HomeMy WebLinkAboutBLD2005-00234 ou! 11)
Jefferson Cnn Department
PERMIT •
621 oun epaart F nt of Community Development
Port Townsend, WA 98368
PERMIT# (360)379-4450 FAX (360)379-4451
SITE ADDRESS: BLD05-00234
694 E MARROWSTONE RD
Issue Date
NORDLAND 98358 Received Date 04/15/2005
APPLICANT:
GREGG F LARSON 06/17/2005
SHARON K OLSON
694 E MARROWSTONE RD PHONE:
NORDLAND WA 98358-9633
SUBDIVISION: 206-719-3052
PARCEL NUMBER: OLSON & HAMBLETON'S
977700082
CONTRACT Section: 9 Townshi : Block:
OWNER/BUILDER p 29 E
N Range: 01 Lot 11+
OR:
PHONE:
PROJECT DESCRIPTION:
DETACHED UNHEATED GARAGE/SHOP/LOFT-
CALL IN FOR REQUIRED
sf SEMIHTD BATHROOM
SETBACKS:THE QUIRED N PECTIONS THAT APPLY TO Y YOUR
LOFT PROJECT.
UFFER.
Q, S.�.S` OUR PROJECT.
Footing:
l
Foundation:
/z 4!S
Stormwater FINAL A
Underground Plumbing:
��
Underground I ` ` "
ulation: ,6_Os--
Shear
Wall : O -03-
Sheathing: /O-S
Framing:
Plumbing:
Propane Tank/Line :
Insulation:
a
Sheetrock:
Septic Sytem Final A
Road A pproval (If not on sewer):
pproach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval:
HEALTH DEPARTMENT AND PUBLIC WORKS
HOTHIST-3N VALID FOR APPROVAL REQUIR
ONE YEAR OR IT MUST BE PROPERLY WED
LY RENEWED
L INSPECTION
E 379-4455. CALL 24 HOURS IN ADVANCE TO
BUILDING INSPECTION
HOT LINE AVAILABLE 24 HOURS A DAY SCHEDULE INSPECTIONS.
p.m.
SPECIAL CONDITIONS APPLY-SEE REVERSE
w �0
�UILpING PERMIT ApPLICAN MRAOe00
Community Development
Jefferson County Department Townsend, WA 98368
621 Sheridan Street Received Date: 411512005
BLD05-00234
PERMIT #: 694 E MARROWSTONE RD PHONE: 206 719-3052
SITE ADDRESS: NORDLAND, 98358
GREGG F CARBON
OWNER: SHARON K OLSON Lot 11+
694 E MARROW 9 O35E RDD3 Block:
NORDLAND WA N Range: 01 E
HAMBLETON'S 9 Township: 29
OLSON & Section:
SUBDIVISION: 977700082 PHONE:
PARCEL NUMBER:
CONTRACTOR: OW NERIBUILDER
PHONE:
REPRESENTATIVE nn teOD/0 ---/— -
PROJECT DESCRIPTIOP
DETACHED UNHEATED GARAGE sf LOFT OFT-
5 sf SEMIH ROOM,H
GAR SQUARE FOOTAGE: EEE
TYPE OF WORK NEW MAIN: HEAT TYPE:
TYPE OF IMP 45 832.00 ADD'L; HEAT TYPE:
VALUATION 2003 HEAT BASE: #OF STORIES:
INKSHOP
CODE EDITION: UNHEATED: 473 SHORELINE: 60
OCCUPANCY: OTHER: 1459 SETBACK 62
OCCUPANCY: GARAGE: BANK HEIGHT.
CONST TYPE: DECK:
CONST TYPE:
SEWAGE DISPOSAL: CONj
WATER SYSTEM: BATHROOMS:
Et. ELL
.
Exist:
Exist Prop; 1 .
