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HomeMy WebLinkAboutSEP1973-00101I' Jefferson County Health 6 -Human Services L'Lk'.� CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND, WA 98368 N()FOR YOUR INFORMATION PLEASE RESPOND () PER YOUR REQUEST Date: July 26/01 To: Kenneth Austin 190 Stevens St. Port Townsend, WA 98368 From: Susan Porto, R.S., Environmental Health Specialist Jefferson County Health Department Subject: Permit Application SEP 73-101 #953101801, Gise's addition Block 18, lots 1 and 2 Message: On July 10, 2001 this office received an application for a designation of reserve drainfield area and an evaluation of the existing system to permit the replacement a residence that burned down. Following submittal of the redesign showing well locations on the adjoining parcels, this office has approved your reserve area with the condition that you understand that at the time of repair and this area is utilized, the existing well located less than 100' to the repair area, may need to be abandoned and connection to city water may be required. Additionally, a restrictive covenant or an easement will be required to utilize the drainfield area proposed for reserve. Cc Bob Reed ✓ HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOUDRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX 'qFn/3R.r,-Q4nn qRn/.qRc;-x444 360/385-9400 360/385-9435 360/385-940 'a F Jefferson County Department of Community Development b21 Sheridan St., Port Townsend WA 98368 (360) 379-4450 I— _ . _ . _ _ Evaluation of an Existing Onsite Sewage System Attach plot plan showing location of: Structures, Drainfield, S is Tank, Well, etc ALL SPACES MUST BE FILLED IN EXCEPT AS -N n space if Informatio .Is not available (NV) or not applicable Type of X Evaluation of on-site sewage O Evaluation of Drinking Water 0 Evaluation of on-site sewage & Date of this inspection Owner or Current owner � 2001 0 itnla Water Name/Address/Phone Reason for Evaluation Voutit O & M Inspection We tate Transaction te a Permit # Building Permit Review and/ 0 Other Owner Phone #3 Kj— 9 ► Mcf Previous property owner name (S) if known _ Parcel #!q T- ® I Subdivision, division, block and IOUs) Permitte Systemes no Permit/case # �• / Date system installed 41yj 2 17 a Age of dwelling ## bedrooms -ouseAccupied, es no, vacant how long? Designer�� - Installer _04.f � Water supply Sample was taken Yes No Sample Results Well casing 12" above ground Yes No Sanitary Seal in place Yes No Public: offsite onsite. Name of System ndividual: 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 dyes no, if not, distance ONSITE SEWAGE SYSTEM #1 - Septic Tank- Tank size ® gal. single compartment two compartment (' _ T al Riser to grade on inlet yes-, no. Riser to grade on outlet yesno Condition of tank good needs repair, describe 1st comp. Scum (top layer) n. sludge (bottom layer)4X, in. 2nd comp. scum in. sludge in. Was ground water observed leaking into tank ? as —X no If yes, where was water Condition of baffles: Inlet aoodneeds repair material (PVC oncrete Off Outlet: aoodneeds repair material (PV concrete r, Screened Outlet o_no _yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b))___,)( — yes no Effluent level at outlet (mark level on circle) If effluent is below the outlet, indicate when tank was last pumped: Onsite Sewage System Inspection Report Page 1 of 3 Parcel # Owner Name -iA -Does system include a pump? yes _ _x no If yes, complete the next section. #2 - Puma Chamber Tank size gal. Material. Riser to grade? ves no Condition of tank good 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? Electrical Components Pump operating ves no, describe High water alarm functions _yes no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured ves no #3 — Drainfield Appropriate Vegetation in area /7 Yes no. Describe vegetation 4,/12nen Indications of surfacing sewage 0 ves , if yes, describe and diagragm