HomeMy WebLinkAboutBLD2004-00597 • •
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#: BLD04-00597 Received Date: 9/22/2004
SITE ADDRESS: 210 PATISON ST Issue Date: 10/11/2004
PORT HADLOCK, 98339
APPLICANT: HARVEY J MINNIHAN TRSTEE
CAROLYN J MINNIHAN TRSTEE
PO BOX 1407
PORT HADLOCK WA 98339-1407
SUBDIVISION: TAMARACK VILLAGE Block: Lot: 51 +
PARCEL#: 998300051 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR/
DEALER
INSTALLER: JAIME KOZELISKY WAINS0626 Expires: 7/31/20M
1112 S JACOB MILLER RD PORT TOWNSEND WA
98368
PROJECT DESCRIPTION: NEW MANUFACTURED HOME
SERIAL NO GR222&XY
MAKE: GLEN RIVER
YEAR: 1984
SIZE: 66 X 28
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/11/2005.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):
Stormwater FINAL Approval:
Blocking/Plumbing:
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):____
Road Approach Final Approval:
Final/ irting/Vents/Porches✓Steps: V 31_12,09S _
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
MLA04-00558
' Review Type: I
M ANUFACTURED/ MOBILE HOME INSTALLATION
Jefferson County Department ofCommunity oWnsend, WA Development
98368
621 Sheridan Street
Received Date: 9122/2004
PERMIT #: BLD04-00597
SITE ADDRESS: PATISON ST
PORT HADLOCK, 98339
APPLICANT: HARVEY J MINNIHAN TRSTEE
PHONE: (360)437-0380
CAROLYN J MINNIHAN TRSTEE
3659 OAK BAY RD
PORT HADLOCK WA 98339-9730 Block: Lot: 51 +
SUBDIVISION: TAMARACK VILLAGE 01 W
PARCEL NUMBER: 998300051 Township: 29 N Range:
Section: 2
PHONE: (360)385-3215
CONTRACTOR/ JAIME KOZELISKY
DEALER: 1112 S JACOB MILLER RD
PORT TOWNSEND WA 98368
Contractor's License WAINS0626 Expires 7/31/2007
INSTALLER: JAIME KOZELISKY
WAINS0626 7/3112007 (360)385-3215
1112 S JACOB MILLER RD PORT TOWNSEND WA
98368
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW F
SERIAL NO GR2225XY
TYPE OF WORK MOB MANUFACTURED HOME:
SHORELINE:
RIVER SETBACK:
TYPE OF IMP NEW MAKE: GLEN1984
VALUATION 17,500.00 YEAR: BANK HEIGHT:
SIZE: 66 X 28
LABOR& INDUSTRIES APPROVAL?
SEWAGE DISPOSAL: CON NO
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES
Exist: AREA Plat Conditions
Prop:Exist: 2 Erosion
3 Prop: Wetland
Total: 3 Total: 2 Seismic Streams
Flood plain
Flood Way Landslide
F&W
Routing Date: Zt L C,� / (1 Shoreline Aquifer
Ap•ro,e•/*ei
Amount Paid Bv: Date: Receipt:
Type $154.00 KAS 09/22/04 66712 OCT 1 1 2004
Manufactured Homes
Potable Water Application $52.00 KAS 09/22/04 66712 Jefferson County PlaJet'stw.
$206.00 & Building Departmen�
Total: ODV—LE . "'` 4
W. a G - •
WV MO
PLEASE MAIL TO:
= FERSON COUNTY ASSESSOR
,
JACK WESTERMAN 11 } JEFFERSON COUNTY COURTHOUSE
ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368
(360) 385-9105
ta
MOBILE HOME INFORMATION FORM
OWNER'S NAME / MAILING ADDRESS: THIS IS NOT A TAX STATEMENT
NAME: 8E477 - 5 e C= The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the
ADDRESS: 953. D/`Co:/zz' R Y previous ownership and location of a mobile home. This will
help our office determine whether the mobile home is already
?O i 70 cJ,V & /V-1), G✓R. 7F13 6 g 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: C.360) 30/- J Cl3 additional information.
1) MOBILE HOME DATA:
(A) MAKE G� N Q/V� R (B) MODEL � (C) YEAR /9 ec f
(D) LENGTH 6 / (E) WIDTH e S (F)SERIAL NUMBER R,.,24 2 5X Y
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) / 7 S,:2!") (H) PURCHASE DATE f S4�/.0 0 9
2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME:
(A) FROM WHOM DID YOU PURCHASE MOBILE -70e/51C 7 XA//04: K
ADDRESS 206 3;2 £ /'( /960 4-// /✓47: s e Q'. cv19_ 7S'3 76
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES (g (IF NO,WHAT COUNTY? XJTS .09 J )
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 (;)
(B) IF LOCATED IN A MOBILE HOME PARK:
NAME ei ADDRESS OF PARK /1.,/041 SPACE NO.
