HomeMy WebLinkAboutBLD2005-00179 BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD05-00179 Received Date 03/24/2005
SITE ADDRESS: 153 MARINA DR Issue Date 04/22/2005
PORT TOWNSEND, 98368
APPLICANT: FRANKLIN H HAZLEHURST PHONE: 206-285-4407
PAMELA BEKINS
2546 37TH WEST
SEATTLE WA 98199
SUBDIVISION: CAPE GEORGE COLONY DIV 6 Block: 13 Lot: 7
PARCEL NUMBER: 939301305 Section:. 12 Township: 30 N Range: 02 W
CONTRACTOR: DISCOVERY BAY CONST CO INC PHONE: 385-4372
2016 WATER ST, SUITE A
PORT TOWNSEND WA 98368
Contractor's License: DISCOBCO90B9 Expires: 9/9/2005
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE
CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER:
Footing: r;L 6p 1' rayi� � s� WerY7 6" , �-(7-OS wc��' CS
(asr
Foundation: S iaEibNTa�kb Z,�,u�Q�.�,/,/6-- � � '�l,r �-305 0
Stormwater FINAL Approval:
"Underground Plumbing: pJc 0g.64,J ,(..„( _so-ts- 9 _:)_i3 06--
Underground Insulation:
Shear Wall :`C -1 7-c �
Sheathing:
Framing:JO77_0c 1-13
Plumbingu -7 7 -czp
Propane Tank/Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning,Final Approval:
Final/Occupancy Approval(\yL 2\2.� O`t
HEALTH DEPARTMENT AND PUBLI 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
IUILDING PERMIT APPLICA N MLA05-00176
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00179 Received Date: 3/24/2005
SITE ADDRESS: 153 MARINA DR
PORT TOWNSEND, 98368
OWNER: FRANKLIN H HAZLEHURST PHONE:
PAMELA BEKINS
2546 37TH WEST
•
SEATTLE WA 98199
SUBDIVISION: apt' GE COLONY DIV 6 Block: 13 Lot: 7
PARCEL NUMBER: 939301305 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: DISCOVERY BAY CONST CO INC PHONE: 385-4372
2016 WATER ST, SUITE A
PORT TOWNSEND WA 98368
Contractor's License DISCOBCO90B9 Expires 9/9/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 160,000.00 MAIN: 581
CODE EDITION: 2003 ADD'L: 484 HEAT TYPE:
OCCUPANCY: R_3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER:
GARAGE: 282 SHORELINE:
CONST TYPE: SETBACK:
DECK: 204
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 1 Prop: 1
Total: 1 Total: 1
Routing Date: -` /7 / \ (11 4)
Type Amount Paid By: Date: Receipt: APPROVED
Permit $1,329.75 BAC 03/24/05 71579
Plan Check $864.34 BAC 03/24/05 71579 APR 2 2 2005
State Building Code $4.50 BAC 03/24/05 71579
Potable Water Application $53.00 BAC 03/24/05 71579 Jefferson County Planning
&Building Depart
Total: $2,251.59 / r
• •
OWNER BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project. ,I
Signature: Date: MAR 24
• 1
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: i FAX:
DlscovE,�-r J3.�y (360)355, [437Z (36o ) 3$5, ?697-j
MAILING ADDRESS: 201 b wA-7E-11._ ST, sc./?E A EMAIL: /l,O g^eAt,'YE" pISCO 1 E,a y g,.Y,Ca,,q
CONTRACTOR'S LICENSE PO 2? 76 .SEA'O wq 9 1373 SS WAINS
NUMBER:
NUMBER
ARCHITECT/ENGINEER: 9 BA At4-4/4S 4 19EG?S PHONE ( 206)322.-7 95'9 FAx: 2O
( 6 )322.7 9 63
MAILING ADDRESS:
6// .EAST Pl t<Lc- 5?gEti, 5t7417LE EMAIL BRETf®A.8404y444M54./24,0/7-E'4,7,f_ 4-6n-t
Prpject Type: Freme Type: Bathrooms: Shoreline: Type
. Newer of Sewage Disposal:
Wood Existing: D r?vSewer
1 Addition ❑ Steel Proposed: I Bank
0Alteration/Remodel [Ig El Individual Concrete Total: / Height: ❑ Community System
Repair ❑ Masonry — SEP Permit#yO2 2 6,5
