HomeMy WebLinkAboutSEP1982-00129 Now filed to
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JEFFERSO`N COUNTY HEALTH DEPARTMENT 1z9
802 SHERIDAN AVENUE
_ INSTALLER 5D PORT TOWNSEND,WASHINGTON 98368 RECEIPT NO.
BUILDER C//411) G�P,
(206)385-07n
DATE 6,.=Z//' --
SEWAGE DISPOSAL PERMIT
• Submit In Duplicate
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Owner Address Phone r
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Directions for locating site a 0,r,i6 NT 'Ttl12N$ p
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INSTALL NEW SYSTEM REPLACE SYSTEM❑ PARTIAL REPAIR 0 TANK/DRAINFIELD0-
TYPE OF3Iv64 FA►ri. NO. OF I ' SITE I, 3'
BUILDINGyAv11{�i k1Z BEDROOM I BASEMENT 0 SIZE /Z.a CN+e._ Em
DRAW DETAILED PLOT PLAN BELOW.STUB OUT PLUMBING ABOVE FOUNDATION FOOTING - m q
(or draw on attached sheet) SOIL LOGS ' 2 -
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Dig two holes per site. Minimum • �,��®
4' deep-2' diam.-50' apart & flag location APPLI i r41./ ,�.: /' ioiji C1 ,/, Z
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ANY REM-OR MAJOR DISTURBANCE OF ;SOIL IN THE PRO'':ED.OR APPROVED DRAI NF I ELD E - m
AREA MAY CRE4TE SITE CONDITIONS THAT ARE UNACCEPTABLE EOR THE INSTALLATiOIy OFA .,,,
SEWAGE DISPOSAL SYSTEM. ANY CHANGE" IN 'BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING
PLUIIBING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD.INVALIDATES' THIS
PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT. (Call Health Dept. it
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Drainfield Length__ / ' n Width -2 Depth 4 # Lings Tank Size I / Gal. C
COMMENTS: (TWO COMPARTMENTS)' i
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APPROVED DAT- I INSPECTED PARTIAL/FINAL DATE g
y at is system was I •tall/ a manner approved by the Health Department.
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Jefferson County Department of Community Development JUL 1 2 2005
621 Sheridan St., Port Townsend WA 98368, (360)379-4450
SEPTIC PERMIT APPLICATION
PROPERTY OWNER _Tim Berryt^'t
MAILING ADDRESS 71 Shorecrest Ct
Port Townsend.WA. 98368
PHONE Area Code(_360 )—385-9524
SYSTEM DESIGNER Soils Application Inc.(Ken Warren )
LEGAL DESCRIPTION: Section 27 Township_30N Range 1W _ PARCEL#_965 000 309 _
Subdivision Name _KIA a Pp t.T - Division Block Lot(s) 460
SITE LOCATION 71 Shorecrest Ct. Port Townsend,WA. Zip Code 98368
SOURCE OF SEWAGE: Residential.x _ Residential ADU Commercial Community
TYPE OF WORK: New Redesign_ _ Upgrade Repair Partial (tank) (drainfield)
Expansion Designate Reserve Area X Modification
Conventional )X Alternative Drainfield Length ft. Trench Width ft.
Number of Gallons/day. Trench/Bed Depth in. Number of Lines_
Site Size a o9f 5"; / -5/ Rcrt FS Septic Tank size gal. Pump Chamber size _gal.
Water Source: private___ public Soil type 3 .(ATTACH SOIL EVAL.)
Previous eval: yes / no # 82-129 Application Rate _ .$ _gal./sq.ft./day
TYPE OF SYSTEM Conventional
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 it's employees, representatives or agents for the purpose
of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be
requested and shall occur during regular business hours.
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 permission to build a permanent residence or other structure on this parcel. Any
future applicat'•n will be separately judged by the rules and laws in effect at that time.
6 0
AiOwner Signature Date
QQ ,� t i FOR OFFICE USE ONLY �� 1 ) C'/
J o D PARTIAL /�L
ASBUILT v F N ' •� 3,
APPROVED (re .57 aNi
PRESS/TEST PUD al I
Fire District 8C�Planning District
�//.� School District Zone
Date��Ia/ O5 Fee v Rec# `60;5 ' Check# I D5 ?' Case#SEP 8,� - 1 . c 1
A
Jefferson County Environmental Health Dept.
615 Sheridan St., Port Townsend,WA 98368
SOIL EVALUATION
Property Owner- Tim Berry
System Designer- Soils Applications Inca Ken Warren
LEGAL DESCRIPTION: Section-_27_Township- 30N Range-1W Parcel#965000309
Subdivision: Kala Point#8 Division- Block Lot(s)- 460
Date Logged: 06/24/05Logged 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.
SOIL LOG#1 ,''i.
-3" to 0"in. : Duff +���
� /0" to 9"in : Loamy Fine Sand ..-7%;7?**-
9" to 64"in : Fine Sand (.4:S,
Antic' ter table in. •'t
Roo to 56" i hes.
Health Dept. Comments
SOIL LOG#2
-4" to 0"in. : Duff
0" to 8"in : Loamy Fine Sand
8" to 49"in : Fine Sand Lc— ,�r c:, x `'t
g
49" to 60"in : Medium Sa
Anticipated water table in.
Roots to 49" inches.
Health Dept. Comments ., .. w >" .. 1
JUL 12 2005
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