on plot plan no overgrown/ not observable -> -AFz �Ci �� t� �R Signs of parking/driving in area es n• Ground settling or erosion ves no overgrown/not observable Monitoring Port Observations: Residual Head ves, # of inches no Ponding in trench yes, # of inches of ponded effluent no .Repair area is adequate limited none available, describe Complete this section if system is permitted but did not receive an OK to cover or final approval OR there was no septic permit on file. Describe materials observed in drainfield construction: D -box present yes if yes, material no Drainlines rigid PVC corrugated flex pipe clay file concrete file seepage pit or cesspool other Drainfield dimensions length width # of drain lines Do observations coincide with permitted system requirements/conditions? _yes no Comments: p HEC EQdE JUL`52001 JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Onsite Sewage System Inspection Report Page 2 of 3 Document8 'Parcel # !7S3 •— / ® 1 — $T Owner Name 44 - Treatment Unit (Sandfilter, Proprietary Device, etc) Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage ves, if yes, describe and diagram on plot plan no overgrown/not observable Riser to grade? ves no Signs of parking/driving in area ves no Ground settling or erosion ves no overgrown/not observable Monitoring ports in good condition ves no none present/no port found Monitoring Port Observations Residual Head ves, if yes, # of inches no. If no, notify Owner immediately Ponding in trench ves, if yes,.# of inches of ponded effluent no Electrical Components Pump operating ves no, if no, describe High water alarm functions yes no; if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured yes no COMMENTS JUL "5 2001 JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Was a System Problem Identified? Yes if yes, what section #. No_ I certify that the information provided is based on a review of County records and my direct observations at the time of inspe n. ame/Signature to No guarantee of future performance is implied or granted based on the information contained in this report. This report constitutes a summary of findings only. Onsite Sewage System Inspection Report Page 3 of 3 bocument8 PROPERTY OWNER MAILING ADDRESS PHONE SYSTEM DESIGNER LEGAL DESCRIPTION: Subdivision Name et SITE LOCATION Jefferson County Permit Center 621 Sheridan St.; Port Townsend WA 983 360-379-4450 SEPTIC PERMIT APPLICATION f 'IX �7v-s 7-/;�i J U L 5 2001 coUNTY Area ,tion Township Range PARCEL # Ta LT QT TO met— TYPE OF IMPROVEMENT: Resident®I Re Is dential ADU TYPE OF WORK: New Redesign Upgrade Repair Expansion _(:Desig�Reserve Division Block /8 Lot(s) f9L .1. tO L. (D)L)Fr-ZeQgg C �!�=> 6W `M ltJ'Mai Cpde Commercial Community Tb Partial (tank) (drainfield) Conventional A— Alternative Drainfield Length ft. Number of Bedrooms Trench Width ft. Basement: yes / no Trench/Bed Depth in. Site Size /®D fk /00 Number of Lines Previous evaluationyes / no SEP `% 3-/0/ Tank size gal. Water Source: private public Soil type (ATTACH SOIL EVAL.) Application Rate gal./sq.ft./day TYPE OF SYSTEM r-7- �- � *****************************************************************4******************** THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signature .4 22�� � t "�10 �APPROVED RENEWED RENEWED Date ////� o ® / FOR OFFICE USE ONL Y PARTIAL PRESS/TEST ASBUILT PUD FINAL Fire District Planning District School District Zone Date Fee rj Rec # 295-e$ Check # 1=0 Case # SEP h:\home\pincntr\hithinfo\permitapp.doc 10197 SOIL EVALUATION PROPERTY OWNER z4a z, P SYSTEM DESIGNER C L'EHE -J U L 5 201 0 LEGAL DESCRIPTION- Section Township Range Parcel # Subdivision Name Q , Division Block Lot(s) f —Z Date Logged: ,� O1 Logged By: l�g iSON COUNTY PU NTY DEVELOPMENT D7/^ Include soil textural characteristics and the depths at which significant changes occur. Be sure to Include depth where mottling or impermeable layers occur. \ SOIL LOG #1 l SOIL LOG #2 ® to�in. 2J to _in. . to in. to in. to in. � to in. to in. �' to in. � � p Anticipated water table in.AV Anticipated water table in. Roots to inches \ J. Roots to O - v?W f inches Health Dept. Comments `f/J Health Dept. Comments SOIL LOG #3 SOIL LOG #4 to in. to in. to in. to in. to in. to—in.