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HomeMy WebLinkAboutSEP2017-00059? PHONE SYSTEM DESIGNER Jefferson County Public Health 615 Sheridan St., Port Townsend WA 98368, (360) 385-9444 SEPTIC PERMIT APPLICATION PROPERW OWNER MAILING ADDRESS Leslie Allen PO Box 2036 wA 98370 360 ^ -t@= Suzanne Martin Phone# (360)990-3304 "4d^ LEGALDESCRIPTION: Section 165 Township 27N Range 1E PARCEL #950 100417 Subdivision Name Trails End Homesites Division Block 4 ?At Site address/Directions to 553 Seattle Drive- By signing the application form, the applicanUowner 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 applicanUowner 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. lnspections shall occur during regular business hours. lnitial 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. 3_ t4- L7 Property ignature (..,a WATER SOURCE PrivateeuuticF SOURCE OF SEVIIAGE/USE Residential { ResidentialADU _ Commercial Community_ TYPE OF WORKNew_l_ Tank/s only_ Modification_ Expansion_ Repair_ Partial Repair - (tank) _ (drainfield)_ Designate Reserve Area_ Redesign_ SITE SIZE +l-29023sf Previous Evaluation Yes #No/ SYSTEM TYPE Conventional { Alternative_ SYSTEM DETAILS Number of Gallons/day 360 Soil type-!- (attach soil eval.) Application Rate 0.60 gal./sq.ft./day Drainfield Length 200 ft. Trench Width 3 ft. Trench/Bed Depth 12-24" in. TypE OF gyglglg converrtional trench aal Pump Chamber size-n/a-galSepticlsnk s;2g 1000 FOR OFFICE USE ONLY (r oa s:o DaE 3// L//7 Rec# / reement ? -3o- 11 JT? 7 OA-Zch""k #-l-O Y.J-case # sEP / 1 - AS? ASBUTLT -i"- a - ALL HOLD MET PARTIAL 6( F'NAL 5- L- zciq Rsr %tq INSP/PUMP resr l'/A Monitoring Ag G:\B-oNslTE\Forms\Application Eorm & Info\201-5 Septic Permit Application.doc Date ry ll e9 -r4l 1.,1r"***_/" Cariqtublic Heolth JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan St. Port Townsend, WA 98368 www. jeffe rso ncou ntyp u b I i chea lth . org Phone 360-385-9444 Fax 360-379-4487 PERMIT #: SITE ADDRESS ON-SITE SEWAGE DISPOSAL PERMIT SEp17-00059 Date Received: 04t1il17 SEATTLE DR Date tssued: 0612311T , WA Date Expires: 06123120 LESLIE ALLEN PHONE: PO BOX 2036 POULSBO WA 98370-0938 APPLICANT: LEGAL DESCRIPTION: TRAILS END HOMESITES BLK 4 LOTS 21, 22,33, & 34 BLA#6008I5 PARCEL #:9501 0041 7 Section: 16 Township: 27N Range: 1E DESIGNER:SUZANNE L MARTIN PO BOX 125 CHIMACUM WA 98325 PHONE: 360-990-3304 SYSTEM DESCRIPTION: No. of Gallons per Day: 360 Drainfield-- Length: 200 feet CONVENTIONAL TRENCH Type of work:NEW -----Trench -------Septic Tank------ Size: 1,000 gallonsWidth: 3 feet Depth: 12 inches DISGLAIMER- 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 wil! 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 Iaws 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. lf 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 MODIFYAN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON This permit is issued for a period of three years (unless othenrvise 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.,Z/hzz J effe rson ( ounty tnviroyintal Hea lth S pecia I ist 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.: SEP17-00059 1.) 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. 2.) Distribution boxes shall be fitted with a riser to grade, constructed of durable materials and a secured lid, adequately sized to allow visible inspection of the liquid level in the box. 3.) H - AS PER WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 ALL ONSTTE SEWAGE SYSTEMS REQUIRE THAT A RESTRICTIVE COVENANT REGARDING THE MONITORING OF THE ONSITE SEPTIC SYSTEM BE RECORDED TO THE PROPERTY TITLE. THE PROPERTY OWNER SHALLASSURE THAT MONITORING IS PROVIDED BYAN APPROVED ENTITYAT THE FREQUENCY DEFINED PER STATE WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 AS ADOPTED OR AMENDED. 4.) 5.) 6.) 7.) A COPY OF THE RECORDED OPERATIONS AND MONITORING AGREEMENT IS REQUIRED PRIOR TO FINALAPPROVAL OF THE SEWAGE DISPOSAL PERMIT 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. Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. H - An asbuilt drawing and certification of completion by the Designer is required prior to final approval. 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. Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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. This approval is valid only with a connection to an approved public water supply. This system as designed and approved is sized for only one single family residence. lt is not sized for an Accessory Dwelling Unit (ADU). The minimum daily design flow per residence is 240 GPD. 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. Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 8.) e.) 12.) 10.) 11.) 13.) sEP17-00059 \\tidemark\data\forms\F_SE P_Perm itmod.rpt Page 2 of 3 6123t2017 14.) 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. 15.) The site plan as submitted with the new onsite septic system application on April 12,2017 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. 16.) This approval is for a new onsite septic system for a single family residence 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.) 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 lnformation Systems mapping review the following CriticalAreas were confirmed to be present on the subject property: high risk seawater intrustion protection zone. 18.) The parcel is located within a High Risk SIPZ (seawater intrusion protection zone) according to the County GIS map. There are mandatory measures identified in the Jefferson County Seawater lntrusion Policy (Resolution 61-02, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. sEP17-00059 \\tidemark\data\form s\F_SEP_Perm itmod. rpt Page 3 of 3 6t23t2017 Permit Owner: CONVENTIONAL SYSTEM AS-BUILT INSPECTION REPORT Shold Excavating (Evan Neville)Parcel# Permit #en 950 100 417 sEP17-00059 Design Flow: 360 qpdDesigner:Suzanne Martin Site Address:543 Seattle Dr, Port Ludlow, WA 98365 lF PUMP AND PUMP CHAMBER REQUIRED: Shroud/Screen Tank Size: nta Float Arrangement High water float - distance to top of tanUemergency storage Dose drawdown (# of inches) # Gallons/Dose Timer/Dose Counter info Pump Size/ Manufacturer COMMENTS (inspection notes, changes from design or deficiencies installation) Attach additional sheet(s) if necessary oPermit Conditions:o 2.) Distribution box has Riser & speed-levellers 4.) Pre-cover inspection was conducted 11 April 2019 7.) OM manualto be mailed Users Manual Provided to Homeowner 1 Mav 2019 Date ATTACH ASBUILT DRAWING signed by Designer or stamped/signed by a Licensed Professional Engineer ICERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY TE) OR THAT CHANGES HAVE BEEN NOTED THIS SYSTEM IS IN COMPLIANCE WITH WAC 346-272 5100342 Signature Date License # DRAINFIELD TRENCH WDTH TRENCH DEPTH TANK SIZE # OF BEDRMS #GAUDAYLENGTH 2oo 3' 12-24" 1000 gal Cotton s 360 spd Record Drawing SEP1 7-00059 Site Area: +/-29023sf Area Soils: lndianola sandy loam,0-15% slope Elevations are approximate/from Jefferson County website N 0 30'60' -r{:I ?0', SCALE 1"=30 FEET t 160' ^, .UL.r lB0' EA ST Legend f reserve Z WSOOH JCHD oss BOD TSS FOG Soil Log Wa. State Department of health Jefferson County Public Health On-Site Sewage Disposal System Biochemical Orygen Demand Total Suspended Solids Fats, Oils & Greasesll, =Eo lrl J o C,c! -F Eoz. LUa o oe. l-rJ:z oz.e.o-F Penmit Conditions 2.1 Distribution box has Riser r speed-LeveLLensl.l Pre-cover inspection was conducted ll ApriL 2019 7.1 0M manuaL to be maiLed system construction has met aLL permit conditions, RS r Gs and appLicabLe state and county codes and poLicies. EAST 2dO.OO REC E,IVED ]\ anat zots Desiqn Parameters:MAY 0 2 2019This system is designed to process 270 gallons of typical residential strength sewage per day with infrequent peak flows of 360 gallons/day. Extended flows above 270 gallons/day or at waste strength above parameters, may cause system failure. Septic Tank efiluent design waste strength parameters (maximum levels): -CBODS: <l=125 mgll -TSS: </=80 mg/l -FOG: </=20 mg/l JEFFEBSON COUNTY 0SS Recond Drawing PreDared for: LesLie ALLeN Lots 21,22,33,34; BLock I; TraiLs End Homesites ParceL t950 l00ll?; SEPI?