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
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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
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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
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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.
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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.
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