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HomeMy WebLinkAboutSEP2010-00077 Jefferson County Department of Community Development 621 Sheridan St.,Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Deann Wood MAILING ADDRESS 29210 3rd Avenue South Roy WA 98580-8544 PHONE ( 253 ) 720-7233 SYSTEM DESIGNER Nathan N. Cleaver Designer Phone# (360) 598-6546 LEGAL DESCRIPTION: Section 20 Township 30N Range 1 E PARCEL# 021-203-011 Subdivision Name Mumby Short Plat#2 Division Block Lot(s) 2 Site address/Directions to site 265 Mumby Road, Nordland SOURCE OF SEyVAGE/USE TYPE OF WORK WATER SOURCE Residential V/ New Tank/s only Private Residential ADU Modification Public Commercial Expansion Community Upgrade Repair VSITE SIZE 278,478 +/- SYSTEM TYPE Partial Repair (tank) (drainfield) Previous Evaluation Conventional , Designate Reserve Area Yes# Alternative Redesign No SYSTEM DETAILS Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 18 in. Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal. TYPE of system Simple Pressure 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. Staff's 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. Property Owner Signature Date FOR OFFICE USE ONLYo[ I J I O PARTIAL ASBUILT (, ) FIN,,,� - A PROED INSP/PUMP TEST 2 it ' D13,100 ga.•p ALL HOLD REQ.MET , Date�G�Z '")VFee If') Rec# 1 ( 1 J Check# _Case#SEP — 7 7 1,i H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC SEWAGE DISPOSAL PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 PERMIT #: SEP10-00077 Date Received: 06/23/10 SITE ADDRESS: 265 MUMBY RD Date Issued: NORDLAND, WA 98358 Date Expi e APPLICANT: CHARITY R WOOLBRIGHT PHONE: 253-720-7233 DENISE WOOD/DACIA W NAMES 29210 3RD AVE S ROY WA 98580-8544 LEGAL DESCRIPTION: MUMBY SHORT PLAT#2 LOT 2(TAX 78)&TL ADJ W/EASE PARCEL#: 021203011 Section: 20 Township: 30N Range: 01 E DESIGNER: NATHAN CLEAVER PHONE: 360-598-6546 CLEAVER SEPTIC DESIGN INC. 1990 KIMBALL ST. NW POULSBO WA 98370 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. Permit issued to CONSTRUCT,ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY,WASHINGTON Thls permit is issued for a period of three :.rs (unless otherwise stated abave) in accordance with Jefferson County Rules and regulations for on-sit: se age systems, codifi .15 a ' -nded per ordinance no. 06-0719-07. This permit may not be renewed. / /I n& 4eferson County Environmental Healt Specialist 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. HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION. SYSTEM DESCRIPTION: 130-PRESSURIZED TRENCH No. of Gallons per Day: 360 Type of work: REP Drainfield Trench Septic Tank Length: 200 feet Width: 3 feet Depth: 18 inches Size: 1,000 gallons SPECIAL CONDITIONS APPLY - SEE REVERSE CONDITIONS OF APPROVAL- PERMIT NO.: SEP10-00077 1.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other development or a building permit on this site. Compliance with other Jefferson County and Washington State Codes is required. 2.) 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. 3.) This permit was issued to correct a violation of WAC 246-272A. The permit must be completed within 90 days of the date of issuance. 4.) H -Well to be decommissioned as per WAC 173-160-381 by licensed well driller. Contact Jefferson County Public Health for information on required applications and inspections. Verification of decommissioning to be provided to Public Health Department. 5.) 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. 6.) 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 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.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 13.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 14.) Setback to surface waters- 100' required from drainfield and reserve areas. 50' required from tanks. 2 of 3 11/22/19 I:\F_SEP_Permitmod.rpt 15.) MAXIMUM TRENCH DEPTH 18 INCHES 16.) A 30' setback shall be maintained from the disposal component and reserve area to any downslope footing, curtain or interceptor drain or drainage ditch. 17.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. 18.) Drainlines are to be installed along the natural contours. 19.) Contact designer prior to installation for staking of drainfield area. 20.