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HomeMy WebLinkAboutSEP2002-00086 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION 45) 0,6 PROPERTY OWNER Foresters Hall LLC do Amanda Kingsley A, MAILING ADDRESS 526 Thunder Rd. w,tei6)'44. r Port Townsend,WA 9836E PHONE (360)379-9191 .0��0 SYSTEM DESIGNER: Michael S.Deeney Designer Phone#: ( 800 ) 395-7296 0i O°t LEGAL DESCRIPTION: Section 24 Township 27 Range 2W PARCEL#937200701 do OA Subdivision Name D ivision Block Lot(s) Site address/Directions to site 51 Rogers St.,Quilcene,WA 98376 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential New Private X Residential ADU Modification Public Commercial X Expansion Community Repair SITE SIZE 34,300 ft.2 SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes SEP02-00086 Alternative X Redesign X No SYSTEM DETAILS Number of Gallons/day 555 Soil type 3 (attach soil eval.) Application Rate 0.8 gal./sq.ft./day Bd Length 88.0 ft. Bed Width 8.0 ft. Bed Depth 45 to 61 in. Septic Tank size 1,500 gal. Pump Chamber size 1,500 gal. TYPE OF SYSTEM Pressurized Sand-Lined Beds 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 ap lication will be separatel judged by the rules and laws in effect at that time. (.e,e/ t ci,44c)a 5`14,0; 211 11 Property ner S nature ate FOR OFFICE USE ONLY r i PARTIAL/ / 11/7 6D ASBUILT 6/1/17 7 'P6/ /1 7 FINAL A' 'R•VEF4 INSP/PUMP TEST 11 Monitoring Agreement 45\\,\\ ( � 1 'b q ALL H��OJJLD EQ.MET Q / Date ;/q�/-9'Fee 26`7 Rec# / (0�to_g check it /0 O.,/ ._C /sEP 02.-0 J (p D;\Data\W pw County&State Formsllefferson\Septic Permit Forms Redesign\Kingsley,937200101 Se .PTauaaak mad JEFFERSON COUNTY PUBLIC HEALTH � g o15 Snendan St. /*mon urt Townsend, WA 98300 Health www.jeffersoncountypublicheal.th Public Heaa lth Phone 360-385-9444 Fax 360-379-4487 ONSITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP02-00086 Date Received: 10/09/2002 Revised Date: 03/08/2017 SITE ADDRESS: 51 RODGERS ST Redesign Issued: 03/08/2017 QUILCENE, WA 98376 Date Expires: 12/13/2005 APPLICANT: FORESTER'S HALL LLC PHONE: 360-379-9191 526 THUNDER RD PORT TOWNSEND WA 98368 LEGAL DESCRIPTION: CAMPBELL'S H.W. ADDITION BLK 7 LOT 1(LESS S120'& 1/2 VAC ST) PARCEL#: 937200701 Section: 24 Township: 27N Range: 2W DESIGNER: MIKE DEENEY PHONE: 360-379-2879 CREATIVE DESIGN SOLUTIONS PO BOX 2787 PORT ANGELES WA 98362 SYSTEM DESCRIPTION: PRESSURIZED BED No. of Gallons per Day: 555 Drainfield Trench Septic Tank Length: 44 feet Width: 8 feet Depth: 21 inches Size: 1,250 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 System , codified in JCC 8.15 as amended. This permit may not be renewed. / G'"1 Jeff-rson County Envi(onmental 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 REVERSE & ADDITIONAL PAGES CONDITIONS OF APPROVAL- PERMIT NO.: SEP02-00086 1.) This onsite sewage system is designed for domestic strength wastewater only. Disposal of any other waste strength is considered a violation of this permit. 2.) H - Permanent barriers are required along/around primary and reserve drainfield areas to protect from parking, driving, and other land disturbing activities prior to final. 3.) 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.) Approval of this permit does not assure the existing septic system has capacity for all uses allowed by current code. 5.) This onsite sewage system is designed for domestic strength wastewater only. Disposal of any other waste strength is considered a violation of this permit. 6.) Health Dept. required to observe pressure test when system fully installed/complete, 48 hours notice to be provided for scheduling. 7.) An asbuilt drawing and certification of completion by the designer is required prior to final approval. 8.) Setbacks to all wells- 100' required from primary drainfield area. 50' required from tanks and effluent transport lines. Reserve area setback must meet the waiver conditions 9.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 10.) Designer must be contacted prior to installation for staking of drainfield area. 11.) 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 246-272A 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 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Low use water fixtures recomended, 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. 16.) This site has been granted a waiver from the state onsite sewage regulation 246-272-09501 for a reserve drainfield <100' to a well. Compliance with conditions of the waiver is required. 