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HomeMy WebLinkAboutSDP2013-00051 - APPLICATION W„,,<, . `acs JEFFERSON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT . . 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment " iiNci Tel:360.379.4450 I Fax:360.379.4451 I Email:dcda(�co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): h?i✓s 'r- stye -iv 1/5 hir. b . 'k ` 1' it i ! l h al are A.. ow 09 r i Tax Parcel Number: i et- (a!� luCer►f fD `Iei/907-y'roperty Size: 120• q a-c— (acres/square feet) Site Address and/or Directions to Property: /� /� //1->Lcvf da/are-et hi'J7`f"of lo/ ,1,17a fn•iui i ;4 f`levet a 6k-a/eer)?- Property Owner(s)of Record: ' 'KSOY) ) yl Telephone: (&U-- '7'7 i- 4'4 6,6 Fax: _ email: G%{yc�5t�/c/iyl ( Ce'.id-i#641.t,,.fil,tic Mailing Address: 2/ Sliek-7A-di/l .%t4�-2r r�t /Ot-mS,,t,d a/3 34 J Applicant/Agent(if different from owner): . USf ii9 W,/Sdy17 A/7-7 (-,�`r f�MI e-e✓t Di'i�y inA a�p(1 c‘La21J Telephone:124O- 2- SH y r Fax: email Ju 5?'7h 0 Ytf/ 4G4•G7 sr Mailing Address: 7/7 3 r Pea beefy "-- Gh r 4 f'l,//t% 9 r3 k 1- What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building 12/Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑ Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑Stormwater Management 2'Shoreline Master Program Exemption/Permit Revisions** i ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: F Jerez i,erm,l ern(1er s f M -(ore ,Fug noel de✓ela 0 /ell # rI141-f cvv1(kill f .", / DEGNA ION OF AGENT I hereby designate G/5 i/✓I Vv ?/a'ri (Air/ ) to act as my agent in matters relating to this application for permit(s). �� L !Jrt ''owmt SIGNATURE 1 `" " Thg —91— Date: i' iii j_j 3 By signing this application form,the agent attests that the 044 mation provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material ehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. ;=c c>f( /nemn I further agree to save,indemnify and hold harm ess 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 unty in writing at the time of the applica on that he or sh wants • notice. Signature: V °— ' , 410 Date: /I // The action or actions Applicant will undertake as a result oft. issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable res onsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and igns and dates it below. Date: Js•1 // J Signature: --���/I�lY- .y 111 07/24/2013 BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New I Wood Existing: 1 Sewer 1. Addition I Steel Proposed: Bank 1 Community System Alteration/Remodel 1 Concrete Total: Height: I, Individual System Repair -1 Masonry SEP Permit# I Demolition 1 Other: Bedrooms: Water Supply: Existing: Setback: Private well I Two Party Type of Heat: Proposed: 1 Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO i evotS telleP i knaT retaWtoH i Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. S•uare Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated __ EH Bld App Review: 2"' Floor Heated __ Consistency Review: Other Heated __ Base fee: S tk ' 11111 Mezzanine Additional Section: .P— q I LSIr- Heated Basement __ Plan Check fee: Allr■ p Unheated Basement __ State Surcharge fee: l Other Unheated __ Pot Water Review fee: Garage/Carport __ SUBTOTAL Decks __ 911/Rd Approach fee: Other TOTAL: $ Receipt Number: Vl Cf6!g k ii Cash/Check Number: 0 ESTIMATED COST(REQUIRED) Date: /2/�r •Fair market value of all labor and materials foundation to finish ! I Initials: 07/24/2013 CASES, FINDING, CONDITIONS, PERMISSIONS FOR Parcel 701194029 Printed: January 2, 2014 Cases Name Review Status Planner Type BLD05-00550 MLA05-00511 DOUGLAS 1 F Michelle Farfan Application Received: 8/24/2005 Permit Issued/Case closed: 12/28/2005 Case Finaled: 9/6/2006 NSFR W/ATTACHED GARAGE 1.) The application was reviewed by the Jefferson County Department of Community Development staff on September 1, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: waterfowl concentrations; landslide 2; SUSC aquifer recharge area; coastal SIPZ. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 5.) 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. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 8.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 9.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 10.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 11.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 12.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 13.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. \\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 1/2/2014 Page 1 of 5 Cases Name Review Status Planner Type 14.) VOLUNTARY MEASURES OF COASTAL&AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three(3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 15.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 16.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 17.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 18.) The applicant is proposing to create or add 4595 square feet of impervious surface and 8346 square feet of land disturbing activities. 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.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 21.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i). 22.) The site plan as submitted with the building permit application on August 23, 2005 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 stamped, approved site plan dated September 1, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) This approval is for a single family residence with attached garage 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. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) The building height is not to exceed 35 feet. 28.