HomeMy WebLinkAboutSEP1994-00020 JEFFERSON COUNTY PERMIT CEN. a FOR OFFICE U,SE
621 SHERIDAN 4°' RECEIPT # //doe
PORT TOWNSEND WA 98368 AMT. PD fro—
(206) 379-4450 CHECK #
DATE WE•
SEPTIC PERMIT APPLICATION
LEGAL DESCRIPTION: Section 32. Township JD N Range /CJ PARCEL # ,OC,/ '6&4
Subdivision Name Division Block Lot •
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OWNER NAME /C /'� �Cs�l��/�SDill _--' Ci_: r �� ' i /,
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MAILING ADDRESS P,0, .vo-k� 2-S5 `7 0_Xec—ziL-c_e_A )
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PHONE 3,5'S /YS-6
SITE ADDRESS/DIRECTIONS / moi% _52,V714- oN 4csid i .8444 Ali
5,1c a,c' 4471 S,c% of /CoC.`LA-4c --,8/ue(ATTACH MAP)
TYPE OF STRUCTURE' f e. ,d etc e
TYPE OF WQ.R K
1/ NEW UPGRADE REDESIGN
REPAIR /
PARTIAL (tank or drainfield) /COMPLETE RECEIVED
Number of Bedrooms _ 3 Basement yes ✓no
Site Size 1 26 acres JAN $ 1994
JEFFERSON EERTY
Previous evaluation yes /no RNT
Water Source private r public
drilled well dug well other
ATTACH SOILS INFORMATION
TYPE OF SYSTEM CO&UeAy 7 (WA! 7?we 4
Drainfield Length _ LSO' Drainfield Width .36. "
Trench/Bed Depth 2.6"
Number of Lines 3
Tank size /b6C0 gallons
Soil type Application Rate gal/sq.ft/day
THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT
FLASE INFORMATION WILL NEGATE AND INVALIDATES THE APPLICATION AND/OR THE SUBSEQUENT PERMIT.
THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES.
Signature Date
**************************************************************************************
OFFICE USE ONLY /a
Gig K.1-14 . - 'I'
APPROVED PARTIAL FINAL
RENEWED RENEWED
h:\HOME\PLNCNTR\INFOHLTH\PERM IT.FRM
SEWAGE DISPOSAL PERMIT
JEFFERSON COUNTY PERMIT CENTER
621 SHERIDAN STREET, PORT TOWNSEND, WA 98368 (206) 379-4450
PERMIT NUMBER:SEP94-0020
ISSUE DATE: 02/17/94
DATE RECEIVED: 01/28/94
Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE
DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON
ISSUED TO • PHYLLIS WESTERFIELD
Os7 45 STR: 32-30-01W
PARCEL NUMBER • 901324'021
(Permit valid for this/these parcel(s) ONLY)
LEGAL DESCRIPTION/SUBDIVISION: BLOCK:
LOT(S) :
LOCATION • ADELMA BEACH RD
DESIGNER • ED THOMPSON
THIS PERMIT IS ISSUED FOR A PERIOD OF ONE YEAR (UNLESS OTHERWISE STATED
BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR ON-
SITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO. 1-83 .
DATE OF EXPIRATION:02/17/95 4--
Jefferson Co. Environmental Health Specialist.
The property owner will be 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 building or
sewage disposal plans (including plumbing stubout location) and/or location
of house or drainfield invalidates this permit unless prior approval is
obtained from the Jefferson Co. Health Dept.
Issuance of a permit or renewal does not preclude the applicant from
complying with all other state and local land use, planning and building
regulations .
HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION.
TYPE OF SYSTEM: CONVENTIONAL TRENCH NO. OF BEDROOMS : 3
Drainfield Trench Tank
Length: 150 ft. Width: 3 . 0 ft. Depth: 26 in. Size: 1000 gal .
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
1111 4111
Conditions of Approval - Permit no. : SEP94-0020
For: PHYLLIS WESTERFIELD
Page: 2
1) Primary drainfield is to be installed in the area of test holes #1
and #3, contact designer prior to installation for staking of
drainifeld area.
2) Installer will verify pump requirements at time of final
inspection.
3) A riser will be required over the pump chamber.
4) Maintain a 5 foot setback from the property lines with the
drainfield areas .
5) Drainlines are to be installed along the natural contours .
6) Divert all sources of drainage away from septic tank and drainfield
area.
7 ) All components of the septic system are to be completely protected
from vehicular traffic or mechanical disturbance. Protective
barriers may be required around the drainfield areas .
8) When/if designated reserve area is utilized an alternative system
may be required.
sepprmt.txt 09/05/91