HomeMy WebLinkAboutSEP2019-00190Jefferson County Environmental Public Health
615 Sheridan St., PortTownsend WA 98368, (360)385-9444
SEPTIC SYSTEM PERMIT APPLICATION
Wei Thorr
75O Rltta Skv Dr Porl Townsand WA OA3AR
PROPERTY OWNER
MAILINGADDRESS
PHONE
SYSTEM DESIGNER
(-360 )531-0609
NATHAN N- CLEAVER
EMAIL ,Ugahqpiw@yahoo.com ,,,,-"
/360\Designer Phone
LEGAL DESC Rl PTION: Sectiont3LTown shipJS0LRa ngeJlA{-PARC EL #
Subdivision Name
Site address & Directionstosite & test pits S Gary Avenue. Port Town*
Hlp"rBseestAyetrue-.".Prepery-o-n-L@*ssrne,r*ojNLateJAvs-&P e/Ssi
the lot
By signing the application form, the applicanuowner attests that the information provided herein is true and correct lo the best ofilrair rzaare';radaa ^^" rateriel falsehocd or any omission of a material fact made by the applicanUcv.,ner with respect tc this:rei ,ur, rr
application packet may result in this permit being null and void. I further agree to save, indemniff and hold harmless Jefferson
Cou.nty ag_?inst all liabilities, judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue
against Jeffei'son County as a result of oi' in consequence of the Eranting 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 lhe
applicant informs the County in writing at the time of the application that he or she requires prior notice. lnspections shall occurduringregularbusinesshours.lnitialhereifyourequirenotificationbeforeentry-
Aopeal- 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 Gounty approvais. For exampie, it DOES NOT G1iARANTEE that you wiii iater
obtain permission to build a permanent residence or other structure on this parcel. Any future afplication will
be separately judged by the rules and laws in effect at that time.
2,sl
r re
FOROFHCEUSEONLY
PARTIAL ASBUI ,a Zo2o NAL Zob
INSP/PUMPTEST*_HA._ MonitoringAgreement ta'1)'l\ Jx
ALL HOLD REQ.
,"*_&l_t_I 9 _, "" 7-f _6. o 9_*"" u_U_6 fl._cn""r 7760 # SEP lq-00 no
B
SOURCE OF SEWAGE/USE
Residential X
Commercial
Community
TYPE OF WORKNew_ Tanks only XModification Expansion_
Repair_ Tank(s)_ Drainfield
Replacement Tank(s) Drainfield_
Designate ReserveArea XRedesign_
Water SourcePrivate_
Public X Name-
SITE SIZE o29
Previous Evaluation
Yes case+-95J)l35-_No-
System Type
Conventional X......*. ,
Alternative
SYSTEM DETAILS
Number of Gallons/day 360 . Soil type-.,Q-(attach soil eval.) Application Rate__Og__gal./sq.ft.iday
Drainfield Length Ext 150 ft. Trench \Mdth Ext. 3 ft. Trench/Bed Depth Ext. 30 in.
SepticTank size '!.1QQ0 gal. Pump Chamber size_Nl\_gal.
TYPEOFSYSTEM
Ci:tl.()NS I [ [-:\l:ornrs\Ag.r1:lit;atiorr I r.rirrr & lnfo\$ L i.. . l:)or Itit Agrlrlica.tiorr 11t2$tlfl liAI-t
#-
JEFFERSON COUNTY ENVIRONMENTAL PUBLIG HEALTH
615 Sheridan St.
Port Townsend, WA 98368
www.jeffersoncou ntypu bl ichealth. org
Phone 360-385-9444 Fax 360-379-4487
PERMIT #:
SITE ADDRESS:
ON.SITE SEWAGE DISPOSAL PERMIT
SEp19_00190 Date Received: 08/15/19
'ROS,ECTAVE
Date lssued: 09125119
, WA Date Expires: 09125122
APPLICANT:WEIZHOU
750 BLUE SKY DR
PORT TOWNSEND WA 98368.9691
LEGAL DESCRIPTION: PROSPECT VIEW ESTATES LOT I5
PARCEL #:98960001 5
PHoNE: 360-531-0609
Section: 35 Township: 30N Ranqe: 1W
DESIGNER:NATHAN CLEAVER
NATHAN CLEAVER SEPTIC DESIGN
262 NW THOMPSON RD
POULSBO WA 98370
PHONE: 360-598-6546
SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS
No. of Gallons per Day: 360 Type of work: NEw
Drainfield- -----Trench
Length: 0 feet Width: feet Depth: 0 inches
-------Septic Tank------
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 wil! 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. 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 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 Environmental 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 REVERSE & ADDITIONAL PAGES
CONDITIONS OF APPROVAL - PERMIT NO.: SEP19-00190
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.) H - AS pER WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE
