HomeMy WebLinkAboutSEP2015-00024 r
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Jefferson County Department of Community Development P�0 Au.,, ��
621 Sheridan St., Port Townsend WA 98368, (360)379-4450 .,• o t,; •� _ /r
SEPTIC PERMIT APPLICATION F : 4 'r`�,r-T-'::‘,„, ' i, r
PROPERTY OWNER Joe and Nancy McGloughlin AUG 0 49 �" + d
2�i5 I MI i,
MAILING ADDRESS P.O. Box 868
Shady Cove, OR 97539 3' ,9,. > ' ,'
PHONE ( 541 ) 261-9099 ;r \\,, t' f i;;, 14
SYSTEM DESIGNER Paul Austin Designer Phone# 360-698-1',6,1 ''"
-ft 1ra` r,
LEGAL DESCRIPTION: Section 23 Township 2 8NRange IE PARCEL# 983400412 t41 ,, =I
Subdivision Name Paradise Bay Estates r Division Block 4 Lot(s) 15
Site address/Directions to site ) 4O E I I `tel)od S� • .t.11- Au
SOURCE OF SEWAGE/USE TYPE OF WORK '•�i' /
WATERS• - : �f� • /�
Residential x New Tank/s only x Private ;. _ ',
Residential ADU Modification Public f.:�//a -"7' f
Commercial Expansion �dVk' ti
Community Upgrade `��V� .
`'`i►'\
Repair SITE SIZE 00 i w4
SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous E ,.. 7',, e '
Conventional x Designate Reserve Area Yes# \y. I }
Alternative Redesign x No
SYSTEM DETAILS
Number of Gallons/day 120 Soil type N/A (attach soil eval.) Application Rate N/A gal./sq.ft./day
Drainfield Length 120 EXft. Trench Width N/Aft. Trench/Bed Depth N/A in.
Septic Tank size 10 0 0gal. Pump Chamber size n/A sal.
i
TYPE of system r„ ;-i / D ,
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 application will be separately judged by the rules and laws in effect at that time.
9 -7ki.4./ ..____-
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Property Owner Signature l Dat ,
a tA)A co(Y•e�t�e) ep C6�d
FOR OFFICE USE ONLY /1(10113'/J
4//i -- PARTIAL g7iz/i7 hD ASBUILT eerl /(O / FINA.. a°L/j
APPROVED
INSP/PUMP TEST �I -+�,,.,,.tri 001;c:t -5.
ALL HOLD REQ.MET
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Date e 7 - Fee CP Rec# 1 e `/ 7 Check# //511)--- Case#SkP -0 Li
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`1 JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street•Port Townsend•Washington •98368
2ifi tii+'c
www.jefferson countyp ub licheakh.o rg
I-11one 36U-38b-9444 I-ax MU-3/9-448f
ON-SITE SEWAGE DISPOSAL PERMIT
PERMIT #: SEP15-00024 Date Received: 03/02/15
Date Issued: 08/06/15
SITE ADDRESS: 140 E HEMLOCK ST Date Expires: 11/06/15
PORT LUDLOW, WA 98365
APPLICANT: JOE MC GLOTHLAN PHONE:
NANCY MC GLOTHLAN
PO BOX 868
SHADY COVE OR 97539-0868
LEGAL DESCRIPTION: PARADISE BAY ESTATES BLK 4 LOT 15
PARCEL#: 983400412 Section: 23 Township: 28N Range: 1E
DESIGNER: ERIC CLEAVER PHONE: 360-620-2276
CLEAVER CONSTRUCTION
19351 8TH AVE NE SUITE 110
POULSBO WA 98370
SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS
No. of Gallons per Day: 120 Type of work: REP
Drainfield Trench Septic Tank
Length: 0 feet Width: feet Depth: 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 Environrfiental 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 ADDITIONAL PAGES
CONDITIONS OF APPROVAL - PERMIT NO.: SEP15-00024
1.) This permit was issued to correct a violation of WAC 246-272A for an improperly draining septic
tank, causing sewer gas smell in home. The permit must be completed within 90 days of the date
of issuance.
2.) should a poly tank be substituted for the concrete tank it must be 2 compartment, have risers to
grade, be a minimum of 900 gallons in size AND be the current state approved list of tanks.
3.) 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.
4.) 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
5.) 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.
6.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health
ONE WORKING DAY prior to start.
7.) H - An asbuilt drawing and certification of completion by the Designer is required prior to final
approval.
8.) 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.
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.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
11.) 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.
12.) H - 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.
13.) 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.
14.) 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.