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: o Setback: PP y
Type of Heat: Proposed: I ❑ Private well ❑ Two Party
Total: f ❑ Public
Name of System:
If this is a Commercial Project you must answer the following: ,
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants, employees,etc) Current Proposed
IBC Occupancy: p
IBC Type of construction: Will you have Food Service?, es / o
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: !Ali 2 '+ 2005
i Underground Tank I Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove tI. Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No r J
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
ISquare Footage For Office Use Only I
Current Proposed Amount
Main Floor Consistency Review:
581 3T47..1.a 44.®o
2""Floor Base fee:
481 3tSQT:Q- , t32q .7S
3`tl Floor Additional Section:
Mezzanine: _. Plan Check fee:
E.4 .W
Heated Basement _. State Surcharge fee: rL SO
Unheated Basement T • O
— Pot Water Review fee: f
Other Unheated " ` *60
911/Rd Approach fee:
Garage/Carport Gr
28 2 4 lit TOTAL: $ 2:3�/7'[ .,s1
Decks
201 (1460t.71Receipt Number: 11 51 Q
Other �• Cash/Check Number: 4-1
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and • a ion o ' h 3(24405_
/6 D O OD Initials: 4215
C:ADocuments and Settings\mochil\Desktop Aillastcr Permit Application-S-Ild.doc
-: 0—N �lill4 o� JEFFER COUNTY • ` E,
et W / DEPARTMENT OF COMMUNITY DEVELOPMENT �`
F' 621 Sheridan Street • Port Townsend • Washington 98368 r
360/379-4450 • 360/379-4451 FaxNAR 2 4
cq O� www.co.jefferson.wa.us/commdevelopment
. _; E
Master Permit Application Pit-1L' MLA: i
D5--I-t-
Project Description(include separate sheets as necessary):
co/v5?2uC.7/a.v of n/01•v S in;6LE f.4MILy ALsio07,vcE
Tax Parcel
Number. 93 .5 93013 0 Property
Size: /6, 2-9 2 S>`. (acres/square feet)
Site Address and/or Directions to Property: /53 "AA/ZIivA p,23 vE- ('d/LT 'TbwniSEivp
Property Owner(s)of Record: H Am I LT On►P Y NA Z,L.[=K c./LS7 ,4iv0 PAM LPL A B EK/HS
Telephone: 2.0 6. Z ., 14O 7 Fax:
email: slA.vti1._.7o.vH ®Vuc.[a-, Co,..t
Mailing Address: Z 596 371H vvEST 5E-,��-rLF w,,r i'SI 99
)
Applicant/Agent(if different from owner
s} /Z,1� ifA-MS .42CN/f�G%,f
Telephone: 206 . 322, 7959 Fax: 206 . 322 . 7963 email: 8,-E7r®
Mailing Address: 6// EAS'r i'ikt S7ZEE i S4-,4-r•"L Ut.A 98/22 A-atA-KgMSA.Qfi!/7Ec-7S,ca.2,t
WIJat kind of Permit?(Check each box that applies)
u Building ❑ Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or CI**
Ingle Family ❑ Discretionary"D"or-Unnamed Use Classification
Garage AttacheQ/Detached ❑ Special Use(Essential Public Facilities)**
Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
n Commercial* ❑ Binding Site Plan**
Change of Use ❑ Long Plat**
❑ Address i Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
E Propane ❑ Plat Vacation/Alteration**
0 Allowed"Yes'Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions--
E. Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Wireless Telecommunication* ❑ Jefferson County Shoreline Master Program Amendment
Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGN TION OF AGENT
I hereby designateDJ$COY Z3
to as my agent in matters relating to this applica 'on for permit(s).
