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HomeMy WebLinkAboutBLD2005-00184 79 ItUILDING PERMIT APPLICATION ML viewTy Type: Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00184 Received Date: 3/25/2005 SITE ADDRESS: 441 MONTGOMERY LN PORT LUDLOW, 98365 OWNER: SANDRA L NELSON PHONE: 360-385-3606 PO BOX 942 PORT HADLOCK WA 98339-0942 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: 9 PARCEL NUMBER: 990400209 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979 371 BISHOP HILL RD CHIMACUM WA 98325 Contractor's License BISHOBC093D6 Expires 1/11/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GARAGE & U/G 250 GALLON PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,938 VALUATION 20,000.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2003 HEAT BASE. HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 572 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: LUDLOW BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date:, Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,553.75 BAC 03/25/05 71587 APPRoVED Plan Check $1,009.94 BAC 03/25/05 71587 State Building Code $4.50 BAC 03/25/05 71587 Potable Water Application $53.00 BAC 03/25/05 71587 APR i�nnnn 1 1 2005 Total: $2,621.19 Jefferson County Pfannin A....,cgtu' • 1 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00184 Received Date 03/25/2005 SITE ADDRESS: 441 MONTGOMERY LN Issue Date 04/11/2005 PORT LUDLOW, 98365 APPLICANT: SANDRA L NELSON PHONE: 360-385-3606 PO BOX 942 PORT HADLOCK WA 98339-0942 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: 9 PARCEL NUMBER: 990400209 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979 371 BISHOP HILL RD CHIMACUM WA 98325 Contractor's License: BISHOBC093D6 Expires: 1/11/2007 PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE & U/G 250 GALLON PROPANE TANK CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: e1* 0/65 UFFER: elk 6/0 Footing: r 9k ;' � Foundation: !* 1/y ..-+ ' Stormwater FINAL Approval: ,Pit d,,,� // (v`a,a ta-a3-A-fibv7t/ Underground Plumbing: Underground Insulati_o� Shear Wall : Dili�I��i�� Sheathing: Framing: t}k W2/45 Plumbing: 114 9/2/O5* Propane Tank/ Lines: liurOksoefkovlo-ES1r sOK rs1425.11k6krrzo I-hogt5� 1'/i41d6 fr Insulation: fJg« 4 VAu�-T- D c�)LM 5S Sheetrock: .SNFiieh2hILS DK i/10 45, Septic Sytem Final Approval (If not on se r): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: Ok -Pot- C/D 0/04 HEALTH DEPARTMENT AND PUBLIC WORKS A ROVAL 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 � • SPECIAL CONDITIONS FOR CASE A BLD05-00184 1.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 2.) 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. 3.) 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. 4.) 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. 5.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 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.) A Stormwater Site 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. 8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • • 9.) 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). 10.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 11.) The building height is not to exceed 35 feet. 12.) Minimum setback from Montgomery Lane right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 13.) 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. 14.) 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. 15.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 16.) Per MPR Code Section 3.17, Accessory dwelling units (ADU's) shall not be allowed in the MPR-SF zone. I:\F_BLD_Permit_Buildng.rpt 10/29/19 OWNER BUILDER STATEMENT • The signer of this statement does hereby certify ttkey 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. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 51SA .,z 5,--o le4 rfs C;,.: s_'.. (360 ) .3o/ -/17'-) (.3" ~) 73.E - r MAILING ADDRESS: / i - 3�l, ,3i,5- oO F/f /> /PD EMAIL: CONTRACTOR'S LICENSE C'1,f p,a•! WAINS NUMBER: 81-5~/C.33 CO ")3 06 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: i New P'Wood Existing: p ❑ Sewer ❑ Addition 0 Steel Proposed: _V Bank .t7 Community System ❑ Alteration/Remodel ❑ Concrete Total: _ .,2 Height: ❑ Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: C) Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ,® Public Hest 1- PAPA, Total: _ 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: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: AT Underground Tank 0 Above ground Tank Size of Propane Tank: . S ( ❑ Heat Stove [I Cook Stove 0 Woodstove )( Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes NoJ 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. p y po Square Footage For'Office Use Only - f Current Proposed - Main Floor /) 1(/�x, Consistency Review. 2`u Floor 6ase'fee: ]i :sset406:is_ 3`a Floor `Additional Section: Mezzanine: • :plan Check flee Heated Basement 'State Surcharge...,...,..,..., ,. ::....„ ,„ `� Unheated Basement • f .7_ 00___:,. ..;,,,.,-„--., ,,,.:-,„.:,.=,_-,.,..,:..,. ,_ k(Water• ., ,,,,, ::::,..r. Other Unheated 9i1!Rd A� '"'- 7 .. � 47 -�i �� -7`N711 /t � x'aGarage/Carport *.ge 4(-- Decks n11�'' S Ndt �y IpcelptJ+ltatrI ��j T � 7 Other ems/1.*gir ' Ut • f "'` ,, F`S. ESTIMATED COST(REQUIRED) Date• •Fair r and materials foundation to finishz r Initials. i `'' .,+ ",� ,, G:\PermitCentcr\FORMS\DRD FORMS\Master Pernrit Application 7-8-04.doc 1 ,�� oiv cod, JEFFERSON CONY '� J DEPARTMENT OF COMMUNITY DEVELOPMENT ").4rING'. 0 �' ` ''� 621 Sheridan Street • Port Townsend •Washington 98368 2 5 360/37'9-4450 • 360/379-4451 Fax l t www.co.jefferson.wa.us/commdevelopment j. Master Permit Application MLA: Project Description(include separate sheets as necessary): 1lJ(LV C.s'7Y';. 7 , ....,,,-"4" .., Est' Tax Parcel Property q Number: ! qQ -'110,j a 6, Size: / :ta",T2O (acres/square feet) Site Address and/or Directions to Property: �'/J /70,r c1 /n e- -. 4 P PO,-4 �r� Gl 1a - Property Owner(s)of Record: 5 ^;^%r,:. /?✓f/5 a, Telephone: _3 360 6 Fax: -email: Mailing Address: BOY '? '2 ,- - Te1-o., ` • '33`? Applicant/Agent(if different from owner): .Co"-t c, r31 5 A c Telephone: 4.2 -3; .` /9 7 3 Fax: 360 - .) - `y`9/.5 email: Mailing Address: 3 7/ 13, 5 r D.a I-/ /i , ',; CX,n-1 c 1.N wAl `7,)'-d' " 5 What kind of Permit?(Check each box that applies) Ed Building ❑ Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** jii'Single Family ❑ Discretionary"D"or Unnamed Use Classification lit Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)Amendments** §r Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ 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 *Ma re•uire a Pre-A..lication Conference - **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate "SO r t 0 F .5^0.10 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE_ i-VL _- Date: 7 2 C7 By signing this application form,the owner/agent attests that the information provided 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 aoaue 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 its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. _ � /�\ o' Signature: ��.I�s��!ti-.�����"l/ — Date: y• '� The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead 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."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferatr elesponsi ility for g ,and complying/ with the ESA. The Applicant has read this disclaimer and sigand dates it below. Signature: f/1��1--shy'/ i C� Date: 7 2 7 c2 7 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc .,,e,.. ON---68..\\ grke:1,, JEFFERSON COUNTY M ,I DEPARTMENT OF COMMUNITY DEVELOPMENT 4, 'tts „ , 621 Sheridan Street • Port Townsend •Washington 98368 �O 360/379-4450 • 360/379-4451 Fax NQ` http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# ©1'C1 "/ PROJECT/APPLICANT NAME: 5 :.,i s.. ,4 e s 0 e I • 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. .ffl. s r 3 e. fl:,, >'U ..,L, S , fr- _ � Jv.a7� Sf'rtc' ,J S Irt"t`<s t�, c,6/r /0„ f • Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. A, tf4- s sari , -(-:.,c /47.e_s ;1- , , :�,. tf- 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. Srt, ) ce.c.1.:, s -., _1.4 i4 , c 4' ;1�: /,,, :E,l el 1 ,--c,: „ f�,{, -,, 4. Describe the existing soils. Indicate soil type on the site map. 5 C , l 50,' c p 0,- 4 d C /5 •- t ry ._-tr - /" 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. -hp I,/6-,- : 'I-4 e .C\ 5'I /� L-e.5' .7. 