HomeMy WebLinkAboutSEP2000-00179 Jefferson County Permit Center (� (� nRp 2 --,
621 Sheridan St., Port Townsend WA 9836a D l5 V E 11 fir'
360-379-4450 I t i
SEPTIC PERMIT APPLICATION JUL 2 7 ' , i �'
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PROPERTY OWNER f 1 � INE ii h ear 1EFFtiNSU. C�' N iY
MAILING ADDRESS 41 g Oct 145 >7 .5G - Ca vi- Ec s-obi. OF COMMMIUNITY DEVELOPMENT
ac erwi ce., La, 9 8 4443
PHONE Area Code ( I 1
SYSTEM DESIGNER Cs Q�Irl -1'. sJ /
LEGAL DESCRIPTION: Section 210Township 2eM Range i G PARCEL # g 21 - Zoo 2, - 0 1 1
Subdivision Name 50044 Wo zd/s .S. (. Division Block Lot(s) I
SITE LOCATION ?vie? rip t az1 etc/ 4 F4t,rz F r
--text .cit s , lbc,y Zip Code ______LIL-------*
TYPE OF IMPROVEMENT: Residential Residential ADU % Commercial Community
TYPE OF WORK:
New %71". Redesign Upgrade Repair Partial (tank) (drainfield)
Expansion Designate Reserve Area
Conventional Alternative Drainfield Length 1 (:,C) ft.
Number of Bedrooms 2- Trench Width *3t• t/�
Basement: yes / ^o
Trench/Bed Depth in. 0*4
Site Size 2 7e, Ac r e S Number of Lines 2-
Previous evaluatio r no SEP 91 - (70 Tank size 1000 gal.
Water Source: private public Soil type 2. (ATTACH SOIL EVAL.)
Application Rate • 6 gal./sq.ft./day
TYPE OF SYSTEM e,97 (/-eii -1 1 4,71Ce.• ) `7'r e C
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 qA) 7-
Ali /I Date 7- a - ®Q
FOR OFFICE USE ON L Y
g-ED 03. PARTIAL 6-
APPROVED RENEWED PRESS/TEST FINAL
ASBUILT 1.1 7)l 07-
C-IP'
• PUD
RENEWED
Fire District Planning District School District Zone
Date a Fee 750-c-° Rec # 33352 Check # 1b23.€› Case # SEP
h:\home\pincntr\hlthinfo\permitapp.doc 10197
CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT
•
INSTALLER dil e) l c Xca f21 e1f7 PARCEL # e-I - 2-6 - ® 1 l
;'ermit Owner 15 r l {f k e h y,`o ci Permit # 5 £ o c '"- 1 79
ABSORPTION AREA: r f
DRAINFIELDTRENCH / TRENCH to TANK / #OF #GALJ
LENGTH /CO WIDTH 3 DEPTH l SIZE /MO BEDRMS e— DAY 2 `1(Q
Tank Shroud/
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 ONSITE SEWA T•20.( WAS INSTA . . ' SIGNED, PER PLAN APPROVED
'� ' /- 3/
DATE APPROVED IN ALLER SIGNATURE DATE
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SEWAGE DISPOSAL PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 (800) 831-2678
PERMIT #: SEP00-00179 Date Received: 07/27/00
SITE ADDRESS: PARADISE BAY RD Date Issued: 08/28/00
PORT LUDLOW, WA 98365 Date Expires: 08/28/03
APPLICANT: BRITT KENNEDY PHONE:
JANET NEAL
4809 145TH ST COURT EAST
TACOMA WA 98446
SUBDIVISION: SOUTH PARADISE SHORT PLAT BLOCK: LOT: 1
PARCEL#: 821262011 Section: 26 Township: 28N Range: 01 E
DESIGNER: JOHN(DUKE)SHOLD PHONE: 385-0480
PO BOX 179
PORT HADLOCK WA 98339
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.
( 46.
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: 110-CONVENTIONAL TRENCH
No. of Bedrooms: 2 No. of Gallons per Day: 240
Drainfield Trench Septic Tank
Length: 100 feet Width: 3 feet Depth: 1% inches Size: 1,000 gallons
SPECIAL CONDITIONS APPLY - SEE REVERSE
CONDITIONS OF APPROVAL - PERMIT NO.: SEP00-00179
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.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50'required from
tanks and effluent transport lines.
3.) 100 ft. setback from all surface water to be maintained from primary and reserve drainfield
areas.
4.) MAXIMUM TRENCH DEPTH 18 INCHES
5.) When/if designated reserve area is utilized an alternative system providing an additional
level of treatment may be required.
6.) All components of the septic system are to be completely protected from vehicular traffic
or mechanical disturbance. Protective barriers are required around drainfield.
7.) Drainlines are to be installed along the natural contours.
8.) Divert all sources of drainage, including roof drains away from septic tank and drainfield
area.
9.) Any portion of transport line under a driven way is to be double cased or equivalent.
10.) Asphaultic emulsion or equivalent required on septic tank and/or pump chamber.
11.) Risers are highly recommended to grade with secured lids over the inlet and outlet of the
septic tank. Minimum 24"riser over inlet.
12.) 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.
13.) Approval of this onsite sewage permit that includes an accessory dwelling unit does not
assure that a building permit for an accessory dwelling unit will be approved. Building
permit applications are subject pp pec to the requirements at the time of application, of the Jeff.
Co. Building Code, Zoning Ordinance, Comprehensive Land Use Plan and Land Use
Procedures Ordinance as well as any other environmental approvals duly adopted by
Jefferson County, the State of Washington or any other agency with Jurisdiction.
2 of 2
11/22/99
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