OWNER SIGNATURE Date: !s— (J
By signing this application form,the owner/agent attests that the information provid herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 nd ' t of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required t . .Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: MX alcie
Date: 31.1 .or
The action or actions Applicant T (''undertake as a result of the issuance of thispermit maynegatively impact 9 Y p upon one or more threatened or
endangered species and could d to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA." fferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not viola ' the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you ar , ' with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable re o • adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: "�
(7 , r
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SPECIAL CONDITIONS FOR CASE A BLD05-00179 •
1.) Any future building permit must verify actual location of primary and reserve areas of
septic system and tank location prior to approval.
2.) A Geotechnical Report dated August 11, 2004 prepared by Hart Crowser, Inc was
submitted in conjunction with this application. The report addressed the stability of the
geologic hazard area. The geologist did not observe the presence of the possible
underlying glacially consolidate lacustrine silts that are typically encountered below the
advance outwash soils in areas where instability is prevalent. There is no evidence of this
geologic stratigraphy at this site and no signs of flowing groundwater other than some
minor surficial erosional features. It is the geologist's opinion that the potential for
deep-seated slope failures at this site is low based on the geologic conditions
encountered.
3.) 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.
4.) 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.
5.) 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.
6.) 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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
•8.) Not more than two (2) unlicensed or inoperable vehicles shall be
than one-half acre unless totally screened from view of neighboring dwellings and
n any lot less
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).
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Minimum setback from Marina Dr right-of-way is 20 ft. Minimum side and rear setbacks is
5 ft.
12.) 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.
13.) 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.
14.) A minimum of two (2) on-site parking spaces are required for the single family residence.
15.) 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.
16.) The applicant shall fully adhere to all conditions and requirements of the Geotechnical
Engineering Design Study dated August 11, 2004 by Hart Crower, Inc..
•
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
�I soiv ca
�A JEFFERSON COUNTY PERMIT # ,p
ti 1 DEPARTMENT OF COMMUNITY DEVELOPMENT
ti 621 Sheridan Street• Port Townsend • Washington 98368 0 5 - 0 1 7 9
14,, �0 360/379-4450 • 360/379-4451 Fax
tiNG http://www.co.jefferson.wa.us/commdevelopment/
RR= OMIT KO
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
• I MLA# O 17 f. PROJECT/APPLICANT NAME: HAM/[xON HA
?1-Ert u4S7 .aNW rs►nAEt.4 gc111.415
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.
PAL0PO 514 2 COAI5r/ZUG710A) OF ,4. Ave,--, SEPTIC 5y$76M S/NGL.L�
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Oft/vEwAy FdLtar.4S C1C137/NG s/7e-- ,tccFss .
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
fL 47 !3 u/LD/n/G 5 rrC w/ s rE-E]' c.a-r PFF.¢l.4E-i ' 7e 7"F A.od7N .4.,7,
WEST.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
FO/2E5? 7, .2/M L tZ „„/ cLEi+R`p $V/L,D/NG S/rE- A.viO AL-vFw,qy
4. Describe the existing soils. Indicate soil type on the site map.
4-vvA.✓CE O v1 w,t5Ail -s'Lr GED•7ECH,v/C4L Rpj'R7
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.
NO 5/6/✓S OF 6'/LOL,.�Q14..4-rex S -p.1.GE pe stk/ e AtC7/v/1r, SE-E
6Eo?E0NA✓/C4 L PO127-
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
/voNe-- STORMWATER PLAN
APR 2 0 2005
stormwater site plan template.doc-rev.10/12/2003 JEFFERSON COUNTY
DEPT.OF UN _ E NT 5
SIGNATURE: 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.
STEEP St-OPES pN pE/2.IME'1 & oP 5i E.
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.).
SITE IS $O(4.'0E9 ON 3 SI17E5 ay nn 4.4/N44 07Q/YE. INEK.F -42E"
NO Srge-A,Mj., WFT..,4N05/ ale 1—.EKES
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.
PottiNSfov1S smut- pi-HN 10 9�e-A"=HBG-oCKS
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.