- to—in. oin.toin. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments SOIL LOG #5 SOIL LOG #6 to in. to in. to in. to—in.- to—in. oin.toin. to—in.- to—in. oin.toin. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments HAINFOHLTHWIL.FRM 1100 WAL of - V`H'F ig ` � L f C.) 3 aye 7T-,4 q ,yr- i i z I IYO 0:/+ x I I x sr,4}t f ff—C —El V JUL 5 2001 DEPT. Of �vt h,V-r` ? Sv' ro c V T N r 7 f!i i i El i V Jefferson County Health 6 -Human Services Lm&CASTLE HILL CENTER - 615 SHERIDAN - PORTTOWNSEND, WA 98368 July 11, 2001 KENNETH W AUSTN-%. 190 STEVENS RD PORT TOWNSEND WA 98368 SUBJECT: 190 STEVENS AVE SEP73-00101 PARCEL#: 953101801 Section: 16 Township: 30N Range: 01 W SUBDIVISION: GISE'S ADDITION Block: 18 Lot: 1&2 PROJECT DESCRIPTION: CONVENTIONAL REPAIR DEAR KENNETH AUSTIN This office has completed a site inspection and review of the design for the proposed onsite sewage system. The following items need to be completed prior to issuance of the permit: 1 Receipt and review of design corrections as outlined in the attached letter. 2 Sign off/approval from the Development Review Division for Unified Development Code review please call 360 379-4450 with questions regarding the Unified Development Code. 3 Combine lots to meet the required minimum lot size, Restrictive Covenant is enclosed. 4 Application for waiver from standards, information is enclosed. 5 Easement for drainfield on another lot or parcel, a sample is enclosed. 6 Letter of water availability from an approved public water supply. 7 Road Crossing Permit and/or Franchise approval. 8 Receipt of Zoning approval from the Development Review Division. 9 Final approval of Subdivision. 10 SEPA - if conditions of the SEPA review require revisions to the sewage disposal design, those changes will need to be submitted for review prior to the issuance of the permit. 11 OTHER The sewage disposal permit will be approved or denied within two (2) weeks of receipt of the items listed above. If you have further questions, you may contact this office at (360) 385-9444 or 1 (800) 831-2678. Your prompt attention to this will assist us in completing the permit for you. S' rely, LINDA— -TKiNS Environmental Health Specialist C .C.. ' ri�!'- > ie�'D is\F_SFAIr$LLV"'t.rpt ENVIRONMENTAL DEVELOPMENTAL DEPARTMENT HEALTH DISABILITIES 360/385-9400 360/385-9444 360/385-9400 ALCOHd1l.MG ABUSE CENTER 360/385-9435 FAX 360/385-9401 I' Jefferson County Health 6- Human Services CASTLE HILL CENTER - 615 SHERIDAN - PORT TOWNSEND, WA 98368 01 () FOR YOUR INFORMATION PLEASE RESPOND () PER YOUR REQUEST Date: July 11, 2001 To: Kenneth Austin 190 Stevens St. Port Townsend, WA 98368 From: Susan Porto, R.S., Environmental Health Specialist Jefferson County Health Department Subject: Permit Application SEP 73-101 #953101801, Gise's addition Block 18, lots 1 and 2 Message: On July 10, 2001 this office received an application for a designation of reserve drainfield area and an evaluation of the existing system to permit the replacement a residence that burned down. The following items were noted in review of the site and applicatio d mu✓" addressed prior to further review: 1. The outlet tee on the existing septic tank must be replaced. Q s� P 2. The sewer line exitingthe septic tank was cracked; this must be repaired. P 3. The reserve drainfield area must be designated with dimensions. b 4. The site plan must be modified to include the 100' well radius for the subject lot and the lots adjacent. 