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HomeMy WebLinkAboutSEP1975-00123 Monitoring Inspection Site Plan Update Include the following items on the site plan Case# 5e/9 7c-00 /2 3 Property boundaries ➢ Drainfield area if known Parcel# g 783 00150/ y Names of adjacent streets ➢ Septic tanks and/or Pump chamber Address /05-3 V iehQG'�/' i Driveways and parking areas ➢ Wells w/distance to O55 components Prepared by /440944 ft, `of i> Surface water(ponds,creeks,etc) ➢ Buildings-residence,sheds,garages,etc Date Prepared .-""/?/.7 Y North Arrow i , K 11(\al ---- '09' el: ..,4, a1.. °5® k\t,,,,,,: ,,, t .4.4.'S j '‘1.)1,•—iine L citi i 1 r1 Plot plan submitted Cby� �, ('re as a part of a Monitoring inspection Not reviewed or approved by JCPH. a PROPERTY OWNER MAILING ADDRESS PHONE SYSTEM DESIGNER Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 SEPTIC PERMIT APPLICATION /A1r SUN s � Rich Holtman 9 ,M - e.te--- 8// Nathan N. Cleaver Designer Phone #(360) 598-6546 ►IrlGli LEGAL DESCRIPTION: Section 10 Township 29N Range 1W PARCEL # 978 300 601 Subdivision Name Olson's to Irondale Division Block 6_ Lot(s) 1-8 Site address/Directions to site See Vicinity Map on Design SOURCE OF SEWAGE/USE Residential Residential ADU Commercial x_ Community SYSTEM TYPE Conventional Alternative SYSTEM DETAILS TYPE OF WORK New Modification _ Expansion Upgrade Repair Partial Repair - (tank) (drainfield) Designate Reserve Area x Redesign WATER SOURCE Private Public x SITE SIZE 41.266 Previous Evaluation Yes # SEP75-123 No Number of Gallons/day Soil type (attach soil eval.) ApplicationRate gal./sq.ft./day Drainfield Length ft. Trench Width ft. Trench/Bed Depth in. Septic Tank size _gal. Pump Chamber size_gal. TYPE OF SYSTEM Desionating a Reserve Area Only (See attached change in use description) 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 tf 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 applig�aon will be separatgWJudged by the rules and laws in effect at that time. C— '®2! Owner Signature Date FOR OFFICE USE ONLY auck OK 1�g-cJ _ PARTIAL ASBUILT FINAL APPROVED INSP/PUMP TEST PUD ALL HOLD REQ. MET S� Dat Fee IU2 Rec #`�I I�f)62- Check # Case # SEP SON NOS° �TE�'iOl�t COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street , Port Townsend, WA 98368 Al Scalf, Director Letter of Representation* When an applicant for a permit is not the owner of the property it is necessary for the property owner to submit a letter of representation. The letter needs to have the owner's original signature. An example is below: Date To Whom It May Concern: I, John Doe, owner of 123 Fir Street, Parcel # 123-456-789, give permission to Tom Sawyer to apply for a permit on the above referenced property. Sincerely, To Whom It May Concern: �'y'y fie //,0!2j�o ,, owner of /��►^, (propegybwnees ormitej a r gg or ega c p Parcel # _ �� :�a° �v61 give permission toi' �� (par' 1.nuTTi�,er.).... _.____. (appUranYs name)-- - to apply for a .fie dV< ermit from Jefferson County on the above type of permit) referenced property. Sincerely, Building Permits/Inspections (360) 379-4450 GAPanni1CentedF0RM8%Lelter of Representa8on.doc I' �P y V7 Development Revimivision Dong Range Planning PRIX: (360) 379-4451 Nathan Cleaver Septic Design Inc. Contractor Registration#: NATHACS940O2 Soil Logs Re: Tax Parcel #: 978-300-601 Rich Holtman 10534 Rhody Drive Chimacum Wa 98325 Soil Logging done on 5/22/2007 Soil Log #1 0-28' Sand 28 " Excessive avelly Sand 5/29/07 Please feel free to call with any questions. t' Thank you, �s Nathan N. Cleaver Address: Telephone: 360-598-6546 1990 Kimball St NW Fax: 360-598-6548 Poulsbo, WA 98370 Email: nathan®nathancleaver.com Please call ahead to make an appointment if you would like to meet with me. Nathan Cleaver Septic Design Inc. Contractor Registration#: