HomeMy WebLinkAboutSEP2000-00232 0008
Jefferson County Permit Center
621 Sheridan St., Port Townsend WA 98368 L�" -\
360-379-4450 (� L
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SEPTIC PERMIT APPLICATION \ ' '\
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PROPERTY OWNER R IGI-Icxrd Bom b o.cd Ieir I.:
MAILING ADDRESS 1 13 0 - 13 9 + h S+ • G+ • F o .. i 1
Puvo. I iup WA 98-3-( 1-1- o�r�. ace cti._
PHONE Area Code ( Z5 3 ) S LI- I - 1 c C 5
SYSTEM DESIGNER 0 OW l d Je n s e,n FE ° D, R . ST I9 0 N G 3
LEGAL DESCRIPTION: Section 11 Township .Z 9 Range I PARCEL # 9 5 2 2 0 0 00
Subdivision Name Fu I le, f S A o r e 3 Division Block Lot(e) 3
SITE LOCATION I '-t0 16e,rxc, h 1 1ncx ri '( D rive))
Zip Code
TYPE OF IMPROVEMENT: Residential X Residential ADU Commercial Community
TYPE OF WORK:
New'- Redesign X Upgrade Repair Partial (tank) (drainfield)
Expansion Designate Reserve Area
Conventional Alternative X Drainfield Length N /A ft. M _
Number of Bedrooms 2 Trench Width N/A ft.
Basement: yes / no Trench/Bed Depth N)A in.
1 G Ienc�o r
Site Size 2 5 y- 10 f U z -4-4)-10 Number of Lines N/A
Previous evaluation:Ce / no SEP 00- 23 Z Tank size I 000 gal.
Nater Source: private X public Soil type 5 (ATTACH SOIL EVAL
Application Rate Q . 9 gal./sq.ft./day
TYPE OF SYSTEM G I ej n O O rI
ME UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE
NFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE
'ROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES.
Signature oU Ca d it/ P. E Date G - Z--c) I
FOR OFFICE 4 . 0 [ f06 ,J /i'3-13 11(1
PARTIAL ll-$- sr lit ca-. �I
A R VED RENEWED PRESS/TEST 2..- c. - I FINAL 1�/I v/
ASBUILT imaz
PUD UN
RENEWED — k
Fire District Planning District School District Zone
Date ' V( 0( Fee 55 )-9.- Rec # 23593 Check # 5358 Case # SEP Q C� - '232
:\home\pincntr\hlthinfo\permitapp.doc 10197
JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368
ASBUILT INSPECTION REPORT For RECORD DRAWIN
Designer Suzanne Martin(DR Strong) Permit # SEP 00-00232 (d,
Installer Bernt Ericsen Parcel # 952 200 003
Electrician Fredrickson Electric Design Flow 240gpd peak
Property Owner JoAnn Jackson
Site Address 140 Beach Drive-Nordland b b Z 5 Z
Answer all questions or indicate NA
DATE
Tanks, Pumps and Controls INSP.
Tank (manufacturer, size, baffles) 1150 Fred Hill; risers installed; sock filter installed 12/20/05
Pump chamber (manufacturer, size) 1150 Fred Hill; Riser installed;22.5 gal/inch 12/20/05
Screen(s)and/or Pump Shroud (type, location) Shroud around pump in tank 2/10/14
Were Tanks tested onsite for water tightness? Yes / No
Panel Model Aquaworx Timer Model IPC 2/10/14
Pump 1 — Man./Model Flow Rate n/a apm 2/10/14
Pump Location (i.e. garage, treatment unit, basement) pump tank
Float/transducer settings Inches Timer
from bottom of tank- On/off- 16.9 in. Functions: On 7 ? ec min
Veto - 25.2`° in. Off- 8-25 sec hr
Alarm '25 in. Veto On - ? Qmin
Storage Above High Water Alarm +/-490 gal. Veto Off , 6:18 sec/Qfhr
Dose Counter Reading 0 dose/13 vdose # gallons/dose 1.05 F gal.
Elap. Time Meter Reading 00:16:58 mine Pump Throttled? Yes N
Dose Drawdown (in inches) n/a," in.
Pump 2 — Man./Model n/a Flow Rate qpm
Pump Location (i.e. garage, treatment unit, basement)
Float/transducer settings Inches Timer
from bottom of tank- On/off- in. Functions: On sec/min
Veto - in. Off- sec/min/hr
Alarm - in. Veto On sec/min
Storage Above High Water Alarm gal. Veto Off sec/min/hr
Dose Counter Reading # gallons/dose gal.
Elap. Time Meter Reading min/hrs Pump Throttled? Yes / No
Dose Drawdown (in inches) in. If additional pumps-complete the info in this table
for each and attach.
Other Timer functions & settings (e.g. override on/off) Autoclear 22 doses;49 events
ID: 09-04-0089; ZB-OA
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 1 of 2
r
r
P re-Treatment Date Ins
Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No
Sandfilter Basin size/location n/a
Sand Fill met design spec? Yes / No
ATU (manufacturer, model) n/a Alarm tested Yes / No
Disinfection Unit (manufacturer, type, model) n/a Independent Alarm Yes / No
Drainfield
Transport Pipe size, schd, diameter 1"pvc Manifold size/schd 1"pvc 12/20/05
Orifice size n/a Lateral Size/schd n/a
Barrier Material n/a Cover Material/Depth
Residual Head (lat.# & ft. Head) n/a
The laterals/pods were balanced es / No
Source/Manufacturer of Drainrock/Gravelless chambers n/a
Drainrock Clean? Yes / No If no, what action taken? n/a
Mound/Glendon Site Prep n/a 12/20/05
Drainfield Length 19 ft Width 15 ft Depth n/a inches
Caps for measuring residual head stored (location) n/a
COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional
sheet(s) if necessary
.Dates noted as 12/20/01 were inspections made by DR Strong.
System has had sand added &outlet filter installed.
Health Department Inspection issues resolved Yes / No /0 If yes how?
Users Manual Provided to Homeowner /"'! l/ /.
�G/ Date /'7°k ielzi
Tank/component Decommissioning Report Attached Yes /0 NA pump out report previously submitted
Installer Certification attached/signed Yes / No
ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer
I CERTIFY THE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, T1- E
SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY
(DATE) OR TEAT CI-ANDES HAVE BEEN NOTED AND
niE SY M IS IN COMPLIANCE WITI-E WAC 246-272. s- d'�f,,, /I
I fff
Gl j� !� 5100342 . 441•
Designer Signature Date License# 5,.t .Z / '+
Suzanne L Ma '•: +)
•."It-d— ens. i It,
EYW'.3 b1Lt5
H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2
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System Owner: JoAnn Jackson
SEP00-00232;
Parcel #952 200 003
Site Address: 140 Beach Drive-Nordland
Pump Tank Detail
2 3/8"
Installed Riser
22 7/8"Riser
Inlet -±493gallon storage below ;j
.' invert of inlet of pump tank 60 5/8"
above veto level $:
-not including additional i.:
capacity in septic tank and =
;; tank dsers •2•
t
Veto set 9.2"from the
u
bottom of the bell
;.
.� alarm set for 9"from
4: bottom of the bell
-182 gal working volume
kii 73
Fred Hill 1000 gallon ft'
on set 0.9"from bottom
Y.
t. pump tank;22.5 gallons 4"betwee .ell j of the bell
n, per inch 0<nd shrou.i 16"from bottom of tank
zb-OA Aquaworx IPCS01
14 to the bottom of the bell
i1 0
w: n
1,... 41 4.
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