Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SEP1996-00103
E *LSD Cp il 10 — 14 Jefferson County Permit Center, 621 Sheridan, Port Townsend WA 98368 1 1. SEPTIC PERMIT APPLICATION PROPERTY OWNER IL. ET 1 ______ MAILING ADDRESS .01- � 2-47 7- 411° - A41 ?off 4g4t to ck 'V k, V 33 9 PHONE Area Code ( j eat ) " ( r 2 . 7- SYSTEM DESIGNER 'be r-' .r1cSen , Z �{�C (7[LEGAL DESCRIPTION: Section 3$ Township 3O/U Range ILO. PARCEL # U Subdivision Name liM d.-A/-+ .-- Division Block 6 q Lot(s) JI—, SITE LOCATION q ` d ►- o-f c p a cr ' Ag . Zip Code 7( L37 TYPE OF IMPROVEMENT: Residential `4 Commercial Community TYPE OF WORK: New X Redesign Upgrade Repair Partial (tank) (drainfield) Conventional X Alternative Drainfield Length / TO ft. Number of Bedrooms 3 Trench Width '3 ft. Basement: yes / (3 Trench/Bed Depth --30 in. Site Size 10O )3/ 10 ' Number of Lines 3 Previous evaluation: yes / 0 SEP / Tank size //rZj-0 gal. Water Source: private public )4 Soil type 3 (ATTACH SOIL EVAL.) Application Rate e gal./sq.ft./day TYPE OF SYSTEM Cevo),64147 p-yl of --[y ci. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signature Date ****.***********.*********.***:.4 ** ****,**64i*cvE*0-***c .,2:2: to*.. *.........* 'TAN U �/ FOR`OFFICE USE ONLY / zE CE1�i D S- ?- q( 1 ) 1711k FOD ° 81996 APPROVED PARTIAL FINAL �-/�.- � � � � � � q I / JEFFERSON COUNTY Z I I PERMIT C NTER RENEWLD'' RENEWED .� ' / C 1 1 i//" Fire District Planning District School District Zone �, t r? Date 2l4: -96 Fee ooDD Rec # I/J 7 3 heck # //7v Case # SEP 6s - 0/03 2441 iLi (1-1-C- Oit — ' 4Sb Z 4. ,p. Oor . '8/7-0-r- ( e 0 k II tN c-?P 1-pft1.1 4- --1-, ide2TA(1-6° 9A CLuj tkie. ‘ ' co►k ii,ec-rlo s 9t, ee Poet SEWAGE DISPOSAL PERMIT JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN STREET, PORT TOWNSEND, WA 98368 (360) 379-4450 PERMIT NUMBER:SEP96-0103 ISSUE DATE: 05/08/96 DATE RECEIVED: 04/03/96 Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON ISSUED TO • MIKE REGAN 231 W KINKAID PORT HADLOCK WA 98339 PARCEL NUMBER: 961806406 (Permit valid for this parcel ONLY) LEGAL DESCRIPTION Section: 3'A , Township ;54: 1\T, Range \ West Subdivision Block : Lot (s) : ; LOCATION • 9 TH AVE DESIGNER • BERNT ERICSEN THIS PERMIT IS ISSUED FOR A PERIOD OF ONE YEAR (UNLESS OTHERWISE STATED BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR ON- SITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO.l 1-83 .DATE OF EXPIRATION: 05/08/97 ^CL, Jefferson Co. Environmental Health Specialist . The property owner will be 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 building or sewage disposal plans (including plumbing stubout location) and/or location of house or drainfield invalidates this permit unless prior approval is obtained from the Jefferson Co. Health Dept . Issuance of a permit or renewal does not preclude the applicant from complying with all other state and local regulations . HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION. TYPE OF SYSTEM: CONVENTIONAL TRENCH NO. OF BEDROOMS : 3 Drainfield Trench Tank Length: 150 ft . Width: 3 . 0 ft . Depth: 24 in. Size : 1000 gal . SPECIAL CONDITIONS MAY APPLY - SEE REVERSE Conditions of Approval - Permit no. : SEP96-0103 For: MIKE REGAN Page: 2 1) Recorded easement required for primary and/or reserve drainfields prior to final approval . Easement to be recorded with the Jefferson County Auditors office . 2) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance . Protective barriers are required around drainfield. 3) Drainlines are to be installed along the natural contours . 4) Divert all sources of drainage away from septic tank and drainfield area. 5) Any portion of transport line under a driven way is to be double cased or equivalent . 6) Approval/issuance of a sewage disposal permit does not guarantee the approval of a building permit on this site . 7) 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 . sep prmt.txt 09/05/91 t JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING Designer Alle''''ge- D /u�Y Permit # SEP 4!a- Dolma 3 Installer mo/'--, .i Parcel # ( F06, ��‘=:' Electrician Design Flow 2 40 Property Owner /�l-f/- ' 2 X025�rt�" Site Address Z6 Z- % y-X4)1 , , PeVZ t1/1-4> - cK, {.//,4 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) 1000 &G 7co%7iA. 4)/131fPc - 4143 v)"z-z-7-P'' ).7-12 T-Z/-7( Pump chamber (manufacturer, size) Screen(s)and/or Pump Shroud (type, location) Were Tanks tested onsite for water tightness? Yes / No Panel Model Timer Model Pump 1 - Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) Pump 2 - Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) If additional pumps complete this info for each C:\Data\Wpw\County 8 State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 09/06/11 page 1 of 2 t Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location Sand Fill met design spec? Yes / No ATU (manufacturer, model) Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe Size/Sch. 4''' ' 034-- Jb V c- Manifold Size/Sch. Orifice Diameter Lateral Size/Sch. Barrier Material Cover Material/Depth —Z'e/SG ltc-LS 4—Z/—/( Residual Head (lat.# &ft. Head) Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean?j/ No If no, what action taken? Mound/Glendon Site Prep. Drainfield Length 34' ft Width ft Depth 3Z yo 3(o inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Other Aquaworx panel settings: SWarn at , ZBios at , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner Vv OW neEco21> ®/z$4,«6, Date Tank/component Decommissioning Report Attached Yes / No/ NA Installer Certification attached/signed Yes / No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I certify the information provided above was verified by inspection(with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed(no backfill, except over transport pipes), and final inspection of the completed system (with exceptions as noted, if any). To the extent revealed by these periodic inspections, the system complies with all the conditions noted in the permit as approved by Jefferson County ' —96, (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. /,' -"Z-�---/( 5100110 Designer Signature Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 09/06/11 page 2 of 2 N 73 ©S?m •F:5 �,� �'$��� °� �(4o 0° C C00-1 Doti m 0 ! k! � '•�� m �'�'i/// ova°O o� D �2M.ZO� --i D D n 3 k - L$�////� �! °1. -•Z°,� 'roe o�� m 2 ° %%�//// �oo�ao°i vaio �i") O 2 _Cr) �i/N// / 2t�ER.2 �T17f rn hi r O N (� O1- 2 ��cnp� O 0,in 4. ° : : !fl ?7~� � 0b Nikb Iv)C ) �ir-2op Z 2� � 0Za2-1 22 ac)p O°rym�\ -1 (4 2 ti Cr) CO O 0 I 50' Z 0 - - - - A V E.Cs) 0 0) rn Ts -0 W \ r--1-, co \K . - 2a N. o \ \. 0) © -100' 0) // • , \ I �,, \ ■ I , , � ' I � % I \ / oni \] 2r-...1 r ' . , -----c.. ....