(C) IF NOT LOCATED IN A MOBILE HOME PARK:
NAME OF LAND OWNER: aoe6-7-7 /2,
LOCATION(ADDRESS) (i n P97�5 O,Y 5 7. 11/9 01-O , c✓ : 7 fr 32 9
REAL PROPERTY PARCEL NUMBER/DESCRIPTION i fJf/7Z,e/)K J//LC/9 6i LC5 i
/- 973 000 S/
THANK YOU FOR YOUR HELP! e=�'� �✓ �''�
SIGNATURE
KELLI LARSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
dy%14/2004 16:05 3.4 F- 1
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\ y DEPARTMENT OF COMM .DEVELOPMENT
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621 Sheridan Street-Port end•k •sphirt1 68
i ,�, / 360/379 4�50. 36t7;37��,4 1Fez ~v�C
G,s0 www•co.jefferson.wa.w/co m(rrcievelopment
Master Permit Application ?T.G G M_ "k`� :"
Pro ee Desc�ption include eMLA: tYILA/Det—T3
.�
MIAOW
separate sheefs as neoossary}�tic it_k
M
Tax Parcel
Number. 1 �j S.:" 3 004 5 / Property
Sire: / 7.2 j (acr>:s/quara foot%
Site Address,,andfor Directions to Prnperty. 97 9`l 9; S o n/
Pr t;�wrna s rif '----- ,S 7_. r.4rn Rlt A,K ✓.'!.LAr l 5
Property r( ) Record: IfiRFt'i.eF Y ,,o-j/v^11 iy
Tetrip!itxrs:_ __ Fax:
Mailing Address: — --_- email: _-
1 pplicsat/Agsrn;(f different from owner): �E'L--," ,� , -'
7dephan VAgsnt 3�5- 3 2 7 2 c_s. e.,E('
Fax:
Mail Address: YS 3 y `- m...,..e :
tom 3 o scoye;6 r?D- S- /'avRr :drbiNS6-tV(. k.P- 6' S'
Mot kind of Permit?(Chock each box that applies)
Mot ~—
-it Building
❑Demolition Permit U Variance(Minor,Major or Reasonable Fconormic Use)
G unrplle Family 0 Condltlonal Use[C(a).C(d),or CI
f7 Garagemilt' Eted/beached D Discretionary'D'or Unnamed Use Cisa�tsifrr.;ste ri
I y3.Lfantrfactunad Home 0 Specie!Use(E4sentlef Public Fa fides)"
7 Modular 0 Boundary Lino Adjusb ant
Co dinar clal•• 0 Short Plat"
n Change of Use 13 Binding Site Pion
Address Long Plat'"
KRoad Approach 0 Planned Rural Residential Devel a y •
0Propane ❑Plat Vacation/Alteration" ern,( Rrtr.}lArngndrtgrtts•-
C Mowed*Yes"Use Consistency Analysis 0 Shoreline Master Program Exemptti lgarm;t 2evisions.J Stonnwa%r Management
0 lJ Site Ptah Approval Advance Determination(SpAAD)• 0 Shoreline Management Substantial Develr,�„m,ent•'
C TeTernpfx-ary Use G Shore,ine Management Variance
ttler�:Telec omrnunl t;on• 0 Comprehensive Plan/UDC/Land Use Dis!4c Map Amendment
0
G Forest Practices Act/Release of Six-Year Moratorium Jefferson Courtly Shoreline Master Prr,gr$yr Amendment
•May regr:tm s Pie-Rpplfezfron Ce,f4rutt a •.
F'lease Identify any other Focal,state or federal ermItsRequ�proposal,
R "'oorrfkxxsr s —
p- requIred for this ra osal p invert:
f hatesy designate DESlGNATToN OF AGENT-'
rC���_�' �Q�S C' tr act as fi
` --` /��my agent in makers relating to this eptsf ca4i^.ri for Getmlt(5).
