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HomeMy WebLinkAboutSEP2010-00034 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Dave Theriault MAILING ADDRESS 5 W Marilyn Ave Everett,WA 98204 PHONE ( 360 ) C/O 1/4)7oar-5//4 (' `-/ 7 9 SYSTEM DESIGNER Eric Hibbard Designer Phone# (360)683-6300 LEGAL DESCRIPTION: Section 34 Township 30N Range 1W PARCEL# 001-343-008 Subdivision Name --s' " i'V(L..S— E/Zit/e1S-4/3.11/) -S 7791(` Site address/Directions to site 1091 Four Corners Rd, Port Townsend C Q.t' (n_ate ars Qc, i.��r 1151 c t I ,F a21 SOURCE OF SEWAGE/USE TYPE OF WORK WATE- SOURCE Residential_X_ New Tanks only Private Residential ADU Modification Public X Commercial Expansion Community Upgrade aL- Repair X SITE SIZE '86818.33 A7 She SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evaluation , Conventional Designate Reserve Area Yes# Alternative_X Redesign No X SYSTEM DETAILS Number of Gallons/day;�40 Soil type 3_(attach soil eval.) Application Rate 0.8 ' gal./sq.ft,/day Drainfield Length IS ft. Trench Width 3 ft. Trench/Bed Depth 1.16: in. Septic Tank size 1000 gal. Pump Chamber size 1000 gal. TYPE OF SYSTEM Pressurized Deep Trench 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 anyway 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. CVZ r 4/i / a Property Owner Signature Date FOR OFFICE USE ONLY �A f 728710 - PARTIAL ASBUILT " ^'� /i1FIN tV 7/l APPROVEDoo_FrmQ� INSP/PUMP TES /1 �\ k LP ALL HOLD REQ. MET Date -10 Fee Rec# Check# � / . Case#SEP )C) ' 3 \\Soils-sto\storage 1\office Docs\Forms\Jefco\Application Forms\Permit Application2008.doc £00/£0012 Z595£89O9£ XV. 6T:17T OTOZ/6T/TO . SEWAGE DISPOSAL PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 PERMIT #: SEP10-00034 Date Received: 04/14/10 SITE ADDRESS: 1091 FOUR CORNERS RD Date Issued: 05/28/10 PORT TOWNSEND, WA 98368 Date Expires: 08/28/10 APPLICANT: DAVID G THERIAULT PHONE: 5 W MARILYN AVE EVERETT WA 98204-2729 LEGAL DESCRIPTION: S34 T30 R1W SWSW(LS E1/2 NESWSW)LS TAX 9,10,14 &LS R/W'S PARCEL#: 001343008 Section: 34 Township: 30N Range: 01 W DESIGNER: ERIC HIBBARD PHONE: 360-683-6300 SOILS APPLIICATIONS INC 863 CARLSBORG RD STE A SEQUIM WA 98382 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 codified 8.15 amended per ordinance no. 06-0719-07. This permit may not be renewed. Jefferso County En ronmental 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 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: 150-SAND LINED TRENCH No. of Gallons per Day: 240 Type of work: REP Drainfield TrenchlO. Septic Tank Length: 100 feet Width: 3 feet Depth: i Iii inches Size: 1,000 gallons SPECIAL CONDITIONS APPLY - SEE REVERSE CONDITIONS OF APPROVAL- PERMIT NO.: SEP10-00034 1.) This permit was issued to correct a violation of WAC 246-272A as the system is failing. The permit must be completed within 90 days of the date of issuance. 2.) TRENCH TO BE EXCAVATED TO 115"or as needed to reach sands. THEN BACKFILLED WITH ASTM 33 TYPE SAND TO 24" AS PER DESIGN. 3.) 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. 4.) 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 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.) 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. 7.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 8.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 9.) 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. 10.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 11.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. 12.) 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. 13.) 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. 