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. \\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 1/2/2014 Page 2 of 5 Cases Name Review Status Planner Type 29.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 30.) Minimum setback from Wampum Point Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear (shoreline) setback shall be 30 feet from Ordinary High Water Mark if bank is less than 10 feet in height. If bank is greater than 10 feet, shoreline setback shall be measured from the top of the bank back 30 feet. (Site plan depicts a 50 foot setback from house foundation to mean high tide line). 31.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 32.) A minimum of two (2) on-site parking spaces are required for the single family residence. 33.) An address of 101 Wampum Point Road, Quilcene has been assigned to the lot. Wampum Point Road is a private road (P538). 34.) A septic permit (SEP99-0068) was finaled on May 25, 1999. A water review(USR98-0095)was approved on December 13, 1998. A road approach permit (RAP05-0212)was cancelled on August 11, 2005. PRE12-00010 DOUGLAS M Donna Frostholm Application Received: 5/21/2012 Permit Issued/Case closed: 6/14/2012 Case Finaled: PRE APPLICATION QUILCENE BAY SPIT RESTORATION &ACCESS No findings, conditions, or permissions found. RAP05-00212 DOUGLAS C Application Received: 8/5/2005 Permit Issued/Case closed: Case Finaled: 8/11/2005 911 & RAP No findings, conditions, or permissions found. SEP99-00060 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 2/10/2005 Case Finaled: 1/7/2009 serves Lot 4(D)#70119402/, drainfield on Lot2(B)#701194029 with a portion on lot 1(A) Filed with SEP07-265 tank only permit. 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL 2.) The drainfield for this lot is located on lots 1&2 (A&B on survey) 3.) The reserve beds are located between the primary beds. A minimum of 12 feet of separation is required between the primary beds. 4.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. PRJ10-00047 DOUGLAS F Application Received: 2/11/2010 Permit Issued/Case closed: Case Finaled: TANK ONLY CONNEC I ED I O SEP99-68 NOW FILED HERE No findings, conditions, or permissions found. SEP05-00324 DOUGLAS F Application Received: 9/21/2005 Permit Issued/Case closed: 12/27/2005 Case Finaled: 8/28/2006 TANK ONLY CONNEC I ED I 0 SEP99-68 NOW FILED HERE 1.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. Documentation must be provided that states the existing transport line was installed per this requirement. \\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 1/2/2014 Page 3 of 5 Cases Name Review Status Planner Type 2.) An asbuilt drawing and certification of completion by the designer is required prior to final approval. AS-BUILT MUST INCLUDE THE DRAINFIELD ALSO 3.) Health Department is to be contacted for a final inspection of the septic tank and pump chamber prior to covering. 4.) 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. 5.) Permanent barriers are required along/around primary and reserve drainfield areas to protect from parking, driving, and other land disturbing activities prior to final. 6.) AS PER WAC 246-272 AND JEFFERSON COUNTY CODE 8.15 ALL SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. While the County strongly recommends that the property owner allow inspectors to enter their property to inspect the system in order to insure that the system is functioning correctly, the property owner always has the right under the Fourth Amendment and our State Constitution, to refuse the inspectors access to their property. The property owner never loses the right to refuse access and can do so despite never having refused access before. 7.) As per Jefferson County Code 8.15 all onsite sewage systems require monitoring. Monitoring shall be provided by an approved entity. THIS SYSTEM IS REQUIRED TO BE INSPECTED EVERY 3 YEARS AT 6 MONTHS, AT ONE YEAR AND ANNUALLY THEREAFTER. 8.) Health Dept. required to observe pressure test when system fully installed/complete, 48 hours notice to be provided for scheduling. 9.) Designer must be contacted prior to start of construction and for inspections during installation. 10.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 11.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 12.) Dose counters are required in the control panel for all drainfield components. 13.) Risers are required to grade with secured lids over both compartments and over the outlet of the septic tank for inspection and maintenance/monitoring. Minimum 20" riser over inlet. 14.) 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. 15.) 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. 16.) 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. SOM99-00068 DOUGLAS P Application Received: 8/28/2006 Permit Issued/Case closed: Case Finaled: No findings, conditions, or permissions found. SOM99-00060 DOUGLAS F Application Received: 3/15/1999 Permit Issued/Case closed: Case Finaled: serves Lot 4(D)#701194027, drainfield on Lot2(B)#701194029 with a portion on lot 1(A) Filed with SEP07-265 tank only permit. No findings, conditions, or permissions found. SEP99-00068 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 5/5/1999 Case Finaled: 8/28/2006 Now filed with SEP05-324 a tank only lot 2(B)#701194029 (per BLA), drainfield is on lot 1(A)#701194030 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL, 28 INCHES OR MORE IN SOME AREAS. 