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HomeMy WebLinkAboutSEP2016-00023 Jefferson County Public Health 615 Sheridan St., Port Townsend WA 98368, (360) 385-9444 04(04 SEPTIC PERMIT APPLICATION 14, PROPERTY OWNER Frances L. Whelan and Mark E. Schlipf v . 4/40. ) 4) MAILING ADDRESS 432 30th Street ®-, Port Townsend, WA 98368-6127CI% PHONE ( 360 ) 316-9450 /y*40, SYSTEM DESIGNER Everett A. Sorensen, P.E. Designer Phone# 360-821-9960 444 LEGAL DESCRIPTION: Section 33 Township 30N Range 1E PARCEL# 976200108 Subdivision Name 9762 - Nordland Division Block Lot(s) Site address/Directions to site 2615 East Marrowstone Road; Nordland, WA 98358 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New X Tank/s only Private Residential ADU X Modification Public X Commercial Expansion Community Repair Partial Repair-(tank) (drainfield) SITE SIZE 66,102 SF SYSTEM TYPE Designate Reserve Area Previous Evaluation Conventional Redesign X Yes# SEP16-23 Alternative X No SYSTEM DETAILS Number of Gallons/day 480 Soil type 4 (attach soil eval.) Application Rate 0.6 qal./sq.ft./day Drainfield Length 267 ft. Trench Width 3 ft. Trench/Bed Depth 12 in. Septic Tank size 1 ,000 gal. Pump Chamber size 1 ,000 gal. TYPE OF SYSTEM 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. Property Owner Signature Date 7E ONLY FOR OFFICE U ASBU LT -��0/I PARTIAL 7o/i �/ '�� 1 FI NAL U l 07)7 APPROVED / INSP/PUMP TEST >/± r"r 7 Monitoring Agreement 'SI l (I 1 �1 ALLL HOLD� JREQ. MET 1 Date il S i I�- Fee I `'t Rec# I—0V I Ct O Check# 14.- �I Case#SEP 1 — 2- G:\B-ONSITE\Forms\Application Form & Info\2015 Septic Permit Application.doc JEFFERSON COUNTY PUBLIC HEALTH „ 615 Sheridan St. Port Townsend, WA 98361 Public Health Phone 360-385-9444 Fax 360-379-4487 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP16-00023 Date Received: 02/25/16 Date Issued: 04/10/17 SITE ADDRESS: 2615 E. MARROWSTONE RD NORDLAND, WA 98358 Date Expires: 07/10/17 APPLICANT: MARK E SCHLIPF PHONE: FRANCES L WHELAN 432 30TH ST PORT TOWNSEND WA 98368-6127 LEGAL DESCRIPTION: NORDLAND BLKS 1 &2 TAX 88 BND THRU LOT CONSOLAF#596064 PARCEL#: 976200108 Section: 33 Township: 30N Range: 1E DESIGNER: EVERETT SORENSEN PHONE: 360-821-9960 STREAMLINE ENVIRONMENTAL, INC 715 GRANT STREET PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: PRESSURIZED TRENCH No. of Gallons per Day: 480 Type of work: NEW Drainfield Trench Septic Tank Length: 267 feet Width: 3 feet Depth: 12 inches Size: 1,000 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 Systems codified in JCC 8.15 as amended. This permit may not be renewed. Jefferson County Environmental 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.: SEP16-00023 1.) The drainfield must be located as shown on the design due to water table issues below soil test pits 1&2 2.) MAXIMUM TRENCH DEPTH 12 INCHES 3.) Contact designer prior to installation for staking of drainfield area. 4.) 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. 5.) 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 246-272AAND 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 6.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 7.) 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. 8.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H - An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) 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. 11.) Setbacks to all wells, including the one to the south, 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 12.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required and must comply with code at the time of application for use. 13.