14.) Low use water fixtures recommended, 1.6 gal. flush toilets and 2.5 gpm shower heads. 15.) 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. 2 of 3 11/22/19 I:\F_SEP_Permitmod.rpt 16.) 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 D ' .. Designer H-72138 /7,0 Permit # S" 0 -00-0 3 Installer l)--7.2-? /,3.23/ Parcel # Ot / " k3 -cogs- Electrician co8`Electrician P- C-O 6,9v 7-6)z.--77?.. .__ Design Flow -aro i%9/t Z,'O Property Owner ,C1/3 V& ' &-77.-7411e..j /91/‘._Site Address /0 9/ Fall CET~/?titq-c ,7/ El VE n Answer all questions or indicate NA 4U6 08 2011 DATE Tanks, Pumps and Controls INSP. T� /f County Tank :;manufacturer, size, baffles) /� ,�� /� .f Ir Pump chamber (manufacturer, size) -S'/Q/ 7nment���ealth 6- Screen(s)and/or Pump Shroud (type, location) OV77.-CJ's' /3/9,4- -‘4,--- ,�'C-/? t,, / �`7WI- 7 - - '' vhlere Tanks tested onsite for water tightness? Yes / ,gJ _ Panel Model /44/(//9 Gv't fi Timer Model Lam-- 'O / Pump 1 - Man./Model /nelle7? /''7 e W 4/c Flow Rate -Lis qpm Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Zia - a/9 Timer from bottom of tank- On/off - /g' in. Functions: On 5 9 • se min Veto - 3 in. Off - z,sato sec a r - _ __, — Alarm - 3 gin. Veto On - 5 4t 0min Storage Above High Water Alarm 3c- �'- gal. Veto Off - /8'O sec0,hr Lose Counter Reading e-/ # gallons/dose 0 gal. Lap Time Meter Reading �:DZ : S C min/hrs Pump Throttled? Yes Dose Drawdown (in inches) in. Pump 2 - Man./Model Flow Rate qpm Pump Location (i.e. garage, treatment unit, basement) Float/transducer settings Inches Timer i 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. -Flap Time Meter Reading min/hrs Pump Throttled? Yes / No ,.,J ;� ,n If additional pumps- complete the info in this table ... se 0.z.lWdObt_, (in inches) in. for each and attach. Other Timer functions & settings (e.g. override on/off) H \WEB\ONSI TE'\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 Pre-TreatmentRE.CIvD Date Insp '4/ VED Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location AUG 08 2011 Sand Fill met design spec? Yes / No jeersOn ATU (manufacturer, model) -ntdron Rigtletlested Yes / No Disinfection Unit (manufacturer, type, model) nInn'dII dent Alarm Yes / No Drainfield Transport Pipe size, schd, diameter Z 1SCh' Manifold size/schd Z-1/--c-C/7"/C) Orifice size Y� z-' GL- Lateral Size/schd / iff-Cfilid Barrier Material c r ? ?? F'98/i1(_-Cover Material/Depth %sY Residual Head (lat.# & ft. Head) // i The laterals/pods were balanced Yes / No Source/Manufacturer of Drainrock/Gravelless chambers C 077Cri'� Drainrock Clean? I/ No If no, what action taken? • Mound/Glendon Site Prep Drainfield Length /00 ft Width -3 ft Depth //.S inches Caps for measuring residual head stored (location) ' 7-'Q 01C e-//7-E7?/57C- COMMENTS // 7?/9G S' COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary /9 -' wwS / 9(;:. 'S/f 0v'1-'70 _ 7/7"-&-- or 70 D_7E7/ T .r'via<' E t ,`? 7-67'.17 .0 v/?r721,-- tfz379/V 1'3'9Z-r./ C's9 671 ,6r7-ri ' Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner //—Z /— 2.0 /C') Date Tank/component Decommissioning Report Attached Yes / Irk NA Installer Certification attached/signed Yes / ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY T}EE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, TifE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY (DATE) 02 Y- 4T CHANGES HAVE BEEN NOTED AND THE SYSTEM IS CO PLIANCE WIT}f WAC 246 -272. //-l'l-Zoio 5/ac) 36 z Designer Signature Date License # H.\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 ,.40/0(/2010 16:00 TEL 360 417 1932 Bishop Enterprises I1001 i2495 Cape George Road �-moia4141111,IF Port Townsend,WA 98368 SEPTIC TANK OPERATIONAL REPORT 360-385-7155 . 