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SEP1990-00003
Jefferson County Department of Community Development • 621 Sheridan St., Port Townsend WA 98368, (360)379-4450 SEPTIC PERMIT APPLICATION PROPERTY OWNER Michael Stevens MAILING ADDRESS 511 Marristone Rd _Nordland,WA 98358 "'Li' IAN 1 4 2009 PHONE L360_:379 .�y' g SYSTEM DESIGNER Ken Warren Designer Phone# (360)683-6300 LEGAL DESCRIPTION: Section_9_ Township_29N_ Range_1E PARCEL#_921-092-081 Subdivision Name _Efird Short Plat Division Block Lot(s) 1 Site address/Directions to site Hwy 116 to 415 East Marristone Rd SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE Residential X New Private X Residential ADU Modification Public Commercial Expansion Community Upgrade SYSTEM TYPE Repair X SITE SIZE Conventional Partial Repair- (tank) )( (drainfield) x Previous Evaluation Alternative X Designate Reserve Area Yes #_5157 Redesign (1972) SYSTEM DETAILS Number of Gallons/day 360 Soil type 5/ (attach soil eval.) Application Rate_0.6 gal./sq.ft./day Drainfield Length a 0© ft. Trench Width 3 ft. Trench/Bed Depth(-/y in. Septic Tank size_1000 gal. Pump Chamber size 1000 gal. TYPE OF SYSTEM Pressuried \e- By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur during regular business hours. Initial here if you require notification before entry Appeal — A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision. DISCLAIMER-This application is for an on-site sewage system that meets the state and county standards in effect on the date of application. This application for an onsite sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain pe ` ission to build a permanent residence or other structure on this parcel. Any future application ill bas-par.. el judged e rules and laws in effect at that time. Property Owner Signature Date 3(i 14FOR OFFICE USE ONLY I / �( PARTIAI;�6d /dam(_ ASBUILT 1` IAC ` �� FIN �. APPROVED �,'� INSP/PUMP TEST 2ja1`lL t‘\\-\/\6 ALL HOLD REQ. MET Date II"I ef.R Fee ��� Rec# 2 Check# 10Case#SEP 0 ci'� SEWAGE DISPOSAL PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend WA 98368 (360) 379-4450 PERMIT #: SEP09-00003 Date Received: 01/14/09 SITE ADDRESS: 511 E MARROWSTONE RD Date Issued: 03/11/09 NORDLAND, WA 98358 Date Expires: 03/11/12 APPLICANT: MICHAEL S STEVENS PHONE: 360-379-3684 PO BOX 512 CHIMACUM WA 98325 LEGAL DESCRIPTION: EFIRD SHORT PLAT LOT 1(LESS TAX 65)BND TGTH THRU BLA#112111 PARCEL#: 921092081 Section: 9 Township: 29N Range: 01 E DESIGNER: KEN E WARREN PHONE: (360) 683-6300 SOILS APPLICATION INC PO BOX 387 CARLSBORG WA 98324 DISCLAIMER- This approval is for an on-site sewage system that meets the state and county standards in effect on the date of application. This approval for an on-site sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. ALL CONSTRUCTION AND DEVELOPMENT ACTIVITIES MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODES, AND RECOMMENDED STANDARDS AND GUIDANCE DOCUMENTS IN EFFECT WHEN THE PERMIT IS ISSUED. Permit issued to CONSTRUCT,ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY,WASHINGTON Thls permit is issued for a period of three years (unless otherwise stated above) in accordance with Jefferson County Rules and regulations for on-site ge systems, codified 8.15 amended per ordinance no. 06-0719-07. This permit may not be renewed. D if4C Jefferson County Environmental Health Specialist The property owner is responsible for the accurate location of all property lines.Any removal of or major disturbance of soil in the primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system.Any change in drainfield or tank location may invalidate this permit unless prior approval is obtained from the Jefferson County Environmental Health Division. If during excavation or development of the site an area of potential archeological significance is uncovered,all activity in the immediate area shall be halted,and the UDC Administrator shall be notified at once. HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION. SYSTEM DESCRIPTION: 130-PRESSURIZED TRENCH No. of Gallons per Day: 360 Type of work: REP Drainfield Trench Septic Tank Length: 200 feet Width: 3 feet Depth: 14 inches Size: 1,000 gallons SPECIAL CONDITIONS APPLY - SEE REVERSE CONDITIONS OF APPROVAL- PERMIT NO.: SEP09-00003 1.) 