HomeMy WebLinkAboutBLD2004-00009 . • MLA04-00008
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00009 Received Date: 1/7/2004
SITE ADDRESS: 364 PORT HADLOCK HEIGHTS RD
PORT HADLOCK, 98339
APPLICANT: WALT KRACK PHONE:
LINDA KRACK/C/O BRODERS INC
4503 OLD GARDINER RD
PORT TOWNSEND WA 98368
SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: 1-45
PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR/
DEALER:
INSTALLER: C JON LUGAR WAINS0260 7/31/2004 (360)479-8312
PO BOX 48300 OLYMPIA WA 98504-8300
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MFH
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SKYLINE SETBACK:
VALUATION 65,178.00 YEAR: 2004
LABOR & INDUSTRIES APPROVAL?
SIZE: 27 X 56 BANK HEIGHT:
SEWAGE DISPOSAL: CMY
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: 2 Exist: 2 AREA Plat Conditions
Prop: 0 Prop: Wetland Erosion
Total: 2 Total: 2 Seismic Streams
Flood Way Floodplain
Routing Date: �7 F&W Landslide
/ 3 Shoreline _Aquifer
Type Amount Paid By: Date: Receipt:
Apvp,moVED
Manufactured Homes $154.00 KAS 01/07/04 62368 FEB - 3 2004
Potable Water Application $52.00 KAS 01/07/04 62368
Total: $206.00 Jefferson County Planning
& Building Depa tment
pAi:1/9") le Seal
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368
MANUFACTURD HOME INSTALLATION PERMIT APPLICATION
Dv % ,i BUILDING 0 REPLACEMENT
in t,! JAN 7 ;SIZE a.-.7 X ..5
L YEAR �601i
KEPT. OF LiJ d _MAK EPMLr3 t_ S K 1 (t KC
COST 4 6.S 17 8.0 to
BEDROOMS: BATHROOMS:
EXISTING 2.. EXISTING 2.
PROPOSED PROPOSED
TOTAL TOTAL Z.
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER X COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL
❑ INDIVIDUAL SYSTEM 0 Conventional Y1 PUBLIC PERMIT#SEP 03-601430 Alternative Name of water system: P.U• 7fr:' I
IF WATERFRONT PROPERTY, pcFt- (-f 1 Li..0:
DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft
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 busine s ours.
SIGNATURE javadi. - DATE S,Th6 2 e D
r rr
NAME(PLEASE PRINT) 3iG�d&.df A,'rod-err J A-PS f �i
r IN,end L% -tcic
_ - FOR OFFICE USE ONLY - .,` s i h i
CONSIST c . Yf (IEW ; Q EI
w
' BASE;FEE
ADDITIONAL SECTIONS CASH/CK�# q(0 C
SUBTOTAL
��D DATE t '7 /{',moo - ,«fix
POTAW41 V 5
911/ROAD APPROACH
TOTAL 122 41.
HW omapLNCNTRUNFOBLowoRmsWmoBILEAP.11/26/01
• •
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT 8
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD04-00009 Received Date: 1/7/200
SITE ADDRESS: 364 PORT HADLOCK HEIGHTS RD Issue Date: 2/3/20C
PORT HADLOCK, 98339
APPLICANT: WALT KRACK
LINDA KRACK/C/O BRODERS INC
4503 OLD GARDINER RD
PORT TOWNSEND WA 98368
SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: 21
PARCEL#: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR/
DEALER
INSTALLER: C JON LUGAR WAINS0260 Expires: 7/31/200z
PO BOX 48300 OLYMPIA WA 98504-8300
PROJECT DESCRIPTION: NEW MANUFACTURED HOME and SOO &*l Vv 9yi d Prv.pdt`.t-1—
MAKE: SKYLINE
YEAR: 2004
SIZE: 27 X 56
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 2/3/2005.
REQUIRED INSPECTIONS:
'V Setbacks/Footing (CONTINUOUS FOOTING,,(Alr PADS USED): /'S-mom/
L 7 Propd.r1P_Tank]Lirte-- 0/4 tlye iicirbos6 5/z7/4
[ ] Blocking/Plumbing: , y 7
[ ] Zoning Approval:
[ ] Septic System Approval:
[ ] Final/Skirting/Vents/Porches/Steps: to �� � 4C
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
SPECIAL CONDITIONS APPLY-SEE REVERSE
HOT-LINE AVAILABLE 24 HOURS A DAY
• •
SPECIAL CONDITIONS CASE # BLD04-00009
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on January 13, 2004 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:
Special Aquifer Recharge Protection Areas and Coastal Seawater Intrusion Protection
Zones (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.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
4.) 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.
5.) 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.
6.) 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.
•
7.) 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.
8.) 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.
9.) 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.
10.) The applicant is proposing to create or add 2688 square feet of impervious surface and
4076 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal submit a stormwater plan
meeting Minimum Requirements#1 through#5 of the Stormwater Management Manual
for Western Washington.