2.) The drainfield for this lot is located on lot 1 (A on survey) Drainfields for lots C&D (4&5) are locate on this property,(lot 2 (B)) See survey recorded on 4/14/99 3.) Reserve beds are located between the primary beds a minimum of 12 feet separation is required between the primary beds. 4.) All components of the septic e sept c system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. \\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 1/2/2014 Page 4 of 5 Cases Name Review Status Planner Type 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. USR98-00095 PHILLIPS F Application Received: 10/30/1998 Permit Issued/Case closed: 8/29/2005 Case Finaled: 8/29/2005 lot B (2), Unique ID#on well verified 8-15-02 AEJ773 No findings, conditions, or permissions found. SEP99-00061 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 6/20/2003 Case Finaled: 7/8/2011 Drainfield on Lot 1(A) /01194030 and 2(B) 701194029 now filed w/SEP07-57 the tank only 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL. 27 INCH TRENCH DEPTH OR MORE MAY BE REQUIRED. 2.) The drainfield for this lot is on lot 1&2 (A&B) See the recorded survey of 4/14/99 3.) Reserve beds are located between the primary beds. 12 feet of separation is required between the primary beds. 4.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent Yp p Y q 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. \\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 1/2/2014 Page 5 of 5 ON cci)U JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend, WA 98368 I Web: www.co.jefferson.wa.us/communitydevelopment -iSN y ING.co Tel. 360.379.4450 I Fax: 360.379.4451 I Email:dcdco.jefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center To: Philip Morley, County Administrator From: Carl Smith, Community Development Director Date: December 16, 2013 Regarding: Douglas Wampum Point Restoration Project—Memo to the File The above referenced project proposes to realign an intertidal channel of an unnamed stream which drains into Quilcene Bay in Jefferson County. The work is proposed to occur on County owned land known as "Jefferson County Tidelands Tax Lot B, SE1/4, S19, T27, R1W". County planning staff understands that the intertidal channel in question migrates over time and its location has been manipulated by human action in the past. This project requires a shoreline permit through the Department of Community Development (DCD). DCD's permit application typically requires the land owner's signature as an applicant. However, in this instance, the County, (acting through Administrator Morley), declines to sign as an applicant, and instead, signs this memo on behalf of the County in order to authorize access by the applicant to the County-owned property for the proposed project. This is due to the fact that the County is not in any way sponsoring, advocating, initiating or attesting to this project, and assumes no responsibility or liability for the outcomes of the project. The County's role in this project is only to grant access to County-owned property for the applicant's use for this project, and to process the application for the project in a manner consistent with the County's adopted regul. .•ns. f 0#46(L (2/2_03 Philip Morl: i}•','untyAdministrato Date JEFFERSON COUNTY ..c.' ,. :;,iaA DEPARTMENT OF COMMUNITY ~1 DEVELOPMENT 621 Sheridan Street,Port Townseno,WA 98368 I Web•www.co jefferson.wa us/communitydevelopmert '"' Tel:360.379.4450 I Fax:360.379 4451 I Email dcd @co.jefferson.wa us • SquareONE Resource Center I Building Permits&Inspections I Development Review I Long Range Planning January 15, 2015 KATHLEEN DOUGLAS 101 WAMPUM POINT RD QUILCENE WA 98376 RE: SITE ADDRESS: 1 CASE#: MLA13-00165 Dear KATHLEEN DOUGLAS: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. DCD has reviewed the comments received during the notice of application and has reviewed the stream restoration plan submitted for this application. In part. this application is intended to provide habitat benefits for shellfish. The proposal includes salvaging and replanting native plant species. To ensure that shellfish and forage fish benefit from the proposed work and to help ensure stability of the new channel, propose additional mitigation measures that would provide habitat benefits to shellfish and forage fish and would meet the critical areas stewardship plan (CASP) requirement in JCC 18.22.461(4), which states: CASPs must provide equal or greater protection of critical area functions and values than the perscriptive standards of buffers and setbacks. This could include additional plantings or other habitat features. Please submit an addendum letter for the mitigation proposal. Please submit the above information to the Department of Community Development within 90 days of the date of this letter which would be 4/15/2015. As required by Jefferson County Code, JCC 18.40.110(3) and (6), if the information is not submitted or additional time to submit the required information within the ninety (90)calendar day period is not requested, the application would be considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson County Code provides that the Department of Community Development shall not be responsible for notifying the applicant of an impending expiration, thus any further notification would not be forthcoming. Sincerely, Attma Yttfothi titt Department of Community Development Staff c: File 4 e',<: tt o i ti i e iii ti 1,3-4 A''5`. d" Ir1a'cifS 1\tidemark\data1formsT_MLT_Addlnfo_Requst rpt 1/15/2015 JEFFERSON COUNTY "° � DEPARTMENT OF COMMUNITY K DEVELOPMENT y'. • 621 Sheridan Street, Port Townsend, WA 98368 I Web:www.co.Jefferson.wa.us/communitydevelopment Tel: 360.379.4450 I Fax: 360.379.4451 I Email:dcdco.jefferson.wa.us SquareONE Resource Center(Building Permits&Inspections I Development Review I Long Range Planning January 15, 2015 KATHLEEN DOUGLAS 101 WAMPUM POINT RD QUILCENE WA 98376 RE: SITE ADDRESS: 1 CASE#: MLA13-00165 Dear KATHLEEN DOUGLAS: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. DCD has reviewed the comments received during the notice of application and has reviewed