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HomeMy WebLinkAboutSEP2013-00034 Jefferson County Department of Community Development 621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 /J SEPTIC PERMIT APPLICATION PROPERTY OWNER '7 ��R '9/ ��/ u,vv MAR 2p MAILING ADDRESS Po /30)( s 3 Q ti te e.-&22,/ ; l4//7 9 _7 PHONE ( ) SYSTEM DESIGNER /411---2--43 /M00�J Designer Phone# 3L-0 61?CV LEGAL DESCRIPTION: Section / qTownship 7-7/1/Range Range I PARCEL# 70/ /'9 C0ts- Subdivision Name 7i* F(hi OF C G &' -''0.) Division Block Lot(s) Site address/Directions to site Z- / 70 7519 SOURCE OF SE GE/USE TYPE OF WORK WATER SOJJ.CE Residential O/ New Tank/s only Private (,� Residential AD Modification Public Commercial Expansion Community Upgrade Repair_ SITE SIZE .5-F,7-Z-S3I SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evaluation Conventional Designate Reserve Area Yes# Alternative J Redesign No 41;' SYSTEM DETAILS Number of Gallons/day 36j C © Soil type 3 (attach soil eval.) Application Rate 0' ��y gal./sq.ft./day Drainfield Length 7-5 ft. Trench Width (� ft. Trench/Bed Depth 'eSin. Septic Tank size /000 gal. Pump Chamber size /0C4f) gal. TYPE of system S /'A7e, 7-1/679 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 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. a 3 - /s - f3 Property Owner Si nature Date FOR OFFICE USE ONLY %/ ` PARTIAL ASBUILT / FINAL AP°ROVEI INSP/PUMP TEST PUD [ ' 1 2 Z ALL HOLD EO. MET AF 5 / to ' Fee!a2 Rec#f ti` a( Check# ` �T� Case#SEP jiff H:\WEB\PDFS\Septic\septic_permitapp_2008.DOC - JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street•Port Townsend•Washington •98368 www.jefferson countyp ub lichealth.o rg I'hone 5W-365-U444 Fax 3tiU-3/9-448/ ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP13-00034 Date Received: 03/26/13 Date Issued: 06/28/13 SITE ADDRESS: 2170 EAST QUILCENE RD QUILCENE, WA 98376 Date Expires: 09/28/13 APPLICANT: ROGER SORENSEN PHONE: P.O.B. 245 NEAH BAY WA 98357 LEGAL DESCRIPTION: S19 T27 R1W TAX 8(W OF EAST QUIL RD)(LESS R OF W) PARCEL#: 701194006 Section: 19 Township: 27N Range: 01 W DESIGNER: ERIC HIBBARD PHONE: 360-683-6300 SOILS APPLICATION INC. P. O. BOX 1120 CARLSBORG WA 98324 SYSTEM DESCRIPTION: SAND LINED BED No. of Gallons per Day: 360 Type of work: REP Drainfield Trench Septic Tank Length: 75 feet Width: 6 feet Depth: 48 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 Envir mental 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.: SEP13-00034 1.) This permit was issued to correct a violation of WAC 246-272A for a failing drainfield. The permit must be completed within 90 days of the date of issuance. 2.) H - The existing greywater line out of the home must be re-routed into this new system. Confirmation and doccumentation required by designer prior to final. 3.) This system must be constructed by an installer certified by the Jefferson County Public Health Department per state code WAC246-272A-0250. 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.) Setbacks to all and EXISTING well(s)- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 6.) BED TO BE EXCAVATED TO 48" DEPTH AND THEN BACKFILLED WITH ASTM 33 TYPE SAND TO 24" AS PER DESIGN. 7.) H - BOTH Existing tanks shall be properly abandoned. They shall be pumped and filled with clean fill. Documentation to be provided to Health Dept. prior to final. 8.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 11.) 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. 12.) 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. 13.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other development or a building permit on this site. Compliance with other Jefferson County and Washington State Codes is required. 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.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 16.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. 17.) 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. 18.) This system as designed and approved is sized for only one single family residence. It is not sized for an Accessory Dwelling Unit (ADU). The minimum daily design flow per residence is 240 GPD. SEP13-00034 Page 2 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 6/28/2013 19.) 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. 