11.) 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).
12.) The revised site plan as submitted on January 9, 2004 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 January 14, 2004 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
13.) This approval is for a manufactured home 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.
14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
15.) 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).
16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
17.) The building height is not to exceed 35 feet.
18.) Minimum setback from Port Hadlock Heights Rd right-of-way is 20 ft. Minimum side
setbacks are 5 ft. Minimum setback from the north (rear)setback shall be 25 ft, per
dedicated 25-ft buffer per plat.
19.) This parcel was created through the Port Hadlock Heights Mobile Home Park Binding Site
Plan, filed of record April 15, 1998 under AFN 409746 in Vol 1, page 28-32 with the
Jefferson County Auditor's office. The binding site plan was reviewed by Jefferson County
Department of Community Development under BSP94-00001.
20.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County
Comprehensive Plan Land Use Map effective August 28, 1998.
21.) Community Drainfield "C" (SEP95-00290) serves this site and was finaled January 4,
2002. A septic permit(SEP03-00293)was approved on December 23, 2003 for a septic
tank and pump chamber to be connected to Community Drainfield "C".
22.) Port Hadlock Heights Rd (P516) is a private road. The road approach is existing and an
address of 364 Port Hadlock Heights Rd has been assigned to Lot 21.
23.) Jefferson County PUD provides potable water to this site.
24.) A minimum of two (2)on-site parking spaces are required for the manufactured home.
25.) A stormwater plan for a medium project 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.
26.) The 25-ft wide buffer shall remain in its naturally vegetated condition. No constructed or
erected facilities shall be placed within the buffer with the exception of utility lines, fencing
or security posts.
FORT RIND LOcX &zGt4rs LOT 21
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APPROVED ;` - _ PERMIT # BLB
SITE PLAN N 0;1a
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BAN 1 - 1i l a. 'FFFSONJEFFERSON COUNTY0'•T/0i , v CUNTY D
DEPT.OF }7 uNttY •,y ,p ; .! f ° , t s ,,E_pat� tip_ c
SIGNAI URE��. i. Q' T+ ' _ _ ._,
1
1 ( l n i PLEASE MAIL TO:
Q �-— — �rFERSON COUNTY ASSESSOR
JACK WESTEItAN III r, ;1 JEFFERSON COUNTY COURTHOUSE
ASSESSOR 0! JAN — 7 2004 PDX 1220,PORT TOWNSEND WA 98368
(360) 385-9105
L_._...
MOBIL Nptle NFORI IAT 1`FQ tM
OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT
NAME: [►rat-- 2>.. Le . a k v•a CK The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the
ADDRESS: cia ii%-olets , 7.►l c previous ownership and location of a mobile home. This will
help our office determine whether the mobile home is already
-4 56,3 CO!d ( r. 4Iivs /Q 1. Pi?, Y$368 on the tax rolls in Jefferson County or if it has been moved to
this county from another area. Please see reverse side for
TELEPHONE NO: additional information.
1) MOBILE HOME DATA:
(A) MAKE ,SZCy One (B) MODEL L..e x(%#,4ovt 6?ay CT (C) YEAR Zo eY
(D) LENGTH 5b (E) WIDTH 2.'7 (F)SERIAL NUMBER
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) .f 6 S, 1 ? S. o• (H) PURCHASE DATE r4
M zee/
2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME:
(A) FROM WHOM DID YOU PURCHASE MOBILE Ce ldc.bt Preo'sirs
ADDRESS S-e.T..t-„i• l v /1-
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY?
IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE?
3) WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO
(B) IF LOCATED IN A MOBILE HOME PARK:1 ,
NAME azADDRESSOFPARK pop4- t4tc-1cc�� (�er'�It4-s ,ENO. I
(C) IF NOT LOCATED IN A MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION(ADDRESS)
REAL PROPERTY PARCEL NUMBER/DESCRIPTION
THANK YOU FOR YOUR HELP! rectV
SIGNATURE 41_,L for. (,v, (., f(r,c/<
•
KELLI LARSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
JEFFERSON COUNTYellk
I, -11 r
g - ‘ iki r,,..., DEPARTMENT OF COMMUNITY DEVELOPMENT ( E .
JAN - 7 2004 ' ,
tli 0:9Z. 4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax 9
http://wvm.co.jefferson.wa.us/commdevelopment/ 0 PT. OF C t; , t
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Y 'I -00 0 0'✓ PROJECT/APPLICANT NAME: jC,K A GK / B,RO0&AS
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, tl
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map. �1 II
--XI's1�h c.n--ovr3 w ,'i"*.11tin •. Ali QXp6 riK .ZSi v-o f o4t.t••d o !