the stream restoration plan submitted for this application. In part, this application is intended to provide habitat benefits for shellfish. The proposal includes salvaging and replanting native plant species. To ensure that shellfish and forage fish benefit from the proposed work and to help ensure stability of the new channel, propose additional mitigation measures that would provide habitat benefits to shellfish and forage fish and would meet the critical areas stewardship plan (CASP) requirement in JCC 18.22.461(4), which states: CASPs must provide equal or greater protection of critical area functions and values than the perscriptive standards of buffers and setbacks. This could include additional plantings or other habitat features. Please submit an addendum letter for the mitigation proposal. Please submit the above information to the Department of Community Development within 90 days of the date of this letter which would be 4/15/2015. As required by Jefferson County Code, JCC 18.40.110(3) and (6), if the information is not submitted or additional time to submit the required information within the ninety(90) calendar day period is not requested, the application would be considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson County Code provides that the Department of Community Development shall not be responsible for notifying the applicant of an impending expiration, thus any further notification would not be forthcoming. Sincerely, _Deana g Jtfeliw Department of Community Development Staff c: File \\tidemark\data\forms\F_MLT_AddInfo_Requst.rpt 1/15/2015 ,Jefferson County Assessor & Treasurer - Property Details - 63 REIMER L DOUGLAS fo... Page 1 of 2 Jefferson County Assessor & Treasurer 17463 REIMER L DOUGLAS for Year 2014- 2015 Property Account Property ID: 17463 Legal Description: S19 T27 R1W TAX 47&TL TAX 13 SUBJ/EASE Parcel Number: 701194029 Agent Code: Type: Real Tax Area: 0321-1-48F2H2C2L1 Land Use Code 11 Open Space: N DFL N Historic Property: N Remodel Property: N Multi-Family Redevelopment: N Township: 27N Section: 19 Range: 1W Location Address: 101 WAMPUM POINT RD Mapsco: QUILCENE,WA 98376 Neighborhood: S19T27R1W(W OF BAY)/QUIL BAY VISTA/QUILCREST/HOY/BATCHELDER Map ID: Neighborhood CD: 2340 Owner Name: REIMER L DOUGLAS Owner ID: 14719 Mailing Address: KATHLEEN M DOUGLAS %Ownership: 100.0000000000% 2021 N 78TH ST SEATTLE,WA 98103-4907 Exemptions: Taxes and Assessment Details Property Tax Information as of 02/04/2015 :;J Amount Due if Paid on: M. NOTE:If you plan to submit payment on a future date, make sure you enter the date and click RECALCULATE to obtain the correct total amount due. Click on"Statement Details"to expand or collapse a tax statement. Year Statement ID First Half Second Half Penalty Interest Base Paid Amount Due Base Amt. Base Amt. lo Statement Details 2015 7294 $2470.74 $2470.64 $0.00 $0.00 $0.00 $4941.38 ■Statement Details 2014 7362 $2370.06 $2370.02 $0.00 $0.00 $4740.08 $0.00 Values Taxing Jurisdiction Improvement/Building Sketch Property Image Land Roll Value History Deed and Sales History Payout Agreement http://trueweb.jeffcowa.us/propertyaccess/Property.aspx?cid=0&year=2014&prop_id=17463 2/4/2015 .,Jefferson County Assessor& Treasurer - Property Details - 63 REIMER L DOUGLAS fo... Page 2 of 2 ~" This website is under active development. Some functionality is not yet available and data is not guaranteed. Assessor Home Page Treasurer Home Page County Maps Disclaimer Website version:9.0.32.2200 Database last updated on:2/4/2015 4:24 AM ©2015 True Automation,Inc.All Rights Reserved.Privacy Notice http://trueweb jeffcowa.us/propertyaccess/Property.aspx?cid=0&year=2014&prop_id=17463 2/4/2015 D -I X X -b co Cl) —I fi X —I —I co 0) -- -- 0) C!) 0) X O_ C7 r+ X 0) n -5 -0 0 0 - -0 -s -5 C7 0) C O. 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CA) H O 3 O I Z D CZ - O C) r CO o C0 0 0) -1 E o M C D rn 0_ 70 CD o C D Cl) CD CD 0 0 -1 -1 M 3 0 -D r 0 73 0 Z rn C-D C) C) Cr D �I Cl) 0- S 3 C I CD CD II 0_ r+ CO 0 0 M I-1 C O C7 O Z CA r+ 0_ 70 3 C>_ G7 -5 0 0 r N - O. 0 m C- CA) CA) - CD fi D - - -- -- L 0) O H O — T Z o- N m .E7 0 C 0 H CJ1 70 w -< �w`�SON c0r,� JEFFERSON COUNTY ►d DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 itor 360/379-4450 • 360/379-4451 Fax 4.<gS, N0�0$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Quilcene Bay Spit Restoration &Access Tax Parcel Number: 701194029 Property Size: 2.2 ac (acres/square feet) Site Address and/or Directions to Property: 101 Wampum Point Road, Quilcene, WA 98376 Property Owner(s)of Record: Reimer& Kathleen Douglas Telephone: 206 235-2991 Fax: email:v-kadoug @microsoft.com Mailing Address: 2021 North 78th Street, Seattle, WA 98103 Applicant/Agent(if different from owner): Harriet Cornachione, NTI Engineering &Surveying Telephone: 360-379-5430 Fax: email: harriet @nti4u.com Mailing Address: 914 Washington St., Suite 6, Port Townsend, WA 98368 What kind of Permit?(Check each box that applies OBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit O Variance(Minor, Major or Reasonable Economic Use) ❑Single Family O Garage Attached/Detached ❑Conditional Use[C(a),C(d),or CI** O Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* O Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment O Address 0 Road Approach ❑Short Plat** LI Home Business 0 Cottage Industry ❑Binding Site Plan** ❑Propane 0 Long Plat*" O Sign ❑Planned Rural Residential Development(PRRD)/Amendments** O Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** O Stormwater Management IXShoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** O Temporary Use O Shoreline Management Variance O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: Section 404 Permit; Hydraulic Permit Approval NTI Engineering &Surveying DESIGNATION OF AGENT I hereby designate 9 9 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE C Date: April 10,2012 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 ry to Jefferson rson Coun hand its employees,representatives resentatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the Itime of the application that he or she wants prior notice. i Signature: (..,t, �. � . Date: April 10, 2012 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable res onsibility for adhering to and�gmply with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: L`.