17.) This permit is granted based on the recorded NOTICE TO TITLE combining parcels 937200701 & 937201152. to meet the minimum land area required under WAC 246-272 Onsite Sewage Code. NOTICE recorded under AFN 460853 18.) Exceeding the permitted design flow of 555 gal/day peak use, shall constitute a violation of this permit. Water usage monitoring may be required Page 2 of 3 \\tidemark\data\forms\F_S E P_PermitRedesig n_nw.rpt 3/8/2017 19.) 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. 20.) 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. 21.) 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. 22.) 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. 23.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 24.) 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. 25.) 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. 26.) 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I Li z � � Q ' 1 I I I IIIIINI i W ssR cc IfY0. _N N U raQI 0 zzvs 11 aU W2 \ ZQ tn i Q�a o 0 6 ti Z •••••• ..........t!"------------------. Eo OI N� J Ri4. \ NC' �3Q vci' 0 QZ 0,•-1:1))0 � :Cr) - 0-0.OY ti Z m cc Q Z a / o° � N w c2 1 o U W s 2 o`O O fn JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING Designer MICHAEL DEENEY Permit# SEP 02-00086 Installer DAN MORGER, JIM MORGER CONSTRUCTION Parcel # 937200701 & 937201152 Electrician Design Flow 555 GPD Property Owner FORESTER'S HALL LLC Site Address 51 RODGERS ST., QUILCENE, WA 98376 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) 1,500 GAL. 2 COMP. W/BAFFLES g`CoUT,L.ET''FILTER 4-28-17 Pump chamber (manufacturer, size) 1,500 GAL. 4-28-17 Screen(s)and/or Pump Shroud (type, location) PUMP VAULT W/ BIOTUBE FILTER 4-28-17 Were Tanks tested onsite for water tightness? Yes / No Panel Model AQUAWORX IPC-S01 Timer Model AQUAWORX 4-28-17 Pump 1 — Man./Model ORENCO PF500512 Flow Rate 61.7 gpm 4-28-17 Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank 24" Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - 0.9" On - 1 MIN 0 SEC Veto - 25.9" Off - 239 MIN 0 SEC Alarm - 25.9" Veto On - 1 MIN 0 SEC Storage Above High Water Alarm: 466 gal. Veto Off - 239 MIN 0 SEC Dose Counter Reading: 0 DOSES, 0 VDOSES Gallons/Dose: 61.7 Elap. Time Meter Reading: 10 MIN 24 SEC Pump Throttled? Yes / No Dose Drawdown: 1.8" Pump 2 — Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - On - Veto - Off - Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off - Dose Counter Reading: Gallons/Dose: Elap. Time Meter Reading: Pump Throttled? Yes / No Dose Drawdown: If additional pumps complete this info for each 1\LENOV02D16DEC1Data\Wpw\County&State Forms\Jefferson\Construction Rpts\Pres Dist\Kingsley,937200701&937201152,Alt sys 2010-2 FRM.wpd D5/03/17 Page 1 of 2 Pre-Treatment Date lnsp 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/Sch. 2" SCH. 40 Manifold Size/Sch. 2" SCH. 40 4-19-17 Orifice Diameter 1/8" Lateral Size/Sch. 1.25" SCH. 40 4-19-17 Barrier Material FILTER FABRIC Cover Material/Depth 6 to 27" L.S. 4-19-17 Residual Head (lat.# & ft. Head) 72" (USING CLEAR RESIDUAL HEAD TUBES ON THE 4-28-17 LATERAL END CLEANOUTS) Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean? Yes / No If no, what action taken? Mound/Glendon Site Prep. Bed Length 44.0 ft Width 8.0 ft Depth 45 to 61 inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Other Aquaworx panel settings: Swarn: , Zbios: 08 , Autoclear: 1 doses min-sec. t Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner WITH RECORD DRAWINGS Date 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 (with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed (no backfill, except over transport pipes), and final inspection of the completed system (with exceptions as noted, if any). To the extent revealed by these periodic inspections, the system complies with all the conditions noted in the permit as approved by Jefferson County 3-8-17 (Permit Approval Date) or that changes have been noted and the system is in compliance with WAC 246-272. if j =3-1-7 5100110 Designer Signature # Date License # \\LENOV02016DEC\Data\Wpw\County&State Forms\Jefferson\Construction Rpts\Pres Dist\Kingsley,937200701&937201152,Alt sys 2010-2.FRM.wpd 05/03/17 Page 2 of 2 m y .a*Y CERTIFICATION OF TANK ABANDONMENT ® '` ` Parcel numbers "20 ( -+Popt,...-vr? 1y 6, Address $ 1o Q��ikS �� ���� C3� eellt Property Owner Name MI cVt"e l ``'C✓C5�S) ecy Septic Permit# (if applicable) S� �� 3/CQ. Individual/Company Certifying Abandonment 4-.0CL1s', Phone Number 3e't -1' * I certify that the septic tank and/or pump chamber on the above referenced site has been abandoned to Washington State and Jefferson County Public Health Requirements. Signature illt4A4 44/194/A'e Date 5—'2- -`.l Print Name 49(A /44j: (---. Pump receipt attached 61. 