J CWvusn Srlw.Tua,£ti i V rtt-G?/
By signing true -- - -- - __application,four,,vie ownertagent attests that the lnformafon provided herein.and in any attachments.Is hue and carrel:;to the best of
his.hor or Irr krowtedge Anyrn,Nariel falsehood or any ornicesort of a matetrat fact made by Vie owner/agent with re_ t_
may rrautt In this pemtit being null and void. respect 3a un,epP!ication packe
I further agree to save.Indemnify and hold harmless Jefferson County against all Irablaties,lodgments court costs,reasonable att(n-,e 's fees and
expenses which may in arty„ay acme against Jefferson County as a result of or in ConseGuertca,,of the granting of thin peny,jt
I further agree to provide amass and right of entry to Jefferson County and Its Cut review ord any recuirod tater inspections.Access right ,:tr{to es propertyashall be requested
a red and so all occurc only sure l regular
of application
hours. t eGuestrsd shad during g rrf;ts ar business
-__- -- - - ---- fate
The a:ion ca nctkru Applicant will undertake as a result of the Issuance of tote permit may negat'vely impact upon one or more threatened or
endanger d spocteri and could lead to a potential lake"of en endangered specks as those terms are defined In the federal taw kR:mill as the
'EndangerwJ Species Aerie"ESA.'Jefferson Court maws no xssuranc to Vie applicant Het the actions that will its undertaken r ec.ause this
permit has trees Issued wItl not violate the ESA. Any Indlv(duai.group or agency cars ate a lawsuit on behalf of an endangered spades"fig your
actions)even If you are I;,compliance with the Jefferson County devetooment code.The and Wort-transtera e responsibility for edit to and complying pp Aant it gC mad this " , that tie,s ig ors a ru,;os s belo/'! wish the ESA The PPt� bar inter and signs
Signature: , s'P--and dales it below.
-/ "c.Y 7—J--t 1rLr.CJ CtG A
G:\ParnirCntet\POR S1DRDPORDd'S\hturerPenultApphc*,.7.gegdoe --
-2%;4/2004 16:05 3054196 - ('- 2
PAGEe
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OwNER BUILDER STATEICENT —____
The cloner of>t>s seder; t dogs hereby Cater lrM ace the Olers clf I*proposedDcec;lv 4 her�{�.1hat f ray am mot L'oere,-•C ccr4- a
they val!be eawnli g the d ere General Gontrador for ere
nd tklt
G c GoNra•�crOR as MrwuFirt.-rt>r>F-0 hio rr+st tiL - '— ----
A.rr)it- Prrat ---
Ko G�;c/S K y Ak:
tifar rraG pooacss: , 5 _ (360) SYS • 2/t
Cerrt•CrcRsuce sE L--— waivs
ALIcNr! r/Era rt: L '' '-- wuaeea
Auld rat s,.. -- )
Project Type:: Frame Typo: ___
O A�+ilrfor, t3 Wood eeoorrra. $hrsrotir+e. e �Rts� posyi
0 Now
O �� ❑ Steel Proposed:
0 Sewer
froctel 0 commie Total: - Bari O Car/enmity Stem
O Rap* kdhht.4 rer
❑ Masonry
tax- System
0 pemt�ir y ❑ othor: Avi
_ E
Wader
❑ Pdvat Weh ❑ Tkto Part'
I Total: iseibmic:
Public !
Narno of SSm: Ptl�
Number of we'must eiteawwr ttrs t �, eotx ___^
Pam' Spaces: Current
Number of occupants(Inductee owners, `d:
lamas,employees.etc) Current Number al ,k3s:
IOC�xy 10C Type of —__„_____� ---
IBC !a a f'r cy:_re T>srlrc ru:tiror C Type r..N,, :_--- WTI Y+k ro FGpd Ser oe? Y -
O Underground Tank �s nscm4t martati /_hJr
o Hest stc G Oda Tank
t�of Propene Tank:
Tres codetore 0 Fkap y hurt 0 Not water Tank egp0 et- -----Sto
stated r Motrtfe Home? Yes I No i•l�
r9A'Wiles;fors --
; Hoer,%14 tank l es;fort ter / d sank yOl17— tIso submit a alto ptoo showfirg calf of tho bmea Ai4 arc... prUQDlt@ tank?!2 aAPrgPar[ylNlpx, ' ,tApr
Curroat �i� �.-r. 2.�-_.;•,r . ,` _>'.,.:.....,�:_ ��septic aft 'w"rrts'
Main Floor
_ « „-if...1 ftiyf,".. ,,, r r rC. i' .. +.,.r6,A.•K :R _.� rMq• <.
no Floor �� Ili ,�r, .. : j il v+�,yy1�_��i: c �.
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• •
SPECIAL CONDITIONS CASE # BLD04-00597
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on October 7, 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, the following ESAs were
confirmed to be present on the subject property: Special Aquifer Recharge Protection
Area (SARPA).
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.) 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.
5.) The applicant is proposing to create or add 2,248 square feet of impervious surface and
2,798 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires the project applicant submit a stormwater plan
meeting Minimum Requirements#1 through #5 of the Department of Ecology Stormwater
Management Manual for Western Washington. The stormwater plan shall address
measures to control stormwater, erosion and sediment during construction and shall
address permanent measures to stabilize soil exposed during construction, and in the
design and operation of stormwater and drainage control systems.
