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HomeMy WebLinkAboutBLD2004-00789 4110 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00789 Received Date 12/13/2004 SITE ADDRESS: 1466 A EGG & I RD Issue Date 03/7/2005 CHIMACUM, 98325 APPLICANT: ROBERT S OLSEN JR PHONE: (360) 732-0519 MARY C OLSEN PO BOX 424 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: T 4 PARCEL NUMBER: 801022009 Section: 2 Township: 28 N Range: 01 W CONTRACTOR: TOWN & COUNTRY POST & FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE B LYNNWOOD WA 98037-3161 Contractor's License: TOWNCPF099LT Expires: 6/30/2005 PROJECT DESCRIPTION: NEW POLE BUILDING CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: 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 4Ik UILDING PERMIT APPLICA`iION ML vy 691 Review T Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00789 Received Date: 12/13/2004 SITE ADDRESS: EGG & I RD CHIMACUM, 98325 OWNER: ROBERT S OLSEN JR PHONE: (360) 732-0519 MARY C OLSEN PO BOX 424 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801022011 Section: 2 Township: 28 N Range: 01 W CONTRACTOR: TOWN & COUNTRY POST & FRAME PHONE: 800-824-9552 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2005 REPRESENTATIVE: DONI STAMATIOU PHONE: (425) 743-1555 16521 HWY 99, STE C LYNNWOOD WA 98037 PROJECT DESCRIPTIOr NEW POLE BUILDING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 19,553.00 MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: UH OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: 1,344 GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Total: Total: Streams Flood Way Floodplain Routing Date: 12 / f ii '�, F&W Landslide f „ , Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $349.25 BAC 12/13/04 68825 APPROVED Plan Check $227.01 BAC 12/13/04 68825 State Building Code $4.50 BAC 12/13/04 68825 Total: $580.76 MAR - 7 2005 Jefferson County Planning A8�Building Dep entj . OWNER BUILDER STATEMENT 1 ( ; .f The signer of this statement does hereby certify that they are the Owners of the they will be acsuming the res ' 'ity of the General Contractor for the proposed parcel ry rented herein,that they are not licensed contractors and that Signature: N s- Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER; PHONE: FAX: v>1 A MAILING ADDRESS: lJ / I SZ) ( (125 ) 7 y -I SSS l 4LS) 7,/L-/b�-r/ CONTRACTOR'S LICENSE L y n n w o , W A- EMAIL: o n i 5 C9 e r M a b 1/� , c o oi ,,•i NUMBER: 9 80 37 WA1NS ARCHITECT/ENGINEER: NUMBER MAILING ADDRESS: Sri / PHONE l y2 s )7y3-ISSS FAX:( ) 54 rnL A S C opt Eta Project Type: Frame Type: Bathrooms: Shoreline: Type .f Sewage Disposal: ❑ New 0 Wood Existing: ❑ Addition 0 Steel Proposed: 0 Sewe ❑ Alteration/Remodel 0 ConcreteHe k 0 Comm.. Syst_ ❑ Repair otal: He' ht: 0 Masonry ❑ I S m ❑ Demolition Other. Bedroo SEP Permit t�oS± H Existing: water Su Type of Heft: Proposed. Se • ❑ Priv. - well ❑ Two Party �/� otal: ❑ Put ic Na ,e of System: If this is a Commercial Pro ect u must answer the followin : Number of Parking Spaces: Current Number of Deco Proposed: m er of ADA Parking Spaces: find ers,tenants,employees,etc nt IBC Occupancy: IBC T Proposed Type Will you have Food Service? Yes / No If this is a Propane Tank and/or Applia stallation ❑ Underground Tank 0 Abo all items below that a I ound Tank Size of Propa n_k:❑ Heat Stove ❑ 0 Woodstove 0 Fireplace Insert C Hot Water Tank 0 Pellet Stove 0 Is this appliance being installed in a Manufactured/Mobile Home? Yes / No Other When apIying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all prope lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components includin the reserve area. uar Sqe Footage For Office Use Only Current Proposed s '..i.Main Floor Amount �' Consistency Review 2 Floor