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 21.) Risers are required to grade with secured lids over both compartments and over the outlet of the septic tank for inspection and maintenance/monitoring. Minimum 20" riser over inlet. 22.) 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. 23.) 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. 24.) H Prior to final approval of this system the DCD review and shoreline exemption fees will need to be payed if full. 3 of 3 11/22/19 I:\F_SEP_Permitmod.rpt x JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING Designer T m. N_ ('.� 44 J Permit # SEP \O—ooc l.rl- Installer \pYc1.1SONJ Parcel # —2.03—O \ Electrician GLENN <SGI(ARS Design Flow 34,O Property Owner CI4AR2t'ry VJooL(3R.C.NHfi1DelJISE Woob/DACIA NRmFS Site Address 2v5 MUVY►BY RO4 D) A/ORf(,AnrL+l Answer all questions or indicate NA DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) ?ENINSulti , tpoo C/q/(oil / ' (o p L.rwt,Ea-t— 29A/01/ZO60 Pump chamber (manufacturer, size) PENtNS•JIA t(Ot/U (jA-(l V 29Nq/ZOO Screen(s)and/or Pump Shroud (type, location) Sk{vwvp, pxrrt-Pr BAA(e 1 JAN Vitt Were Tanks tested onsite for water tightness? Yes / No Panel Model AQ11AV JORX /PG—S4 Timer Model dat. Pump 1 — Man./Model L113ERri PU,1,(oAolle,/Moll Flow Rate q3 qpm 6a.12i1\ Pump Location (i.e. garage, treatment unit, basement) tp* c Float/transducer settings Inches Timer from bottom of tank- On/off - Q,'9 in. Functions: On 31 ec,min Veto - 39.1 in. Off - Z sec/mine Alarm - 3t4 i"»' in. Veto On - 31 min Storage Above High Water Alarm -515 gal. Veto Off - 2 sec/minim Dose Counter Reading 00 (oq # gallons/dose 22,S gal. Elap. Time Meter Reading 02.62 50min/hrs Pump Throttled? Yes /(E) Dose Drawdown (in inches) I is/(12 in. Pump 2 — Man./Model 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 I 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) Z.8—OB Avro C ^cr2. 2.. Doses H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 k Pre-Treatment - 1\1P\ Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location Sand Fill met design spec? Yes / No ATU (manufacturer, model) Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe size, schd, diameter 24 &Ai 40 Manifold size/schd 2" Scm. 40 24 14a/2010 Orifice size 1A?;." Lateral Size/schd 1" SCI-!40 za NOV 2410 Barrier Material \1*-En, P-PcEVILIC. Cover Material/Depth (SAW / 12_' Z9 NoV 2010 Residual Head (lat.# & ft. Head) (o' sat,k[LT oto PtU., 3 Livrerzqks Zq NOV 2+10 The laterals/pods were balanced 40 / No 2.9 WV 2610 Source/Manufacturer of Drainrock/Gravelless chambers StioLD -LkicA\tATIOc Drainrock Clean?4,/ No If no, what action taken? Mound/Glendon Site Prep Drainfield Length 201-.3' ft Width 3' ft Depth 1e" inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner (- Date //1/`if Tank/component Decommissioning Report Attached Yea / No / NA Installer Certification attached/signed Yes / 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 by JEFFERSON COUNTY —7/./12?((DATE) 012 THAT' CHANGES HAVE 'BEEN NOrED AND TIEY E I N OMPLIANCE WITH WAC 246-272. 1a� , .,, -2/11/11 316o2 5( Designer Signature Date License # H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 a'2�� S - w D4, I I z N - T n —I pn r N W p T a m m N r, . 0 3 -3a m F, D m a • m o- r z cn " 0 o o o —I , C 00 / f) O ' m / , /N . �� 0 7 " yya /' dads / wN rncn -PwN —z0ncoD ,,, // �Q� O n/ CO V V N v . cn O O 00 Cr! 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Contractor Registration#: NATHACS940 2 ^ I Soil Logs , Re: Deann Wood / ID Parcel#: 021-203-011 Sec: 20, Township: 30N, Range: l E Soil Logging done on 7 June 2010 by Nathan Cleaver Soil Log#1 0-6" Duff 6-30" Brown Gravely Loamy Medium San 30-60" Brown/Gray Medium/Coarse Sand 60" No Compaction Roots to 60" Soil Log#2 0-2" Duff 2-26" Loamy Fine Sand 26-50" Gray Fine Sand 50" Compacted Roots to 50" Soil Log#3 0-2" Guff ray 2-26" Gray Fine Sand 26-48" Lightly Mottled Gray Fine Sand 48" Compacted Roots to 48" Soil Log#4 0-3" Duff 3-26" Brown Loamy Medium Sand 26-42" Gray Fine Sand 42" Compacted Roots to 42" 112 , oeis Please feel free to call with any questions. a z .s��� you, �� Thank ou 5100251 i *1 WOMAN N CLEAVER •7\ // Nathan N. Cleaver Licensed Onsite Wastewater Treatment System Designer. UUi'i L v LUV0 Address: Telephone: 360-598-6546 1990 Kimball Rd. NW Fax: 360-598-6548 Poulsbo, WA 98370 Email: nathan@nathancleaver.com Please call ahead to make an appointment if you would like to meet with me.