SYSTEMS REQUIRE THATA 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 246-272AAND JEFFERSON COUNTY CODE
8.15 AS ADOPTED OR AMENDED.
3)
4.)
5.)
6.)
7.)
8.)
e.)
10.)
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 DOA 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.
10' separation required between a Water line and all portions of the onsite sewage system; effluent
transport line, tanks, treatment and disposal components.
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.
The project shall adhere to the Best Management Practices (BMPs) for the control of 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.
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.
11 .)
sEP19-00190
\\tidemark\data\forms\F_SEP_Permitmod. rpt
Page2 of 2
9t25t2019
CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT
INSTALLER Tarl B*^r'roo. N^ru.t"r0,uxe SD.PARGEL # qa? -boD-O/{
Permit Owner Permit #.<EP /q -@t?o
DRAINFIELD
ur.rcrx =xt ro rftEdfif aa"err rSEIr" 'o*r. 3 f*beTank Shroud/ t
lF PUMP AND PUMP CHAMBER REQUIRED: Size-Sqeen &etlgD boTll* antcr fr/k-
Float Arrangement
High water float - distance to top of tanUemergency
Dose drawdown (# of inches) # Gal
Timer/Dose Counter info mp Size/ Manufacturer
! CERTIFY THIS ONSITE SEWAGE SYSTEM WAS INSTALLED AS DESIGNED, PER PLAN AP PRovEo o?/4/.?
tQ ose ?Dn
INSTALLER SIGNATURE DATE INSTALLED
o(s
MAINTENANCE BASICS
'There is a "filter sock" in the outlet baffle of the septic tank. The filter sock should be pulled out and
hosed off every 6 months to avoid clogging and backing up into the house. Rubber gloves and other
precautions must be taken to avoid contact with sewage.
'The tank should be pumped every 3-5 years.
'The drain field area needs to be seeded to prevent erosion.
'The D-box should be opened once a year to make sure that the outlet pipes are all level. Rubber
gloves and other precautions must be taken to avoid contact with sewage. There is a "Speed
Leveler" dial on each outlet pipe that can be turned to level the outlets
'The large green lids on the septic tank and the green cover over the D-Box must be secured at all
times with screws or bolts to prevent hazard and tampering.
'Keep all traffic and heavy equipment off the drain field area.
'Septic systems are only capable of treating and disposing of normal human waste, toilet paper and
water. Some mild soaps and cleaners are also expected to go to the system as part of household
cleaning.
'Do not dispose of chemicals, harsh cleaning agents, medications, garbage disposal waste, etc. to
the septic system.
Please feel free to call with any questions.
360-598-6546 Nathan N. Cleaver
Licensed Onsite Wastewater Treatment System Designer
RE,CE,I VED
iAN 0 6 2020
COUNTY
ASBUILT CONVENTIONAL FRM 05-10-04 od
ENVIHON MiNrnL PueLtc Hroi it
DATtr
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AJ Soil Log
Building Envelope
Setback
Existing Septic
Clean Out
Septic Tank
Filter Sock
D-Box with Riser
LEGEND
#
10' No Build
(A)
(B)
(c)
(D)
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1OO% RESERVE
AREA 10'x 80'
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PROPERTY LINES BASED ON COUNTY RECORDS:
AF# 382369: 14 JUN 1995; Vol. 17 P9.022
CONTOUR LINES SOURCED FROM:
Jefferson County Central Services GIS Mapping
RECORT)
DRA\ryING
SCALE: 1" = 20'
THIS IS NOTASURVEY
MEASURE TABLE
oz\
NFI
EXISTING DF,ATN
FIELD PER,
5
ide Ditch
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WE LOCATION PER ORIGINAL PE IT
HAS BEEN DECOMMISSIONED
ATTACHED WATER WELL R
PHONE
POWER VAULT
IO.O' DF,AIN FIELD SETBACK
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WATER MAIN
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A 59.7'.42.6'.