�.(, 4 i �� t Date: April 10, 2012 G:\YertnirCenter\###NORMS###\DRD FOR: ;\Master Tannic Application 5-29-08.doc 7,AS- N % JEFFERSON COUNTY ,� DEPARTMENT OF COMMUNITY DEVELOPMENT •`+'4 621 Sheridan Street ' Port Townsend 'Washington 98368 i,,,. , ,, 360/379-4450 ' 360/379-4451 Fax 1S,,,__ cp www.co.jeferson.waus/commdeve Master Permit Application MLA: Project Description(include separate sheets as necessary): — Quilcene Bay Spit Restoration&Access _ �! ^_„-Tax Parcel Number: 701194029 Property Size: 2.2 ac (acres/square feet) Site Address and/or Directions to Property: 101 Warnpurn Puint Road, Quilcene, WA 98376 Property Owners)of Record: Reimer& Kathleen Douglas — Telephone: 206 235-2991 Fax: email:v-kadoug @microsatt.com Mailing Address: 2021 North 78th Street, Seattle, WA 98103 — --_. Applicant/Agent(if different from owner): Harriet Cornachione, NTI Engineering&Surveying — ______ Telephone: 360-379-5430 __^Fax:_ email: harrieta.nti4u.conl _ Mailing Address: 914 Washington St., Suite 6,Port Townsend, WA 98368 __! What kind of Permit?(Check each box that applies !7Rui!ding 0 Critical Areas Stewardship Plan I 0 Demolition Permit Ci Variance(Minor,Major or Reasonable Economic Use) 0 Single Family U Garage Attached I Detached 0 Conditional Use[C(a),C(d),or C)'• ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification O Commercial• 0 Special Use(Essential Public Facilities)" Li Change of Use 0 Boundary Line Adjustment O Address__.__ _ 0 Road Approach Cl Short Plat" Home Business 0 Cottage Industry 0 Binding Site Plan" ❑Propane 0 Long Plat" 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments•" C!Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration•" O Stormwater Management f;XShoreline Master Program Exemption/Permit Revisions" i O Site Plan Approval Advance Determination(SPAAD)' ❑Shoreline Management Substantial Development" Cl Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication' 0 Comprehensive PlarVUDCA.and Use District Map Amendment Cl Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment "May require a Pre-Application Conference ❑Tree Vegetation Request "Requires a Pre-App/leaf/on Conference Please Identify any other local,state or federal permits required for this proposal,if known: Section 404 Permit, Hydraulic Permit Approval DESIGNATION OF AGENT I hereby designate NTI Engineering&Surveying to .• as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 1L-1-- t.- 101.--"r� ., ~ Date: April 10,2012 By signing this application torn,the owner/agent attests t t,the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnity and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys 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 fight 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 an nor notice. L Signature , ; 'a. ..L t9. .t.0 l4L .LGCLi' Date: April 10. 2012 , _.— The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential'take'of an endangered species as those terms are defined in the federal law known as the `Endangered Species Act'or'ESA.'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because IN's permit has been issued will not violate the ESA Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your actions)even if you are in compliance with the Jefferson County development code,The Applicant acknowledges that he.she or it holds individual and non-trans cable responsibility for:dheri to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature._ ' -.-- uZ. Date: April 10, 2012 ■ GAPcnnitCentcr\##srFORM sa##\DRL NORMS\M,srer Permit Appl cauvn 5-29->H.dnc V BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: .1 New 1 Wood Existing: `.J Sewer i Addition I.1 Steel Proposed: Bank 0 Community System u Alteration/Remodel D Concrete Total: Height: 0 Individual System Repair C Masonry SEP Permit# Demolition G Other: Bedrooms: Water Supply: Existing: Setback: I I Private well 0 Two Party Type of Heat: Proposed: Li Public Total: Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank i Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Offics Use:{3n�r Amount it Revisf.on >, 5 , Main Floor Heated EH Bld App Review: 2"°Floor Heated Consistency Review: Other Heated Base fee: Me77anine i Additional Section: Heated Basement ` Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL • Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: • G:\PermitCentcr\###FORMS###\I)RI)FORMS\Master Permit Application 5-29-O8.doc ��.