SEP15-00024 Page 2 of 2
\\tidemark\data\forms\F_SE P_Perm itm od.rpt 8/6/2015
CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT
INSTALLER Cleaver Construction-Taylor Johnatakis PARCEL # 983400412
Permit Owner Joe& Nancy K8cG|ouqh1in Permit # SEP 15-00024
ABSORPTION AREA:
DRAINFIELD TRENCH TRENCH TANK # OF #G/\U
LENGTH 120' WIDTH N/A DEPTH N/A SIZE 1000 BEDRMS 1 DAY 120
Tank Shroud/
IF PUMP AND PUMP CHAMBER REQUIRED: Size N/A Screen N/A
Float Arrangement N/A
High water float— distance to top of tank/emergency storage N/A
Dose drawdown (# of inches) N/A # Gallons/Dose N/A
Timer/Dose Counter info N/A Pump Size/ Manufacturer N/A
I CERTIFY THIS ONSITE SEWAGE SYSTEM WAS INSTALLED AS DES|GNEO, PER PLAN APPROVED
�� �
�//�� /5 DATE
INSTALLER SIGNATURE DATE INSTALLED
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• . Joe McGloughlin 50'
Telephone Pole
140 E Hemlock •
Port Ludlow, WA
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Tax ID: 983400412
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A. Double Sweep Tee with o„) c,G $Sanitary Cleanout
— F / �
B. Infiltrator 1060 • ' °'i�4
Poly-Septic Tank
C.4"- 3034 PVC Transport Line
D. Existing Distribution Box
E. Existing Drainfield Existing
F. Existing Inspection Ports Carport E. E.
Construction Note:
Pumped old tank dry,crushed concrete
tank and replaced with 1000 Gallon
concrete or Poly tank. Grade
should be set such that 2%slope
can be acheived to Distribution box. - ob
Used 5/8 Pea Gravel below tank. 100 T 100
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Deck
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10+/-
' TrailerMobile 36'+/
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e 14';;sjHome/ 2 bed
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Cleaver Construction, inc
Drafter:Taylor Johnatakis
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Engineer: Paul Austin N
October 2015 O O 8
1-844-CLEAVER / C -1 D.
www.CleaverSeptic.com See Construction Note J
B.
Scale 1:1050 5'Setback
4 4
615 Sheridan Street
fieffetson
•„., Port Townsend, WA 9:368
CPuntY
Public Health www.JeffersonCountyPublicHer
CERTIFICATION OF TANK DECOMMISSIONING o
Parcel number 131160 W„,2 e\
Address /i/ei ile,nhck s /rot LI /t/A 0
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Property Owner Name jee licOhein
Septic Permit# (if applicable) Sepp /5-42924/
Individual/Company Certifying Abandonment
7.--Avhr cleAnAbsiCs/efer,ww. sW'&//o'2
Phone Number (36077/ —S6.6.2
I certify that all sewage was removed from the septic tank and/or pump chamber
on the above referenced site by a Jefferson County Certified Septic Tank
Pumper, the lid was crushed and the tank filled with soil or gravel.
I certify that the septic tank and/or pump chamber on the above referenced site
has been decommissioned to Washington State and Jefferson County Public
Health Requirements.
Signature CZ-N Date 444.5
Print Name 7)/‘, Ic
Pump receipt attached X
Community Health Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
360-385-9401 (f) AIWCWS working for a safer and healthier community (f)360-379-4487
H:\WEMEH-WQ\SEPTIC\Applications-Fonns\cert tank abandon.doc
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Port Tovvrisc.na, WA 98368
'itilittit PH 360-379-9400
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STATE,ZiP CITY,STATE,ZIP
STONIER ORDER NO. SOLD BY [TERMS FOB. I DATE
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1DERED I SHIPPED DESCRIPTION PRICE UNIT AMOUNT
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WAS 11 I* 'it\ (Ate bryl e/e&osimisimed 4.1A $ 5 .
50'
Joe McGloughlin Telephone Pole
Nit •
140E Hemlock .
Port Ludlow, WA 3
Tax I D: �,� N , �, 4��0 ' ',_ i%),jib
��1rp4s cot► I $ 0''�
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A. Double Sweep Tee with / \ 4
Sanitary Cleanout J `� -�
B. 1000 Gallon Septic Tank Existing O`12- 91444H
to be placed in Same location Carport EtZ-2- L'S *oka
as current tank. Raise grade to zg j(, ^'t
get drop to D-Box. yikk 1 'i , �
C.4" 3034 PVC Transport Line ��� � ivki -
D. Existing Distribution Box ti
E. Existing Drainfield
F. Existing Inspection Ports
100' – – ,0 ° 100'
Construction Note: TO
Pump tank dry,remove concrete 'i
tank and replace with 1000 Gallon J Deck
concreted Grade c'
poshould be set such that 2%slope .lo _
can be acheived to Distribution box.