B 66 8'35 2'
c 7L.3'30 5'
D 83.2',27.L',
1 L26.5'gg.6'
2 13 1.3'96.g'
Nothon Cleover Septic Design, Inc.
Phone: (360) 598-6546, Fax: 360-598-6548
262 NW Thompson Road, Poulsbo, WA 98370
E-mail : nathan@nalhancleaver.com
CUSTOMER: WEI ZHOU
TAX lD #: 989-600-015
LOCATION: LOT 1 5; PROSPECT AVENUE
PORT TOWNSEND, WA 98368
DRAWN BY: ZEG, ALR, ICS
DESIGN BY: NATHAN N. CLEAVER
DATE: 5/9/19 ; RD: 20 DEC 2Ol 9
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LEGEND
10' No Build
AJ Soil Log
- Building Envelope
Setback
Existing Septic
#Component
Tree
(A)
(B)
(c)
(D)
Clean Out
Septic Tank
Filter Sock
D-Box with Riser
PROPERTY LINES BASED ON COUNTY RECORDS
#459069: August 16,2002;Vol.24 Pg. 182
CONTOUR LINES SOURCED FROM:
Jefferson County Central Services GIS Mapping SCALE: 1"= 20'
THIS IS NOTA SURVEY
i10
105
5.0'
f 10.0'o)
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b
1
20.0'
Building
Setback
40'
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EXISTING DP"AIN FIELD
sEPg5-OO185
Ditch
5
PROPOSED B
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WELL LOCATION PE
ORIGINAL PERMIT HAS
BEEN DECOMMISIONED
(SEE ATTACHED WATER
WELL REPORT)
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A
0
Exisiting D
ProspectAve
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lOOo/o RESERVE
AREA 10'x 75'
--
-
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CEIVED
AUG I5 2OI9
COUNTY !10025r
NATHAT.I N CLEAVER
Nothon Cleover Septic Design, Inc.
Phone: (360) 598-6546, Fax: 360-598-6548
262 NW Thompson Road, Poulsbo, WA 98370
E-mail: nathan@nathancleaver.com
CUSTOMER:
TAX ID #:
LOCATION:
DRAWN BY:
DESIGN BY:
DATE:
WEI ZHOU
989-600-01 5
LOT 'l 5; PROSPECT AVENUE
PORT TOWNSEND, WA 98368
ZEG, ALR
NATHAN N. CLEAVER
5/9/19
RE
PI,ELIC HEALIH
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T\NK ONLY- SPtr,CIF'ICATION SHE,E,T
2 Co,mpartment Septic Tank Details
(Not Drawn To Scale)
(lonsllruct:ion Notes
(1) Installer must contact Nathan Cleaver Septic Design Inc. a minimum of 15-Days prior to
installation to schedule pre-installation site meeting (materials must be on site), pre-cover
inspection & As-Built cre;rtion (:$500 f,=e will apply.)
(2) CONTI\CT: Nathan Cleaver (360) 598.'6546
(3) AllTanks to be pla:ed must be installed on a level compact base of sand or pea gravel.
(4) Never leave Tank L.ids unsecured.
16" ORENCO FILTER SOCK
RISERS TO SURFACE
$ystem Information & Specifir:ations
(1) 1 Each 1,000 Gallon Septic Tank
NOTE:
-W,rter Tight Tank Riser:; to the surface are required.
(2) A riser with a bolt c,n lid is required on tihe D-box
(3) Speed levelers are required on the outlet pipes
in the D-box.
RECEIVED
JEFFERSON@JNW
ENVIROI.IMENIAL NNLE HEALIH
FROM HOUSE
t
INLET
AH U G I 5 2019
5r 00251
NATHAN N CIEAVER
Ol
Nothon Cleover Septic Design, Inc.