-00059 Sec. 16; Twp 2?N;RlEwm ApriL 2019 133-28 c onve n n ow in ow in ow ii'l ow ifi tow In d -box (riser & LeveLLers instdLLed ) taLLed sewer Line; astm 3034 taLLed septic tdnk taLLed cLedn -out taLLed 360gpd taLLe tionaL drainfieLd yp icd *l_6fi \I rpr osed wdter Llne -must mdintdin min. rom dl,L 0ss componen ENVIRONMENTAL PUBLIC HEALTH I The intention of this permit appLication is to provide an 0SS f or a new home. The intent is for a 3609pd disposaL system, three bedroom capacity dt the time of permit appLication. ol * lB0' Site Area: +l-29023sf Area Soils: lndianola sandy loam, 0-15% slope Elevations are approximate/from Jefferson County website 0 SCALE 1"=30 FEET N 30'60' CL * t70' roposed d -b x (riser required l EAST .00 E A ST 24O.OO Design Parameters: This system is designed to process 270 gallons of typical residential strength sewage per day with infrequent peak flows of 360 gallons/day. Extended flows above 270 gallons/day or at waste strength above parameters, may cause system failure. Septic Tank effluent design waste strength parameters (maximum levels): -CBODS: <l=125 mgll -TSS: </=80 mg/l -FOG: </=20 mgfl Prooosed OSS Components: @L water-tight septic tank. Distribution box 360 gpd/200|f conventional drainfield. 360 gpd Reserve Drainfield area. 2- 3- 4- Legend r t60' f reserve Z WSDOH JCHD oss BOD TSS FOG Soil Log Wa. State Department of health Jefferson County Public Health On€ite Sewage Disposal System Biochemical Orygen Demand Total Suspended Solids Fats, Oils & Greases ; oc! -Fe.oz. E LIJ U) 0SS InstaLlation Notes:l- Drainf ieLd may be ddjusted by instaLLer f or ease of instdLLdtion. Remove l2'of soiL (fiLLt in the dred of SoiL Log l. TotdL Length of instaLLed drdinfieLd must be 2001f, dLL LdterdLs must be instdILed on contour dnd be of equdL Length. Monitoring ports must be instaLLed to$,drd the distaL dnd pnoximdL ends of edch LateraL.2- Septic tank must be bedded in ped grdveL; 0utLet fiLter must be empLdced in the outLet baffLe of the septic tdnk; risers to the surfdce must be instaLLecl on dLL of the dccess port of the septic tdnk.3- Location of septic tdnk mdy be adjusted according to buiLding site but must mdintdin a minimum of 5'from buiLding founddtion dnd d cLedn-out must be instaLLed between the pLumbing stub dnd the inLet of the septic tank.t- Distribution box must be equipped with speed LeveLLers dnd niser to surfdce.5- 0nLy househoLd wastewdter in the drainfieLd6- Direct dLL drdindge dwdy from drainfieLcl r oss components.1- EstabLish vegetdtive cover ds soon ds possibLe dfter instdlLdtion, to minimize erosion potentidL dnd enhdnce evdpotrdnsDirdtion.8- ALL wdter system components must mdintdin a minimum l0 feet trom aLL o< OE LIJ\z oz.e.o-F ula co?o o o 4" threaded cap slot top .1.5" of pipe if slip cap is used BackfillMaterial on -site sewds,e disposaL rr"tt{ponents. A-*p.%January 2017 0SS Site PLan Preoared for: LesLie ALLen Lots 21,22,33,3d; BLock l; TraiLs End Homesites ParceL t950 100 417 Sec. l6; Twp 2?N;RlEwm January 2017 126-38 DrainfieldTrench SL -4 roposed sewer Line; astm 3034 proposed septic tdnk proposed cLedn -out . tl_69 I \ ypicdL, see detdi ZSL-2 {=oq A. rpr osed wdter Line -must mdintdin min rom dLL 0SS componen proposed tightLine -min astm 4034 4'PVC Rebar to secure in trench I Tank Cross Section - Not To Scale (For illustrative purposes only, actual tank configuration may vary, tanks must be on list of SECURED LID WITH GAS TIGHT SEAL I ACCESS RISER FINISH GRADE Distribution Box FROM SEWAGE SOURCE APPROVED EFFLUENT FILTER maximum 1/16" filter SEPTIC TANK ffYPICAL) W^"-W ,orrronmenlal \ <r* tLl co E\o. 9\ \4,or FLOATING MAT SEDIMENTS \ 6@0815 PGS:2 BLAgittqtzelo 10:24 At'l $74 oo LESLIE A ALLEN -l"iiJii."