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 14.) 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. 15.) 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. 16.) This approval is for a new septic system only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 17.) 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. SEP16-00023 Page 2 of 4 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/10/2017 18.) The site plan as submitted with the new septic system application on February 25, 2016 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the approved site plan shall be resubmitted for review and approval by Jefferson County Department of Community Development. 19.) The application was reviewed by the Jefferson County staff for the potential presence of Critical Areas under the provisions of the Unified Development Code (UDC). After a Geographic Information Systems mapping review the following Critical Areas were confirmed to be present on the subject property: stable shoreline slope stability, Special Aquifer Recharge Protection Area, High Risk Seawater Intrusion Protection Zone. 20.) MANDATORY MEASURES OF HIGH RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 21.) MANDATORY MEASURES FOR HIGH RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 22.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. SEP16-00023 Page 3 of 4 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/10/2017 23.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. SEP16-00023 Page 4 of 4 \\tidemark\data\forms\F_SEP_Permitmod.rpt 4/10/2017 Jefferson County Public Health RECEIVE!) 615 Sheridan St„ Port Townsend WA 98368, (360)385-9444 SEPTIC PERMIT APPLICATION FEB 2 5 2016 PROPERTY OWNER Frances L. Whelan and Mark E. Schlipf Jefferson County MAILING ADDRESS 432 30th Street Environmental Health Port Townsend, WA 98368-6127 PHONE ( 360 ) 316-9450 SYSTEM DESIGNER Everett A. Sorensen, P.E. Designer Phone* 360-821-9960 LEGAL DESCRIPTION. Section 33 Township 30N Range 1 E PARCEL s 976200108 Subdivision Name 9762 - Nordland Division Block Lot(s) Site address/Directions to stte 2615 East Marrowstone Road; Nordland, WA 98358 SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New X Tank/s only Private Residential ADU X Modification Public X Commercial Expansion Community Repair Partial Repair-(tank) (drainfield) SITE SIZE 66,102 SF SYSTEM TYPE Designate Reserve Area Previous Evaluation Conventional Redesign Yes# Alternative X No X SYSTEM DETAILS Number of Gallons/day 480 Soil type 4 (attach soil oval.) Application Rate 0.6 9at/sq.ft./day Drainfield Length 267 ft. Trench Width 3 ft, Trench/Bed Depth 12 in. Septic Tank size 1,000• gal. Pump Chamber size 1.000_gal, TYPE OF SYSTEM ?Agatik,(AQ 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 applicanVowner 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 aN liabilities, judgments, court costs, reasonable attorneys fees and expenses yestich 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 veiling within fifteen days after receiving written notice of the decision. D1SCLAIMER-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 ju• • • by the rules and laws in effect at that time, , - tA Owner Signature Date FOA OFFICE USE Oar C-)\41-1 V.Q PARTIAL ')/t Vii V ASBUILT FINAL AP e` INSP/PUMP TEST Monitoring Agreement ALL HOLITEO.MET Date 71Z5 \V) Fee 759 Roc* I LP a;53—Check* ZOO cases 8E13 i —COO 2-3 G:\B-ONSITE\Forms\Application Form 6 Info\2015 Septic Permit Application.doc JEFFERSON COUNTY PUBLIC HEALTH "i. Port Townsend, WA 98368 Coank