Phone: (360) 598-6546, Fax: 3160-598-6548
262 llw Thompson Road, Pouls;bo, WA 98370
[:-mail : nathan @ nathancleaver.com
CUSTOMER:
TAX ID #.:
LOCATICIN:
DRAWN BY:
DESIGN [}Y:
DATE:
Wei Zhou
989-600-01 5
Lot 1 5, Prospect Avsp11s,
Port Townsend, WA 98368
ICS & ALR
NATHAN N. CLEAVER
5/9/19uosreUs(
I
JE'FERSOiI COUNTY PEHI.IIT ;::i::R
621 SHEBIOAfl
PORT TOWTISEND WA 98368
(35C1 379-{450
FOR OFFICE USE
SEPTIC PERMIT APPLICATION
RECEIVED
..rrt{ 2 2 lgg5
JETFtrRSON fi1yrp,riirrirrrrEnIeH
Date
Fee
Receipt #
Check #
Case ;
_t'te3{
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iokq't j
/ofI
PBOPERTY OWNER
MAILING ADDRESS
P!-TONE
SYSTEM DESIGNER
LEGAL DESCRIPTION
Subdivision Name
SITE LOCATION
€t
AreaCcde I 2 04 I 3 Ag - 3 4g 4
Section g=tTownship 3 O Range / /{ PARCEL #
-7.*or. /a,/e.
?-6rtt- ors
Division /- Btock /S I Lot(sl /f
d
4
TYPE OF IMPBOVEMENT: Sesidential f Commercial
TYPE OF WORK:
lievv f Bedesign Upgrade Repair Partial: tank
Drainfield Length
TrenchiBed Depth
Number of Lines
Tank size
Soil type
Application Rate
TTACFItvIAP)
drainf ield
/lO rr.
21 i,,.
/4e2 gat.
3 (ATTACH solL EVAL,
O, B gal./sq.ft./day
liumber of Bedrooms J
Sasement: yes _ ", y'
Srte Size
lr,iater Source: Private- Fublic ll
Drainfield Widrh .3 ;1.
TYPE OF SYSTEM
;;,';;;;;;;;;;;;-;,;i=;;;;;;;;;;;;;;;;il;;;;;;';;;;;';;;';;;;;;;;i;;;;;
FALSE INFORMATION ''VII-L NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEOUENT PERMIT
THE PROPERTY OIVNER \,1iILL tsE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPE.qTY LINES.
Signature Date
;;;';;;,;;il;il;
3- A5' '15APPROVED
B 1 4\
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RENEWED
Planning District School Disrrict Fire District Community Plan _
H .|ror.trPt rycLlRvNFor{tIH\PtnMtI tBM uladd lr95
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SEWAGE DISPOSAL PERT{IT
JEFFERSON COUNTY PERMIT CENTER
621 SHERTDAN STREET, PORT TOWNSEND, WA 98368 (360) 379-4450
PERMIT NUMBER : SEP95-O185
ISSUE DATE 208/25/95
DATE RECEIVED z 06 / 22 /95
Permi-t issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE
DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHTNGTON
ISSUED TO....: GENE SETON
4B9O SO DISCOVERY RD
PORT TOWNSEND WA 98368
PARCEL NUMBER: 98960001-5 (Permit valid for this parcel ONLY)
LEGAL DESCRIPTIONSection: 35, Township 30 N, Range 01 West
Subdivision : PROSPECT VIEW EST Block : l-58 Lot(s):15;
LOCATION : PROSPECT AVE
DESIGNER : TED STRICKLIN, PE
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, ORDTNANCE NO. 1-83.
DATE OF EXPIRATION Z08/25/96
-----DrainfieldLength: 150
;r/^4+/1 \
Je erson Co. Env ronmental Health Specialist.
The property owner will be responsible for the accurate location of allproperty l-ines. Any removal of or major disturbance of soil in the primaryor reserve drainfield area may create site conditions that are unacceptablefor the installation of a sewage disposal system. Any change in building or
sewage disposal plans (including plumbing stubout location) and,/or locationof house or drainfield invalidates this permit unless prior approval isobtained from the Jefferson Co. Health Dept.
Issuance of a permit or renewal does not preclude the applicant from
complying with aII other state and loca1 regulations.
HEALIH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION.