20.) The site plan received on 4-29-20131 was reviewed by the Department of Community Development on 6-11-13 and it was determined the septic permit is exempt from critical area review as it complies with the General Exemption found in JCC 18.22.070 (6) which exempts the following activity: Reconstruction, remodeling, or maintenance of existing structures. This exemption shall not apply to reconstruction which is proposed as a result of structural damage associated with a geologically hazardous area and does not allow further intrusion into a wetland, fish and wildlife habitat conservation area and/or their buffers. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and condition which may be placed on future permits. 21.) This project reviewed and approved as a Shoreline Exemption under JCC 18.25.090(6). 22.) This parcel is within a no shooting area per JCC 8.50. SEP13-00034 Page 3 of 3 \\tidemark\data\forms\F_SEP_Permitmod.rpt 6/28/2013 v _ , t JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN. PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING Designer Suzanne Martin Permit # SEP 13-00034 Installer Dick Shold Parcel # 701 194 006 Electrician Pops Electric " peak Property Owner Roger Sorenson Site Address 2170 East Quilcene Road-Quilcene JUL 03 2014 Answer all questions or indicate NA taismitin county DATE Tanks, Pumps and Controls 491"11--- Wialth INSP. Tank (manufacturer, size, baffles) Cotton 1000gal; baffle&outlet r installed 7/2/14 Pump chamber (manufacturer, size) Cotton 1000 gallon; 22 gal/inch; 7/2/14 Screen(s)and/or Pump Shroud (type, location) Biotube around pump in pump tank 7/2/14 Were Tanks tested onsite for water tightness? es / No Panel Model Infiltrator Timer Model Aquaworx 7/2/14 Pump 1 — Man./Model Orenco P300511 Flow Rate 27.5 qpm 7/2/14 Pump Location (i.e. garage, treatment unit, basement) in pump tank Float/transducer settings Inches Timer from bottom of tank- On/off- 20.875= in. Functions: On 1:03 sec GO Veto - 33.175 in. Off-' 14to sec in hr Alarm 33.375 in. Veto On - 1:03 sec Storage Above High Water Alarm gal. Veto Off - 120 sec/y j hr Dose Counter Reading 1 dose/8 vdose. # gallons/dose 30 gal. Elap. Time Meter Reading 00:11:48 mine Pump Throttled? Yes 0, Dose Drawdown (in inches) 1 3/8 in. Pump 2 — Man./Model n/a Flow Rate n/a gpm Pump Location (i.e. garage, treatment unit, basement) n/a Float/transducer settings Inches Timer from bottom of tank- On/off - in. Functions: On sec/min Veto - in. Off sec/min/hr Alarm in. Veto On sec/min Storage Above High Water Alarm gal. Veto Off- sec/min/hr Dose Counter Reading # gallons/dose gal. Elap. Time Meter Reading min/hrs Pump Throttled? Yes / No Dose Drawdown (in inches) in. If additional pumps- complete the info in this table for each and attach. Other Timer functions & settings (e.g. override on/off) 87 events; autoclear 1 dose; ID=05-08-2013 H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2 e RECEIVED Pre-Treatment UL 03 2014 Date Ins!)Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / Nlo Sandfilter Basin size/location n/a j of n county Sand Fill met design spec? 05 No Envirotimentat Health ATU (manufacturer, model) n/a Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes / No Drainfield Transport Pipe size, schd, diameter 2"pvc sch 40 Manifold size/schd 2"pvc sch 40 7/2/14 Orifice size 1/8" Lateral Size/schd 1.25"pvc sch 40 7/2/14 Barrier Material filter fabric Cover Material/Depth 0" 7/2/14 Residual Head (lat.# & ft. Head) 5.5'with tubes pre cover 7/2/14 The laterals/pods were balanced 0) / No 7/2/14 Source/Manufacturer of Drainrock/Gravelless chambers cotton Drainrock Clean? es / No If no, what action taken? Mound/Glendon Site Prep n/a Drainfield Length 75 ft Width 6 ft Depth 48 inches Caps for measuring residual head stored (location) riser for header manifold COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary The drainfield was altered to be two beds so that more tree removal could be avoided r Setbacks have been maintained AUt�,-rc3 tk :55Lf3e. vtT '1 w a v 4- o.