The URL can be used to link to this page

Home My WebLink AboutBLD2004-00367 M LA04-0033 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD04-00367 Received Date: 6/7/2004 SITE ADDRESS: S DUQUESNE AVE PORT TOWNSEND, 98368 APPLICANT: RONALD F DESJARDINS PHONE: (206) 799-6044 74 BEACH DR QUILCENE WA 98376 SUBDIVISION: IRONDALE Block: Lot: PARCEL NUMBER: 962112704 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ HAI PHAM VAN CONSTRUCTION PHONE: (360) 455-4158 DEALER: W/HERITAGE HOME OF SEQUIM 6642 5TH WAY SE LACEY WA 98503-7975 Contractor's License HAIHC*999PP Expires INSTALLER: HAI PHAM VAN CONSTRUCTION HAIHC*999PP (360)455-4158 W/HERITAGE HOME OF SEQUIM LACEY WA 98503-7975 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MANUFACTURED HOME TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: MARLETTE SETBACK: VALUATION 98,000.00 YEAR: 2004 LABOR & INDUSTRIES APPROVAL? SIZE: 40 X 64 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUBLIC BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 3 Prop: 3 Wetland Erosion Total: 3 Total: 3 Seismic Streams Flood Way Floodplain Routing Date: F&W Landslide D Shoreline Aquifer Type Amount Paid By: Date: Receipt: 1:444JE D Manufactured Homes $154.00 KAS 06/07/04 66358 Add. Manufactured Home $32.00 KAS 06/07/04 66358 JUN 2 9 2004 Potable Water Application $52.00 KAS 06/07/04 66358 Jefferson County Planning Total: $238.00 & Building Departme rvi//01,0)\el • . MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00367 Received Date: 6/7/2004 SITE ADDRESS: 53-13 S DUQUESNE AVE Issue Date: 6/29/2004 PORT TOWNSEND, 98368 APPLICANT: RONALD F DESJARDINS 74 BEACH DR QUILCENE WA 98376 SUBDIVISION: IRONDALE Block: 127 Lot: 13-18 PARCEL#: 962112704 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: HAI PHAM VAN CONSTRU t1:M*999PP Expires: W/HERITAGE HOME OF SEQUIM LACEY WA 98503-7975 PROJECT DESCRIPTION: NEW MANUFACTURED HOME MAKE: MARLETTE YEAR: 2004 SIZE: 40 X 64 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/29/2005. REQUIR SPECTIONS: � / pi Setback /Footing (CONTINUOUS FOOTING, SLAB PADS USED) 1/* a y 1)6 Stormwater FINAL Approval: J Blocking/Plumbing: C, r �_oy Propane Tank/Lines N/,. [ ] Zoning Final Approval: ,V ik 14v Septic System Final Approval: Qj" Road Approach Final Approval: Wolf- 130 Final/Skirting/Vents/Porches/Steps: er co/A.44644 C/0‘ HEALTH DEPARTMENT AND PUBLIC WORKS 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 # BLD04-00367 1.) The application was reviewed by the Jefferson County Department of Community Development staff on June 14, 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.) The subject property is near an airport where a variety of airport dependent uses occur that are not compatible with development. Potential discomforts of inconveniences may include, but are not limited to: noise, aircraft take-offs and landings. 5.) 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. 6.) 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. 7.) 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. 8.) VOLUNTARY MEASURES 0 OASTAL &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. 9.) 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. 10.) 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. 11.) The applicant is proposing to create or add 2560 square feet of impervious surface and 19710 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. 12.) 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). 13.) The site plan as submitted with the building permit application on June 7, 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 June 21, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 14.) 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. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) 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). 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) The building height is not to exceed 35 feet. 19.) Minimum setback from Duque.) Ave right-of-way is 20 ft. Minimum side IIrear setbacks are 5 ft. 20.) Exterior lighting for commercial and industrial uses shall not exceed thirty feet(30') in height from the finished grade. Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 21.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 22.