360-457-4121 s Date of Service_! i' `..-' Technicians signature ° "�'• '�` r y , f � t t CR Pl : RE Service provided for .._.j'-,;:, - � Address - `i:f-7- - . ic 1- , ' .�,� QUG 08 �__.�-- Phone . , - 201; Job Address :?` .: ‘J Last Date Pumped people in home '4 /11^/1- _ if bedrooms ealtk` SEPTIC TANK 12.------, Size of tank 7 O Gallons Compartments: Single ' Double Material: Concrete 1---- Polyethylene Metal Other(specify) Conditions of septic tank: Good... Poor ‘... - Was ground water observed leaking into tank?Yes No t-,- - If yes,where was water observed? Effluent running back into tank from drainfield? Yes No Riser to grade on inlet:Yes No —f iser to grade on outlet:Yes_No 4-Riser to grade on cleanout access:Yes No If no risers,were risers installed? Yes -_No Solids in Tank: 1st compartment Scum(top layer) in. sludge(bottom layer) K, in. 2nd compartment scum(top layer) •r - in. sludge(bottom layer) iliA7 _in. BAFFLES Condition of inlet baffle: Good Needs Repair Repaired Material Condition of center baffle: Good Needs Repair Repaired Material Condition of outlet baffle: Good Needs Repair__ R paired Material Type pe of outlet baffle: Unscreened Screened Filtered Material Cleaned outlet baffle and/or screen: Yes No PUMP CHAMBER / EFFLUENT PUMP Does the system include a pump? Yes - No If Yes,complete the following Size of Tank Gallons Riser to grade: Yes No if no,was riser installed: Yes No Material: Concrete Polyethylene Metal Other(specify) - Was ground water observed leaking into tank?Yes No If yes,where was water observed? Depth of accumulated sludge in pump tank_ inches Was the effluent tank pumped? Yes No Recommended additional Information Condition of Pump: Working Not Working Needs repair Condition of Alarm: Working,_., Not Working Needs repair Pump cycle drawdown: knches Time for pump cycle - minutes/sec. 1 Comments: ,:,•� v I a59s-199 (o90 xd.! 00c9-r99 (09c) kid 1-ir7 b'1213H1 0 29£'96 VM 414111103SdOd W31SAS 03N17 GNVS 03Zi21(1SS3Jd >. 0 'V 311(1S `Ob'0d 02:108S-18VO £99 o$0 0 o 800—£��r—LOG 730?�bd XVI u W N CO w '� �o�� Noildoi�ddd s1�os6.1 'st Co� W W �-- Q,ONIM b'a0 0b+0o3�1 ®3s1/13�1�, N ?o z � a. o L -0-y 0c v30 a�ieo 00 0 O U , O °Zs v.00 1 . 0 rnv v0—. jl 0 Q • 3.�CN h' a l JN'i co O U p N U Y7•4O3 {A C CO,- -0I aUi 0 m 3 0 0 0'00-0 UM •C a•p 0 a l l '`o >.. 0 4 p O O ^ -`. a N 9 _ a. c a acv o--.- 0 0 ---- ---- --- ---4,z --- --- --- ----_tisti --- --- --- -- ,,//: W w W 4.p /�4 SN' W 1 a � o Cc st CC Y�� E,13.7.-.1.1 Y� 401r 'VC' ~t'� 1 om11.1 o�� -- 1.,..Lu k x o z x 0En — .4.411./11, 3,�:1� N 0Leig W ,e 0 (2 LLJ. 'Q3z 2? 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L. cn N N 00 °-o 0 17 00 CA lci cfl 0.- I� H to Jefferson County Environmental Health Dept. 615 Sheridan St., Port Townsend, WA 98368 SOIL EVALUATION Property Owner-DAVE THERIAULT System Designer- Soils Applications Inc. ERIC HIBBARD LEGAL DESCRIPTION: Section-34 Township- 30N Range-1W Parcel# 001-343-008 Subdivision SWSW(LS El/2 NESWSW) LS TAX Date Logged: 2-26-2010 Logged by: Eric Hibbard Include soil textural characteristics and depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. Soil verified onsite 2-26-2010 By Randy Marx, Eric Hibbard and Jason Bishop SOIL LOG #1 Health Dept. Comments: 0" to 4": Dark Brown Sandy loam 4" to 29": Mottled Sandy loam 29" to 108": Compact Platy Sandy Loam 108" to 126": Tan Medium Sand Observed water table @ None Roots to SOIL LOG #2 Health Dept. Comments: 0" to 6": Dark Brown Sandy loam 6" to 109": Mottled Sandy loam 109" to 126": 7P/17 Observed water table @ None Roots to /$ 441,44.0,\ 11 �•� ��. 1 C-- �,1 "".""D DESIGNER OA- 4- A !l rllrf,T1.r r./t 1Mr0615 11na/ > 40'8