NATHACS94002 To: Jefferson County Environmental Health 615 Sheridan St. Port Townsend, WA 98339 Re: Rich Holtman, 10534 Rhody Drive, TP#: 978 300 601 Change in Use Description: The septic system at the above referenced house was installed for a Single Family Residence. As shown on the permit SEP75-123, the system was sized as a 3 bedroom system approved to treat and dispose of 360 gallons per day. The house will now be used for the office of Highway Specialties. The following describes the wastewater flow that will enter the septic system. Please refer to the attached Table 3-4 from the 2002 EPA manual. 3 employees including the owner 1 full time office worker 16 gpd 2 people making deliveries (mostly away from the office) X l Ogal each 20 gpd Customers At this time retail sales are not part of the proposed activities at this site. However, in the event that retail sales were incorporated at some future time, the following activity would be anticipated. 10 Customers per day (this is a high estimate) X 5 gallons each Total anticipated gallons per day 85-100 The anticipated daily flow for this commercial use is well under the design capacity of the existing septic system. It should be noted that only sanitary waste may be discharged to an on-site septic system. This means that the waste strength can not and is not expected to exceed residential waste strength levels. Please feel free to call with any questions. Cell 360-620-4216 Thank you, ° J 0 r Nathan N. Cleaver Licensed Onsite Wastewater Treatment System Designer. Address: 1990 Kimball St. NW Telephone: 360-598-6546 Fax: 360-598-6548 Poulsbo, WA 98370 Email: nathan@ncsdi.com Please call ahead to make an appointment if you would like to meet with me. Table 3.4.Typical wastewater flow rates from commercial sources" .Some systems serving more than 20 people might be regulated under USEPXs Class V Underground Injection Control (UIC) Program. See httpJ/anbw.epa.gov/safewater/uic.MmI for more Information. "These data Incorporate the effect of fbdures complying with the U.S. Energy. Policy (EPAC1) of 1994. ° Disposal of automotive wastes via subsurface wastewater infiltration systenls.9s t Class V UIC regulations to protect ground water. See httpl/www.epa.gov/safewater/ulc.htmi for more information. Source: Crites and Tchobanoglous,1998. 3.3.3 Variability of wastewater,, vy �. F��yre 3-3. Daily indoor water use pattern for single-family residence Flow, gallonssfunlVday Flow, IRersfunlVday Facility Unit Range Typical Range Typical Airport Passenger 2-4 3 8-15 11 Apartment house Person 40-80 50 150-300 190 Automobile service station` Vehicle served 8-15 12 30-57 45 Employee 9-15 13 34-57 49 Bar Customer 1-5 3 4-19 11 Employee 10-16 13 38-61 49 Boarding house Person 2520 40 95-230 150 Department store Toilet room 400200 500 1,500-2,300 1,900 Wastewater flow can vary significantly from day to Employee 8-15 10 30-57 38 Hotel Guest 40-60 50 150-230 190 Employee 8-13 10 30-49 38 Industrial building (sanitary waste only) Employee 7-16 13 2621 49 Laundry (self-service) Machine 450250 IsI 1,700-2,500 2,100 Wash 45-55 f f P 50 170-210 190 Office Employes -16 13 26-61 49 Public lavatory User 32 5 11-23 19 Restaurant (with toilet) Meal 2-4 3 8-15 11 Conventional Customer 8-10 9 30-38 34 Short order Customer 6 1120 23 Bar/cocktail lounge Customer -4, `7--113 C U� / � 7 8-15 11 Shopping anter Employee 10 26-49 38 Parking space 1-3 2 4-11 8 Theater Seat 2 3 8-15 11 .Some systems serving more than 20 people might be regulated under USEPXs Class V Underground Injection Control (UIC) Program. See httpJ/anbw.epa.gov/safewater/uic.MmI for more Information. "These data Incorporate the effect of fbdures complying with the U.S. Energy. Policy (EPAC1) of 1994. ° Disposal of automotive wastes via subsurface wastewater infiltration systenls.9s t Class V UIC regulations to protect ground water. See httpl/www.epa.gov/safewater/ulc.htmi for more information. Source: Crites and Tchobanoglous,1998. 