�,goN ,,t JEFFERSON COUNTY a DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4,<gS, NO5 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Quilcene Bay Spit Restoration &Access Tax Parcel Number: 701194029 Property Size: 2.2 ac (acres/square feet) Site Address and/or Directions to Property: 101 Wampum Point Road, Quilcene, WA 98376 Property Owner(s)of Record: Reimer& Kathleen Douglas Telephone: 206 235-2991 Fax: email:v-kadoug @microsoft.com Mailing Address: 2021 North 78th Street, Seattle, WA 98103 Applicant/Agent(if different from owner): Harriet Cornachione, NTI Engineering & Surveying Telephone: 360-379-5430 Fax: email: harriet @nti4u.com Mailing Address: 914 Washington St., Suite 6, Port Townsend, WA 98368 What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C)** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** ❑ Home Business ❑ Cottage Industry ❑Binding Site Plan** O Propane ❑Long Plat** O Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** O Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** O Stormwater Management ((Shoreline Master Program Exemption/Permit Revisions*" O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** O Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: Section 404 Permit; Hydraulic Permit Approval NTI Engineering & Surveying DESIGNATION OF AGENT I hereby designate 9 9 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: April 10, 2012 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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-t}hat he or she wants prior notice. Signature: 1�, /• ,A, ri - Aril I I• The action or actions Applicant will undertake as a result of the issuance of this permit may neat� n*r =r [:.�,: , ��{e t- e� Of endangered species and could lead to a potential lake"of an endangered species as those terp, a e d to fieTederal law know !asit)tt? "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant thit the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit ob\behalf 91 an endangers rr5pecies regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowldklOS that he,s it Vr it holds individual and non-transferable�ress onsibility for adhering to and/c[imply' with the ESA. The Applicant t!as r ad this disclaimer and signs and dates it below. Signature: ��,�a-( /i 1 —" t! to A r-d 1 2_g. -_ jLrr , { e ; lr _ G:\PcrmitCentcr\###FORttIS###\DRD FOR: :\Master Permit Application 5-29-08.doc BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: , Shoreline: Type of Sewage Disposal: New '1 Wood Existing: ?1 Sewer '1 Addition I l Steel Proposed: Bank C Community System 7 Alteration/Remodel ;..1 Concrete Total: Height: CI Individual System Repair C Masonry SEP Permit# • Demolition C Other: Bedrooms: Water Supply: Existing: Setback: :1 Private well 0 Two Party Type of Heat: Proposed: L I Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No if this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: l Heat Stove 4 Cook Stove } Woodstove i Fireplace Insert I Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings, all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For,Offjce Use Only Amount Rev Sion Main Floor Heated EH Bld App Review: 2m Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review-fee - c, R , Garage/Carport U,PT.tr.Ols.1--L- I I; 1 Decks 911/Rd Approach fee: 2012 I, Other TOTAL: $ Receipt Number: IEFFEF50N GOUNTY o cn! Cash/Chock Number: -- ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: G:\PcrmitCenter\###f ORMS###\DRD FORMS\Master Permit Application 5-29-08.doc - ASS°14 coq, JEFFERSON COUNTY �� *` DEPARTMENT�FC[HMMUN/TYDGVELOPMENT ^� ' ~4 --------- ---'--------------'------- -- � � 621 Sheridan Street • Port Townsend 'VVanhington 08388 30D/3794450 ' 30O/37A4461 Fax , _�0}' w~vx cv��m�omoo.wm uo�oonmdava|opmeot ~E�YIm~ ' Master Permit Application MLA: __ --_-_-� -_____ _ . - Project C)escrrption(include separate sheets as necessary): Quiloene Bay Spit Restoration Access � �a ----______-_ Tax Parcel Number; 701194029 Property Size: 2,2 ac (acres/square feet) Se Address andlor Directions to Property. 101 Wampum Point Road, Qulicene, WA 98376 � �����������- ����� Property Owner(s)of Record Reimer& Kathleen Douglas ____ Telephone:-__ 206 235-2991 Fax: �� on _ email: Mailing Address. 2021 North 78th Street, Seattle, VN\Q81U2 -- _ __ --- -___ App!iomn�Agent(if dU�e�nt�wmnw�r� Harhe(Cunaohione' NTI Engm h - Suiveying � - Telephone: 300_378'5430 Fax; �nei|: hmrhmtpnh4. "/n__ Mailing Address: 914 S Suite 0. pp�To*ooand. VAQ83G8 -__'_ -_--__-_ _ ___-___ _' ====== =--_-_--_- _ �_-��___ What kind of Permit?(Check each box that applies i]8v//d.ng Li Critical Areas Stewardship Plan Li Demolition Permit Li Variance(Minor,Major or Reasonable Economic Use) 0 Single Family UGanngo Attached/Detached [J Conditional Vue(C(a).C(u).orC1^^ El Manufactured Home O Modular [I Discretionary"D"or Unnamed Use Classification ri Commercial^ 0 Special Use(Essential Publk Facilities) O Change of Use 0 Boundary Line Adjustment [1 Address []Road Approach� Onoo�P|a�^^ � OHumeBos�e��----'-OCmnago|ngusin/-------- O Binding Site Plan'` O Propane O Long Plat^~ C3 Sign o Planned Rural Residential Denelopment(pneoVAmoodmo/xo~ Li Allowed Yes*Use Consistency Analysis O Plat Vacation/Alteration° DOtonnwato/Management 1Shoreline Master Program Exemption/Permit Revisions i Li Site Plan AppLoval Advance Detennnatron(SPAAD) Shoreline OTempom�Use OShom|,npMao Management *man�V�n.°o, Development [}wMm�suTok^ommunkahon ^ OC ~Plan/UDC/Land Use District- Map Amendment uFn^stP,aroceu*�»^e�moenr Six-Year Mo,a<ohum [;Juoe� County Shoreline ,,Program Amendment -May require a Pre-Application Conference [} Tree Vegetation Request -- ---- - ---- - --'_ -_' e9uires a Pre-Appliea*foo Con@ngncr } P|*asn |deo0tyanyuthwr |mmaLmtmt*or#ydona| pe,miMmrnquiredynrth/mpnopoom{ �hnovvn' '^�� '"'` '/;' ero,� . 7 '.n`*' :'o,m«Approval ' known: i ' -_---- ,r�'[�������r ` ! ` � " --_-___ .` ' . . �� ^ '� ^'� ^� ` ' ` " ~ ' ' ~ ` ^` / '� . 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'|/ { i ! «^°^-«V' ^---~ � 1/...