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. 2.) H - Existing tank shall be properly abandoned. It shall be pumped and filled with clean fill. Documentation to be provided to Health Dept. prior to final. 3.) H - Permanent barriers are required along/around primary and reserve drainfield areas to I +� J protect from parking, driving, and other land disturbing activities prior to final. "1-1,Q 4 _! ;s tt i 4.) H - AS PER WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 ALL SYSTEMS WI REQUIRE MONITORING. THIS SEWAGE DISPOSAL SYSTEM WILL REQUIRE AN E ,dk ACTIVE MONITORING AGREEMENT RECORDED TO THE PROPERTY TITLE PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL SYSTEM. 5.) 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 PER JEFFERSON COUNTY CODE 8.15 AS ADOPTED OR AMENDED. 6.) Health Dept. required to observe pressure test with system designer when system fully installed/complete, 48 hours notice to be provided for scheduling. 7.) Designer must be contacted prior to start of construction and for inspections during installation. DESIGNER IS REQUIRED TO DO A PRECOVER INSPECTION ON ALL TYPES OF SYSTEMS. 8.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 9.) H -An asbuilt drawing and certification of completion by the designer is required prior to final approval. 10.) Before final approval is given, the designer shall provide an operations and maintenance manual to the property owner and the Health Department. The manual must instruct the owner of the on site sewage system on the ways to properly operate and maintain all components of the system. 11.) Setbacks to all wells- 100' required from drainfield and reserve areas. 50' required from tanks and effluent transport lines. 12.) 10' separation required between a Water line and all portions of the onsite sewage system; effluent transport line, tanks, treatment and disposal components. 13.) Setback to surface waters- 100' required from drainfield and reserve areas. 50' required from tanks. 14.) MAXIMUM TRENCH DEPTH 14 INCHES 15.) When/if designated reserve area is utilized an alternative system providing an additional level of treatment may be required. 16.) A 30' setback shall be maintained from the disposal component and reserve area to any downslope footing, curtain or interceptor drain or drainage ditch. 17.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance. Page 2 of 3 11/22/190 I:\F_SEP_Permitmod.rpt 18.) Drainlines are to be installed along the natural contours. 19.) Contact designer prior to installation for staking of drainfield area. 20.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 21.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent. 22.) Dose counter and elapsed time meter are required in the control panel for all system components. 23.) 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. 24.) 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. 25.) 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. 26.) The application was reviewed by the Jefferson County staff 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: seismic hazard, sea water intrusion protection zone. Page 3 of 3 11/22/19c I:\F_SEP_Permitmod.rpt vik JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 ASBUILT INSPECTION REPORT For RECORD DRAWING i -12z3 6/40141 Designer Permit# SEP _ . Installer '7: 2 -7-el LiOlf,450.72,-' Parcel # Electrician C "fsc,,,,,17,o6,---- Design Flow 3 619 le'le7e,r Property Owner „„,5--77,:a77-,' Site Address „,:.;/,,/ c5:- Answer all all questions or indicate NA DATE Tanks, Pumps and Controls INSP. Tank (manufacturer, size, baffles) I" .c:----/'//ler" II'?''''