Prop: Total: 1
Total: 0
Routing Date: 11,(A r
` Approved/Date
Date: Receipt: APPROVED
Amount Paid By:
04115105 72916
Type $603.35 BAC JUN 17 2005
Permit
$392.18 BAC 04/15/05 72916
Plan Check $4.50 BAC 04115/05 72916
Code 04115105 72916 Jefferson County Planning
State le Wing $53.00 BAC ;, , apartment
Potable Water Application
$1,053.03 pit WIw ,.i.
Total: '
! ID
OWNER BUILDER STATEMENT 4110
per of this statement does hereb certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and,
All be assumin the respopsibir of the General Contractor for the proposed project.
iature: J- Date: #7-/.7 -0 J—
1
iENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
RAILING ADDRESS: APR 1 5 2005 EMAIL:
;ONTRACTOR'S LICENSE 1 I WAINS
iUMBER: ; NUMBER
\RCHITECT/ENGINEER: ^ 1 PHONE ( ) FAX:( )
-
RAILING ADDRESS: 1 _ -- EMAIL
'roject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
4New Wood Existing: ❑ Sewer 1.fiJ
] Addition 0 Steel Proposed: YZ Bank ❑ Community System cp
] Alteration/Remodel 0 Concrete Total: J/Z Height: Individual System �""
] Repair 0 Masonry o 1 SEP Permit# $Z" 70
] Demolition ❑ other: Bedrooms: Water Supply:
Existing: O Setback: %Private well 0 Two Party
Type of Heat Proposed: e) ❑ Public
EDGY R.I c' Total: 0 60 Name of System:
56A1l-tt1 4rED BOTH oNLy
If this is a Commercial Protect 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 appiv:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
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.
Square Footage ;ForOffice Use-Only
Current Proposed - Amount
Main Floor Consistency Review:
2Nu Floor Base fee:
3ia Floor -Mdltiortz l Becton
Mezzanine: Plan Check-fee. c'i l
Heated Basement Surcharge : t f ���
Unheated Basement Pet`Water Reviewfee: NN i ' - -
m
911/Rd:Approach fee:• !•; ,•-• - ,Iq t 1,�;
SEMI-l{btT T34THkoDM 2� 4 4x
Garage/Carport j jS 3l fI 1, TOTAL: ?�( ` ,
r
Decks
Receipt Number. / {
Other L9r1- GGMit;K9/0/11 �6 r ?I � k Number: "r—j
-_ r
ESTIMATED COST(REQUIRED) ! ` 1C,C-,
.Fair market value of all labor and materials foundation to finish
G_\PcrmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
SPECIAL CONDITIONS FOR CM A BLD05-00234 •
1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
3.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
4.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
6.) 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.
7.) 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.
8.) 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.
9.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
10.) MANDATORY MEASURES FIPCOASTAL SIPZ: •
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
11.) MANDATORY MEASURES FOR AN AT RISK 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 requirements:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
b. Installation of a flow meter.
c. On-going well monitoring for chloride concentration.
d. Submittal of flow and chloride data to the County per monitoring program.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
12.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
13.) A flow meter shall be installed prior to final sign off of the building permit.
14.) On-going well monitoring for chloride concentration is required. The property owner shall
allow access to Jefferson County PUD or approved contractor to take samples as
required.
15.) 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.
16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
17.) 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).
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) Minimum seback from E Marrowstone Rd right-of-way shall be 20 ft. Minimum side yard
setbcaks shall be 5 ft. Minimum setback from top of bank shall be 60 ft. Environmentally
sensitive areas further impact setbacks.
21.) 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.
22.) 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.
23.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat
management plan dated June 12, 2005.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
.4s 0N
104 ° JEFFERSON COUNTY
APR 277)
,w a ,.< DEPARTMENT OF COMMUNITY DEVELOPMENT DCD
Sheridan Street• Port Townsend • Washington 98368 JEFFERSON COUNTY DCD
qs, �Sp 360/379-4450 . 360/379-4451 Fax
PIING http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# I'4/..k05-- 00 Z30 PROJECT/APPLICANT NAME: 6/2-EU 6 F
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.