T. "C4., Base fee: - ,..; 3 Floor � '�" Additional Section: .' ...z 71t ,� Mezzanine: �' _ Plan Check fee: Heated Basement Z � Qx State Surcharge fee: Unheated Basement [Yr_ '` • Pot Water Review fee: ' ` a Ys ,�' ;Other Unheated 911/Rd Approach fee: ti � ) Garage/Carport -t44=4 ;' '}-i -.7. TOTAL :"7:^Z� —rt,. i „ T Decks � Receipt Number. � _ Other paf f3/G y � 2 o /3 Cash/Check Number-. t ESTIMATED COST EQUIRED) 7 .Fair market lue of I labor and materials foundation to finish Date: _ If , 5-3 Initials: ^ G:\PecmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-O4.doc • SPECIAL CONDITIONS FOR CAA# BLD04-00789 1.) A setback of 75-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 2.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 3.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 4.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed pole building. 5.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed pole building. 6.) A permanent physical separation along the boundary of the buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 7.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 8.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 9.) A Medium 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. 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) 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). 12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 13.) The building height is not to exceed 35 feet. 14.) Setback from Egg & I Road right-of-way is no less than 20 ft., setback from the private easement 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. • 15.) The project is located in close proximity to an identified wetland and is subject to the delineation provisions of Section 3.6.9 of the Jefferson County Unified Development Code. Based upon the proposed location of the project in relation to the identified wetland, the applicant has agreed to maintain a buffer(setback) that exceeds the standard buffer requirements by fifty(50) percent. The applicant acknowledges the additional setback and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland delineation requirements of the Unified Development Code. • • I:\F_BLD_Permit_Buildng.rpt 10/29/19 gift IMINEMINIMENNEmmilft EGG & I RD BLD04-789 OLSEN Approvals Req'd Prior to Final Inspection SEP ZON lC r SIPCOLOAILQ-OL 3\6106 PVC °(-1°11jj DPW Crt Rug 15 08 09: 23a Jefrson Healthcare H R 360 3 1548 p. 1 R1IC Eli VED Jefferson County Department of Community Development AUG 15 200fi 621 Sheridan, Port Townsend, WA 98368 JffffRSt 1 ti j Subject: Cancellation of permit# BLD04-00789 for Robert Olsen PO box 424 Chimacum WA 98325 To Whom It May Concern, As per phone conversation 9:15 am August 15,2006 I am requesting the cancellation of permit number BLD04-00789. The pole building was not built due to a divorce of my wife. My apologies for not informing your office sooner. Sincerely, Robert S. Oise'C� a !Worm Comity.rthiont of Community ($ }ON III $YI swum street. ioo/mond WA NMI W4 371- o A o ‘S. ..3Lrtb cp permot pp) , a cclpon ,I,..,„,.., . . t 1111 ....---Ne ---.. _ Building Type: Project Type: Frame Type: 0 Single Family ANew 0 Wood Garage Attach . •► ❑ Addition 0 Steel O Modular 0 Alteration/Remodel 0 Concrete ❑ Commercial 0 Repair 0 Masonry 1�05�' F�Yav+�. 