www.jeffersoncountypublichealth.org Public Health Phone 360-385-9444 Fax 360-379-4487 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT #: SEP16-00023 Date Received: 02/25/16 Date Issued: 05/03/16 SITE ADDRESS: 2615 E. MARROWSTONE RD Date Expires: 05/03/19 APPLICANT: MARK E SCHLIPF PHONE: FRANCES L WHELAN 432 30TH ST PORT TOWNSEND WA 98368-6127 LEGAL DESCRIPTION: NORDLAND TAX NO 39,PT 1 &2 PARCEL#: 976200108 Section: 33 Township: 30N Range: 1E DESIGNER: EVERETT SORENSEN PHONE: 360-821-9960 STREAMLINE ENVIRONMENTAL, INC 715 GRANT STREET PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: PRESSURIZED TRENCH No. of Gallons per Day: 480 Type of work: NEW Drainfield Trench Septic Tank Length: 267 feet Width: 3 feet Depth: 12 inches Size: 1,000 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 Systems, codified in JCC 8.15 as amended. This permit may not be renewed. // Jefferson County Env' 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.: SEP16-00023 1.) The drainfield must be located as shown on the design due to water table issues below soil test pits 1&2 2.) MAXIMUM TRENCH DEPTH 12 INCHES 3.) Contact designer prior to installation for staking of drainfield area. 4.) 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. 5.) 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 6.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 7.) 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. 8.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H - An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) 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. 11.) Setbacks to all wells, including the one to the south, 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 12.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required and must comply with code at the time of application for use. 13.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 14.) 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. 15.) 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. 16.) This approval is for a new septic system only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 17.) 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. SEP16-00023 Page 2 of 4 \\tidemark\data\forms\F_SEP_Permitmod.rpt 5/3/2016 18.) The site plan as submitted with the new septic system application on February 25, 2016 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the approved site plan shall be resubmitted for review and approval by Jefferson County Department of Community Development. 19.) The application was reviewed by the Jefferson County staff for the potential presence of Critical Areas under the provisions of the Unified Development Code (UDC). After a Geographic Information Systems mapping review the following Critical Areas were confirmed to be present on the subject property: stable shoreline slope stability, Special Aquifer Recharge Protection Area, High Risk Seawater Intrusion Protection Zone. 20.) MANDATORY MEASURES OF HIGH RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 21.) MANDATORY MEASURES FOR HIGH RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 22.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. SEP16-00023 Page 3 of 4 \\tidemark\data\forms\F_SEP_Permitmod.rpt 5/3/2016 23.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. SEP16-00023 Page 4 of 4 \\tidemark\data\forms\F_SE P_Perm itm od.rpt 5/3/2016 4N. Q oke m .,. - :e. 4 Nctrr,,1,,,.,k741/4...i,-vzi t ?II.'': .Q./4,-°,. N O.t . 5 / 190.-0' I Z N D 1,( O N r, m / \,,, O m cn z CI Om a, r C Z 77 N 'I i Z co m il/m , ,\\,,-----: 'Cr5 CO • ntr _ ' '---''' 4;PIPIr cri v wrn Z i m Qj76 C �' ` o cDn ` 10 � � NN ti $ L,R -I �' C b ,. 