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.The joil• ;s p/A.-I- wi=lh a. s Io,p ..f t e. ppwt- a. le -/-co 441.C. N.5. 1 J
`-e- Q )('sf‘,^V-
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
t^x (s f 1. )rt I.e- -a.--o., j S y r a S.5 o ri a I) LhN/4- 1`'11,r /Vo' 02 S I o f 4 J t jot t
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k.lie t"L 1 i5 n���,.<iCy V�.,,e,+._+•..� „,,,,,tb 4 'e Q,wd. sri. -i/ fry..ej .
4. Describe the existing soils. Indicate soil type on the site map. ,—Ile.. ee1- c /o-i- es 544,4l j, Ci4l.• (D.t x OVQi- S 4n d and ,N4VIElL)]
-
5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above, below,and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
Ara w1+4- .Gv1.4' r-S +)t i S /.4- From o 4h-ei.. /e j•-> m..- +/1e d- o a,Cl - bre-te-
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6. Describe any excess levels of noise generated by the proposed use or activity APPROVED
OM 14 al 1
stormwater site plan template-rev.10V1l2003 JEFFERSON COUNTY 5
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes, etc.)on the site. Indicate location on the site map.
None-
8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
R4tiszd e- 11-c P•v road and c�1- de- S�c a-n S.�-�-b j �/< [.n,t Io7-
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30
in the Manual) or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site.
Locate these facilities on the site plan andL differentiate proposed facilities from existing facilities.
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10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large"projects or projects that involve the potential for dispersion of contaminants.]
/1fo-1- ke
11. Describe the performance goals and standardsf applicable to the project.
�.o .1 j s +o d :S ?e c- G ac n f a i �l L f►•e'�e c,,1 1
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12. Describe the flow control system.
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13. Describe the water quality system. la �' � — 7 zuu4
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14. Describe the conveyance system analysis and design.
No h e.
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
N o n e
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
None •
17. Describe the proposed surfacing material.W �
p1^ VtieaV. SurftCZxq w i 1) I. 3//j ' plus C Yus�1 eC� .YJj s -fre
18. Describe methods for restoration of the site.
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
N /A
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
Nbfl .
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here. __.,_
stormwater site plan template—rev.10/1/2003 7
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will.be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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2. Establish Construction Access. /
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3. Control Flow Rates.
4. Install Sediment Controls.
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5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets.
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stormwater site plan template-rev.10/1/2003 8
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12 Required Elements—Construction SWPPP(continued) i , j i
8. Stabilize Channels and Outlets. �A — 2004 �
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
N/A
11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residentia
areas, roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 40(
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,spttleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence l
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Propo ed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
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8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
tormwater site plan template-rev.10/12003 10
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SECTION II—EROSION AND SEDIMENT CONTROL PLAN 1..;•�
Sediment and erosion control measures may be depicted on the master land use application plci h,a stormwater site plan,and4r 3
separate Construction SWPPP site plan. This is a checklist to ensure that the following are dep 1 'on a filar; 7 2004
1. General.
a. Vicinity Map l t
b. Jefferson County Approval Block =t'7. CF C_. r d FLOPM1-A l
c. Erosion and Sediment Control Notes
2. Site Plan.
a. Legal description of subject property.
b. North arrow.
c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.).
d. Identify and label areas of potential erosion problems.
e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable).
f. Show existing and proposed contours.
g. Indicate drainage basins and direction of flow for individual drainage areas.
h. Label final grade contours and identify developed condition drainage basins.
i. Delineate areas that are to be cleared and graded.
j. Show all cut and fill slopes indicating top and bottom of slope catch lines.
3. Conveyance Systems.
a. Designate locations for swales,interceptor trenches,or ditches.
b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control.
c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts.
d. Shows grades, dimensions,and direction of flow in all ditches,swales,culverts and pipes.
e. Provide details for bypassing off-site runoff around disturbed areas.
f. Indicate locations and outlets of any dewatering systems.
4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs.
5. Erosion and Sediment Control Facilities.
a. Show the locations of sediment trap(s),pond(s),pipes and structures.
b. Dimension pond berm widths and inside and outside pond slopes.
c. Indicate the trap/pond storage required and the depth,length,and width dimensions.
d. Provide typical section views through pond and outlet structure.
e. Provide typical details of gravel cone and standpipe,and/or other filtering devices.
f. Detail stabilization techniques for outlet/inlet.
g. Detail controVrestrictor device location and details.
h. Specify mulch and/or recommended cover of berms and slopes.
i. Provide rock specifications and detail for rock check dam(s),if applicable.
j. Specify spacing for rock check dams as required.
k. Provide front and side sections of typical rock check dams.
I. Indicate the locations and provide details and specifications for silt fabric.
m. Locate the construction entrance and provide a detail.
6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and
illustrated with detailed drawings.
•
7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than
sediment(e.g.,concrete wash water).
8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on
the construction site. Sampling stations should be located upstream and downstream of the project site.
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Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of he affects prope .
(LANDOWNER OR A IZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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stormwater site plan template—rev.10/102003