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 23.) A septic permit(SEP04-00124)was approved on June 23, 2004 for a system of 360 gallons per day. 24.) S Duquesne Ave (C678609) is a county local access road. A road approach was reviewed under RAP04-00130, and an address of 93 S Duquesne Rd has been assigned to the parcel. 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.) A minimum of two (2) on-site parking spaces are required for the manufactured home. 27.) This parcel was created through the Irondale Division No. 5 under AFN 29795, filed of record April 2, 1910 in Plat Book 2, page 135 with Jefferson County Auditor's office. 28.) Potable water is provided by Jefferson County PUD. 29.) A Declaration of Restrictive Covenant was recorded June 21, 2004 under AFN 485964 with the Jefferson County Auditor binding lots 13 thru 18 of Block 127, Irondale Division No. 5 for the purpose of meeting bulk and dimensional requirements and minimum land area. , ., = a• •f y,,,, Irv. O• _"` r^rzf, ,w.. ....„..„:: .., tar, 4., ... Nnr v n % 7 lor 1 . PI; Itat mil .. ) a,,,'' 4. ). : „-,'---,.......I '-':.,-4 ':iv o i .. ! , 0,„�` smoPmM iawm0 AN xog iouelx]'x10'la0d � ill MI 1 ri - _ ; . : .?:. ;r- 3 na.f ;'a+, ,•'=%,?:..'' '^ .:... r;,.':a?`,;ti., o19e1EQ1oM ; on1o45 °4,5 i. r K* / :Ili 'II: „ lII + ' o 0 E �$ Y J / . I� pm II IV ` *. _ ,. .ovalmylao s (r_." 3,",3 rv$ ' Y r `mo w". . Ne gg�� :5 -',.,, r•": �g�¢S `n .a ,;xz'. ,".-ra ,;, -:. R's '.•. ..".'a. '.t'�-a.ss �''E';'�;;.::;<?' .u«tom' yF � b ppc 4t 'F"..?" ':` 5R6 `.ks'�il:4 v;(c '�` • a :. '.`.kr ?', ^'`-i.ti.;`.^*". >'r.s:e.?s.r 000 oN s.HO 4 aseg O,1a0G ::0::,,;ei` §:. .+,s84:. :..':.<:.:ie' :.r;•v �o .ng.e ?.,..' ate..;"':.. n a sa t:?. ////` 1 U 7'.''£r 4??=F',: e,' r:'`< ° "°'}^x,,".''at£ .:,x.4A`. / : 41.4% ...tr,, ,,•n.';'x' ,',..,,A;;;$,Xir,,,,,'F ' 'N1,.:;;;i-,', I j *1-; a cr 4L;fz; f COIsis) CM 9., to)11 14 !) Ilille Eillimil z N.s. ii. ® �� ,,Itor, , 3filik4:;:iit,"11:‘,1i4V 1411 : ,0,:,.;;,,Akp ay _ 4 `4 , ;:;...-. ,':..::�.. ,:„.e,.:;<ia? =,,e-.- moDOIM'1�0 •,,, :-.--,-::: '--`:''',r ,,'.�?;M w r`A;,7fir_'ir'-' "." iiEFFERSON COUNTY ASSESSOR JACK WESTEFAAN I JEFFERSON COUNTY COURTHOUSE ASSESSORt00 i ,�n PO BOX 1220, PORT TOWNSEND WA 98368 J v 7 U (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT NAME: Q0Ki41_CD F, 0 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the ADDRESS: 14- j,>�>�,i r7 previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to ,A00. ` q C 41 this county from another area. Please see reverse side for TELEPHONE NO: '34.,O-1c.:5- 4 5(00 additional information. 1) MOBILE HOME DATA: (A) MAKE NA (2.LC1 (B) MODEL PACtFtCA (3i 4,2 (C) YEAR 3Lja (D) LENGTH (<.= • (E) WIDTH t (F)SERIAL NUMBER O;yt (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) CI 8 (H) PURCHASE DATE 3 "� —C3 2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES CO> (IF NO,WHAT COUNTY? I'\ ) 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 cO' (B) IF LOCATED IN A MOBILE HOME PARK: NAME 8L ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION(ADDRESS) ? (-q 8 REAL PROPERTY PARCEL NUMBER/DESCRIPTION C#F 9, le I.vZ ricetZLOc< t`a`1 THANK YOU FOR YOUR HELP! io„F. ; � 1.4 SNATURE KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. .IEFFERSON COUNTY COM•NITY DEVELOPMENT 621 SHERIDAN ST, PO•TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION NEW BUILDING 0 REPLACEMENT SIZE 4 O*X64: YEAR :)%004 MAKE MAtRLEATE—. COST BEDROOMS: BATHROOMS: TYPE OF HEAT: EXISTING 3 i EXISTING e�1 'IP, Electricity 0 Oil PROPOSED PROPOSED — 0 Woodstove 0 Propane I TOTAL 3 TOTAL 0- D. 0 Heat Pump 0 Other TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARTY WELL ❑ INDIVIDUAL SYSTEM (Pt Conventional p( PUBLIC Name of water system: 2tJ Al Care Sacri.4 PERMIT # SEP 0 Alternative IF WATERFRONT PROPERTY, 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 attomey'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. SIGNATURE C9 ' a DATE , / 7'-'Ot.i NAME (PLEAS PRINT) t b ►,--, -DES }Rb:1\3 s FOR OFFICE USE ONLY CONSISTENCY REVIEW FEE -43 RECEIPT# 60 63-5-g BASE FEE 15_�+' CASH/CK# / 17� ADDITIONAL SECTIONS -,1 DATE 6 / 7/ o Y POTABLE WATER 5 911/ROAD APPROACH I 'I_lj i , 11 \�( [7.-- I ,-, i - J L` a PROPANE TANK TOTAL w ylo3 ri_, �i1 � J U N - 7 2004 ,_,,i g:\permitcenter\forms\bldg forms\mobileap revised 2-11-04doc JE-FERSON COUNTY O AT OF 00',,,MUNITY DEVELOPMENT C% JEFFER N SO COUNTY 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 7 A, 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 0 http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# OWE 3 I PROJECT/APPLICANT NAME: RU 1 r Al_L> F. D C"r5'Y'A1z( t h3 c Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a 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. j c.64f t,, LLo,3-t r .