.4:',.j, .,/ c„,,,4.20 Pump chamber (manufacturer, size) Screen(s)and/or Pump Shroud (type, location) 24 V7& '' e3,79C14"4 0- S'in,41,4:-",. /' Cl:("e;),c',/,'647:2 f.74.---/3,,,,, (,,,&,:,eF:F3 RECEIVED Nere Tanks tested onsite for water tightness? Yes / No Panel Model "cell/4-'1,1-4zi'2z,;.,,4'''''' Timer Model // /-- - J2 ,, DEC 0 8 2015 Pump 1 - Man./Model ZLZ>6Z-c5;16'44%45.,:',1 Flow Rate 6 6 qpm Jefferson County Pump Location (i.e. garage, treatment unit, basement) Environmental Health =loat/transducer settings Inches Timer <-. l',.. '2 :rom bottom of tank- On/off - ./ in. Functions: On ,-P- --- Secisrnin Veto - in. Off - ,,,,,/,,„, sec/minthr ‘.• 7 .•,,./ -, Alarm - -s,6 in. Veto On - •/4, e ,'§ectrn in .,' 7- Storage Above High Water Alarm 9TC; 'IT// ---- gal. Veto Off - ,,, sec/min/11r )ose Counter Reading 3 Zq3 /9 :i'''',6 V--(2) # gallons/dose -' '(9 gal. :lap. Time Meter Reading 3e: rg.,3 min/hrs Pump Throttled? Yes )ose Drawdown (in inches) in. Pump 2 - Man./Model Flow Rate qpm jump Location (i.e. garage, treatment unit, basement) :loat/transducer settings Inches Timer rom bottom of tank- On/off - in. Functions: On sec/min Veto - in. Off - sec/min/hr Alarm - in. Veto On - sec/min >torage Above High Water Alarm gal. Veto Off - sec/minthr )ose Counter Reading # gallons/dose gal. lap. Time Meter Reading min/hrs Pump Throttled? Yes / No ) If additional pumps- complete the info in this table ose Drawdown (in inches) in. for each and attach. )ther Timer functions & settings (e.g. override on/off) :\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page I of 2 Pre-Treatment 1%.*'Ci Date lnsp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Dr. , &:0 Sandfilter Basin size/location cL FhJe ens o8ZOJ5 Sand Fill met design spec? Yes / No frit.onson Coto) eft ATU (manufacturer, model) Alarm . yip, 's / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe size, schd, diameter ° �� ° `Manifold size/schd 8 Orifice size )//.( Lateral Size/schd Barrier Material �' f = ' Cover Material/Depth I)4 Residual Head (lat.# & ft. Head) $,.: _ �- . The laterals/pods were balanced Yes / No Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean? Yes /'No If no, what action taken? Mound/Glendon Site Prep Drainfield Length ft Width . ft Depth PI inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary f„',J Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner Date Tank/component Decommissioning Report Attached Yes / No / NA Installer Certification attached/signed Yes / No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I CE2TIJY TIRE INFORMATION PROVIDED ABOVE WAS VERIFIED BY INSPECTION, T}f E SYSTEM WAS INSTALLED AS DESIGNED AND APPROVED by JEFFERSON COUNTY (DATE) OR THAT CHANGES RAVE BEEN NOTED AND T1- E SYSTEM IS IN COMPLIANCE WIVE WAC 246 -272. „ � 4‘ Designer Signature Date License # t° 't}`ft�', w eeasr c1 EDoop H:\WEB\ONSITE\Asbuilt_Report_Form.doc 04/28/10page 2 of 2 . r I I 1 7/,_ ,___ 1 o \._ o o \ 1 m I 0 -- I- Z " o cr) m CO co c.) / 0) 11 o 0 CA 0 n Z o m r I I I 1.a Z / , CD v) II o I �z I v V)0 �� my I aN Dor .� 1-or �. mfrN � w55m � r7 �� m1X II '' "mI11, eF••yTmo o o mzo�o Cl) z 113 a og � 1c�� ^' 1zo 0 2 1 m .:%1' .-r., m v� "gym I m1�. %A� \ .-Z- 11:o --1 -1:1 ,-- -1 o I /0/ 0 0 o z 0 gJI ',a ❑ o CD J` ❑ CD CD ; f • I' 1, (�0D. ((DD • �'O C� ' I 0 ^1 �f 28' / 0 �` 1. 