0 Multi-family/#of Units ❑ Demolition L Other o Industrial 0 Other. _ Bathrooms: Bedrooms: Type of Sewage Disposal: Type f Heat: Choo tic:Existing. Existing: p Sewer Con System 0 Eke ' B. Proposed Proposed: 0 Intiivid ere ❑ Woodsto 0 Propane Total- Total: ' If not r,fill oar c following: 0 Hea p 0 onventional 0 A t 0 t err Permit# SEP Water Supply: 7❑ Private well. 0 Two Party Well 0 Public:Name of water system: For Office Use O t Square Footage: Office Use �y Main Floor Consistency Review 2ND Floor Base fee 3 49 a5 3n1 Floor Plan Check fee ca r•01 Htd Basement _ ._ State Surcharge fee l Unhtd Basement / ` , Subtotal Loa% rl� % Garage/Carport /3 7'-/ �� l20 D p•40 Pot Water Review fee �J Decks 911/Rd Approach fee 1'AL- Commercial TOTAL ri I a .1G. Industrial Receipt# Other , _ Cash/Check# Initials ji. — Estimated Cost 55 Date If within 200'of the Shoreline, Distance to Bank or Ordinary High Water Mark W/A- . . 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 packer may result in this permit bang null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable auomcy'a 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 accrss and right of entry to Jefferson County and it's employees,representatives or agents for the purpose of applieu ion review and any required later inspections- Access and right of entry to the applicant's ptwwty or structure shall be requested and shall occur during regular business hours. Signature: Date: DEC 8 i884-- OVER ► G:\PczrnitCenter\FORMS\BLDG FORMS\tlLDPermir Applicadon.doc 01/08/2004 • f • • t�w�¢sON c°�, JEFFERSON COUNTY y ri 4 DEPARTMENT OF COMMUNITY DEVELOPMENT . "-, ,., 621 Sheridan Street• Port Townsend •Washington 98368 Is,.._ �O 360/379-4450 • 360/379-4451 Fax HINO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# y 0009 I PROJECT/APPLICANT NAME: ,,„_,� 0,4-) 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. LL tt 1 1� '64` T7'i✓i-4- et.�3 tiv 7,-2_ Y`f Z: F bk C1 /? v.3 .*v- t,-c C.;,5 i T v\Cx. r T I Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 1)t➢tir Cc' !c F r v-a LiAi '.� Uf(tt it 76,p--hell t �. .:(:j E v1 /i s I S�u .- LA.A/J.1 A4" .5 o v ila:._ve ( .- (.1t.-, i r. -?�r-c ++ s�-,,..p r jam'' f., 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. -`�' 1 j 1,�'�P ,'� ;�a rY ai ,r, h rlU j s re -. v1 c,. a-o-n k 1..1 4- p:,- _a,i--• � 4. Describe the existing soils. Indicate soil type on the site map. `>cJ i i S. \l w.y r 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. + ` ?-'t�(-s,n,-,c..., ,r_ 9.X_,.k.-4---t .ctc..1<' .•, S. t-t- ..n_s 3 et.h ice.--hpt �� 'Lex., `.J-c.r 6. Describe any excess levels of noise generated by the proposed use or activity: ti A p P J4O V i�`i�D , 1 !t�'„ .,. >s :1U;s.e"- 1)-Vis.{- 7, � _ STORMWATER PLAN • MAR - 4 2005 stormwater site plan template.doc—rev.10/12/2003 JEFFERS *1 CO NTY 5 SIGN All'Rf. • • 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. t s 's, S SbkQ-v-4(3 ss {7G LSi`C r. +-OW l�� 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.). ` 1 1 ��Cp2 j 5 to ) i a ran.. ws+�t Y'rcV✓l uokt- -tom ,'1 y ivt trn^'y2 ' t�.�✓t4 - a r et&c -1 t et; AAA 6 Gw'-L,L�S tiJ� �./fed Jr,-U.LL��^7.2� C✓l A--442- l^1 ri �t LoJ c�reti5 .f Permanent Stormwater Control Plan DFC 2 9 2304 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. 3414 rib e3 C .S�,� �„je_f . -- roes' n� e� w \� 1i�2 c];; ?. ��+rzy t% i ov'. lanoPQ.,- r �Cw T�J Ni ge L4��il, 9rrt V1(.i rt �,?a�ri.i'•s Jea ."�S 'tom+ «;ra1 f�\L-.h1Yi LrL- . O {_ 1 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.] �--,. .t ` Iv /^S' l�.fa/i '� ""Cfrtn(Al t�4-4-4— 11. Describe the performance goals and standards applicable to the project. 1r\� S i++ l rI � V�i :'S' ,�rv�.«�� �-t..�^ a.n to at t'� i vJL �t �G' 'f1 gd1 t 12. liescrib[e ithe flow control system. .r7C? &St,V/eLL- ©>•i e'r_tC" $'�'7tttl-•nn...sc. y'" .l-P-Ar C1 sn"-:A ) C (- .' 0 C ` stormwater site plan template.doc-rev.10/12/2003 6 • 13. Describe the water quality system. /! C .ctvt ire 2 9 200 14. Describe the conveyance system analysis and design. 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. $v' /A — 18. Describe methods for restoration of the site. _ j 01,(J .-)✓32:-. .�,e 6 f!-✓--Z.es. +J it ���S rvr'to�,e v`-Xr� it.ri s £j s..