\ OF M F tl. A ro u s E_ 0 i..3 (.4,17 c''PE.P .. .. -. M MD Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map.Li ca I,- S Lo E3E "rfs .i DJti✓S 1 - s l S j.`Sp I'm.. Nt a . k1.5�oIF r) - A L-LA.�- -6 I R. 4- M P.t?co 1..1 A:7k 3 tzAS S 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. cS P-1&.1 *P- A-10os t 4. Describe the existing soils. Indicate soil type on the site map. 'S a:w_lc=i Y --BRA i L\/ 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. ' SotLS AcZlc Soc Tp't- P. ` izt t.,..)c4 r iS A-k/SoR-b R t 6k1-- AwAy- Cxi,s-1,'1-)c,, %J SEC II!5: --A:r(okJ c (,S (. 1 . alocc.tz.b (scot l o 6. Describe any excess levels of noise generated by the proposed use or.activity: Nva- APPROVED ________________ _ STORMWAT-ER PLAN �- ` f ,-- i !�'' ;' )1 JUN 2 1 2004 ` JUN - 7 2004 �',? , ,, stormwater site pan template-rev.10/1/2003 "- _` $ JEFFERSON COUNTY - k. +;-. DEPT.OF C MUNITY D DE (/ ME 'TA 1 SIGNATURE. E nO 1 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. 8. Describe the general vicinity of the site,including adjacen land uses and structures, utilities, oads,an sensitive/critical areas) (streams,wetlands,lakes,steep slopes,etc.). g-41—tiis A , ---S oy,,. C )odra Cam , gTCO 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 and differentiate proposed facilities from existing facilities. O1% t��ZS -�Oc�� ci`CC AC.S, C tN /a- l2IkP t "�P s��V� t, F h -TO S V tat?A.v.yd t ►.3 cQ"T-O o to g� �L (A)ocDAS e t_ N1Ay use_ of=P- 3L-isct . SEo►.. s Aeg. Suck `Ttn�T iwbe. Aesorzn t p " 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.] NV 11. Describe the performance goals and standards applicable to the project. /-7 1J1r‘ /, "t.k 12. Describe the flow control system. 10/A, stormwater site plan template—rev.10,1/2003 ; 6 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. N/(_ 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. KVA 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Nita 17. Describe the proposed surfacing material. Nya 18. Descnbe methods for restoration of the site. K` Q 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. / 1u a 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. tila 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. i� J U N - 7 04 4rf stormwater site plan template—rev.10/1/2003 t 7 k : nntrF _ 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. - v/A 2. Establish Construction Access. 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. !- / Qp •. g stormwater site plan template—rev.10/1/2003 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). 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, residential areas,roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). PERMIT # BID 04 — 367 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. 1 �k� 1': ,i ��.,1� 1 1 i 1' j' ^'' Jl1N - 7 2004 ` 'i i ;s xi r stormwater site plan template—rev.10/1/2003 "' 9 b. Description of special requirements for working in or near environmentally sensitive areas. 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,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence 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. II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. ' 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable a f a. Sediment Ponds/Traps. b. Diversions. c. Waterways. ti d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10V12003 10 4, / 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 the affected property. 3 s-41?---$0 (LAN NER OR RIZED RESENTAT1VE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: • • ;;. • stormwater site plan template—rev.10/1/2003 12 ) ,, e., 3 CDp1--Z t 0 1 z /� d it * i Fi —t- - ,f -(s.t, \7 ' P \ .. ;4?r6-13 ,. ..") Z Ur (A 1').3 't .0( 5-- gi 7-- Eic`: Fr 61 VY 1 a ..._ f� .� _."d, �'� ITS_ , 72°� ti \ O� •�, 2 ~-3tri �'d N rn it % af7 r' 3' �' ICam-, ' �� d za ilk. m • t �►6. \ .azi ci Ill \ - \ -. g` ; p 71 )1, 0 r , .• — R n o .? C. .- -- Dp , C. ,E7 ' �i E ar � - X ° tij ny G fir, L AA Lx z ril )iint , . /i -Ti t, c Do in 15q. I �,z„, -..„! ......„ ' . I/ i- ' !i iC n t �R►�OE , gl 70 1 D O 8 C7);• rfi o6' c rr, ,^ T1 T _ y O M y C"2 C �C a O V V.