1 0 aa0 N „� rrl n�z ry a U.o f� a��� 0 9\ \ c-) zm a No S wco cN �u j �,a �'" I z o� I 1� -6--am cn o 65D �O 1 n �o c o �� z� 1 z rn a? I '�0M�MM����� • o z z t 011111.11111111111111111111111111111111111 o). sCD � mz ao rA o 'f 0����NI���� 0 z a 3Q m o =w (b a,-- �x a 5 a \ \ ''' ���������� N pipa o �? I o� a �„ ,=DN ,-o� oopo ,.:,oa \ z m S g r�zr m D "RECORD DRAWING" m N ✓ c-i r `�_ m TAX PARCEL # 921-092-081 SOILS APPLICATION, LLC. z z rri to -, i o r- c opo - o0 zu 0 i 0 m o 863 CARLSBORG ROAD, SUITE A, -� o Z ri PRESSURIZED SYSTEM FOR SEQUIM, WA 98382 W STEVENS PH (360) 683-6300 FAX (360) 683-5652 Check one:INSTALLATION START NOTIFICATION DATE SENT 3/9 /1.2_, PRESSURE/PUMP TEST INSPECTION REQUEST DATE SENT This form shall be faxed or emailed ONE working day prior to starting construction OR a minimum of 48 hours prior to pressure/pump test Jefferson County Public Health - Environmental Health Dept. Phone: 360-385-9444 FAX: 360-379-4487 EMAIL: septic@co.jefferson.wa.us PERMIT OWNER /14 i 6 I V(1 SITE LOCATION 5/ ( GUi T%• PARCEL NUMBER SEP NUMBER INSTALLER s) CONTACT PHONE DATE FOR INSPECTION 3 6) /l 2_ SYSTEM WILL REQUIRE PRESSURE TEST 411g, NO *The designer is required to complete a pre-cover inspection of all systems. Please contact the designer prior to beginning construction to schedule installation inspections and pre-construction meeting if required per the permit or designs specifications. 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LEGAL DESCRIPTION: Section-9 Township- 29N Range-lE Parcel#921-092-081 Subdivision: Efird Division- Block Lot(s)- 1 Date Logged: 06-08-07 Logged by: Ken Warren Include soil textural characteristics and depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. ^I , d� a'3 -CR. SOIL LOG#1 0" to 12": Dark Brown Loamy Fine Sand 12" to 47": Brown Fine Sand 47" to 61": Mottled Fine Sandy Loam Anticipated water table " Roots to " Health Dept. Comments: SOIL LOG#2 0" to 8": Dark Brown Loamy Fine Sand 8" to 36": Brown Fine Sand 36" to ": Mottled Fine Sandy Loam rn . } G:7" Anticipated water table " -- S ' S Roots to 29 0(1 Health Dept. Comments -k-0 '1 J A N 1 4 2009 Jefferson County Environmental Health Dept. 615 Sheridan St.,Port Townsend, WA 98368 Michael Stevens Parcel # 921-092-081 SOIL LOG#3 0" to 6": Dark Brown Loamy Fine Sand 6" to 35": Brown Fine Sand 35" to 67": Mottled Fine Sandy Loam with Gravel Lenses Anticipated water table " _ ( t,^ LS Roots to 35" 3 -5 1 m 6A-' cr\ (` o 'At--r\ Health Department Comments: SOIL LOG#4 0" to 6": Dark Brown Loamy Fine Sand 6" to 38": Reddish Brown Fine Sand 38" to 48": Slightly Compact Faint Mottled Medium Sand Anticipated water table " Roots to " { o mos+ Health Department Comments: SOIL LOG#5 0" to 8": Dark Brown Loamy Fine Sand 8" to 38": Reddish Brown Fine Sand 38" to 46": Slightly Compact Faint Mottled Medium Sand Roots to " Anticipated water table Health Department Comments: JA" 1 4 2009 SOILS APPLICATION Inc. Ken E Warren, Certified Designer (360)683-6300 863 Carlsborg Road, Suite A, Sequim,WA 98382 CONSTRUCTION SPECIFICATIONS FOR: Stevens Date:8-5-2007 Parcel No. 921-092-081 The work described in this document consists of the construction of a septic system for a 3 bedroom residence. The system consists of a septic tank,pump chamber, and drain field. The contractor shall be licensed, bonded, and certified by the Jefferson County Department of Environmental Health. The contractor shall give the designer forty-eight(48)hours minimum advance notice of installation. Inspections: A pre-construction on-site meeting with the installer shall take place for the purpose of layout. Inspections will be required during construction at the following completion phases: A. Trench Inspection 1 Excavation B. Trench Inspection 2-Completed with Plumbing Before Cover Tanks/Pump/Controls Inspection SEWAGE DISPOSAL DESIGN C. Final ' '1p a Or C nstructior1 � e4 ' 1Pd1 Septic Tank: Date The septic tanks shall be a standard two-compartment 1000 gallon concrete tanks. The tank shall meet state and Jefferson County Codes and shall be water-tight. Inlet and outlet sanittees made of plastic material shall be installed. The outlet tee shall have a screened baffle. sers shall be installed to finish grade on both access ports. "Jet-Set" or