-P ©✓'1 f?is Ei3-7 E kt-rittr E►J n',c ze. r1 1) 2jct" i ( t.1/4.)e °t` S' LA-3(I-`-S Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner P..111WWV?C/ 10 d1 k Date 371It/ /y Tank/component Decommissioning Report Attached 0 No / NA es / Installer Certification attached/signed No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED 'BY INSPECTION, THE SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED 1ryJEFFERSON COUNTY (DATE) OR TJ AT CHANGES HAVE BEEN NOTED AND T}EE SYSTEM IS IN COMPLIANCE wiry WAC 246-272. �4'�{'' ci-- 3,V/C/ Iy 5100342 4"430;:..A''Designer Signature Date License# '�'s Suzanne L Martin �I# owr --211/15 H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 System Owner: Roger Sorenson SEP13-00034; Parcel #701 194 006; Site Address: 2170 East Quilcene Road So ISA9 y Pump Tank Detail 9tS. c.):1.%\‘‘ 8" from'op of riser Installed Riser 26}"Riser ra. :Lr..`" %:4x:.13.-:'it? s:-.r. ....s: ei.42.. -Y• t', _ _ °:ti'i.L•e::.i'iv.L'Y %4 A, Inlet ±515 gallons of storage S above high water alarm 57 5/8" -not including additional r ay capacity in septic tank and tank risers -±321 gallon storage below invert of inlet of set 13"from the pump tank(14 ") f' bottom of the bell alarm set for 12.8"from Installed BioTube�I ! bottom of the bell r -270ga1 working volume 3. 4: ' on set 0.5"from bottom n of the bell Cotton-1000 gallon pump if v. tank;22 gallons per inch y, a -zb-08 Aquaworx IPCS01 9? es 20 a from bottom of tank to the bottom of the 1. bell - - 4e {, •1-".. ,J.•:; r .. .--ii=4,'":!.0•"4^;1,.,v-r:....i..".x i.:LV.:+t::..a ... r;i'r..........:. t�, 044 1 .w7lc�ji,,� alr or t- # x A, y r A Of 5100342 A SuZANNE LEA MARTIN• EXPIEES 2'11; �5 / / NN // Cl r (D B (D 7 / CD••a .. 7C i0mvy // : X Xfi �,/ N CD O p / a m a- 7 C' /'" r CD // O. 7. a aiCZ // o / co a; 13 CD ,k,, —• CD — w • " N I o' / Cr C O -a - 3 ci) O O m O - O O a 3 o c0 O O r« o // 0. 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' cg O O ts N ° i cD ,m o o Cn• � fill '. = ° a y m° 0 o, o co c i cD � ° o CA 4 ..2 o ° CD 44 ° • ° ° a a,, , . o : o 7 o o C o o c v o or c< y c � Q o o P o Q.. 'CS 000 0 .0 R. '`8 -, 0'*_ ° H ° d o m C a ,...E. 4; E CD cC'D np o ° o ° °c n. w o 04 tits N 0 °, CD 0 c'-D• .0 Z. d z 7y o o cD o o a o cD o �,c.co Eg c) 4 500g v w ' c w cp c w o w c cr pc Z m c ° w ch- c • cn DA c ' , t tic")a '., = o 2 p C en CD RD i fliJ1Ja. o. . w = fD 0. +� DI d4 Y t i , SOILS APPLICATION LLC Eric Hibbard Designer(360)683-6300 863 Carlsborg Road,Suite A, Sequim,WA 98382 q/eIR 2 5 201:7i Scope of Work: To whom It may concern, RE: Jefferson County Parcel #701-194-006 This property is located at 2170 E Quilcene Rd. Soils Application has been contacted by Owner Anna Marie Nylund. The objective of the permit is to replace the existing septic with new. The old system has hacked up and is no longer functioning properly. There is two systems onsite one for black water and one for grey water. The waste streams will be combined per this design. The size of the system will accommodate the 3 Br SFR. All the sewage generation will take place on the above mentioned county parcel. The lot is located within 200' from the shoreline. No critical aquifer recharge zone and meets the minimum land area requirements. The system will be pressurized sand lined beds meeting treatment level B with time dosing. This design includes: 4 Plan pages 1 Permit page 1 Soils log page 1 Pump spec requirements page\ 1 Scope of work page If you have further questions please call the office. 360-683-6300 Sincerely, Eric Hibbard Washington State Septic Designer Soils Applications LLC. Lic.#5100362 Jefferson County Environmental Health Dept. 615 Sheridan St., Port Townsend, WA 98368 SOIL EVALUATION Property Owner-Anna Marie Nylund System Designer- Soils Applications LLC. ERIC HIBBARD LEGAL DESCRIPTION: Section-19 Township- 27N Range- 1W Parcel# 701-194-006 Subdivision _Division Block Lot(s)- Date Logged: 3-15-2013 Logged by: Eric Hibbard Include soil textural characteristics and depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG #1 Health Dept. Comments: 0" to 4": Organic Duff 4" to 42": Brown Gravelly fine sand 42" to 62": Brown Gravelly medium sand Observed water table @ n/a Roots to 60" SOIL LOG #2 Health Dept. Comments: 0" to 4": Organic Duff 4" to 22": Red Brown Gravelly fine sand 22" to 60": Brown Slightly Compact Gravelly medium sand Observed water table @ n/a Roots to 60" SOIL LOG #3 Health Dept. Comments: 0" to 6": Organic Duff 6" to 66": Brown Gravelly medium sand Observed water table @ n/a 5C Roots to 66" V49/N 1' fit/