TYPE OF SYSTEM: CONVENTIONAL TRENCH NO. OF BEDROOMS: 3
ft. Width:3.0 ft. Depth:24 in. Size:1000 gal.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
Conditions of Approval - Permit no.: SEP95-0185
FOT: GENE SETON
Page: 2
1) l-0 ft. setback to properly abandoned well to be maintained
2) WeIl to be abandoned as per WAC L73-160-455 and DOE guidelines bylicensed well dril-ler. Verification to be provided to Health
Department.
3) MAXIMUM TRENCH DEPTH 24 TNCHES
4) All components of the septic system are to be completely protectedfrom vehicular traffic or mechanical disturbance. Protectivebarriers are required around drainfield.
5) Divert all sources of drainage away from septic tank and drainfield
area.
6) Asphaultic emulsion or equivalent required on septic tank and/orpump chamber.
7 ) Approval/issuance of a sewage disposal permit does not guaranteethe approval of a building permit on this site.
8) Approval of this sewage disposal permit does not preclude thepermit holder from complying with the Critical Areas Ordinance forother development on the site.
sep_prmt.txt W/O5/91
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TRENCH I TRENCH \TANK
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FOR OFFICE USE ONLY FOR FINAL INSPECTION INFORMATION AND APPROVALn\6)'nVd.SYSTEM INSTALLED BY
ABSORPTION AREA:
DRAINFIELD \
\
PRESSURE TEST OBSERV trr'r
APPROVED__ SPECTALTST DATE
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(5) DIMENSIONS: Diffilffol
Drillad le€L O€plhofconrdoled$Eu
Perlomtlona: Yss No
Typo of p€rlorBtor used
SIZE of perlo.slbrt!ln. by
p€rloralhns lrom
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Did any strata conlaln
Type ol wal€t?
tlfolhod of seatlng strata oll
t4 PUIIP: Manulscturers Name
Type:
(8) WATER LEYELS:
Slrtic le8t
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(9) WELL fESTS: Drarrdoffir Is arnount *at€r
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D
trBacondtibned
incn*.
n.
(8) CONSTRUfiIONDETAILS:
castng lnstsllcd: ' oieri.frorn t. to-ll
WofC€d E . mm.frorn - tLlo-tl,
Unor lnslallsd O
,.
lo
Tlpe
WELL COM}TRUCTOR CEFTIFICATION:
I corctruclBd end/or Erccepl IesPonsititrty lor construction of lhis well, and its
compliance wilh ell Weshlnglon ,iuell construcilon slandards. Materbls used and
lhe ihformatron report€d above are truo lo rny b€6t kncrled€E atd beliBt.
Rocovory dalE (tlm€ lakon
lop to rvater l$rsl)
Tima Watsr LsrrEl
ao z€ro Hhan pump lurnsd o0 (watsr
Tlme Watr Leval
moasured lrtrn r€ll
llHsr Leval
Dote o, tecl
Eallsr tBt oel./min. with fl. dra'rdown after
Ajrtost
-ga|./mln.
rdth st€m s€t at
-
n. tor
Artsslanlhw-g.P.m. oalc
Tempsralure ot wabr
-
Was a chgtni:sl analFi3 mad€? YG
EoYosel-zo(ssl)"1 €.
ContaElor'8i?'*"HrAru'naa>3{*.'J-Ztr$-Zf
{USE ADDITIONAL SHEETS IF NECESSARY}
ecobgfr is an Equal opportunity and Afflrmalive Action employer- For spe'
cial acmmmodatlon n€eds, cxlntact tho waEr Flesourc€€ Program at (206)
407-6600. Ths TDD number is (206) 407-6006.
$
hrs.
hrs-
FAOflIIAIEFIAL
Noma
ver E ruo tI
Modol No.
-
Slol size
slze
to--n.
I
Sizo of grav6l
lL to
Yes No
ft.
To what doplh?
--
nNo
Depth ol
water? Yes E No E
H,P-
la ol mll Dato
-
imh DEIE
tt.
l(,reiEd behw slstic ls\lEl
aller
-
hrs,
wfiom?
-
No
/
RECENED
.rJN 2 2 095
JE;Flil,P[#]r'
risposal SYstem
APP ROVED FOR
CONSTRUCTION
t-5 -q5
ThrezJeJ Caps
4"Pye Obs,crtdtorz farlt-s /*io"r*-z
Nefivc Dt.lfi/l
filh, febrtc
4" lt/"rr/
!/1'-, l/;
Dratn Rocl
\
s
Isew age D
t^ 34-
-RENCH "t --P'
,J r'
T
,ue\\ to U. ,"b,.nc\.:r.uA
c.S Q,e-r
-e,^." Setn 3l-, .4ve,
\t
q)
s
\
\
ot
\ttt
* il7,
a
II
Posstb/.3 tilrn
1lo us e.