\-k---- cl . V___.. ( \ / /– — E_ _.,., ,.... ....„5. ,,_ _ ..... .... .- ...... 4. W / 15 I _ / U / f / �............I i ...t ••••: \ r. c. I ® I I 1 w I 50' "ED- c> \/ L 51' 5' m Ca — — — 100'—_ — — , � oa m ��C w co S h o v ba "o pQ o� � y �R7 2k ° m ^ I � _ Cl) co co w n CO 0 O o Z CI) cn v m QQ o 2 oa m • ti m z °zti n�rn�Zra-n,�A2� ON�'� CD o y�22aZ?o-,21-° K�fi n c1 Cr) 0, on z1.o°2"' °� mN m • ��TF9'= N 2 �^' ~~2°C0Z�m-,o3 O\ r ti 'y ill coo nZA'n �r,0� ONO cA - ,"' r cn 44 u, c)c),),, 2ohp,p� Q�m a.., l — (q Or rn� R oiav2i�oa6L4-i n aka m *7%." ..! ��a�/////I v C A• ,<�!',ncn2 ,U22Z Mkt m '1%.1,il'://•D p c)P a R,',�,��ain O p\ 2 rs, �_ -ii O ° k-Z2�0A>coa�n \ -< S ////� r2 y2i �e''�2 :). J,..1',11..1�2 may///// ►v D _ `3 1.c")-cn m� ...-1 p z c.n /////// '� \ \ m ~~Ak�020ri0-1 O ��'I N P (f) 03 '<- mp y o\ ti �nrhry�WpNOo ci O 0202°A'-��_,�i '� v 2�OEnOZr�i�po- a 2 \.rn En^,�aQtcom c)°rn y, ocn -o� O-� �(onoo��rw=-.a O — — — — — — — — — — — �y ' c�Ov, rn -nz Or • ;�� ) A�=�,on OCD V(-J AOZpr,22 2� oo�oA`�-020 2 °m� ,m2�z �O � �° o (� O AApnnO(no ^� ( J ''��,a i2 �, -,, o y oM Om(oO Z� o rn 2 il ] . O � 9th AVE. r......,LI rn _ 0 rti 10 W O 40,± O'� 2 ry id 0) 44. o 0 HZ H- I ,4, „„,:::::,,,,,m,„,,::,:,„,„,„. .,„. .. . i 6:,, 4 44 Iiis:::4;N:::N. ,,,,, a-,. O 6 CD o.------ ") O O — i -d1146. 1411°116::\27.k 10 °w o A CN o m C �m v "") O 2 �w o U o cN °rn `ri s a� (/) , y2A, �� 06 (al A°2° A C4 4Nriir co 2 w •C£ '�Z o Xi n --- co M NO __....._. _._.... ___. ...__ _._ ....._,,. ..._,. ...._. ._.__. _...,... _....._...._,_,.._,Y....__._ ..,co c0 X CO o �W � m a $ W v N ® � C`i N, to C4 m 2= _ =�1\ 'a >c C.) C3 en 121 4 Z- '. __.\ ,.,..r"`e-- "‘-‘.\ ,. ,„,,,, ,- a >a p � Zb r rl��t'''.....' , v co CO CA m 1D J 1 03 rn c • o O yz CO ❑ ❑ ❑ z o ❑ ❑ 0 00 0 0 ❑ 00000 ooZ g ,dv D c rncn � P wN � occoo -4 w cn � wr.J D ..a..; m5CU 3 M n ilI• d a 7 ,n m m y co O CD ? < c ° o = . °' o— ,, .+y o a � j y_ y t O -1 imca 0 N O i 0 cn c O N V y p r-OQ D) CD O -� CU 1 D, O O Z O < a,O n. . Q. (D m m * c O 0, 7 ay O' m o x fl :1)o O o y ,-, 0 0 ti) o w •; m a m Di -.. y to S -0 , — cl -- .+ .+y ' fe y o CD Jo .< y o d y o .2 k .13 Fe, — 3 0 m C„ u A m yc= . m c) " m O m „+ j cu iii co fD ' O C nO i a v p,-V m m SO7 m o . .+ N a s y 3 CD 7•- O C S CD O ri •-r O O -• N D • t0 4 . D -4, >0d ? S r S N y CD O 7 j f7 N. .+ CD O .+ n N C O O Co O .+ . m Cn 5' mm oa oony, I 1 w n CD lk. q, o 0 * i "V .... v Z D 16I to S a f... ■A 0 .4.- O oP \ Z rj,t m O — o , G, • (4, , I - /6 rn r Z 0 0 mZ :.y1 74 -10 t.0 in P C 0 O L t�. H 7 1 Z - 11 11 11 C 4- w fn 1"' O 1 t1 n o ' o a 17 ii ii ii ..4. J • Q n n n 1 Q- • V CC 11 11 11 II 11 y S3 LL.:CC 0. 11 W O II 11 a., 1.1.0.. n' l _ II g to II II :11.65:.1°- U Ui Q vl i " > 11 II w 1s = 1-• 1 a_ ^ 1 II o y 11 N ° II II y o t II II W 11 11 11 ~ L V C y W W W W W II `� II 11 0 0 a a. y Z W Z Z Z Z 11 V II II y o p O Z O O O O II II 11 d y a = 0 = = = 2 •II •II •11 a = a a a a II 11 11 ;n y o N J N a II Y II II CO •Q N MI 11 W to II 0 II 11 N W >. • J u u I r E x 11 11 11 a, O 0 Q ii Ili ii rri m y a u 1 1 p p' Ip E o �•+ N W 1 11 11 11 T L a 0 �- L Q 4, It tu Z E u o Ii r- W ii ii a t- o II 0 = II II II _ 0 Z Q A 11 J tY 11 11 r C 1' Q C II 11 11 O U yE G a. 4a ++ -M r ^a• 11 Ii I 11 J y Y U 0 0 O y a n n d `0 co c 0 F- C W w ti z = it t, ,- j 0 0 c L. ° N '�, • 3 11 m 11 11 3 O x t, J'_ C H Z 0 II n E en to a. q•^ 4. CO II O z 1 1 J L a✓ tp , 1 . 