Use 5/8 Pea Gravel below tank. io+i-
3'
tA1f _ TrailHomebile 36'+/-
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2 bed
0°.,q0'. /Alink DN itoj-I ,
Deck —12_, ^
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Cleaver Construction, inc Q .. ti -, °'c��
Drafter:Taylor Johnatakis B. p • ,°�
Engineer: Paul Austin Nl. IL ..6.0
February 2015 � \ O J lel 7 - +
1-844-CLEAVER / 16' ! 7gc��.a ���4
www.Cl c e�eff c�r fe, dri - ay, accessee Construction Note C. ci‘s1 ALV4"
Scale 1:Q1 other appurtenance has been 50'
reviewed or appr•ved by
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EK ENGINEERING INC DATE:
6/13/11 TANK. N
COST14RUGONRE.& BAR SCHEDULE FOR.MOI)t.:4 -U
* DRAFTED BY: 1000 S, 1000 S-T, c)>
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P.O.BOX 3097 BATTLE GROUND,WA 98604 D.R.N. 1000 P & 1000 P-T
PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE: 01
NTS HAGERMAN PRE-CAST
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Austin Engineerings Am
Professional Engineer, Civil and Land Surveyor 4°A,
Paul Austin, PE �5 Cpl
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Background by
The septic system was installed in 1978, at the time of installation it appears the
septic tank was installed with the outlet baffle 7 inches lower then the distribution
box. Though this seems odd,the lot has been exclusively used as a vacation
property and has not seen continual use. The septic tank in a high water state
would allow flow out to the distribution box and subseque tly the skaln fi d. 14-7c5
)
Drain-feild condition. 2
The drain field was installed at 18" deep and there is 24" of vertical sep ation of
light brown sandy loam. At the time of installation this was more then adequate
for existing codes. There are no signs in any of the three soil logs dug in the drain
field that demonstrate that the drain field is clogged, or otherwise failing.
Overall assessment
It would appear the improper installation of the septic tank is the reason,on a few
occasions,pumpers and inspectors observed the septic tank to be in a high water
state (See Attached JCPH letter June 29, 2010) The distribution box was replaced
in spring of 2015 and this is when it was observed there was a 7" difference in
elevation with the distribution box being higher then the septic tank outlet. There
was no riser or access to the distribution box, and no inspection ports in the drain
field previous to verify that an elevation problem existed. Under normal conditions
this would lead one to think there was clogging in the distribution box or a drain
field failure.
Recommended repair
It is recommended the existing septic tank be decommissioned and a new septic
tank be installed with proper elevation as to have fall to the distribution box and
drainfield. The distribution box has already been replaced, and speed levelers
installed. At time of septic tank installation, installer should verify the distribution
box is distributing equally.
'.7111° 01- AU
P P`‘' ` '�UST '% Q P of AS 11
116.. c_27:"
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Paul Austin, Professional Engineer ti. '�
.;, •- • 44:,; /69(3?),
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4 EXPIRSS
-t/ an Ohs et---.,Le1, , ,JEFFERSON COUNTY HEALTH DEPARTMENT
802 SHERIDAN AVENUE
INSTALLER <.f vi16-r'C.... 1 PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. , /3
(206) 385-0722 /�
BUILDER SEWAGE DISPOSAL PERMIT DATE ( t ,g, 7/
Submit in Duplicate #, r ,M- ;,,,-
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/21 •/ _ X06 4/37 '/0
Owner Address C Phone m
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Directions for locating site r
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INSTALL NEW SYSTEM REPLACE SYSTEM ❑ PARTIAL REPAIR ❑ TANK/DRAINFIELD ❑ -1
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TYPE OF NO. OF SITE z
BUILDING ,70#/c BEDROOMS -I BASEMENT "' SIZE 30 n ( C C v: cn
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING con
SOIL LOGS o —I "`
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Dig two holes per site. (min.) 0
4' deep - 2' dia. - 50' apart & flag APPLICANT IM-S/
Drainfield Length/ Width "2-1.- Depth 7 # Lines e(AC: Tank Sized Gal. D
COMMENTS: 1) Coaz� ,� *ap-.,1 ,,,3 k. S �, �,e -� (TWO COMPARTMENTS) a c
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APPROV D DATE INSPECTED PAR ' AL/F AL ..) \C
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I certify that this sys m w s . stal -d in a manner approved by the Health Department. l
&-41-'(-1-,-/ e if-,3 /-2( r-)6 - 76'
INSTALLER'S SIGNATURE DATE DATE INSTALLED
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