----r,/"= 2o'
4"Pye EnJ CapsO,n
a1
F
"PyL
Fr,g v e I 3-),<5o7
h
4"Pcrf Dratn Ptpe Q l'cc.
,4'+ P)/c
looo Ga/, S ep/tc frnA
* Tlsc
zol t5, BlA /UA
7ron45/e , Dtr. c
a
{'
t
\V:ICIEITI I{ID
(direcfions to your proPotY)
eulag RJ /urr7 F>s JEFFERSON C OUNTY UNIVERSAL PLOT PLAN AND
fftris is not a germitl
f itl In thc fotl*irp inlsratlan es cs'pt
DA/ELOPTUENT APPLICANON
ctcty rs Fs;ibl,co// //' /"v'/
aE fiot7=''/ '€vt',4'/rL '^' '/'
3Z .//-ld "r /<<'/u,r/eJ Up-Q'--'
PTGPETTY ca-vsr **3 8€-3a ?a
XAILIIG Qt 4
ctIr t 9A-aaB
IFPLICIII rl- Cif diffccrnt
T,UTTTZED tP (cirelc c-)
X ILIIG ADO1ESS
SEPTIC D€SI
XAILIIC rcD
TED P,E
ctIE ll CDraTl tr Cl
XAILIIG I)ORESS
STATE LIC3XSE r',J53t_ arpitAlioi DAT
T.ECXITEtrT
X ILIIG f,)ORESS
LUI L.Erc=I I,!€/,?Co E-}Er
f,^lLIxG A:oREss PHAixri=a
t EtEardlga
w-*4d
s'l
, EIEECENIST€aE€?xerIu6
@EEEEryT'IED!4rED- S5r4E XEr(ryEr@tErDXE@@-€IEx-*trt.E-6rqtEreE?IEE| TESI'xDrrr6E @E@I@.erEiEBtaElqE
EJ li,t SITE IDOIESS:
9lfrl.IorD IrE ZtpI
!t
I;r
LriER lv€_LEG L DESCTIPTIO{:
s.,Bolvtstor IYrsto.ji_
-o/,-158
rAI H,{8Er 9 DIGII PA.TCEL
I sEdrd-€.{_ r*nsnrr___5Q r3rrx
a
.,
l^r*lr{
- .aaa
I
rr
!
c
d
2
DESCrtPtlox oF t
v
. ,bc !
I
I
I
!
I
!
LEGEND
lr.E--BPEE-*1?4-.n
a.FFEtwautB.EE
ttI.rsE nLL AJT rll tr rPPttC rtcrE Dcrr ProFcrty O*rcr: Plcrsa fil,l, tjrir taia qrt rs cr+tetely rs pcrtibtc. fhe [c3rl dcs:riptiar rrd 9
digit plrctt rrrrtcr aey be obtrincd frcn yanr trr, atrigEnt or fre thc Assc:sorrr Of{ice in thc Jeff:rtcn
cansy Cs,rthq.rse- Pltrst lltr yanrsclf et lcest qil! coflr of this fora ro thrt yorr ray r,tse it for fwurc
dev.ctotrncnt of 1a.a proFrty- tsh
Frsr'trr Dlldnat
.i.-ad't6xE.aEarI'4L--IMtd-ararp+aE-rtE- o--F
x-ca^trE lar.lr
L,t__
3
lL>
lt-t t m,_=
xlitir.|g ldrx3: Jcffcr:gt Carr3y Pcnit Gcnlcr, 62t Strcridra, Port T*rscrd, uA 9&l6E
II
SOIL INFORI.{ATION
REOE+Yfu
;'ull 2 2 pgs
/o d,.ttltro 4,
or impermea
././ /.9
SOIL LOG 11
a to -fa in.z
5. to 1t/ in. Mto
-_
in.
to __- in.
Antlcipa
Roots to
ted urater table n.