3 c, t ; i, p a R + N > m > I 1 1.- 4 , �1 70 70 O mn 0O L m A :,,,1 Z n I 70 M 191..1 O 83 UIIIIIIIIIIIIMp y ...-- 0 EAST MARRO WSTONE ROAD Z _- O 11 Xi 0 Z 0 D S - ? In H T n pP WHELAN / SCHLIPF RESIDENCE a o I '� NN— I of g z m Dc n c T `N N N 2615 EAST MARROWSTONE ROAD W 7 a N NORDLAND, WASHINGTON W _ t a JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING Designer Everett A. Sorensen, P.E. 360-821-9960 Permit # SEP 16-00023 Installer Evan Neville, Shold Excavating 360-385-0480 parcel # 976200108 Electrician Bob Nordberg, Cascade Electric 360-379-5347Design Flow ;,1 : `;:., .,�, Property Owner Frances L. Whelan and Mark E. Schlipf . Site Address 2615 E. Marrowstone Rd; Nordland, WA 98358 JUN 01 2017 Answer all questions or indicate NA Jefferson ORag Tanks, Pumps and Controls ElwimmenteMatt Tank (manufacturer, size, baffles) Cotton Redi-Mix, 1,500 gallon 2-compartment 5/12/2017 Pump chamber (manufacturer, size) Cotton Redi-Mix, 1,000 gallon 1-compartment 5/12/2017 Approximately 22 gals/inch Screen(s)and/or Pump Shroud (type, location) Orenco BioTube Pump Vault with 5/12/2017 integral filter, in pump tank. Were Tanks tested onsite for water tightness? Yes / No Panel Model Aquaworx IPC Simplex Timer Model Built into panel Pump 1 — Man./Model Orenco PF300511 Flow Rate (nominal) 30 gpm Pump Location (i.e. garage, treatment unit, basement) Pump Tank Float/transducer settings Inches Timer from bottom of tank- On/off - 29 (0.5) in. Functions: On 72 seconds sec/min Veto - 45 (16.9) in. Off -192 minutes sec/min/hr Alarm - 45 (16.9) in. Veto On - 72 seconds sec/min Storage Above High Water Alarm 360 gal. Veto Off - 144 minutes sec/min/hr Dose Counter Reading 0 # gallons/dose 46 gal. Elap. Time Meter Reading 0 min/hrs Pump Throttled? Yes /0 Dose Drawdown (in inches) 2.1 in. Actual flow rate: 38 gpm; Tank: 22 g/inch Pump 2 — Man./Model None 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 / 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) H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 --Pr-e-Tfeat t-- 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, diameter2" Sch40 PVC Manifold size/schd 2" Sched 40 PVC 5/12/2017 Orifice size 0.125-inch Lateral Size/schd 1" Sched 40 PVC 5/12/2017 Barrier Material Class C Geotextile Cover Material/Depth Native soil, 6-8" 5/12/2017 Residual Head (lat.# & ft. Head) Laterals 1-5 each had >5 ft of residual head 5/12/2017 The laterals/pods were balanced Os / No Source/Manufacturer of Drainrock/Gravelless chambers Local quarry, sorted & washed Drainrock Clean? YOs / No If no, what action taken? Mound/Glendon Site Prep Drainfield Length 269' ft Width 3 ft Depth 12 inches Caps for measuring residual head stored (location) Within manifold vault COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Five distribution laterals, 50 total orifices, directed downward toward gravel. Aquaworx pressure transducer Z-bias = OA, mounted 28.5 inches above tank bottom. Autoclear: 1 dose. Trench Lengths: Three lowest elevation trenches: 67 ft long, fourth highest elevation trench: 40 ft, Fifth and highest elevation trench: 28 ft long. Up-swept clean-outs at all five distal ends of distribution trenches, enclosed in cylindrical vaults. Health Department Inspection issues resolved Yes / No / ® If yes how? Users Manual Provided to Homeowner Yes Date 5/15/2017 Tank/component Decommissioning Report Attached Yes / No / Installer Certification attached/signed Yes / ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY T11E INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, TI-CE SYSTEM WAS INSTALLED AS DESICINED AND APPROVED by JEFFERSON COUNTY (DATE) 07Z THAT- C}fANES }PAVE BEEN NOTED AND ,c-c A. SQ,4,� THE SYSTE S I COMPLIANCE WIT}( WAC 246-272. of WAS1447 41 T 5/31/2017 P.E. #32550 , ,,e'2 Lz..7 , + ti Designer Signature Date License # 3 550 v4'; .S H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 `SIGNAL E-74 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, diameter2" Sch40 PVC Manifold size/schd 2" Sched 40 PVC 5/12/2017 Orifice size 0.125-inch Lateral Size/schd 1" Sched 40 PVC 5/12/2017 Barrier Material Class C Geotextile Cover Material/Depth Native soil, 6-8" 5/12/2017 Residual Head (lat.# & ft. Head) Laterals 1-5 each had >5 ft of residual head 5/12/2017 The laterals/pods were balanced Os / No Source/Manufacturer of Drainrock/Gravelless chambers Local quarry, sorted & washed Drainrock Clean? YOs / No If no, what action taken? Mound/Glendon Site Prep Drainfield Length 269' ft Width 3 ft Depth 12 inches Caps for measuring residual head stored (location) Within manifold vault COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Six distribution laterals, 50 total orifices, directed downward toward gravel. Aquaworx pressure transducer Z-bias = OA, mounted 28.5 inches above tank bottom. Autoclear: 1 dose. Trench Lengths: Three lowest elevation trenches: 67 ft long, fourth highest elevation trench: 40 ft, Fifth and highest elevation trench: 28 ft long. Up-swept clean-outs at all five distal ends of distribution trenches, enclosed in cylindrical vaults. Health Department Inspection issues resolved Yes / No / ® If yes how? Users Manual Provided to Homeowner Yes Date 5/15/2017 Tank/component Decommissioning Report Attached Yes / No / Installer Certification attached/signed Yes / 0 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 try JEFFERSON COUNTY (DATE) OR THAT CHANGES HAVE SEEN NOTED AND TH IS IN IANCE WITH WAC 246 -2 72. RECEIVED 5/15/2017 P.E. #32550 Designer Signature Date License # i/ b Jefferson County Environmental Head H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 A D m rn a v .. ye 't F o ;,�o sT,tTA, 'gyp' \ n O .� 0 <6-4/ o v� 2 • �'' � m' � �' ate �;f ,_, ` `` �� N Z Z "�;6 '�7 cam"' eENo�- li- Cif ---- \ n x , 190'-0• I O rn m 2 0 N � o �� TI O x / m z O o mZ ZO —Im mco D I I ii � .( '' -\------'::: 09 wFg5 w g " w 4 IQ c. 5\ § O' \T iii O 4 O• M tri— H .* "`,, (A A it-vt_ k \ Ha -I \\ D N N c t F + N Dm Da` D + x 70 70 N O_11 O A r ah ¼i !. lif gmm C) �s ' A 0 O F.-, m _k— - Z m I Om — t9P-1 z" V y EAST MARRO 0 ONE z O Xi v z 0 C4 o ? .7z r <z N WHELAN / SCHLIPF RESIDENCE a F c s. '^ n . cg I. N 2615 EAST MARROWSTONE ROAD › R re 3 $ 4 NORDLAND, WASHINGTON ws o 3 •Control wires from transducer, through 1-inch PVC Mounting Bracket fastened inside riser pp. ' , mounting pipe, to Aquaworx Panel. Extra slack (Examples include typical orific, ..i ���- provided to allow convenient transducer removal shield made to clip onto 1" Pvcf zn'et 0�, without disconnecting wires. Factory-sized cables ,,, ,s• " ` must not be modified. Available in various sizes L tJ Pump Tank Access Rise Riser tube bonded to tank/cylindrical ring � T7C) 1 - Cylindrical ring bseptic ` into tank Pump Tank Lid 1-inch PVC mounting 14/1" PVC Pipe pipe is removable Air breather tube from transducer, inside 1-inch pipe with end secured outside top of 1-inch mounting pipe, with opening pointing downward e� ,' s� „ V �`yenvIro�me (b*d 1" PVC Elbow ; 1 PVC Tee W d5 1 dr" 2 ! Pressure Transducer Bell ham`" �� .