„4-t APN: I0 I I`1`-40 NAME: I �CJV V1J — r `� Add.APN Add.APN NOT Punted Printed SPAAD Category Intake Req's ® El County Zoning ❑ a V A:�j Cases/Conditions by Parcel# ❑ ►=' Water Service Area P, ❑ Plat Maps ❑ Laserfiche Documents ❑ Road System """ Assessor Maps -H ❑ Lots ❑ Parcel Tags -H ❑ Permits -H ❑ 2006-07 Shoreline Photos ❑ Itf Left(Mid/rRight Shoreline Arcs Shoreline Polygons ❑ El DNR FP Stream Class El J I r,N5lk 'iy_�1 �j�)' ,j r �„p�� DNR Stream ❑ P (Ili-FIB] ' )cue DNR Water Bodies El g LFA-Fish 9 ❑ soils_H ❑ V Marbled Murrulets ❑ Heritage Points ❑ Type: Spotted Owls ❑ Bald Eagle Nests&Buffers ❑ Priority Habitats and Species 8/06 ❑ ❑ Type Wetlands ❑ R Rare Plants-Ecosystems ❑ Type: Seismic Hazard ❑ — Landslide Hazard ❑ t n2ath&lime FEMA FIRMS ❑ Map Panel#: Erosion Hazard El ❑ Critical Aquifer Recharge areas El SUS( Wells-Chloride El Mineral Lands ❑ ❑ Shoreline Slope Stability ❑ O i JJJ)4) t Chanel Migration Cgs ❑ Airport Overlays lR ❑ No Shooting Zone ❑ ,, /} SIPZ CI (1S.- County Zoning -UGA I1_. ❑ LIDAR Hillshade ❑ USGS Topos ❑ 2011 Aerial Photos ❑ Assessor's Info El Pi MLA Number Form El ❑ Pre Application File ❑ El Reviewer Letter Sent El ❑ Eagle ❑ Wetland ❑ Eagle Plan Required ❑ El 1 page ❑ Habitat Man Plan ❑ ESA Map Checklist 10-13-2008 CASES, FINDING, CONDITIONS, PERMISSIONS FOR Parcel 701194029 Printed: May 21, 2012 Cases Name Review Type Status Planner BLD05-00550 MLA05-00511 DOUGLAS I F M FARFAN Application Received: 8/24/2005 Permit Issued/Case closed: 12/28/2005 Case Finaled: 9/6/2006 NSFR W/ATTACHED GARAGE 1.) The application was reviewed by the Jefferson County Department of Community Development staff on September 1, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: waterfowl concentrations; landslide 2; SUSC aquifer recharge area; coastal SIPZ. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 5.) 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. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy (Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 8.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC) Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 9.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 10.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 11.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 12.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 13.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 1 of 5 Cases - Name Review Type Status Planner 14.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 15.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 16.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 17.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 18.) The applicant is proposing to create or add 4595 square feet of impervious surface and 8346 square feet of land disturbing activities. 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.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 21.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i). 22.) The site plan as submitted with the building permit application on August 23, 2005 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 stamped, approved site plan dated September 1, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) This approval is for a single family residence with attached garage 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. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage)yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) The building height is not to exceed 35 feet. 28.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 2 of 5 Cases - Name Review Type Status Planner 29.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 30.) Minimum setback from Wampum Point Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear(shoreline) setback shall be 30 feet from Ordinary High Water Mark if bank is less than 10 feet in height. If bank is greater than 10 feet, shoreline setback shall be measured from the top of the bank back 30 feet. (Site plan depicts a 50 foot setback from house foundation to mean high tide line). 31.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 32.) A minimum of two (2) on-site parking spaces are required for the single family residence. 33.) An address of 101 Wampum Point Road, Quilcene has been assigned to the lot. Wampum Point Road is a private road (P538). 34.) A septic permit(SEP99-0068)was finaled on May 25, 1999. A water review(USR98-0095)was approved on December 13, 1998. A road approach permit(RAP05-0212)was cancelled on August 11, 2005. PRE12-00010 DOUGLAS P Application Received: 5/21/2012 Permit Issued/Case closed: Case Finaled: PRE APPLICATION QUILCENE BAY SPIT RESTORATION &ACCESS No findings, conditions, or permissions found. RAP05-00212 DOUGLAS C Application Received: 8/5/2005 Permit Issued/Case closed: Case Finaled: 8/11/2005 911 & RAP No findings, conditions, or permissions found. SEP99-00060 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 2/10/2005 Case Finaled: 1/7/2009 serves Lot 4(D)#70119402/, drainfield on Lot2(B)#701194029 with a portion on lot 1(A) Filed with SEP07-265 tank only permit. 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL 2.) The drainfield for this lot is located on lots 1&2 (A&B on survey) 3.) The reserve beds are located between the primary beds. A minimum of 12 feet of separation is required between the primary beds. 4.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent. 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. PRJ10-00047 DOUGLAS F Application Received: 2/11/2010 Permit Issued/Case closed: Case Finaled: TANK ONLY CONNECTED I 0 SEP99-68 NOW FILED HERE No findings, conditions, or permissions found. SEP05-00324 DOUGLAS F Application Received: 9/21/2005 Permit Issued/Case closed: 12/27/2005 Case Finaled: 8/28/2006 TANK ONLY CONNECTED I 0 SEP99-68 NOW FILED HERE 1.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. Documentation must be provided that states the existing transport line was installed per this requirement. 2.) An asbuilt drawing and certification of completion by the designer is required prior to final approval. AS-BUILT MUST INCLUDE THE DRAINFIELD ALSO 3 of 5 Cases Name Review Type Status Planner 3.) Health Department is to be contacted for a final inspection of the septic tank and pump chamber prior to covering. 