HEALT}I DEPT. COMMENTS
Zl
owN eI Number
LEGAL DESCRIPTION:Section 3.f Township Jo Ra nge / ,t4
Subdivisi
Division_Jl_ Block- t.f.c Lot./a f #ru ./4
DATE LOGGEDz 8. //LOGGED BY:
Include soil textural characteristics and the depthe at whichsignificant changes occur. Be sure to include depth where mottling
ble ayerG occ
5o lnches
Ic'i
SOIL LOG 12
; o to 43 in.
23 to 24 in.
.' to o? in.
to _- in.
Anticipated water table - _in.
Roots to *4 inches
HEALTH DEPT. COMI'TENTS
ur.
32
)
c/u s4\O c
\-
7
Z"l 7.s-solt Loc #3
o to 24 in.
* to -f4 in.
54 to 8o in. s cr
to in.
Anticipated water table :_in.
Roots to L +inches
HEAITH DEPT. CO}ff'IENTS
SOIL LOG il5
D to 22 . I
-?,rn. ) t L
<\ sorL Loc 11
- :-r / 6 to .}.s-Y/ Jc to ^r4' tl_to 7F
in. C
in. -s Z
in. .S
to _ in.
Anticipated water table
--
j.n.
Roots to 33 inches
HEALTH DEPT. COMMENTS
SOIL LOG
'6o to =l_:Z_ in.4,
3a_ to _tr/in. 3L5,r to 75 in. -s
to _ in.
Anticipated water table
-
in.
Roots to 3 t nches
22 to 4o in.
/o to 8P in.
dL
-/ ,S
to_in
Anticipated water table
-
in.
Root8 to 3 inches l
I]EALTII DEPT. COMMENTS IIIIALTH DEPT. COMMENTS
- 94
t:\
JEFFERSON COUNTY HEALIE DEPAR?IIEN?
ON-SITE SE9IAGE DIS?OSAI SYSTETT DESIGII
RECEIVED
..uil 2 2 tggs
JEEEERSo{ t[\I;*
tJsririlri uEnf iri
Date:(* a* ,-{Deslgner:-/)-,/f e- d ;t'-)../,o
Legrl Dcecrlptlon: Sactlon Tornrhl P Rengr 1 /<1Subd.lvlglon Dlv1r1on 4
/o'. fr.;t 0 rcr o iot /.fl.tL-
Owner:
Aod=ess:{8co s.'. t=ro.ou".. R'O'.<
I. CALCULAIIONS
if fo= residential Ese:
Nr:aber of bed,rooes: 3 x 120 G.p.D. . 3ZO Totar G.?.D.
: f f c= non-res lden:ial l:se, attach caleulatlons ucrd to deteraine G . P. D.
So:l tex:u,=e braste wats: appl:catioa rate
(see -Dag:e 2L4 of -sil€ E?A Deslgn lianual)
DPSiNSiELD SIZTNG:
o, I G.?.D./t=. squa=ed
Acso=ption a=ea:4 sqr:a=e f eet (Total GPD - G?D/ft squa=eo)'
?rench o; bed. width 3 feet
F-6r ni ^- 'raA 'l ar^:iryL5
-E.., r../5c llneal leet (sq. tt. + trench or bec w1q-.e)
ii. A?PUR,TENANCES
Septlc Tark Size / e€a galloss
Frlctlon loss
?r:.ap capaclty ehoufd be
-
gpur at
-
TDH
t
-'
Nusber of doses per d,ay
Doclng volursa grllona
Pu:ap clraober slze gallons
?u.op ReguireEents (if Necessary)
q,
III.DRAI$FIELD CROSS SSCTTON
A
a
D I
RECEIVED
.,ul{ 2 2 lgg5
JE':EqRSCN ffipr./[rinfti uEnic.r
ftapermeeble raarerlc I ;
Seasonel 88EuraE,1on
Netlve
rotl
c
A. Treach Depth 24 lnchee
inches o! dralnrock below plpe
lnches of vertical separation froa trench bottour to
iape eable rnaterial/seasonal, aaturation
D.lnchcs of t111 (lf neeocd)
E. Trenclr wld,th 31 lnchee
Notes:
F111
*tf,,tl ,,,ttt
B
Attrctr detalfed dcrl,gn of 6ystcE