HomeMy WebLinkAboutSEP2010-00031 Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Allan C Soulignv
MAILING ADDRESS PO Box 3064 Carson City, NV 89702
PHONE 775-887-6393
SYSTEM DESIGNER Nathan N. Cleaver Designer Phone# 360-598-6546
LEGAL DESCRIPTION: Section 13 Township 30N Range 2W PARCEL#940 500 063
Subdivision Name Cape George Village Division_3 Block Lot(s)_64 /�
Site address/Directions to site :Take Ridge Drive to Fir(turns to right) 2nd lot on the Right *38 Fir 0lI
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential_x_ New Tank/s only x Private
Residential ADU Modification Public x
Commercial Expansion
Community Upgrade
SYSTEM TYPE Repair SITE SIZE_12,350
Partial Repair- (tank)_(drainfield) Previous Evaluation
Conventional Designate Reserve Area Yes # 00-196
Alternative x Redesign No
SYSTEM DETAILS
Number of Gallons/day_240_Soil type (attach soil eval.) Application Rate gal./sq.ft./day Drainfield
Length ft. Trench Width ft. Trench/Bed Depth _in.
Septic Tank size_1000 gal. Pump Chamber size: 1000
TYPE OF SYSTEM Tanks only for already installed Glendon M-31s
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.
4/6/2n10
Pro y Owner Signature Date
FOR OFFICE USE ONLY
//0 PARTIAL 7l3 i L3 ASBUILT Z� 1 FINAL \�)2' I
I
APPROVED 445
INSP/PUMP TEST �` '2721)7 PUD
ALL HOLD REQ. MET
Date'` 12-1C) Fee (-17 r Rec# ) 11542- Check#_5_1,:f Case#SEP 10 �c �
SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450
PERMIT #: SEP10-00031 Date Received: 04/12/10
SITE ADDRESS: FIR Date Issued: 08/09/10
PORT TOWNSEND, WA 98368 Date Expires: 08/09/13
APPLICANT: ALLAN C SOULIGNY PHONE: 775-882-6393
ROBERTA A MC COLLUM
PO BOX 3064
CARSON CITY NV 89702-3064
LEGAL DESCRIPTION: CAPE GEORGE VILLAGE DIV 3 LOT 64
PARCEL#: 940500063 Section: 13 Township: 30N Range: 02 W
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 years (unless otherwise stated above) in accordance with Jefferson
County Rules and regulations for on-site sewage systems, edified 8.1 mended per ordinance no. 06-0719-07.
This permit may not be renewed.
Jefferson C•u ty Environ ental Health Specialist
The property owner is responsible for the accurate location of all propert/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: 300-SEPTIC TANK TO INDIVIDUAL SYSTEM
No. of Gallons per Day: 240 Type of work: NEW
Drainfield Trench Septic Tank
Length: feet Width: feet Depth: inches Size: 1,000 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL- PERMIT NO.: SEP10-00031 e
5
1.) H - Prior to final approval of the septic permit the driveway must be completed and
included on the record drawing for this permit. Construction must be as per the approved
septic plan and approved waiver. Septic system designer must verrify during
construction.
2.) H -Tanks must be traffic rated if under a driven way. Certification required on record I a' (1‘
drawing. 42
3.) H - Permanent barriers are required around all up slope sides of the driveway to protect ti
from parking and driving on the already enchroached protection area of the glendon01/4,
pods. Barriers required prior to final.
4.) H -Any portion of the transport line under a driven way must be cased in Sch 40 PVC and
bedded in sand as per design.
5.) This site has been granted a waiver from the local onsite sewage regulation. Compliance
with conditions of the waiver is required.
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.) Septic Designer must be contacted prior to start of ANY construction on the property.
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 of the septic system and the Driveway is required prior to final 1 \I 2�
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.) 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.
13.) 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.
14.) 10' separation required between a Water line and all portions of the onsite sewage
system; effluent transport line, tanks, treatment and disposal components.
2 of 3
11/22/19
I:\F_SEP_Permitmod.rpt
15.) Septic tank and pump chamber to be water tight. Extra protection (i.e. Bentonite) to be
used around inlet, outlet, and risers due to high water table.
16.) Risers are required to grade with secured lids over both compartments and over the
outlet of the septic tank for inspection and maintenance/monitoring. Traffic rating of lids
required if in driven way
17.) 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.
18.) 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.
3 of 3
11/22/19
I:\F_SEP_Permitmod.rpt
}
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
ASBUILT INSPECTION REPORT For RECORD DRAWING
Designer 1\ik1uA 4 N . C1,Lkv'EP-- Permit # SEP `O_ 0003
Installer S}ttA.X, `t-XeAVA"111-1 Parcel # CMO -Sow-C6,3
Electrician CA SCA `-Lfik1L, Design Flow 2-4 0
Property Owner 'E11.,..E�1.1 ‘7iR.AcNSCOI/vt1=
r 4' w. ,
Site Address -PM. t LACfv t {?oz'T �2�wNS�NC iF
Answer all questions or indicate NA �� �1 2�x�
N unky DATE
Tanks, Pumps and Controls _cc ,,5O‘' , yez1 INSP.
