22/15
Barrier Material filter fabric Cover Material/Depth 12 10/22/15
Residual Head (lat.# & ft. Head) 7-7.5 balanced pre-cover 10/22/15
The laterals/pods were balanced 0 / No 10/22/15
Source/Manufacturer of Drainrock/Gravelless chambers cotton
Drainrock Clean? Od No If no, what action taken?
Mound/Glendon Site Prep n/a
Drainfield Length 200 ft Width 3 ft Depth 12 inches
Caps for measuring residual head stored (location) header box
COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional
sheet(s) if necessary
.Tank was properly abandoned. The original locate of the power in addition to the power line found during
installation is shown on the record drawing @ the control panel. New propane line was installed as well.
•construction adhered to State regulation, Recommended Standards&Guidance and jefferson county policy and
•code. Post cover inspection conducted 23October15, new sewer line installed to the now installed clean-out then
connect to the existing sewer line.
Health Department Inspection issues resolved Yes / No /0 If yes how?
Users Manual Provided to Homeowner mailed Date 10/23/15
Tank/component Decommissioning Report Attached l / No/ NA
Installer Certification attached/signed Ee / No
ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, THE
SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED b-yJEFFERSON COUNTY
(DATE) OR THAT CHANGES HAVE BEEN NOTED AND
THE SYS M IS IN COMPLIANCE WITH WAC 246-2 72. �'�:
% l ,,
10/23/15 5100342 1 F'g,
Designer Signature Date License # it Suzanne LMam �4,
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2
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Page 1 of 4; Lindquist;
Parcel#940 800 061
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST..PORT TOWNSEND .WA 98368, (3601 3794450 s+
SOIL EVALUATION Grp / '# 1
PROPERTY OWNER Theodore Lundquist Jr '� '1'°I
57 Z ' °I
np
.. Suzanne,L smarm '
ea
.13E N R' ll
SYSTEM DESIGNER Suzanne Martin -
LEGAL DESCRIPTION: Section 13 Township 30N Range 2W Parcel # 940 800 061
Subdivision Name Cape George Village Division 4 Block Lot(s) 65
Date Logged: 3/17 March 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 SOIL LOG #2
0-6"Dark brown gravelly sandy loam 0-4" Dark brown sandy loam
6-29"Yellow brown very fine sand 4-17"yellow brown gravelly very fine sand
29-72+"Yellow brown gravelly fine to coarse sand 17-72+"Very gravelly medium-coarse sand on the west
type 3 soils side of the test pit;
17-72+"gravelly fine-medium sand
stay 3'from fence line for installation
Anticipated water table n/a in. q\11/41:1 )
Anticipated water table n/a in.
•
Roots to 56 inches Roots to 48 inches
Health Dept. CommentsY117 Health Dept. Comments
SOIL LOG #3 LOG #4
0-41"fine to medium sandVii 0-45"fine to medium sand
41-64"gravelly fine to coarse sand 45-66"gravelly medium to coarse sand
type 3 soil type 1 soil
Anticipated water table 64 in. Anticipated water table 66 in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #5 SOIL LOG #6
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:INFOHLTHISOIL.FRM 1/00
page 2 of 4;Lundquist;
Tank Cross Section-Not To Scale parcel#940 800 061
(For illustrative purposes only, actual tank configuration may vary, tanks must be on list of ap ®'products.)
r
SECURED LID WITH GAS TIGHT SEAL ?aIS
,/ ACCESS RISER
A / FINISH GRADE
�f/ \»VIII/ ,
4
' �_ v,
TO PUMP
,ji
/ ' CHAMBER
FROM SEWAGE
SOURCE FLOATING MAT
�. - APPROVED
EFFLUENT
FILTER
4" SEDIMENTS 1/16"filter must
-- �_`` / be installed
$ iO`1e ;,2 SEPTIC TANK
P Da (TYPICAL)
SECURED LID WITH GAS TIGHT SEAL THREADED UNION
ACCESS RISER N\N ir
SERVICE
FINISH GRADE VALVE*
FROM SEPTIC
j \ ri —►TO DRAINFIELD
TANK 7
- 270 11
EMERGENCY STORAGE ANTI SIPHON
VALVE*
HIGH WATER ALARM LEVEL
270 1 Aquaworx Transducer
NORMAL TIMER OFF LEVEL WORKING VOLUME 1
ENCLOSED PUMP V
SEDIMENT SHROUD• ( - CHECK VALVE'
18"
r,.;-
SEDIMENTS
SEDIMENTS _ ,1SUBMERSIBLE
I —1 CENTRIFUGAL
PUMP
PUMP CHAMBER
(TYPICAL)
AS NEEDED
Page 3 of 4;Lundquist;
Parcel#940 800 061
•
.7.--
Effluent p Incorporated
1-800-348-9843
100
. Effluent Pumps
90 PEF150 PEF, PKP Series
1/3 hp to 1-1/2 hp
80 i• . ,
I PEF 1001 '''