7YPIC4L coN.Ptiocn lc.N 5?npN..414/2.PS
12. Describe the flow control system.
N'k
6
stormwater site plan template.doc—rev.10/12/2003
PERMIT # BLD
13. Describe the water quality system. - 0 5 — 0 1 7 9
/voNC �, ..
J IMSON LOOM' DED
14. Describe the conveyance system analysis and design.
No/iE
15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material.
A,ONE
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
/40,./E.
17. Describe the proposed surfacing material.
G/LAV 2/Veit/Ay j ,vtEr4-1 2eOF, vWdOP PECK., STONE PA-71O
18. Describe methods for restoration Q, the site. codrR
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$?OCk_P/UNG ON P/LOPOSfrD OAS✓EM/it'Y e4 AFA
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.
JA
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
GEO- TECW,4/1CAL gL-o,s2-7J
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.doc—rev.10/12/2003
•
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.
772-Ir E PENC/N6 WILL LSE Pl.4CEP 7,16- pE72/4.1E7 o/� SHE
',oz./57 a U(..1I 0N A,a.EA AA/0 A .a I.wO S/G�v/AC4r ?/e&-FS
SITE PLAN.
2. Establish Construction Access.
N4/N/A4 20" OF 7E.4f4.2A.1..Y GlL 4"EL AT E Js7/'G
PIZtvEWAy I°E=R SMP c 105
3. Control Flow Rates.
NOT iE&vl/2t--a. A RE-4 OF 01SrIJ,415ANCF /S lr-H/fED 4.vO
D/IQ.4?loN /S
4. Install Sediment Controls.
4pP/1_ vL=D SE:P/MEN'T cowlRaz_ £4,G4/ES tO t3F" /..a594 WV
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PiabrO.¢YY /,.,/n.E Dog,At6 sEPTK s Ys7F...K iNSr.4-4-LAimrev �EQ
BMP Z30
5. Stabilize Soils.
MUL-C NIA(6 2G6L"ecD iiv ALL P/ST vie BE-D ,41 ,RS 75
PREVFAT EI20S/oN An pv/T J PER_ L3MP C IZI R. S+.u/L. k
6. Protect Slopes.
S1vR.FACC /2-01/6/45:N/,✓G (.BMP C I3O, p2. 6-7/+F-.4. .tPP/�vcp
ME?MOD.
7. Protect Drain Inlets.
is/0 pi2A-/ni /n1LE"Ls n/e',412 PAoPE,2Zy
stormwater site plan template.doc-rev.10/12/2003
8
PERMIT # BED
0 5 - 0 1 7 9 tfF: .._ `,, r
12 Required Elements-Construction SWPPP( EtrtniJ ON COUNTY D CD _
8. Stabilize Channels and Outlets. J[ rt�J E
•
CNAAINELS .9A'P OJr'C/-1ES
NrJT CJr/ECZEO
9. Control Pollutants.
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WILL- i MA-1Av74InrL—D in, 4 QLFA-A, AN.0 OR2OE.QLy F{-S11 c, .
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
OE w.4i& JNG 1S 4E 'i/eip IT wiu_ ,4.v01-E wr7�f
CARS' -74 P/L V GIVT r Qt 5/onl .4 D aFF %J1 co/vr,4.4/.4,47ics .
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).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
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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9
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,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)4
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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. Proposed 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. "'IA
b. Diversions. NdA
c. Waterways. N/A
d. Runoff/Stormwater Detention Calculations pjA
10
stormwater site plan template.doc—rev.10/12/2003
•
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 aff ted prop rty.
(LA DO R O AUTHORIZED REPRESENT IVE SIGNATUR=) (D
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
12
stormwater site plan template.doc—rev.10/12/2003
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SIGNATURE:
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611 East Pike Street
Seattle, WA 98122
Ph:206.322.7959
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Fax:206.322.7963
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REVISIONS:
1 DATE: 3-15-05 . I
JOB #: AA04010
SCALE: 1 /8"=1 ' '
DWN: BVM CHK
SITE kAN
A001
ARCHITECTURAL