5. The application must include a waiver from the 100' required setbacks from the existing well on site to the proposed reserve area. � 6. The site plan must show the lot lines of both lots 1 and 2. If the residence is located on a different lot from the system and reserve area then either a iJ restrictive covenant or an easement will be required. Cc Bob Reed HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX 360/385-9400 360/385-9444 360/385-9400 360/385-9435 360/385-9401 LOCATION MAP SAMPLE PLOT PLAN Distances and setbacks marked in feet. PERTY BOUNDARIES `-L5 1 DRIVEWAY SETBACKS IN FEET ! PROPOSED BUILDING LOCATION OF SEPTIC AND DRAINFIELI QEsE2v£ d'�a'o AgeA TOP OF BANK tIF APPLICABLET Cn O Y a LOCATION OF Cn WELL TOP OF BANK tIF APPLICABLET a►� Pr - 2695 Cape George Road Port Townsend, WA 98368 SEPTIC TANK OPERATIONAL REPORT 360-385-7155 360-457-4121 Company Name ( m�l w -m-', Date of Service , Technicians signature C Ah 1,'°"` .b Job Addre Last Date people in home i—# bedrooms SEPTIC TANK Size of tank d t Gallons Compartments: Single }Double Material: Concrete LX Polyethylene Metal Other (specify) Conditions of septic tank: Good Poor Was ground water observed leaking into tank ? Yes No If yes, where was water observed? Effluent running back into tank from drainfield? Yes No Riser to grade on inlet: Yes No ' Riser to grade on outlet: Yes No / If no risers, were risers installed? Yes No 44 Solids in Tank: 1st compartment Scum (top layer) in. sludge (bottom layer) in. 2nd compartment scum (top layer) n. sludge (bottom layer) in. ,y BAFFLES s �� Condition of inlet baffle: Good Needs Repair Repaired Material Ash Condition of center baffle: Good Needs Repair_ Repaired 'Material Condition of outlet baffle: Good Needs Repair Repaired Material Type of outlet baffle: Unscreened Screened Filtered Material Cleaned outlet baffle and/or screen: Yes No PUMP Does the system include a pump? Yes No If Yes, complete the following Size of Tank Gallons Riser to grade: Yes No If no was riser installed: Yes No Material: Concrete Polyethylene Metal Other (specify) Was ground water observed leaking into tank ? Yes No If yes., where was water observed? Depth of accumulated sludge in pump tank inches Was the tank pumped? Yes No Recommended additional information Condition of Pump: Working Not Working Needs repair Condition of Alarm: Working Not Working Needs repair Pump cycle drawdown: Inches Time for pump cycle minutes/sec. Comments: jd N." - u r - a —� -h o� c C3,- o � -Fs X O —1 — CL — CD - CL C7 r+ X 0! O O — Z7 -3 7 C CL CD d C7 -- CD Cc CD r+ — � CD O O �$ -a CD C-3 C" i CL O -� O C:3 7 a CO C= En cn W CM CD En CD 0 COCM CO C=3 O r-1- - 0) a �►•. r -f- c W m m 0c cn rHCD m Co 74CC13O CCS H m CD C7 x CX) cn CL r a w —1 m CM v o a z —q v o x z cn H a m —I —► r s © m sp z o r%13 C" s n r c � CL c� - O Ir- C3- Cn CD CD Co Co C:3 M z H C7 C7 Cr --� =r s �- m CC3 CC3 Q H c C3 n 3 C$) r+ CL Cn cn CA CD ,-% -,P C7 ch C7 CL CD C7 "3 CD CD • O H T z T 1 (11 - a c C3,- o � O O — CL — CD O H T z T e 903 E. Caroline ���OLYMPIC HEALTH DISTRICT Permit No. Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION/ Submit in Duplicate �Q Builder Court House Port Tov+nnsend Date S/?� DIRECTIONS FOR LOCATING SITE ra4& r T Tp,�av +:- �r�,�. srr�+rE' _fz f � 444V49 4117 over APPLICATION IS HEREBY MADE TO: INSTALL N.734 SYSTEM REPAIR EXISTING.SYSTEM 14/010.,X& i /L%® lea`zX eta ` /���otle%TJt eV, AVS77,J YPE OF BUILDING NO. OF BEDROOMS BASEMENT 1. SITE SIZ "NAME OF INSTALLER DRAINFIELD LENGTH WWIDT1 `-'DEPTH J'#Uwm / SEPTIC TANK SIZE � DRAW A DETAILED PLOT PLAN.BEL014. SEE INSTRUCTIONS. SOIL TYPE /av . eA ItA �o ANY CHANGE IN BUILDING OR SE AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL 013TATNED FROM TNF HT A TTN DF,PARTMFNT _ Vi DATE OF INSTALLATION SIGNATURE OF ANT APPROVED DATE c-? L.g3INSPECTED BY \ ��QN bsN DATE," SANITARIAN'S COMMIIUSF: I CERTIFY THAT THIS SYSTEM 1SAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTMENT DATE INSTALLERS NAME 1: i a L ECIVED JUL 16 2001 JEFF. COUNTY -73- l0 1HEALTH DEPT. ,