� /_ �� ; ,tip:\� , � 4. � ___ - '� BioTube filter and , - a\ C pump assembly Pump Tank Bottom 25" above O�?'7,j, � r �• tank bottom sly c I . '10 \\ Y /.__. Bottom segment of 1" PVC rests on Not-To-Scaletank bottom assuring consistent transducer positioning Sheet 7 Pressure Transducer Installation Details Proposed Septic System for Drawn by: Everett A. Sorensen, P.E. Frances L. Whelan and Mark E. Schli f Streamline Environmental, Inc. p 715 Grant Street; Port Townsend, WA 98368-2405 2615 East Marrowstone Road everett@streamlineenv.com; 360-821-9960 Nordland, WA 98358 February 25, 2016 Parcel Number 976200108 STREAM�E (combined with former parcel 976200109) ENVIRONMENTAL 66,102 ft2 (1 .517 Acres) 47r$'4;,,,N. ti.:)- k.,,,,,-S.. o cca cro ���� :o � OM � O N -0 g09= u ' ,V) E o r 00 O • 0 0 O N a ° c E w ° cn.` O a) 'lo L0 E • °o i >Q N i` SCD - c E 00 U c(N �o E cV,s,r14- @ - Tam W Vj .. > 0) N- LO (i • ) _o o � aC c `s cy wa0- oM c 0c)�t• mY � U 0 w L - -a N c > ca ca - L o oQ'm wy u) :c ° ccoco > o V a 0 C ON - �° c o aci � E -0 a 2. c c)0 @ c c a m a :a Q (a E (Q �' o N co a) N •a'E c a).a N N - a) _ co a m a (a C ' 3 Q N � � > > a�i � c E �� :::�� >Q a N � � CO � 0 o ° E2 N O - p Z L O Q aE) aa) > Y N o co ax) o_ a_ a a) E - o a SO Loi c o o a c Q. c co Z N O CU >, 2 "e c aa) E 40a Q�c cE •� N N � > ac) ti � o a3 'E E Oa. 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FAO . �> ma 3 a0n � ,— f 41 PV*() � Ci) ca 12 o °' '� o a) c ociiU U qtom OumY >c °) � � m ° c a) '5 N � aio ° m' u) >o a) Hc T 70' -0= 0n a) 0 n -a ain o a _ •s t� a) rn E, El c ° ci N ° c L c4 c N t c o � � a "' c � t as C 0 '- (n E � � °) v N U . >+ O a) c _c 4 • c ui 0 as _ > � ° CO � � O N RS U fp °� v°)i c c > E a) o . L c i° H LL C _0 a) --� N a o N a) N n U N t W 0 O O a) m S.) a� O N (ao ° .c o_)w ° 'v is '� LJJ a� E _c cU v E iii co .- .- m 6 2 ° o CZI M w o H M Al c 0 m m E of 8, ill C 00 \\ \ U .c ca 0 ZS) st i co(0. ana)i i ` c0C \ � 8o Al n m = 41/4 s" : SOIL EVALUATION Property Owner Frances L. Whelan and Mark E. Schlipf AN 4, System Designer Everett A. Sorensen, P.E. 360-821-9960 c')L;e'��s 2d - LEGAL DESCRIPTION: Section 33 Township 30N Range 1E 0Vic, Parcel# 976200108 (and former parcel 976200109, now combined into one) �°�!��e.� Subdivision Name 9762 - Nordland Div. Blk Lots 4 Date Logged: 12/24/2015 Logged By: Everett A. Sorensen, P.E. 41-4‘A Ce/744avi /: - 7/jitri4,4\14100'% 11b(/ ;:, off- ',,' d, Zc5�lb ��SOIL LOG #1 /,' , OIL LOG #2 0 to 10 in.Top soil 0 to 10 in. Top soil 10 to 42 in.Tan loamy fine sands 10 to 54 in. Tan fine sands, <15% gravel to in. to in. to in. _ to in. No mottling GWaatt 42" during rainfall ) No mottling, soggy at 54" during rainfall , II Application rate: O. gals/ftf_ aSF) Application rate: 0.6 gpd/SF Anticipated water table 42 in. Anticipated water table 54" in. (1�' Roots to 12 inches. Roots to 12 inches. HeaPIthDe2t. Comments �� LS Heap ept. Comments 5 ilia--1 31' Cx6' 5 2- 0,450,* 1 SOIL LOG #3 SOIL LOG #4 0 to 10 in. Top soil 0 to 6 in. Top soil 10 to 42 in.Tan fine sands ,,, tAVI) \,e 6 to 36 in. Tan fine sands a`�to in. i, ‘ to in. Z. p in. • ql to in. L .21&) * 1 No mottlin during W at 36" i t 1 No mottling, application rate: 0.6 gpd/SF g amfall Application rate: 0.6 gpd/SF 2-1 Anticipated water table >42 in. Anticipated water table 36 in, Roots to 10 inches. Roots to 8 inches. Health Dept. Comments Health Dept. Comments SOIL LOG #5 0 to 6 in. Top soil 6n VI 4 c , 6 to 32 in. Tan fine sands to in. A to in. Anticipated water table 32 in. C , I Roots to 12 inches. No mottling, GW at 32" during rainfall Application ra e: 0. gpd/SF