11 z II 1I -' O J j J- c' ' '••• Q.. n u , L CO Q'..-.0 , `. _� 1 Z II W II II `L 7 V) J `I �- 11 • C 11 II H =' ' `° °� CC \ , `I °' 11 Q 11 11 V B y- C W 0 = H 1t II• d J O I C N \O II • 11 ..- L II H y CO . *' • II ♦ .0. 11 11 4- 7 0 ti Di 11 C 11 r t)• S II 11 y to .- y lYlp� # C 11 F'- ^ . 11 2 11 11 a O E • O Z C W I1 3 11 II T. U 1M II pp 0 II II O V• li , " J • ~ • Z • L N y C y _ C u n w 1 y 10 a o L. U .j. .a .,"4„, 11 W 11 3 d L y a a� ii ` 1 o ° o ° "' Z W m $ 11 .. 11 z 11 w N • L a O s n z n z n L to o CO to O 11 O W II 11 y N >. .. N ac N U N Z N N •11 f 11 • a 7 CO at N N 1 N W N 6 to v1 N 11 I I- Q 11 ti 11 O C O `. N LU W W W 2 W OC W W W W 11 a 2 11 O 11 L L O d'•IL g p M O p p z p OC p 11 CO K 2 II 2 11 0 L a+ L. 0000 O p vi p p W pp W O 11 W U O a' 11 O II L tJ 7 Cy 6 W Q Q .U. H Q p Q 11 et QQ N ^ w II ^ II tp L O a W >~ Q U ~ O U Z • 0 S W N m II H II y 03 U F- t9 O Z J 0 J W O W t.7 11 O p Z z u a n o a pl OC 2 _ 2 V 2 2 H Z J 2 11 < OC > > O II ^ II �.. O C O ^ ^ - ^ W ^ ^ 11 \ J ^ 2 ^ It a' 11 M M .. •J J J F _J W J I- < 2 J_ J_ !! W hY Q p H 11 U 11 # •� CC y O. = U II H C.7 CO X U II N 11 # tT 7 1L d 6 Q 1-- p( Q 11 W 7 d W 1 W II # O y CO O. S Z 6 1 6 s to ` s J g 11 N o. J N 1- to 11 p II it -0 U T) s t f i 1 ) o Q Rj a ri < , 9 < SM3YflJ35 )a a o i I a e e _ H E ( ) O O s J O p+ ti w a N i a e O l.� - v+ 4 c•: M Y 4.44 d Jo r R h ra b � ,r ,7 ti7 J o, ei 6 JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN ST SOIL EVALUATION PORT TOWNSEND WA 98368 (360)379-4450 t ��__ PROPERTY OWNER lV L k4 ✓ e'P1ja y7 SYSTEM DESIGNER �t�'-f E/-1Qor � LEGAL DESCRIPTION: Section 34 Township 3d,4)Range G'tA.) Parcel # Subdivision Name Iv-0' . Division Block (AO Lot(s) al- Date Logged: 5- „2/ -gee Logged By: �j E)—i5 Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG #1 T, .3 SOIL LOG #2 `r 3 0 to /,- in. St/L S �0 to cQ in. saLg. /,Z to _i n. A __, ______to O 66 in. M iu,. , to a in. 17rt •flu..S „, to in. to in. to in. Anticipated water table7f, in. Anticipated water table>64 in. Roots to cw inches Roots to ZU inches Health Dept. Comments c `� Health Dept. Comments SOIL LOG #3 T 3 e SOIL LOG #4 773 0 to /G in. /erg. _to le' in. SLA lb to 96 in. far, s; , i to 0 in. `Z z 5 . to in. ' i k to in. to in. to in. Anticipated water table >0 in. Anticipated water table ->64/ in. Roots to 50 inches Roots to 60 inches Health Dept. Comments Health Dept. Comments RECEIVED APR - 1 1996 SOIL LOG #5 SOIL LOG #6 JEFFERSON COUNT to in. to in. PERMIT CENTER to in. to in. to in. to in. to in. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments H:\\\INFOHLTH\SOIL.FRM E *LSD Cp il 10 — 14 Jefferson County Permit Center, 621 Sheridan, Port Townsend WA 98368 1 1. SEPTIC PERMIT APPLICATION PROPERTY OWNER IL. ET 1 ______ MAILING ADDRESS .01- � 2-47 7- 411° - A41 ?off 4g4t to ck 'V k, V 33 9 PHONE Area Code ( j eat ) " ( r 2 . 7- SYSTEM DESIGNER 'be r-' .r1cSen , Z �{�C (7[LEGAL DESCRIPTION: Section 3$ Township 3O/U Range ILO. PARCEL # U Subdivision Name liM d.-A/-+ .