3.3.3 Variability of wastewater,, vy �. F��yre 3-3. Daily indoor water use pattern for single-family residence Variability of wastewater flow is usually character- 15 4 T- TOILET D -DISH WASH ized by daily and hourly minimum and maximum L - LAUNDRY 'W - WATER ,SOFTENER flows and instantaneous peak flows that occur S - BATH ISHOWER" fl - BOTHER during the day. The intermittent occurrence of 3 individual wastewater -generating activities can ear IO Ct create large variations in wastewater flows fromn. 8 residential or nonresidential establishments. This e variability can affect gravity -fed onsite systems by potentially causing hydraulic overloads of the i system during peak flow conditions. Figure 3-3 T T illustrates the routine fluctuations in wastewater. flows for a typical residential dwelling. O MN 3 6 J iV £+ 9 MN Wastewater flow can vary significantly from day to TJ ME OF DAY day. Minimum hourly flows of zero are typical for Source: University of Wisconsin, 1978. USEPA Onsite Wastewater Treatment Systems Manual 3-7 Q: 0 F+ m O CD r+ 00 n' 2) CL CD C Q r+ s CD 5' v CD Q m 0 0� � C o p I ► � r _ �6' W W N Q o m 7 S. N o m a t bsw rot 3 O 113 �p o -.4 = v 0rt x o p O rt � l0 � o Z a < o 7N � 4 K rt P) lunH m rn 0 F+ m O CD r+ 00 n' 2) CL CD C Q r+ s CD 5' v CD Q r a� m 0 LO) N N O CD N Ln rn Cil 7 (b o • m 0 0� � C o p I ► � o �`" �6' W W Ok Q o m w S. o m a Q 3 O m o -.4 = v N D o p O rt � l0 � o Z a < o 7N � 4 rt m m g = N 25' I A xCD Ln i W n. n ft I CL � o Q 4� go 0 ' I a y 22' m w u' n � I N pop ' r a� m 0 LO) N N O CD N Ln rn Cil 7 (b o • I i � m o I ► � : �`" �6' c �' Q o CL S. o m a Q O m .� ntG � Co o m0 o 9 c o a < o a � _. rt rt m an�aC1 dpi X ' ►� L S9 v @. �8g' CD - -_j- CL m .� D o m cr a _. rt m rn g = N 25' I I Ln i W n. n ft I CL � o Q ' I y 22' m � I N i I� N —J -n 0' z 0) m o m C+ << m .0 c x m r+ cn m o 0 tQ m m 160' cn V1 D Z Z� W C � A er 903 E. Carolia6 OLft1C HEAL'$ DISTRICT_ Permit No.. Port Angeles SWAGE DISPOSAL PERMIT APPLICATION Submit in Dgiicate Blinder Court House: Port -Townsend, Y Date -�� ADDRESS PHONE , 313 DIRECTIONS FOIA LOCATING SITE 5 la\ `til -•� ��•�`��� ' APPLICATION IS HEREBYom MADE T0: INSTALL N„ AIR EXISTING -SYSTEM � OF BUILDING go*- SEDROQMS BASEMENT TE S NAME OF ZNSTALLFiR DRAINFIEID LENGTH l�Q;dIDTH DEPTH+#LINES S TANK SIZE �%Sc� DRAW A DETAILED PLOT PLAN ELAW:• SEE INST:2UCTIONO. SOIL TYPE C 12 5 My CHANGE IN BUILDIN OR SV-',kGE DISPOSAL PLANS, LOCATION_ OR SITVEYLIRALIDATES TH, ° ^'J PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. D'TE OF INSTALLATION SIGNATURE OF APPLICANT Ar�tOVID DATE '7 INSPECTED BYDATE SANITARIAN I S COWENTS : I CERTIFY THAT THIS SYSTEM '.•SAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTME NT AAT INSTALLERS NAME """� • '�"'"� k� - - t i. -S1-31101 / w/o Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368 (360) 379-44450 Evaluation of an Existing Onsite Sewage System (EES) Draw on the back of this sheet a current plot plan showing location of: Buildings, Drainfieids, Septic Tanks, Wells, etc OR attach a current plot plan identifying these Items. ALL SPACES MUST BE FILLED IN. If information Is not available enter (NV) or not applicable (NA). Type of Evaluation I/Evaluation of do -site sewsge system ❑ Evaluation of drinking water ❑ Evaluation of on-site sewage & drinking water Office Use Only Date -1514 10-7 Fee 4D Recpt599_1Z Check case # 5-1 Reason for Evaluation ❑ Routine Operation and Monitoring Inspection ❑ Real Estate transaction ❑Complete a Permit # ie Building Permit Review and/or no septic permit on file Rr Other. explain (IAMgrE 0CySi; Date of evaluation Inspected by _AA nn YAx KI YJ f Tax Parcel #1M M jO(/ jfj Permitted System yes no Permit/case # SEP Subdivision, Division, Block and Lot(s) ®GAO) S 7`ii° I R6hbLE AK 6 l-ffj- %—e Lot Size Acres or Dimensions X i 0 Current Owner -TQ1t7 l j t f -gF`j Site Address0 5, I����?r��.