equivalent shall be used to secure the risers to the tank. Grout or mortar will not be acceptable. Care must be taken to ensure a water-tight seal. Be sure to fill the tank with water when the installation is complete. Pump Chamber: The pump chamber shall be a 1000 gallon single-compartment concrete tank. The tank mut be water-tight and meet state and Jefferson County Codes. A riser shall be installed over the\I access port and shall extend to finish grade. "Jet-Set" or equivalent shall be used to secure the risers to the tank. Grout or mortar will not be acceptable. Care must be taken to ensure a water- tight seal. Be sure to fill the tank with water when the installation is complete. Lateral,manifold, and transport piping shall be schd 40 PVC or better and shall be solvent welded. All piping within the pump chamber shall be schedule 40 PVC or better and shall be solvent welded. All fittings shall be schedule 40 PVC or better. conspecs.wps JAN 1 4 2009 Pump and Controls: The pump shall be a non-clog submersible sewage effluent pump and meet the following specifications: Minimum delivery capacity: 32. .4 GPM @ 19 TDH Discharge size: 1 1/2" dia. minimum Total dose: 20 gal. + 10 %twelve times a day=240 gpd avg The pump shall be able to pass a three-eighths inch solid sphere and be safe in areas of explosive gasses. Pump information, such as specifications, operation, and maintenance, etc., shall be submitted to the designer prior to or at the time of final inspection. A sediment shroud shall be placed around the bottom of the pump extending to 18 inches above the bottom of the pump tank. Controls shall be AQUA WORX or equal. The control panel shall have a NEMA 4 enclosure if exposed to the weather or a NEMA 1 if placed in a weather tight building. The alarm circuit will be separate from the pump controls. A dose counter and timer are required. The pump shall be installed in the pump chamber per Department of Labor and Industries Policy SPC 85-07R. (Electrical Inspection). S ASTM C-33 filter sand is not required for this installation. �. '� �L Di )��-°t �iii tt,� A., d for Construction The Drain Field: _ ( Date All piping shall be installed as shown on the plans, or as directed by the designer. Fill material shall be free from large rocks or objects which may damage the pipe. Laterals shall be installed level with an accumulated elevation difference not to exceed 3/4". The laterals shall be thoroughly flushed until free of all dirt and plastic shavings prior to inspection. 90 degree sweeps with cleanouts &monitoring ports shall be installed in round valve boxes at the ends of all laterals. An 18" length of#3 rebar shall be driven into the ground at each end of the manifold piping to assist in future location purposes. The sidewalls and bottoms of all trenches shall be hand-raked after excavation and before the placement of gravel and distribution lines to remove smears caused by the excavation process. The designer must have all pump curve data, technical support manuals, warranty cards and operating instructions for all components to assist us in our maintenance &monitoring efforts. We will incorporate all pertinent data into the Operations and Maintenance Manual that we present to the home owner upon completion of their new system. conspecs.wps JAN N 1 4 2009 Li.i', • DESIGNER MUST BE NOTIFIED OF ANY VARIATION OR MODIFICATIONS CONTEMPLATED FOR THE SYSTEM DESIGN OR SPECIFICATIONS. CHANGES MUST BE AGRE ! 0 IN WRITING BY THE DESIGNER. en '. en Licensed Designer SE-Vv' GE DISPOSAL DPT Is A ed for Construct 3 _ 11_0 Dare JAN 1 4 2009 conspecs.wps Y . . M E 0 W Z N = O E w ¢ o U O C_ > O E W O Z W C ( ( foil CLI 0, Nr (n m W H LL O to to to _co_ -d'CN a0 7 tea, cY o a)a a O W Lt-W N aN O E Q o QjIn CD L O C) v _N 0 I/1i O z M O N O_ O - IO I ':N O 10 O O M I - LT. 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