-- Division Block 6 q Lot(s) JI—, SITE LOCATION q ` d ►- o-f c p a cr ' Ag . Zip Code 7( L37 TYPE OF IMPROVEMENT: Residential `4 Commercial Community TYPE OF WORK: New X Redesign Upgrade Repair Partial (tank) (drainfield) Conventional X Alternative Drainfield Length / TO ft. Number of Bedrooms 3 Trench Width '3 ft. Basement: yes / (3 Trench/Bed Depth --30 in. Site Size 10O )3/ 10 ' Number of Lines 3 Previous evaluation: yes / 0 SEP / Tank size //rZj-0 gal. Water Source: private public )4 Soil type 3 (ATTACH SOIL EVAL.) Application Rate e gal./sq.ft./day TYPE OF SYSTEM Cevo),64147 p-yl of --[y ci. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signature Date ****.***********.*********.***:.4 ** ****,**64i*cvE*0-***c .,2:2: to*.. *.........* 'TAN U �/ FOR`OFFICE USE ONLY / zE CE1�i D S- ?- q( 1 ) 1711k FOD ° 81996 APPROVED PARTIAL FINAL �-/�.- � � � � � � q I / JEFFERSON COUNTY Z I I PERMIT C NTER RENEWLD'' RENEWED .� ' / C 1 1 i//" Fire District Planning District School District Zone �, t r? Date 2l4: -96 Fee ooDD Rec # I/J 7 3 heck # //7v Case # SEP 6s - 0/03 2441 iLi (1-1-C- Oit — ' 4Sb Z 4. ,p. Oor . '8/7-0-r- ( e 0 k II tN c-?P 1-pft1.1 4- --1-, ide2TA(1-6° 9A CLuj tkie. ‘ ' co►k ii,ec-rlo s 9t, ee Poet SEWAGE DISPOSAL PERMIT JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN STREET, PORT TOWNSEND, WA 98368 (360) 379-4450 PERMIT NUMBER:SEP96-0103 ISSUE DATE: 05/08/96 DATE RECEIVED: 04/03/96 Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON ISSUED TO • MIKE REGAN 231 W KINKAID PORT HADLOCK WA 98339 PARCEL NUMBER: 961806406 (Permit valid for this parcel ONLY) LEGAL DESCRIPTION Section: 3'A , Township ;54: 1\T, Range \ West Subdivision Block : Lot (s) : ; LOCATION • 9 TH AVE DESIGNER • BERNT ERICSEN THIS PERMIT IS ISSUED FOR A PERIOD OF ONE YEAR (UNLESS OTHERWISE STATED BELOW) IN ACCORDANCE WITH JEFFERSON COUNTY RULES AND REGULATIONS FOR ON- SITE SEWAGE DISPOSAL SYSTEMS, ORDINANCE NO.l 1-83 .DATE OF EXPIRATION: 05/08/97 ^CL, Jefferson Co. Environmental Health Specialist . The property owner will be 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 building or sewage disposal plans (including plumbing stubout location) and/or location of house or drainfield invalidates this permit unless prior approval is obtained from the Jefferson Co. Health Dept . Issuance of a permit or renewal does not preclude the applicant from complying with all other state and local regulations . HEALTH DEPARTMENT MUST BE CALLED FOR FINAL INSPECTION. TYPE OF SYSTEM: CONVENTIONAL TRENCH NO. OF BEDROOMS : 3 Drainfield Trench Tank Length: 150 ft . Width: 3 . 0 ft . Depth: 24 in. Size : 1000 gal . SPECIAL CONDITIONS MAY APPLY - SEE REVERSE Conditions of Approval - Permit no. : SEP96-0103 For: MIKE REGAN Page: 2 1) Recorded easement required for primary and/or reserve drainfields prior to final approval . Easement to be recorded with the Jefferson County Auditors office . 2) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance . Protective barriers are required around drainfield. 3) Drainlines are to be installed along the natural contours . 4) Divert all sources of drainage away from septic tank and drainfield area. 5) Any portion of transport line under a driven way is to be double cased or equivalent . 6) Approval/issuance of a sewage disposal permit does not guarantee the approval of a building permit on this site . 