���%d�� r s� Owner Phone # 5r A;L6 A 14Te Previous property owner name(s) - (NN if not known) ,Bb'9 Oh7A;5 Directions to Site , G13 /� N .RA Af6,� rr� Date System Installed Yl) ql ,V _ _ Age of Dwelling / / ye # Bedrooms_ House Occupied - p� Yes no, vacant how long? Who installed system? L.it?JIS;¢I'FS Send completed report to: Owner Name, 1 GjN 1317SO1� Mailing Address—L-5— /-z WAY PaRr 6.. LwLe ��- 78J 6S Phone/emailffax Realtor or Other Representative b Randy Calkins Nam e1� / C lt/ (T �.7"�yJ/� F'1 North Sound Septic SawRo9 601 Warner Rd Mailing AddressQ, - k14 Port Ludlow WA Phone%malUfax 37--1 yQQ $33q : 360437-070W' EES Evaluation Form 07-30-Od_pdf w Include the following items on your plot plan: �j Property boundaries f' 0-f V fl?) f'lfp d Names of adjacent streets Q/ Driveways and parking spaces e Suriaw water (ponds.c reeks, etc) n d �7 coo' Buildings(residence, sheds, garages, etc) M/wens PV 1311 G A/ Septic tank l/ Orainfidkl (enter NN if unknown) no d North arrow Permit # or Parcel 54P 7�-- I ) 3 9v21uation of an ng Onstte Sewage System _07f30104Jadf a Date of Inspection 11f QZ6f,7 • Inspected by ,AAopy -Water supply (fill in only if water supply is being tested in this evaluation) Sample was taken_______Yes No Sample Results v1 Well casing 12" above ground __Yes No Sanitary Seal in place Yes No Public: offsite onsite Name of System Individual: offsite onsite Is well more than 100' to drainfield/disposal component _yes no, if not, distance Is well more than 50' to tanks and effluent transport line _yes no, if not, distance ONSITE SEWAGE SYSTEM # Bedmoms/gallons per day indicated in County Health Dept records for this case P,!%�i rv► #1 - Septic Tank Tank size::: gaL, single compartment____ w compartment C®hL. ff�_ material Riser to grade on inlet ves no Riser to grade on outlet _yes no Condition of tank _needs repair. describe 1st comp. Scum (top layer) _In. sludge (bottom layer) C_ in. 2nd comp, scum ! in. sludge in. Was ground water observed leaking into tank 7,ves no If yes, where was water observed? / Condition of baffles: Inlet: _ Outlet: Screened Outlet Septic tank needs to be pumped (per ads repair - c*45r /R6si material (PVC,Concrete) Ws repair _ r. MEL 1907 material (PVC,concrete) condition clean dogged/dirly County code 8.15.150 (1) (b)) y no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: Does system include a pump? yes If yes, complete the next section >nono skip to section 3) #2-- Pump Chamber Tank size gal--n/—A— Material. Riser to grade? _ ves no Condition of tank 000d needs repair, describe Solids in Tank (see 8.15.150) yes no scum In. sludge in. Was Ground water observed leaking Into tank ? yes no If yes, where was water observed? Screen around pump? no ---Yes, conditlon_,^ dean dirty/dogged Shroud around pump? no __ves Electrical Components Pump operating-vesno, describe High water alarm functions yes no, if no, describe Elec. Panel condition 900 -needs repair, describe Pump cycle drawdown inches. Time for pump cycle mm/sec. - Timer Settings min/sec on mbAm off Floats secured: ves no Pemdt # or Parcel .Evaluation of an 5CP 75-193 A System _07/30/04 #3 — Drainfield Appropriate Vegetation in area --___yes no Describe vegetation, &KI ji G Indications of surfacing sewage (check one) ves , if yes, describe and diagram on plot plan n drainfield area is overgrown and not observable Signs of parking/driving in area no drainfield area unknown Ground settling or erosion VAS no overgrown/not observable Monitoring Port Observations (if present). Residual Head -Yes, —/?