1 t.c, 4 S' 11/(8- - I TANK PUMPING REPORT .. <,i'2J17 Site Name:House Location:51 Rodgers St Service Company: � '�" Quilcene Tax ID:937200701 Enviro Check, LLC �y Owner.Michael Hoskins 1612 Hastings Ave.West 1,7I/� r,e ""r!G° use:Residential,Other Port Townsend,WA 98368 "OtifnAV Oar/, Jurisdiction ID:SOM16-00108 360-379-9400 � 0 " Serviced:04/10/2017 by:Dale Wurtsmith Submitted 04/10/2017 by:Dale Wurtsmith Dump Location:Port Townsend Compost Facility COMMENTS 1-Tank was pumped for abandonment. 2-Tank was partially full and a small hole near the bottom of the tank was seen after pumping. TANK:Septic Tank-2 Compartment 1000 Gal POLY tank Tank Pumped: YES Tank Size(Gallons)(Number only,no text): 1000 Effluent level within operational limits(if NO explain in comments): NO Deficient Total Gallons pumped from tank(Number only,no text): 300 Effluent returning back into tank after pumping: NO Tank depth below grade(inches): 12 Access Risers installed to grade(N/A if not present): N/A Access Risers securely fastened(N/A if no riser present): N/A Tank Construction Material: Concrete Tank Condition Good: NO Deficient Roots or ground water observed leaking into the tank or around the risers: NO Baffles in good condition(N/A if not present): YES Effluent screen cleaned(N/A if not present): N/A Effluent surfacing around site components(N/A if not checked): NO Tank abandoned after pumping: YES Were repairs made to the Tank or Tank Components?(if YES explain in comments): NO Compartment 1 Scum accumulation(Inches,if other specify): 2 Compartment 1 Sludge accumulation(Inches,if other specify): 6 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 3 Drainfield was vacuumed or hydro jetted?(If YES,explain in comments) NO This report indicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. 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W Z\ tn 2 CA x co Li al WE k f2 I 11 0 CO ri- �e 111 o 0 a zm II f. �I $ a0; er.e/ CREATIVE DESIGN SOLUTIONS, INC. l5Z(N4 Site//oils ETO aFFICE luationnsOX&Feasib2787,ility ty ReportORT s ELESINSani ary Surveys Septic System Designs■Construction Inspections&Certifications CDS (360)457-6353 (800)395-7296 FAX(360)457-6687 Email:mike@cds4you.com A�� 1 INC. e�L.. 69 1, „i),› MemoOee TO: Randy Marx, Jefferson County Environmental Health Department FROM: Michael Deeney DATE: February 1, 2017 SUBJECT: Septic System Permit Application, Parcel Numbers 937200701 & 937201152, 51 Rodgers St., Quilcene. Hi Randy, The attached site plan and soil logs are from SEP96-00009 and are included as supplemental information of help document the depth of permeable unsaturated soil in the area. These soil holes were just across Masonic Temple Road from the proposed septic disposal area being proposed under SEP02-00086. CREATIVE DESIGN S UTIONS, INC. Michael S. Deeney Professional On-Site Wastewater Treatment System Designer License No. 5100110 D:\Data2\Wpw\Memo\Kingsley,937200701,Memo,Additional Soils Information.wpd C�� Ve k76,8 Q SOIL INFORMATION 09 2Q,, `ie1et Owner: 1 .t.._ 4. . .irihVirO/as® �Ba. • Legal Description: Section`' Township �'�P Range °,-YID- Subdivision i- \44,/ Cet/n\44• -�A_ �� ,1 Division Block Lot ry1)13 () Date Logged: ° - - 90 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 .D____ to �] in. 4.t A . ..6�-. .i ll wrrt— ��— to )? in.�r . t .A. 0.' ..a � r to 7 '7 in. ;�'�i...r..l __'-.a.. t0 C.in. the_ r.. 4,A.., .1 .46.. to i n. q ., to ) in 1 : r- , . m\ to in. to in. ' ' 4' A"./1-1g • Anticipated water table in. Anticipated water table in. Roots to 670 inches ' Roots to 144- inches Soil Log #3 Soil Log #4 {/ t _O___O__ tO in. it b.i mi O to 6— -- in. 44 1111116. lat... . 4 1 J �- to,3 in. • ..11. tt ..:.:, to4R LA in. ' toW.? ln./ ._.►.•.: a[iDFi:►* s.i •\ t a '1 (04? to F7) in, Gaeta i ' At/'' i►• v tO 7 '7' in. !..! ;ri1.41e., .�.w �'15.14 to in. Anticipated water Mable ' in! Anticipated water table in. Roots to (0 0 inches Roots to AR) inches Soil Log #5 Soil Log #6 to in. to in. to in. to in. to in. to in. to in. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches 1 a02.4 NOt 4 .. c:,..., RECEIVED It cr JAN 1 61996 U *. Alio S}r-cc&r % 1-I it) PERM C � -s s f,ry\ JEFFERSOi *. 1 fg .21, 'Er/ Wi `. ...tit - 1 - ''44 _ q m014 .0 rrt ' � 3:) 1i .t \ . .r . , . - „.-: 1 1 si ______ , :1.- . _ 1 i1 _______ c) _ _ . _____ 40 ...- 11 t> C!` Q:1 , r• 1 .., CD j t % C.Z. 1 t 46 .Q.liY1 „9 $ �` = r 4 : -0 ...t, . ..._,„ ssi 41 ,...c, i.. 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