APD NEW DETAcYi b IANH-E4TED 6,4RftC /5fLoP - SEE 5/TE M,4P
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
- SMALL war oREA 5(ki coR►JE2 7 2F pA-RcEL CcA1TLE 5 ..cPE op EASTE21.y
• To (4REA OF EXIST/nick HOUSE ,1nla PRoPos+<'D G424c,E/S)4oP� 'rtl•Eki !-Etta To TOP
OF BLUFF. SEE 5/rE Pt.4J-
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
IDARCEt_ IiA5 RET4/niED NA-TV24L VE4Erf+Tior.) XcLP r FoR f-1:7V5E An > Acc.ESS.
FIZS) ALDER— CE�r41Z S,4L,4t 5 LA livN VUFR EXIST/nJG DR/1") FIE2-D.
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.
RAIN WATER_ Cart0 ERA 1.4- FLOW WEST 4Wi%/ FRorM 151.11FF
EX l5rik t RA/k}4E FLows WEST, •,
?Roe()se.), -MA/NA6E FLoOJ.S WE sr) ••
6. Describe any excess levels of noise generated by the proposed use or activity,
f}Frt.R NoRML GONSTR te.TIDNNoISE, 4o Exc, PPRYED
STORMWATF.R PT.AN
J U N 1 4 2005
JEFFER O COUN Y
DEPT.OF('OM ITY D: ?I.OP
SIGNATIIRF
11
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, 4
steep slopes, etc.)on the site. Indicate location on the site map.
SMALL WET ?JD fart Su) CottJEi= or PARCEL
STEEP SLOPE EA-5T S1DE OF PA-R.c-L
5el- 51rtE MA.P
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.). S E MARROW5Y c JE (5l-RN13 1eE.S(D�T1T►/'rL RkAAAL
YD£VNRc ,oOD N POWER ANT) ?1+OiJE7 (PAVEL PR►VEu)R7 Yz_ M1LL To E./1.4RROWSio1J£RD._
SN-ABED 131 55 FP 2a1 S
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 p oposed facilities from existing facilities.
STD(OM J Al R FROM PRoPvSED aE SRfoP AT t.EVEL- A-R£q NEAR HouSE
WILL BE DIREc.TE.D -WEST AwAy FR01 STEEPS,OPE. 7o APF.A¢ 2F NATU L
VEGf-TAT0/J) PrNb 'B.E. F LA MLy D15PEASE_D ON 771-15 -PARCEL__
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"largeNro eects or projects that involve the potential for dispersion of contaminants.]
ft
11. Describe the performs a goals and standards applicable to the project.
N7
12. Describe the flow control ystem.
N/k
.. • , 4-;,,zor
FT- t `I: -
JEFFERSON COUNTY DCD
iiii
13. Describe the water quality system.
N/Pr
14. Describe the conveyance system analyis and design.
N/A
15. Describe the source of fill material, phys pal characteristics of fill material, and deposition of excess material.
N Pr
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
N /A-
17. Describe the proposed surfacing material.
N/A-
18. Describe methods for restoration of the site.
N/A
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.
N(A
20. List here and include any special re orts or studies conducted to prepare the Stormwater Site Plan.
N 4 _
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.
Nfit.
.. I ;. '4. L4C44)
AR F"
JEFFERSON COUNTY DOD
•
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. �� ,1
W L V L 13E M A E-b W 1 T H Z- Y Lc.a.AJ 'cA uTi t7N TAPE
2. Establish Construction Access.
V►R- E)ctSTi06 GM'E-t- DR\VEul )L MILE FROM P7lvg_-D Rot'rD, SimcE
Tikt5 15 A "SMALL" PRorECr 11 AFF1c WILL $E V€A" MItvlM�}t--
3. Control Flow Rates.
coNSTRvcriON TO TAKE (FLAKE BE>=ru)EE,J 5 t P-N)D to-I � 50 To.ra r
t�v (LL DONE "DLR.1t3 DR/ SE/60.1• ALL Rv,J oFt= wltt. f Efl4 itJ AVS1 -
•
4. Install Sediment Controls.
STRAW rto SE Pt.RC.ED AROUrMD di-EA/WA To TRAP SED►MEn/7T.S.