/A # of inches no Ponding In trench s, # of Ies of ponded effluent no Repair area is? Available as shown on permitNone evaluated or shown on permit Addendum (page 5) Is attached for evaluation of Treatment Unit or detailed evaluation of drainfleld _ yes no COMMENTS (attach additional sheet if necessary); /E9)111T ' PW,4W,j7 6- Yiv ws AOR srMUE, __.-----�° Was a System Problem IdenitfiedtYesJ—if yes, what section #. No This report on the existing onsite sewage system is valid for the permitted or historic (if installed prior to permit requirements) use of the system only and does not constitute assurance of future County approvals (such as building permits) on this parcel. Any future application will be judged separately by the rules and laws in effect at that time. I certify that the information provided is based on a review of County records and my, d' observations at the time of inspection. 1/7 ot,7 Name/Sig1!�a- � mvatsNo guarantee of future onsite sews a g system performance is implied or granted based on the information contained in this report. This report constitutes a summary of findings only. Permit # or Parcel # J CJ / j •- /� Evaluation of an Existing Onsite Sewage System 07 - 12/06/2004 12:45 3603859197 JEFF CO ASSESSOR PAGE 01/01 PARCEL No.9 0/ Sec. Lot TWp Rge Block District Code Olson `s �c� �.rond�.le ►-'� 9 (`' I� at..' callo 1,S-'74 '-)QAO Description TBR C❑ C ❑ Grade Ac Os A❑ OS C1 T❑ Grade Ac Refor ❑ Ac YEAR IMPROVED UNIMPROVED TIMBER LAND TOTAL IMp8 TTOTAL, VALUE Comments --�• ACRE VALUE ACRE VALUE ACRE VALUE ACRE VALUE VAWE .NIOR CITIZEN EXEMPTION .AR -de I -de II COUNTY ASSESSOR PART TOWNSEND WASHINGTON 98308 It BUILDING PERMIT APPLICATION I�IReview59 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368. PERMIT #: BLD04-00736 Received Date: 11/23/2004 SITE ADDRESS: 10534 RHODY DR CHIMACUM, 98325 OWNER: ANTHONY RICHARDSON PHONE (360)385-0002 SUSAN RICHARDSON 10565 RHODY DR PORT HADLOCK WA 98339 SUBDIVISION: OLSON'S TO IRONDALE Block: 6 Lot: 1-8 PARCEL NUMBER: 978300601 Section: 10 Township. 29 N Range: 01 W CONTRACTOR: REPRESENTATIVE: OWNERIBUILDER PROJECT DESCRIPTIO? SIGN PHONE: PHONE: TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP SGN MAIN: INDUSTRIAL: VALUATION 250.00 F&W Landslide CODE EDITION: 2003 ADD'L HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK DECK BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing ate: 6 r-1% NUMBER OF EMPLOYEES: PARCEL TAGS: YES NO STORMWATER: YES NO AREA Wetland Erosion Seismic Streams Flood Way Floodplain F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid BY: Date: Receipt: Approved/Date Permit $38.75 BAC 11/23/04 68801 Plan Check $25.19 BAC 11/23/04 68801 State Building Cade $4.50 BAC 11/23/04 68801 n Total: $68.44 (� GIMIL=-- ArdMS HTML A llC 94MCOM Im'"OVOY SUSM102 NnO%% 94,Z=Mn6XW I .- owoxft "3eWM4 "nouft *MMM %noxw s4MIM F-WZ-ANAT OM00,110 f I qMX0103 9Y I04 WMM ST tl 0429ONM L I fe 97832 Mao ivy jeefum C*d" .*W VC" CAS 1 943BOW14.. 04290M), 13 9DIOM10 INFORMATIONAL PURPOSES ONLY- fson County does not attest to the accuracy of the data contained herein and makes no warranty respect to its correctness or validity. Data contained in this map is limited by the method and racy of its collection. Sat Oct 3014:45:23 2004 NOV 2 3 20046. Un, cA e, 9e3 ro,-5 hftp://MaM.co.j,effemn.wa.uslservlelVcomesri.esfimap.Estijmp?Sen&eName=ovmap_putside&Client-- 10/30/2M L"and -raw,, t,l RoW Sydem El Pames-H Wow INFORMATIONAL PURPOSES ONLY- fson County does not attest to the accuracy of the data contained herein and makes no warranty respect to its correctness or validity. Data contained in this map is limited by the method and racy of its collection. Sat Oct 3014:45:23 2004 NOV 2 3 20046. Un, cA e, 9e3 ro,-5 hftp://MaM.co.j,effemn.wa.uslservlelVcomesri.esfimap.Estijmp?Sen&eName=ovmap_putside&Client-- 10/30/2M