-cr"n[v rae niaitoi's 6iiice - Rose Ann Carroll, Auditon itt t l+rrn'p ul,l{l :td l, il,{tlfi 1.1 t,ultri l{u lrrl h[ ll II I AF'TER RE,CORDING MAII+ TO: Name:Leslie Allen Address: PO Box 2036 City/State: - Lot ConsolidationBoundary Line Adj Grantor(s); MLA ll 1. Leslie A. Allen Grantee(s): 1. Leslie A. Allen Legal Description: Parcels involved in the adjusunent are as follows (include Assessor's Property Tax Parcel Account Numbers); Parcel A: Assessor's Parcel No. 950-100-417,4 Trail's End Homesites Inc., as recorded in Vol 3 of Plats, Page 30 records , WA within Section 16, Township 27 North, Range I East, Parcel B: Assessor's Parcel No. 950- l Block 4 Trail's End Homesites Inc., as recorded in Vol3 of Plats, Page 3 County, WA within Section 16, Township 27 North, Range I Parcel C: Assessor's recorded in Vol3 of , Lot 33 Block 4 Trail's End Homesites Inc., as of Jefferson County, WA within Section 16, Township 27 Parcel D: Assessor's o.100-428,Lot34 Block 4 Trail's End Homesites [:.c', as recorded in Vol 30 records of Jefferson Counfy, WA within Section 16, Township 27 East, WM Boundary lin described as follows (new legal description): Lot A Line Adjustment Lot Consolidation;being Lots 21, 22,34 & 35 Block 4 End Homesites Inc., as recorded in Vol 3 of Plats. Page 30, Records ofs J,, WA; situate in Section 16, Township 27 North, Range I East, W-M., , wA. rhe adjustment is described as follows: Consolidate fOur lots into one parcel. Trilir-ia i iqi l,q f f 11 JL .J:rii I i 'l,1 ;-x"i'r' 600815 Page 2 ot 2 0711412016 10:24 AM STATEMENT OF INTENT: This recording is for the purpose of assisting with a boundary line adjustment pursuant to RCW 58.17.040(6). It does not create any additional lots, tracts, parcels, or division as the land described herein shall merge or be integrated into abutting property presently owned by the proponent. Nor does the boundary line adjustment result in any lots, tracts, parcels, or division which contain inzufficient area and dimension to meet minimum County requirements for width and area for a building site. sanitation U*bt^-e_ (Proponents' STATE OF WASHINGTON COLNTY OF JEFFERSON On fkt-A t€20-4,appeared the basis ofl^es iler^me on satisfactory evidence to the person whose name acknowledged that she executed it. to this instrument, and WITNESS my hand and official seal this 2011. 7t1, Notary in and Residing at This adjustment has been reviewed and approved by the Jefferson County Division. Llr/erk Date CAR E ?ery PUBL\I' OF PROPERW OWNER SYSTEM DESIGNER Leslie Allen Suzanne Martin LEGAL DESCRIPTTON: Section 16 To*nship 27N Rango 1E Lots 21, 22,33 & 34; Block 4; Trail's End Homesites Date 15 April 2016 where mottling or lmpermeable layers occur. SOIL LOG #1 0-12" fill & disturbed soil 12-23127" loamy sand and fine sand 27-72" Yellow fine sand organic in pit (root) Anticipated water table n/a in. Roots to inches Health Dept. Comments SOIL LOG #3 0-7" Dark brown sandy loam some compact and bits of charcol 7-28" dark yellow brown loamy sand 28-55" yellow brown fine sand 55-60+" Yellow brown sandy loam Anticipated water table n/a in. Roots to 48" inches Health SOIL LOG #5 Anticipated water table_in. Roots to_inches Health Dept. Comments Dept./omments Page 1 of 4; Allen; Parcel #950 100 4'17 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMEN' 621 SHERIDAN ST.. PORT TOWNSEND .WA 98368. (3601 379-445( SOIL EVALUATION parcet # 950 100 417 Logged Suzanne Martin lnclude soil toxtural characteristics and the depths at whlch signfficant changas occur. Be sure to lnclude depth Health Dept. Comments SOIL LOG #4 0-7" Dark brown sandy loam 7-23" dark yellow brown loamy sand t, 23-65+" yellow brown fine sand I A ^ Ihu'1Wt"lT-W- Anticipated water table n/a in. Roots to_60 _inches Health Dept. Comments SOIL LOG #6 Anticipated water table_in. Roots to inches Health Dept. Comments HIINFOHLTH\SOIL.FRM I /OO SOIL LOG #2 0-29" Dark yellow brown loam 29-60"