6.) A Medium Stormwater Plan 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.
7.) 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).
8.) The revised site plan as submitted on September 27, 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 October 8, 2004 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
9.) 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.
10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
11.) Not more than two (2) unliceed or inoperable vehicles shall be stored oily 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).
12.) The building height is not to exceed 35 feet.
13.) Setback from Patison St. right-of-way is no less than 20 ft., side and rear setbacks are no
less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more
restrictive setback shall apply.
14.) 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.
15.) 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.
16.) This parcel was created through Tamarack Village as amended under AFN 469892,
recorded May 19, 2003 , Volume 7, pages 189-190 with the Jefferson County Auditor's
office.
17.) A septic permit (SEP02-00273) was approved June 14, 2003 for a capacity of 360 gallons
per day. This site is not in the planning sewer service area.
18.) This parcel is a legal conforming parcel designated Low Density Residential 4-6:1 through
the Irondale & Port Hadlock Urban Growth Area Zoning Map effective August 23, 2004 as
an amendment to the Jefferson County Comprehensive Plan Land Use Map effective
August 28, 1998.
19.) Patison St. (C635609) is a county local access road. A road approach (RAP04-00240)
was approved on October 7, 2004 and an address of 210 Patison St. has been assigned
to the parcel.
20.) The road approach permit (RAP04-00240) must be inspected and finalled by the Jefferson
County Department of Public Works prior to the final inspection/certificate of occupancy of
this residence. Contact Terry Duff at 360-385-9159 for the road approach inspection.
21.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
22.) Maximum lot coverage in Urban Low Density Residental is not to exceed 60%. Lot
coverage is defined as amount of impervious surface which includes roof tops, driveways,
concrete, etc.
! ,
• • APPROVED
�O STORMWATER
PLAN
°cifiNc>., JEFFERSON COUNTY
.. DEPARTMENT OF COMMUNITY DEVELOPMENT OCT ' 8 Itleg
A 621 Sheridan Street • Port Townsend •Washington 98368
�Q lO 360/379-4450 • 360/379-4451 Fax
lEFFERS•N C UNTY
xNa' http://www.co.jefferson.wa.us/commdevelo ment/ isii?iitz.c.A.
vI,t�MI;Kt
Ptt l.�L42 /=«
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICANT NAME: ,6-, C=7- f7, ,,4.,4:2%v+ 1 1t
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.
it] N c<l ,4Rt•5 t ~ l�tr ll<oi . z'x6f. ) cr/:tG, .6c L-I< ATG•'R' f0' .%i?o 1-) e•,,4;,nX t.1
S- ,3c'3;,' Y ay
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' 50) (f'+i rfrie
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
Pi't?. .wfn
G ;� e Y 1 is r%'.A i.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
::? G.A R C=i T.'a.C:'(r;.i W r/4-14 kJ i GC ,>e/7'A t A) ✓N 0 t' i G-k S E'er.. %t t'5 1- 0. j,l!e-
r'keFLCl:7 Y , c4,✓4".c6 D !•v 6'1.,Ac4.A4-rReYS Anl l_ 6 reri).0
4. Describe the existing soils. Indicate soil type on the site map.
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.
6. Describe any excess levels of noise generated by the proposed use or activity:
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t
10- %
stormwater site plan template—rev.10/1/2003
• , I
elvonqqA___ 0 .
Describe significant eograp is features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
s e p slopes,etc.)o the site Indicate location on the site map.
y ri%n•1v'z`"s . t ti
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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.).
}' Q's> :0,\I 5 7. %,,•' j.;.._f,.'> vtt'. >`C'.,'1./,../:ck' ! . c,,.,yi. L%Y:; c :y4 L'^l _,. .-i✓. t.C.>;C -Li,' _ f%''{t i�Lf„
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.
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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.]
11. Describe the performance goals and standards applicable to the project. _
/v'//-;
12. Describe the flow control system.
stormwater site plan template—rev.10✓1/2003 6
• .
13. Describe the water quality system.
14. Describe the conveyance system analysis and design. C C
15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
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.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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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.
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stormwater site plan template—rev.10/1/2003 0 13
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• •
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.
-
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
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6. Protect Slopes.
7. Protect Drain Inlets.
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8
stormwater site plan template—rev.10/1/2003
• •
12 Required Elements-Construction SWPPP(continued)
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8. Stabilize Channels and Outlets. r
9. Control Pollutants.
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610„,k-0,s e, ,(;tom e'/.CAR ✓JD �-a'. S/76=
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
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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). _
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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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).
1.
5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)
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6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
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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.
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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. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/1/2003 10
• •
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.
(LANDOWNER E E A SIGNATURE) DATE( S NT TIVE (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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12
stormwater site plan template—rev.10/1/2003
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