7) 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 . sep prmt.txt 09/05/91 t JEFFERSON COUNTY PUBLIC HEALTH, 615 SHERIDAN, PORT TOWNSEND WA 98368 CONSTRUCTION INSPECTION REPORT For RECORD DRAWING Designer Alle''''ge- D /u�Y Permit # SEP 4!a- Dolma 3 Installer mo/'--, .i Parcel # ( F06, ��‘=:' Electrician Design Flow 2 40 Property Owner /�l-f/- ' 2 X025�rt�" Site Address Z6 Z- % y-X4)1 , , PeVZ t1/1-4> - cK, {.//,4 Answer all questions or indicate NA Tanks, Pumps and Controls Date Insp. Tank (manufacturer, size, baffles) 1000 &G 7co%7iA. 4)/131fPc - 4143 v)"z-z-7-P'' ).7-12 T-Z/-7( Pump chamber (manufacturer, size) Screen(s)and/or Pump Shroud (type, location) Were Tanks tested onsite for water tightness? Yes / No Panel Model Timer Model Pump 1 - Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) Pump 2 - Man./Model Flow Rate gpm Pump Location (i.e. garage, treatment unit, basement) Bottom of transducer to bottom of tank Float settings (above bottom of tank) / transducer settings Timer Functions: (above bottom of transducer) On/off - On - Veto - Off- Alarm - Veto On - Storage Above High Water Alarm gal. Veto Off- Dose Counter Reading # gallons/dose Elap. Time Meter Reading Pump Throttled? Yes / No Dose Drawdown (in inches) If additional pumps complete this info for each C:\Data\Wpw\County 8 State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 09/06/11 page 1 of 2 t Pre-Treatment Date Insp Sandfilter basin high water alarm shuts down pump to Sandfilter Yes / No Sandfilter Basin size/location Sand Fill met design spec? Yes / No ATU (manufacturer, model) Alarm tested Yes / No Disinfection Unit (manufacturer, type, model) Independent Alarm Yes / No Drainfield Transport Pipe Size/Sch. 4''' ' 034-- Jb V c- Manifold Size/Sch. Orifice Diameter Lateral Size/Sch. Barrier Material Cover Material/Depth —Z'e/SG ltc-LS 4—Z/—/( Residual Head (lat.# &ft. Head) Source/Manufacturer of Drainrock/Gravelless chambers Drainrock Clean?j/ No If no, what action taken? Mound/Glendon Site Prep. Drainfield Length 34' ft Width ft Depth 3Z yo 3(o inches Caps for measuring residual head stored (location) COMMENTS (inspection notes, changes from design or deficiencies in installation) Attach additional sheet(s) if necessary Other Aquaworx panel settings: SWarn at , ZBios at , Autoclear set at doses min-sec. Health Department Inspection issues resolved Yes / No / NA If yes how? Users Manual Provided to Homeowner Vv OW neEco21> ®/z$4,«6, Date Tank/component Decommissioning Report Attached Yes / No/ NA Installer Certification attached/signed Yes / No ATTACH RECORD DRAWING stamped/signed by Designer or Licensed Professional Engineer I certify the information provided above was verified by inspection(with exceptions as noted, if any). I also certify that this on-site system was installed in accordance with the approved design and verified through periodic observations of construction such as site plowing for mounds, pressure testing with all system components exposed(no backfill, except over transport pipes), and final inspection of the completed system (with exceptions as noted, if any). To the extent revealed by these periodic inspections, the system complies with all the conditions noted in the permit as approved by Jefferson County ' —96, (Permit Approval Date)or that changes have been noted and the system is in compliance with WAC 246-272. /,' -"Z-�---/( 5100110 Designer Signature Date License# C:\Data\Wpw\County&State Forms\Jefferson\Construction Reports\Alternative sys ASBUILT 2010-2.FRM.wpd 09/06/11 page 2 of 2 N 73 ©S?m •F:5 �,� �'$��� °� �(4o 0° C C00-1 Doti m 0 ! k! � '•�� m �'�'i/// ova°O o� D �2M.ZO� --i D D n 3 k - L$�////� �! °1. -•Z°,� 'roe o�� m 2 ° %%�//// �oo�ao°i vaio �i") O 2 _Cr) �i/N// / 2t�ER.2 �T17f rn hi r O N (� O1- 2 ��cnp� O 0,in 4. ° : : !fl ?7~� � 0b Nikb Iv)C ) �ir-2op Z 2� � 0Za2-1 22 ac)p O°rym�\ -1 (4 2 ti Cr) CO O 0 I 50' Z 0 - - - - A V E.Cs) 0 0) rn Ts -0 W \ r--1-, co \K . - 2a N. o \ \. 