Tank (manufacturer, size, baffles) savrT150 'RtEDf,1MtX f 1ObtOClpr(kea 2co►,,,T. ►6_Ju1�►?D13
Ci'p. [2
Pump chamber (manufacturer, size) 'lOf�UA v c, (1c O rIA(lj1�
n1 6 "'"13
Screen(s)and/or Pump Shroud (type, location) "ZUFF T\t\(kF-� ctii-r volj ice
sect to err OF . fi<.Tarltz..
Were Tanks tested onsite for water tightness?al No
Panel Model -\AUaW02X/1.Pd.-SCI Timer Model 12NtV WS"
Pump 1 - Man./Model FliartWALG SD30-t6IDS' Flow Rate W14 qpm 12.101-201S
Pump Location (i.e. garage, treatment unit, basement) `vv•- p `N.:NJx_
Float/transducer settings Inches Timer
from bottom of tank- On/off - 20,9 in. Functions: On se min
Veto - in. Off - 'o sec4Ohr
Alarm - 30 in. Veto On - -"1 sec/min
Storage Above High Water Alarm Los' gal. Veto Off - `p sec/min/hr
Dose Counter Reading QCO99 # gallons/dose (,toe gal.
Elap. Time Meter Reading (20 :/y:V5 min/hrs Pump Throttled? Yes IR
Dose Drawdown (in inches) NI1/4" in.
Pump 2 - Man./Model Flow Rate ,�a�r .qp ,
Pump Location (i.e. garage, treatment unit, basement) :1,,,,i t, `.
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
Dose Drawdown (in inches) in
If additional pumps-complete the info in this table
for each and attach.
Other Timer functions & settings (e.g. override on/off) 0 ' r, -,;t. *��
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2
Pre-Treatment NOV 23 2615 Date Insp
,rson County
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No ,-rental Health
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 C$w(Q Manifold size/schd la.sect40 12 NW ZO►S
Orifice size 1•11ke Lateral Size/schd 1. '
SCk1L40 I1Z14p/ ?,015'
Barrier Material SIA Cover Material/Depth IMEDWv.I SAN07I2." 121.16V 201S
Residual Head (lat.# & ft. Head) "'Nh-
The laterals/pods were balanced G/ No 17.Mkt 20/5
Source/Manufacturer of Drainrock/Gravelless chambers X($11 `PODS
Drainrock Clean? Yes / No If no, what action taken?
Mound/Glendon Site Prep
Drainfield Length t-XT ft Width ft Depth NA4- inches
Caps for measuring residual head stored (location) "011x. -
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 .� t Date '/2 7
Tank/component Decommissioning Report Attached Yes / 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
<DATE) OR THAT CHANGES HAVE SEEN NOTED AND
r' E SY /____7/AL.IANCE WITH WAC 246-272.
iffL/___, /i .57e 02 5I
Designer Signature D to License #
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2
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Jefferson County Permit Center
621 Sheridan Street, Port Townsend WA 98368
360-379-4450
SEPTIC PERMIT APPLICATION J LS
I i 1
PROPERTY OWNER: Larson, Bob J ai
MAILING ADDRESS: 390 South Eighth Street
Port Townsend, WA 98368 JEFFEJ Q C UN v
DEPT Of i UF'tv1UN1Y O�VELOP,"-,1ENT
PHONE: 360-379-2154, work 385-1509, home - - --------- `_
SYSTEM DESIGNER: JSF Engineering
LEGAL DESCRIPTION: Section: 13 Township: 30N Range: 2W PARCEL#: 940-500-063
Subdivision: Cape George Village Division: 3 Block: Lot(s): 64
SITE LOCATION: Lot 64, Fir Place, Port Townsend: Ridge Drive west to end, right onto Fir Place, second lot
on right — — —TYPE OF IMPROVEMENT: Residential: X Residential ADU: Commercial: Community:
TYPE OF WORK:
New: X Redesign: Upgrade: Repair: Partial (tank): (drainfield):
Expansion: _ Designate Reserve Area:
Conventional: Alternative: X Drainfield Length: 35 ft.
Number of Bedrooms: 2 Trench Width: 14 ft.
Basement: Al\
es, ok' n/a in.
O
Site Size: ± 0.28 acres Number of Lines: 1
Previous evaluatio / no SEP: OTH99-2 Tank Size: 1000/ 1000 gal.