5. Stabilize Soils.
t GON STR ucT,oN S t Tr I S LEv. 6 AO OND I M Eat iFTt 7 f F reR Ci_E4R1
Pw&51-1C._ 5 HE-ET WILL. 3E PPLaEr> To 7$E CLEJ LD AREA,
6. Protect Slopes.
CoN5Tr Uc.T/oN Sire 15 LEV'EL 64OUti1D.
7. Protect Drain Inlets.
STRAuJ lb BE PLAcEt. J S7-0RMW*Tf- DR4i /IU/.Er
0111
JEFFERSON COUNTY DCD
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
MO C(tA J LS o R OuT 1E-7-5 OM-S I TE_
9. Control Pollutants.
OIL 4b5oRBA 1p47)5 t,JILL BE t}Vftlt.$gl.E. ON 5l7F FOR f}IJy M'%Cttii.Ji f
LEAKS. CONC -E75 TR°CI. C!-E.tNING WILL BE I1QTb Fi"A-STIL 1_llJFP)
De5t4N ,42EA
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
NO DE.-WATT=.R 106 R .Q t1 l Re-D qU 11415 PRU.JECT
11. Maintain Best Management Practices(BMPs).
W ll.L BF MOA)ITGR>"b D4!�y AND REMO\IED VPO&J Co.M P1„£r/OA) OF
tPROTfl'r-
12. Manage the Project.
7I4A5E CONSyRUc.T',on) To PREvuJT RUNOFF
Pl0.i l5 E+ Con.,STIk 4crioIJ $EFORE (O t
C,002birJi+'f'E_ Wo/tK CKe S
lNSPEcr A/OD MONiTog_ PRo -ea- D4 — Ou1MER/14h10,44t✓e LIVES
oNsirg
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
Not'l�
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
Nl Pr _
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
, I14Gt_ LUCT4AND GU CJ20E/2 OF SJT -
L.,42GF1L WE-ruffU PAACEL To Taft= WEST"
klEF
FEESON COU DCD
b. Description of special req irements 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).
NONE
5. Construction Phasing.
a. Construction sequence
Cc.F4R Ai?EA ?OUP-, CONCRE SLAB ON 4RhbE1 1NSTALt_ f -'R,ME- POt.UNSPoJT'
pAA/1351BAZKFIU.I FR IE1 RooP1 w/NDo+)5 -r DOORS 1 ute + EI.ELT•
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.
STA R r ASAP) f-}AVE. W ATt+EAF IN AND 5ToRM W hTER C OiU/JEcrE l3, 10 -1
•
PlNiS N Pttcttm6/ U6 + to Ir21NG fi-SA-P.
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
I N rER i oR PLuMB/tkk- + WA) J6N IF NOT tql,ReADy DONE
b. Proposed wet season construction activities for environmentally sensitive areas.
NoNE-
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
6REU6� F. t-4et50/J
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design C Iculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. '�i4
b. Diversions.
c. Waterways. 7.1A -n
d. Runoff/Stormwater Detention Calculations /A- ...
t
. 1.
r-t-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 my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected pro erty.
yZzo3-
(LANDOWN R AU HORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
lA a ij
�J p
JEFFERSON COUNTY DCD_
l
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Adjoining parcel #977700033
undeveloped rural 170' Property Line
m —I —I m .. .. ram"' .. m
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cn' o � c � °�' <3 6, a = rD 3 �Tuir-TI:
Gravel driveway 9' wide _ ___�
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