0) © -100' 0) // • , \ I �,, \ ■ I , , � ' I � % I \ / oni \] 2r-...1 r ' . , -----c.. ....\-k---- cl . V___.. ( \ / /– — E_ _.,., ,.... ....„5. ,,_ _ ..... .... .- ...... 4. W / 15 I _ / U / f / �............I i ...t ••••: \ r. c. I ® I I 1 w I 50' "ED- c> \/ L 51' 5' m Ca — — — 100'—_ — — , � oa m ��C w co S h o v ba "o pQ o� � y �R7 2k ° m ^ I � _ Cl) co co w n CO 0 O o Z CI) cn v m QQ o 2 oa m • ti m z °zti n�rn�Zra-n,�A2� ON�'� CD o y�22aZ?o-,21-° K�fi n c1 Cr) 0, on z1.o°2"' °� mN m • ��TF9'= N 2 �^' ~~2°C0Z�m-,o3 O\ r ti 'y ill coo nZA'n �r,0� ONO cA - ,"' r cn 44 u, c)c),),, 2ohp,p� Q�m a.., l — (q Or rn� R oiav2i�oa6L4-i n aka m *7%." ..! ��a�/////I v C A• ,<�!',ncn2 ,U22Z Mkt m '1%.1,il'://•D p c)P a R,',�,��ain O p\ 2 rs, �_ -ii O ° k-Z2�0A>coa�n \ -< S ////� r2 y2i �e''�2 :). J,..1',11..1�2 may///// ►v D _ `3 1.c")-cn m� ...-1 p z c.n /////// '� \ \ m ~~Ak�020ri0-1 O ��'I N P (f) 03 '<- mp y o\ ti �nrhry�WpNOo ci O 0202°A'-��_,�i '� v 2�OEnOZr�i�po- a 2 \.rn En^,�aQtcom c)°rn y, ocn -o� O-� �(onoo��rw=-.a O — — — — — — — — — — — �y ' c�Ov, rn -nz Or • ;�� ) A�=�,on OCD V(-J AOZpr,22 2� oo�oA`�-020 2 °m� ,m2�z �O � �° o (� O AApnnO(no ^� ( J ''��,a i2 �, -,, o y oM Om(oO Z� o rn 2 il ] . O � 9th AVE. r......,LI rn _ 0 rti 10 W O 40,± O'� 2 ry id 0) 44. o 0 HZ H- I ,4, „„,:::::,,,,,m,„,,::,:,„,„,„. .,„. .. . i 6:,, 4 44 Iiis:::4;N:::N. ,,,,, a-,. O 6 CD o.------ ") O O — i -d1146. 1411°116::\27.k 10 °w o A CN o m C �m v "") O 2 �w o U o cN °rn `ri s a� (/) , y2A, �� 06 (al A°2° A C4 4Nriir co 2 w •C£ '�Z o Xi n --- co M NO __....._. _._.... ___. ...__ _._ ....._,,. ..._,. ...._. ._.__. _...,... _....._...._,_,.._,Y....__._ ..,co c0 X CO o �W � m a $ W v N ® � C`i N, to C4 m 2= _ =�1\ 'a >c C.) C3 en 121 4 Z- '. __.\ ,.,..r"`e-- "‘-‘.\ ,. ,„,,,, ,- a >a p � Zb r rl��t'''.....' , v co CO CA m 1D J 1 03 rn c • o O yz CO ❑ ❑ ❑ z o ❑ ❑ 0 00 0 0 ❑ 00000 ooZ g ,dv D c rncn � P wN � occoo -4 w cn � wr.J D ..a..; m5CU 3 M n ilI• d a 7 ,n m m y co O CD ? < c ° o = . °' o— ,, .+y o a � j y_ y t O -1 imca 0 N O i 0 cn c O N V y p r-OQ D) CD O -� CU 1 D, O O Z O < a,O n. . Q. (D m m * c O 0, 7 ay O' m o x fl :1)o O o y ,-, 0 0 ti) o w •; m a m Di -.. y to S -0 , — cl -- .+ .+y ' fe y o CD Jo .< y o d y o .2 k .13 Fe, — 3 0 m C„ u A m yc= . m c) " m O m „+ j cu iii co fD ' O C nO i a v p,-V m m SO7 m o . .+ N a s y 3 CD 7•- O C S CD O ri •-r O O -• N D • t0 4 . D -4, >0d ? S r S N y CD O 7 j f7 N. .+ CD O .+ n N C O O Co O .+ . m Cn 5' mm oa oony, I 1 w n CD lk. q, o 0 * i "V .... v Z D 16I to S a f... ■A 0 .4.- O oP \ Z rj,t m O — o , G, • (4, , I - /6 rn r Z 0 0 mZ :.y1 74 -10 t.0 in P C 0 O L t�. H 7 1 Z - 11 11 11 C 4- w fn 1"' O 1 t1 n o ' o a 17 ii ii ii ..4. J • Q n n n 1 Q- • V CC 11 11 11 II 11 y S3 LL.:CC 0. 