Water Source: Private: Public: X Soil Type: 4 (attach soil eval)
Application Rate: 1.08 gal/sq.ft./day
TYPE OF SYSTEM: Glendon®Biofilter, reduced size
THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT
FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT.
THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES.
Signature • Date (1J1/60
John S. Fleming, P. .
of JSF Engin ering, POB 44, Port Angel , WA 98362, 360-452-8500 Job#: 20032
16
2_ICt o �( FOR OFFICE USE ONLY 4„ ��v+^- 03
L �' '� PARTIAL i [a1 L O3 hr6'^' Dt /5 , p�
AP"OVED RENEWED PRESS/TEST FINAL /a-Yi ,/l h ild
ASBUILT S • to-3)
PUD
RENEWED er..41,1 at. 6.4a �..o
Fire District Planning District School District Zone
Date q /5100- Fee`k W Rec# t ( 9 I 0 Check# ej Case#SEP
SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 (800) 831-2678
PERMIT #: SEP00-00196 Date Received: 09/05/00
SITE ADDRESS: FIR Date Issued: 11/27/00
PORT TOWNSEND, WA 98368 Date Expires: 11/27/03
APPLICANT: ROBERT LARSON PHONE: (360)379-2154
390 S 8TH ST
PORT TOWNSEND WA 98368
SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 BLOCK: LOT: 64
PARCEL#: 940500063 Section: 13 Township: 30N Range: 02 W
DESIGNER: JOHN FLEMING PE PHONE: (360)452-8500
PO BOX 44
PORT ANGELES WA 98362
Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL
SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON
THIS PERMIT IS ISSUED FORA PERIOD OF THREE YEARS (UNLESS OTHERWISE STATED
BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR
ONSITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO. 1-83, CODIFIED 8.15 AMENDED
PER ORDINANCE NO.11-1115-99. This permit may not be renewed.
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Jefferson County Environmental Health 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 building or sewage
disposal plans (including plumbing stubout postion) and/or location of house or drainfield may
invalidate this permit unless prior approval is obtained from the Jefferson County Environmental
Health Division.
ISSUANCE OF A PERMIT DOES NOT PRECLUDE THE APPLICANT FROM COMPLYING WITH
ALL OTHER STATE AND LOCAL REGULATIONS.
HEALTH DEPARTMENT MUST BE CALLED FOR FINAL APPROVAL.
SYSTEM DESCRIPTION: 280-GLENDON BIOFILTER
No. of Bedrooms: 2 No. of Gallons per Day: 240
Drainfield Trench Septic Tank
Length: 35 feet Width: 14 feet Depth: inches Size: 1,000 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL - PERMIT NO.: SEP00-00196
1.) This site has been granted a waiver from WAC 246-272 table VII and Jeff. CO. Policy
97-02. Waiver based on a County Method II analysis for the Cape George Colony and
Village subdivisions.
2.) Setbacks to road sideditch 100' required from drainfield and reserve areas. 50' required
from tanks and effluent transport lines. Ditch flows water a significant part of the year.
3.) An inspection by this office is required when the system is complete up to the rim prior to
covering.
4.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS
MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY
ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC
UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN
ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL
OF THE SEWAGE DISPOSAL SYSTEM.
5.) Performance monitoring schedule for treatment systems followed by reduced sized
drainfield/infiltrative area shall be :1) Two times per year(once every six months) during
the first and second year following installation. 2)One time per year beginning with the
third year following installation. 3) In response to complaints or problems.
Observation ports to the bottom of the trench are to be installed in at least two places on
each drainfield line: One within 10 feet of the end of each line.
6.) Health Dept. required to observe pressure test, 48 hour notice to be given.
7.) An asbuilt drawing and certification of completion by the designer is required prior to final
approval.
8.) Dry season installation required.
9.) 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.
10.) Curtain Drain required a minimum of 10' upgradient of primary and reserve drainfields.
11.) Drainlines are to be installed along the natural contours.
12.) Contact designer prior to installation for staking of drainfield area.
13.) Divert all sources of drainage, including roof drains away from septic tank and drainfield
area.
14.) Dose counters are required in the control panel for all drainfield components.
15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank.
Minimum 24" riser over inlet.
16.) Approval of this sewage disposal permit does not preclude the permit holder from
complying with the Critical Areas Ordinance for other development on the site.
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11/22/99
is\F_SEP_Permit.rpt
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s m m w r TITLE: WASTEWATER SYSTEM NOTES JOHN SCOTT FLEMING ENGINEERING. INC.
-4 o co o TAX PARCEL # 940-500-063 J5l77
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O N x r CLIENT: BOB LARSON
W OX 44
390 SOUTH 8th STREET PORT ANGELES,0 WA 98362
o PORT TOWNSEND, WA 98368 (360) 452-8500, FAX: (360) 452-3383
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