HomeMy WebLinkAboutSEP2015-00032 - 01 APPLICATIONJefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379 -4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Brett (Daniel) & Lucresha Thacker
MAILING ADDRESS PO Box 1374
Port Hadlock, WA 98339
PHONE ( 360 301 -2808 (Lucresha); 301 -4445 (Brett)
SYSTEM DESIGNER Suzanne Martin Designer Phone # 990 -3304
LEGAL DESCRIPTION: Section 20 Township 28N Range 1 W PARCEL # 801 201 009
Subdivision Name Thacker- Schlief Short Plat Division Block
Site address /Directions to site 7991 Center Road - Quilcene, WA 98376
SOURCE OF SEWAGE /USE
Residential
Residential ADU ✓
Commercial
Community
SYSTEM TYPE
Conventional
Alternative ✓
SYSTEM DETAILS
TYPE OF WORK
New ✓ Tank/s only
Modification _
Expansion_ —
Upgrade
Repair
Partial Repair - (tank) (drainfield)
Designate RPCPrve Area
Redesign_
Lot(s) 2
WATER SOURCE
Private
Public
SITE SIZE +/-92401sf
Previous Evaluation
Yes # SEP99 -00233
No
Number of Gallons /day 240 Soil type 4 (attach soil eval.) Application Rate 0.60 gal. /sq.ft. /day
Drainfield Length 19 ft. Trench Width 14.5 ft. Trench /Bed Depth mound in.
Septic Tank size 1000 gal. Pump Chamber size 1000 gal.
TYPE OF Proposed Glendon Biofilter 2 total M31
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 wiip -lpter 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 th t ti
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Property Owner Signature Date
A PR VED
). Fee
FOR OFFICE USE ONLY
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