11 W O II 11 a., 1.1.0.. n' l _ II g to II II :11.65:.1°- U Ui Q vl i " > 11 II w 1s = 1-• 1 a_ ^ 1 II o y 11 N ° II II y o t II II W 11 11 11 ~ L V C y W W W W W II `� II 11 0 0 a a. y Z W Z Z Z Z 11 V II II y o p O Z O O O O II II 11 d y a = 0 = = = 2 •II •II •11 a = a a a a II 11 11 ;n y o N J N a II Y II II CO •Q N MI 11 W to II 0 II 11 N W >. • J u u I r E x 11 11 11 a, O 0 Q ii Ili ii rri m y a u 1 1 p p' Ip E o �•+ N W 1 11 11 11 T L a 0 �- L Q 4, It tu Z E u o Ii r- W ii ii a t- o II 0 = II II II _ 0 Z Q A 11 J tY 11 11 r C 1' Q C II 11 11 O U yE G a. 4a ++ -M r ^a• 11 Ii I 11 J y Y U 0 0 O y a n n d `0 co c 0 F- C W w ti z = it t, ,- j 0 0 c L. ° N '�, • 3 11 m 11 11 3 O x t, J'_ C H Z 0 II n E en to a. q•^ 4. CO II O z 1 1 J L a✓ tp , 1 . 11 z II 1I -' O J j J- c' ' '••• Q.. n u , L CO Q'..-.0 , `. _� 1 Z II W II II `L 7 V) J `I �- 11 • C 11 II H =' ' `° °� CC \ , `I °' 11 Q 11 11 V B y- C W 0 = H 1t II• d J O I C N \O II • 11 ..- L II H y CO . *' • II ♦ .0. 11 11 4- 7 0 ti Di 11 C 11 r t)• S II 11 y to .- y lYlp� # C 11 F'- ^ . 11 2 11 11 a O E • O Z C W I1 3 11 II T. U 1M II pp 0 II II O V• li , " J • ~ • Z • L N y C y _ C u n w 1 y 10 a o L. U .j. .a .,"4„, 11 W 11 3 d L y a a� ii ` 1 o ° o ° "' Z W m $ 11 .. 11 z 11 w N • L a O s n z n z n L to o CO to O 11 O W II 11 y N >. .. N ac N U N Z N N •11 f 11 • a 7 CO at N N 1 N W N 6 to v1 N 11 I I- Q 11 ti 11 O C O `. N LU W W W 2 W OC W W W W 11 a 2 11 O 11 L L O d'•IL g p M O p p z p OC p 11 CO K 2 II 2 11 0 L a+ L. 0000 O p vi p p W pp W O 11 W U O a' 11 O II L tJ 7 Cy 6 W Q Q .U. H Q p Q 11 et QQ N ^ w II ^ II tp L O a W >~ Q U ~ O U Z • 0 S W N m II H II y 03 U F- t9 O Z J 0 J W O W t.7 11 O p Z z u a n o a pl OC 2 _ 2 V 2 2 H Z J 2 11 < OC > > O II ^ II �.. O C O ^ ^ - ^ W ^ ^ 11 \ J ^ 2 ^ It a' 11 M M .. •J J J F _J W J I- < 2 J_ J_ !! W hY Q p H 11 U 11 # •� CC y O. = U II H C.7 CO X U II N 11 # tT 7 1L d 6 Q 1-- p( Q 11 W 7 d W 1 W II # O y CO O. S Z 6 1 6 s to ` s J g 11 N o. J N 1- to 11 p II it -0 U T) s t f i 1 ) o Q Rj a ri < , 9 < SM3YflJ35 )a a o i I a e e _ H E ( ) O O s J O p+ ti w a N i a e O l.� - v+ 4 c•: M Y 4.44 d Jo r R h ra b � ,r ,7 ti7 J o, ei 6 JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN ST SOIL EVALUATION PORT TOWNSEND WA 98368 (360)379-4450 t ��__ PROPERTY OWNER lV L k4 ✓ e'P1ja y7 SYSTEM DESIGNER �t�'-f E/-1Qor � LEGAL DESCRIPTION: Section 34 Township 3d,4)Range G'tA.) Parcel # Subdivision Name Iv-0' . Division Block (AO Lot(s) al- Date Logged: 5- „2/ -gee Logged By: �j E)—i5 Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG #1 T, .3 SOIL LOG #2 `r 3 0 to /,- in. St/L S �0 to cQ in. saLg. /,Z to _i n. A __, ______to O 66 in. M iu,. , to a in. 17rt •flu..S „, to in. to in. to in. Anticipated water table7f, in. Anticipated water table>64 in. Roots to cw inches Roots to ZU inches Health Dept. Comments c `� Health Dept. Comments SOIL LOG #3 T 3 e SOIL LOG #4 773 0 to /G in. /erg. _to le' in. SLA lb to 96 in. far, s; , i to 0 in. `Z z 5 . to in. ' i k to in. to in. to in. Anticipated water table >0 in. Anticipated water table ->64/ in. Roots to 50 inches Roots to 60 inches Health Dept. Comments Health Dept. Comments RECEIVED APR - 1 1996 SOIL LOG #5 SOIL LOG #6 JEFFERSON COUNT to in. to in. PERMIT CENTER to in. to in. to in. to in. to in. to in. Anticipated water table in. Anticipated water table in. Roots to inches Roots to inches Health Dept. Comments Health Dept. Comments H:\\\INFOHLTH\SOIL.FRM