� TO • vl4i�j• (frx_es_ es,set IS In S +.. �`c�+viW�A asp ,v-2-e • 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. 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. slormwater site plan template.doc—rev.10/12/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated t the,ppplicant(n the template that follows must be installed on the ground during all construction phases of the project. The propon6nt is'respdtIgi6le 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. '".\C3(-1 vv. L A 2. Establish Construction Access. 11 13DU' jfi .cct5t. �,� V) EA.t.. r>s r .r.i-t_ \r..✓i 3. Control Flow Rates. l.t`L +"� a.:Fs c en.: VNi en_icS c�i i itrs c 4.v�.- vac �2 4. Install Sediment Controls. 1 + t i`1 0' �til� i-> '- ?�ULA CAS 5 hct"' E`:tit 1't�a s 5. Stabilize Soils. 1 ere s, v tG n°fir c k inr, be. �'..e c.+ ' vu. cl G 6.-.�^Protect Slopes. iiL 1 l • Cr4:6;c.,0 C.-tow/Iv,/ 4 r!e_ usQ ` ,410 p.v - "I :S/Wk. - ,.s ,y' L'c'.++�+,v�?-k -- s. Tom-t��Le.9 7. Protect Drain Inlets. stormwater site plan template.doc—rev.10/12/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize/ Channels and Outlets. SPI ieck ie (3Ir.eelk) Sa .t T cntn l+ 7�." �l��.r5 C�'•�2. V i�� Veci:4.141Go 9. Control Pollutants. LCah r�v�w�.�c vts3 sz 1S DEC 2 9 2CAN 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). �v�ovt chi tc k . Y1.Bc_assetr .. (/11 11. Maintain Best Management Practices(BMPs). L_ e- t+.v�,c� C✓' �✓5 IA/j ` t�►cl;�1 r!/'� �i ✓t C.o,i "tn l r7s'Y1G77f-e-S 12. Manage the Project. w . Ab.,x-e•ci i. �v r wv. (-4'te-4.1.-. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,rods). [ l ko /*Air AG� 4-o La(l�ti[ �%n4 pe of ai t'v Si I a elt,0 1 � G� b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). il4 • 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. iti stormwater site plan template.doc-rev.10/12/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. tki 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, erodibility,settleability,permeability,depth,texture, ssoil structure). Y `- q 1 ,JI i5 c -c 'i' k.V3� co- cs R � z;%�J k�l, L?.tC b�^t:clJ2- AN> 5.ti+t��l �ftQ1L Cs"1 c rY�11 \ (1-:tea. n 2 9 ait 5. Construction Phasing. a. Construction sequence l�taa i�j Y t '1 t C( *L. i.u4,. etc.( ;I✓t. LJ ram- ear'L) )evv16 — s b. Construction phasing(if proposed) Al/4 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide proposed construction schedule. ``,, a" 0.5V,.(k! + a IL:GS kla isafu_i s� a < Wet Season Cons ruction Activities.a. Proposed wet season construction activities. f6v e4 J b. Proposed wet season construction activities for environmentally sensitive areas. I /i 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. it/7/ b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation irr pacts. 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.doc—rev.10/12/2003 10 r ! 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 m knowledge. I also certify that this application is being made with the full knowledge and consent of all ow ers of the aff d p perty. i (s — ' 1 2— 2— E Zi LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) ° THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: flEC 2 2004 stormwater site plan template.doc—rev.10/12/2003 12 :#PLY! -_ `��• -;;y �,. .4.mjuuu,,mw-,uu� 146/S 1,4N211 saulsnpul Mill: Jad S061 0 �j�. 'LS , + .� - �.-. •uo)leool laauoa ay3 u)8u)me1P situ uo unigyfs?�e sgnl[!'#41 uu!popWJd-poluaplo[) *SuuunoaatI-pm ,Wu,)aaWO-,Cn:ue7 ,Cd°O JauJolsuJ-aV4M Ile will sauuan pue'y1JoN 341 o18ulppnq ay3}o uoµeluauo'Sulpllnq atop uopeaol ay)panoidde pueflaw.124.0t.ta001,119p i INV'Id31ISai2'Id1\jOOA[•I . #;,LO1,, ,' c, y, - :• I. -I ,i • i , 1.' ) `d , 11 7 ''' ' • . 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