4.) 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. 5.) Permanent barriers are required along/around primary and reserve drainfield areas to protect from parking, driving, and other land disturbing activities prior to final. 6.) AS PER WAC 246-272 AND JEFFERSON COUNTY CODE 8.15 ALL SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. While the County strongly recommends that the property owner allow inspectors to enter their property to inspect the system in order to insure that the system is functioning correctly, the property owner always has the right under the Fourth Amendment and our State Constitution, to refuse the inspectors access to their property. The property owner never loses the right to refuse access and can do so despite never having refused access before. 7.) As per Jefferson County Code 8.15 all onsite sewage systems require monitoring. Monitoring shall be provided by an approved entity. THIS SYSTEM IS REQUIRED TO BE INSPECTED EVERY 3 YEARS AT 6 MONTHS, AT ONE YEAR AND ANNUALLY THEREAFTER. 8.) Health Dept. required to observe pressure test when system fully installed/complete, 48 hours notice to be provided for scheduling. 9.) Designer must be contacted prior to start of construction and for inspections during installation. 10.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 11.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 12.) Dose counters are required in the control panel for all drainfield components. 13.) Risers are required to grade with secured lids over both compartments and over the outlet of the septic tank for inspection and maintenance/monitoring. Minimum 20" riser over inlet. 14.) 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. 15.) 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. 16.) 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. SOM99-00068 DOUGLAS P Application Received: 8/28/2006 Permit Issued/Case closed: Case Finaled: No findings, conditions, or permissions found. SOM99-00060 DOUGLAS F Application Received: 3/15/1999 Permit Issued/Case closed: Case Finaled: serves Lot 4(D)#701194027, drainfield on Lot2(B)#701194029 with a portion on lot 1(A) Filed with SEP07-265 tank only permit. No findings, conditions, or permissions found. SEP99-00068 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 5/5/1999 Case Finaled: 8/28/2006 Now filed with SEP05-324 a tank only lot 2(B)#701194029 (per BLA), drainfield is on lot 1(A)#701194030 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL, 28 INCHES OR MORE IN SOME AREAS. 2.) The drainfield for this lot is located on lot 1 (A on survey) Drainfields for lots C&D (4&5) are locate on this property,(lot 2 (B)) See survey recorded on 4/14/99 3.) Reserve beds are located between the primary beds a minimum of 12 feet separation is required between the primary beds. 4.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent. 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 4 of 5 Cases • Name Review Type Status Planner 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. USR98-00095 PHILLIPS F Application Received: 10/30/1998 Permit Issued/Case closed: 8/29/2005 Case Finaled: 8/29/2005 lot B (2), Unique ID#on well verified 8-15-02 AEJ773 No findings, conditions, or permissions found. SEP99-00061 PHILLIPS F Application Received: 3/15/1999 Permit Issued/Case closed: 6/20/2003 Case Finaled: 7/8/2011 Drainfield on Lot 1(A) 701194030 and 2(B) 701194029 now filed w/SEP07-57 the tank only 1.) MINIMUM TRENCH DEPTH IS 6 INCHES INTO NATIVE SOIL. 27 INCH TRENCH DEPTH OR MORE MAY BE REQUIRED. 2.) The drainfield for this lot is on lot 1&2 (A&B) See the recorded survey of 4/14/99 3.) Reserve beds are located between the primary beds. 12 feet of separation is required between the primary beds. 4.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Protective barriers are required around drainfield. 5.) 5 ft. setback from roadway easement to be maintained. 6.) Any portion of transport line under a driven way is to be double cased or equivalent. 7.) AS PER WAC 246-272 ALL ALTERNATIVE SYSTEMS REQUIRE MONITORING. THIS MONITORING IS PROVIDED BY AGREEMENT BETWEEN THE JEFFERSON COUNTY ENVIRONMENTAL HEALTH DIVISION AND THE JEFFERSON COUNTY PUBLIC UTILITY DISTRICT#1. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN ACTIVE MONITORING CONTRACT WITH THE PUD#1 PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 8.) Health Dept. required to observe pressure test, 48 hour notice to be given. 9.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 10.) Contact designer prior to installation for staking of drainfield area. 11.) Dose counters are required in the control panel for all drainfield components. 12.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 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.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Critical Areas Ordinance for other development on the site. 15.) Risers are required to grade with secured lids over the inlet and outlet of the septic tank. Minimum 24" riser over inlet. 5 of 5 road Page 1 of 1 ADDRESS INFORMATION FOR 101 WAMPUM POINT RD ROAD NUMBER P538 ROAD NAME WAMPUM POINT RD ADDRESS:101 APT: REAL MILE POST:.10 APPLICANT:REIMER&KATHLEEN DOUGLAS ADDRESS CREA HON DATE 08/05/05 PARCEL:701194029 LEGAL: GRID K-2-H FIRE DS 2 ZIP:98376 POSTAL DISTRICT:QUILCENE PLANNING AREA: VOTING DIST: CEMETERY DIST: HOSPITAL DIST: SCHOOL DIST: WATER DIST: SITE LONGITUDE:122.84936 SITE LATITUDE:47.81585 SITE COORDINATE TYPE:PARCEL CENTER-MANUAL ACCESS LONGITUDE:0 ACCESS LATITUDE:0 MODIFY DELETE ADDRESS NAME SEARCH REPORTS http://isserver/Address/RoadAddressDetail.asp?ROAD NUMBER=P538&ADDRESS=101 6/4/2012