ling 4.' ... •,
CD
W "4
p IPEF75�
F—
.Q
W
= 50
v effluent pump
'E
to
0 PEF 50Ns...s.,...NN,N.... . .
p 40
+r 35'of
H head
30
20
10
PKP 350 PEF 3311
0 b t 1 r 1 1
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
Page of 4;Lundquist;
Parcel#940 800 061
Pressure Distribution On-Site Sewajie Disposal System Work Sheet 0
ce,7_
Name of Applicant Theodore Lundquist Site Address or Location 41 Dennis Blvd-PT ✓5'
Tax Assessors# 940 800 061 Date 20 March 2015
Designer's Name Suzanne Martin Company Name none Phone# 360-990-3304
Property Information:
Number of Bedrooms 3 3 bedrooms X 0.60gpd/sf=600 sf
Maximum Daily Flow 360 drainfield required/3'wide
Total Absorption Area Required(Sq.Ft.) 600 trenches=200 LF
12-24'trench depth; 0-12"cover
Trench Information: 36+"vertical separation
Trench Width 3'
Trench Depth 12-24
Total Lineal Trench Length 200
Total Washed Drain Rock Under Lateral 6-8" TDH=20(30)feet
Gravelless Chamber Drainfield(Yes-No) no -Residual-5'
-Friction loss-6'
Manifold. Lateral& Transport Information: --Transport line+/-1'
Total Lateral Pipe Length 200 --Manifold&Lateral-+/-5'
Lateral Spacing 6-9'oc El. Difference-+/-9'
-Pump On-+/-250'
Transport line Length 25 -D/F ie elevation-+/-259'
Transport Line Pipe(Schedule) sch 40
Manifold&Laterals Pipe(Schedule) sch 40
Lateral Line Diameter • 1"
Manifold Line Diameter 2"
Transport Line Diameter 2"
Pump Information: -3'spacing-13 per lateral x
Residual Lateral HeadS uirt Height)( q g ) 5=65 orifices
Pump Size 35gpm(a5 30'head -65 orifices @ 0.41 gpm
=26.65(35 gpm)
Dosinji Information:
Orifice Spacing(inches)-
36"
Total Orifices 65
Orifice Diameter 1/8"
Total Dose Volume 45
Number of Doses Per Day 6/8
Size of Pump Tank(gallons) 1000slt
sio
1
Control Panel In rmation • Suzanne L MarOn
Aquaworx IPC-1
Other Information:
tet. ' '
Lindquist;
Parcel#940 800 061
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST.,PORT TOWNSEND.WA 98368, (3601 379-4450 %v}
SOIL EVALUATION IWO 1 l .+',.
PROPERTY OWNER Theodore Lindquist JR ' 5102 �)+
. Suzanne.L Martin ';1�
Mit N -'A /I
SYSTEM DESIGNER Suzanne Martin
LEGAL DESCRIPTION: Section 13 Township 30N Range 2W Parcel # 940 800 061
Subdivision Name Cape George Village Division 4 Block Lot(s) 65
Date Logged: 3 March 2015 Logged By: Suzanne Martin 00).9--d
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Include soil textural characteristics and the depths at which significant changes occur. B s to de epth
where mottling or impermeable layers occur. / __,,,�Q-/q)k
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SOIL LOG #1 SOIL LOG #2 I
0-6" Dark brown gravelly sandy loam `` 0-4" Dark brown sandy loam
6-26"Yellow brown fine&medium sand 4-30/48"yellow brown gravelly fine sand
26-72+"Yellow brown rav I mediu sand 2, 30/48-72+"Very gravelly medium sand (&coarse)
D.—Z�Va Q o'�p . vey ✓ , ! o--1.7 ` v_e-1/\
06T_V-(4.--6(-5sivt -r_3 544e4 % t 0'49' "ID ti.kr"(1V4451:11vigtav Aitad-44d5
Anticipated water table n/a in. • k 34 Antici ated water table n/a in. 51/1061-"Aezz4_
VARoots to 56 inches Roots to 48 inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #3 SOIL LOG #4
O"r"(c ( S(&W`e) Sill/ ten'^-- ` litk 1 C%
C � �� 0 I - te.
1141/
(.1 ( -A6(/ � uS � cry ��-��� S
6q+ i 426 6L'441 I -j
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
SOIL LOG #5 SOIL LOG #6
491 .---40).,(A3,
Anticipated water table in. Anticipated water table in.
Roots to inches Roots to inches
Health Dept. Comments Health Dept. Comments
H:UNFOHLTHISOIL.FRM 1 MO
# l
Randy Marx
From: Suzanne Martin <septicbysuzanne@gmail.com>
Sent: Friday, March 13, 2015 8:23 AM
To: Randy Marx
Subject: Tech Assists
Good Morning Randy,
There are three requests for tech assists, here they are in order of importance
1-SEP77-00023; Cape George Road;002 124 010. For a real estate transaction with questionable soils and drainfield
that only has about 6"vert sep &wetlands abound, have already contacted DCD about reports required
2-SEP80-00037; 940 800 061 Tech Assist in Cape George, want to back fill test pits asap& have the medium/coarse
sand question
3-SEP98-00265;978 900 039; For a bla and want to back fill test pits.
This one may be an interesting one to bring Evan out,there is everything from 14" questionable soils,fill &conventional
soils all in one small space.
Regards, slm
thank you for coming out yesterday!
"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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