7 1. r_ G t �,t j J—,' `q ,\ .- ' G>i t .Z is s! f ,,C' 6. Describe any excess levels of noise generated by the proposed use or activity: V,4 APPROVED � STORMWATER PLAN • 1,, t , APR - 5 2005 StorrriWate ; DEFT.OF Is , 'I .ilk; stormwater site plan template—rev.10/1/2003 fRequire ; 1EFFERSONS.013EUMpmET`> CO1 r it SIGNATURE,:'i 1 i 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. //4 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.). % / 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. 4/7 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. !J1/7 MAR 25 AU 12. Describe the flow control system. stormwater site planempae rev.tlt — 10/1/2003 6 13. Describe the water quality system. 4/4 14. Describe the conveyance system analysis and design. L/f 15. Describe the source of fill material,physicalcharacteristics 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. .? 134't k /1/ /1 id, L? 3 _et• J/) . 7 t L:/ y` ' 17. Describe the proposed surfacing material. r L V / c /_7rf 18. Describe methods for restoration of the site. • / I C t �-� r ,!L7 �:/! T A �"I�tC tr E'� t' ?Le. . 7,0,7 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. 4, 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. 4 stormwater site plan template—rev.10/1/2003 7 CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. , / / (� )/4•�J (-1rle" .S z'1C /,(• c�"[3i ci �C' per•; hN 2. Establish Construction Access. 3. Control Flow Rates. / / l c /,- C t c, 5 /-,il Gt G !, /'l u1. ) 4 : �: (/ c' 7 c /, C., C,, Cl Z. • .5'/e // C'wr /1--4\r ✓t i'cs' 5 '"(Do c' 5 /t1 , 5 C rc •"r'c° 4. Install Sediment Controls. t C' 4 Y't•'E; /.{ •l j/ /- fj• .t /I7 it r /t;�! ! �t� C/t_ �, L'i, I . t .. S '?f c' ,,(� , / `e✓ *re• t/ I) 4' C <f L� %iC' J c',/ 5. Stabilize Soils. / I / / /✓it✓`"r ✓!4j CJ( C(r e). 7-o i` Tv r t 1; Cyr E / iilG i7 /CST. C. CC`` .. 3� G.CGr /e: Ut 44_5 c (1,1 /d :"aT t' �:'�r S Cr -. L't✓ Ji 6. Protect Slopes. / i •�G/ --/j t! /G> T ' 'v / v z' / C r', `,4 j 7. Protect Drain Inlets. / _ (`✓) v'.'' , •k i �S /c �S c?i? /o C's.'L'• .5'✓r�c C.t -i, /o /.. / J 1 stormwater site plan template—rev.10/1I2003 8 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. , ,Clt�.e: /�` // c, /I 0i ,r r'S ''� /t t't e i > C t< S a C>t . ) z.0 �()5-�lr 9. Control Pollutants. - �. / / /1-�c'�//i`i 7 S ( /'`?G'. t L7 C/ /� 1,{,'z�C' � /y IfAGi e y J `f'1.�`' �(:!c�: C c'� k 1 a i � / l/t'Gi ,-t C.,_L ] ,? c 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). r D z f- -1-c- / L--A , s 74^ i) e c; p / C� t/c .-- /04 z:s' h , r rn5f' //,wry c 11. Maintain BestManagement Practices(BMPs). C J // ,;e lC'ia tt),:t i7 s.5 : c1 6 r'a i //I� 1 . j r-.c A F S r-tie rc : c1 r s '77 hG.//zr 12. Manage the Project. /p%L'.el t • 9_ 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. /1• 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 �/ f 7 ,..�'' C i... i f�4«. c"/ , ., �v, /t ,� 1/2.7. 7 <1.(///' K", r7�1 ! (/ 2 /E' t 5 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. f(7/b. Proposed wet season construction activities for environmentally sensitive areas. 7. FinanciaVOwnership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. / //r7 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calcullations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stoirmwater 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. `= _* c 0 .mot r -' i - y -C.* (LANDOWNER OR AUTHORIZED REP#SENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: MAR 2 sb � stormwater site plan template—rev.10/1/2003 12 I 0 o , - ) Ci) al CD 12- A b----2 cu � wz Cn W g W 0-' ,-. -- \\ or, e._ w ti w O A al I_. . rA- a, II 0 0 T „, ....z)., ...,,.. , ,,4 _... ''FD--'444.. i NC \ "*'-Ni: v �S. C A 1 i 1 O , ' ------/ L CS i - - : .s.e.,‘ 4.; I, / I v t - 0... c� 0 c i. _w � ao :&.), - � � o0 o L CD 0 co 4- " o csoit, �� , CDo cz � m 0"-)C U N s -r)‘--- V; r E C-6 CO co L,D-,.- .,. E CNI C) '"'IEY z. c:A- t .,..t ,_ e _41r- 2 ° o �� = 4_ O _ O -a 3N v I A ,b/ _______ >1 O o c�� __ 75 O p o N -0 (6 a) E _� L ._ p- U_ O Q o C E- a3Av8 8 A8 •I I '1.I 1 Ar'(IA'(NA 1-,nn7 Ah7 inn 'G 1 n17N1"l I 'fAAf'yel1-1_17.1vw 1A c I cJnn]\1 fJn 1,fh11 I IHI.I%AAnlnn71 un 1, 1 1