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Home My WebLink AboutBLD2005-00320 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD05-00320 SITE ADDRESS: 592 BROAD SPIT RD Issue Date: 07/21/2005 QUILCENE, 98376 Final Date: 04/30/07 APPLICANT: JOHN ALBERTI PHONE: 206-282-7105 1100 UNIVERSITY ST#14D SEATTLE WA 98101-2890 SUBDIVISION: Block: Lot: 3+ PARCEL NUMBER: 701204002 Section: 20 Township: 27 N Range: 01 W PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE / A/G 120 GAL PROPANE TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 04/30/07 ate, !aid 5 L Ji Building Official Signature Date I:\F_BLD_Occupancy.rpt 10/29/19 BUILDING• 0 PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00320 Received Date 05/19/2005 SITE ADDRESS: 592 BROAD SPIT RD Issue Date 07/21/2005 QUILCENE, 98376 APPLICANT: JOHN ALBERTI PHONE: 206-282-7105 1100 UNIVERSITY ST#14D SEATTLE WA 98101-2890 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701204002 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: EVERGREEN MODULAR HOMES INC PHONE: (253)582-3423 10720 26TH AVE S LAKEWOOD WA 98499 Contractor's License: EVERGMH243C7 Expires: 9/30/2006885 PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE , Act ( Is,k l CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. i ! !�� SETBACKS: l}l{ /7-NO '�Q,L UFFER: ALO� Footing: 11< /05 t:Li4 V2 Foundation: M,(lo't9 Stormwater FINAL Approval: ?FjQtrn (,�(o-p(o � �o'm�'A 4 Underground Plumbin � ��Cs�L'1! ' Underground Insulation: Shear Wall : Lxi- /2e—rfeli-, Sheathin Framing: .Pr cotru.104J94ria-2 2,-0 Plumbing: ,495 O. y OK 4//4A4� 4o 22,-ok oPA �AN�C locFoK 1�!7 Propane Tank/Line�S: Lyr "As JjL D ® S# /4/ic ,,l� Insulation: //4/ / /1r � /�vt vn �A� /�i BAD u t, j r_31Lt l e OK_ 413eyc.777 ME��to 11e�r t4 ii, i'� 1' �B'r Sheetrock: /)g. .113nft ALWin41: Septic Sytem Final Approval (ff no on sewer): 111 vJ• Road Approach Final Approval: !,�I Zoning Final Approval: Final/Occupancy Approval: 43‹ ;1. 4%) , seVe,7 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUI�RIOR TO FIN AL 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 IPUILDING PERMIT APPLICAAN ML Review T Ty y 305 pe: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00320 Received Date: 5/19/2005 SITE ADDRESS: BROAD SPIT RD QUILCENE, 98376 OWNER: JOHN ALBERTI PHONE: 206-282-7105 1100 UNIVERSITY ST#14D SEATTLE WA 98101-2890 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701204002 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: EVERGREEN MODULAR HOMES INC S1IANF LLkb ( -` '� ` E: -: t I4 ' PHON 10720 26TH AVE S LAKEWOOD WA 98499 '25?)— 8{I - 3c10C Contractor's License EVERGMH243C7 Expires 9/30/2006 REPRESENTATIVE: EVERGREEN MOLAR HOMES PHONE: 2531 CARL D ESTER— Jeff) L .hcd 107202 AVES `� 2r)3 - Y'L{ I - 3900 PROJECT DESCRIPTIOt NEW SFR W/ATTACHED GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,465 VALUATION 242,005.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: 1,153 HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 312 SHORELINE: CONST TYPE: DECK: SETBACK: 360 BANK HEIGHT: 260 SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 3 Total: 2 Total: 3 Routing Date: C ZC_,/0,� iFi, Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,794.55 BAC 05/19/05 73139 APPROVEr Plan Check $1,166.46 BAC 05/19/05 73139 State Building Code $4.50 BAC 05/19/05 73139 JUL ! 2005 f'42 Potable Water Application $53.00 BAC 05/19/05 73139 Total: $3,018.51 • " on Count Planning •uildin, I el)'Age nt i t/3/LA.a&r r.:�,Al -'n -•�, yif • 7 r ---.......„...... 1..... ( I �r I . / . „......-- ----.... �. V. fl _\,...... r":0" ,-- /Ill i j,/ 410 \.., ,11j JUL 2 0 2005 f+l , i f 4> \ 1 t--Qr ,, r,srr , , • \ \ 4 of -�► ` t. -s ,A‘.\;.-s 1 , At)''' .-.• . At 4 ',U . \ • T (i) 8 1 r �k- Z k-- 2 N � fll — Zil la Ili ,, \\,\\ 0 „isibt. \_...1 \ 211 \\\ \i tt ..M. rs,\ •ftb..... . .:.. ; ) :1.. > 5 1 .. ` s us No *V,iJ i d o'y • Z It%.*::-< 1 i II.‘9 411 , '. .404; . • , k,„.. . I '1 ‘7' t • -, 440104t46. _..- • ., - 9 ‘.4.4 CD i Z a ,laz ......„ ,... . 0 iel -00' ''......-- ....--•• ........ "441, / gr 0 • fit:. / wQ r // SPECIAL CONDITIONS FOR CA A BLD05-003204111 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.) A Geotechnical Report dated June 4 2003 prepared by Shannon &Wilson, Inc. was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A setback of 20-feet from the edge of the north-northwest facing slope and for the east and southeast facing upper slopes require a minimum of 50-feet from the natural face of the slope (the presence of side-cast fill should be excluded in the setback determination). The larger setback from the east and southeast facing upper slopes is prudent given the observed recent movement on the southeast facing upper slope and on the waterfront bank and ravine below these upper slopes. shall be measured perpendicularly from the top or toe of the geologic hazard to the proposed (indicate type of development). 3.) 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. 4.) 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." 5.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 6.) 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. 7.) 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. 8.) 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. 9.) 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. 10.) VOLUNTARY MEASURES OFFOASTAL &AT RISK SIPZ: • 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 11.) 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. 12.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 13.) 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. 14.) 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. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) 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). 17.) Maximum lot coverage is not to exceed 10%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) The building height is not to exceed 35 feet. 19.) Minimum setback from Broadspit Road right-of-way shall be 20 feet. minimum side yard setbacks shall be 5 feet. Minimum setback from shoreline (per submitted site plan and geotechnical report) is 285 feet. If ESA's are present, then the more stricter setbacks shall apply. 20.) 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. 21.) 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. 22.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 23.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat management plan signed by WDFW on July 15, 2005. I:\F_BLD_Permit_Buildng.rpt 10/29/19 • # OWNER BUILDER STATEMENT p 6),I _ ! _F 1 1-7) The signer of this statement does hereby certify that they are the Owners of the parcel referenced hviain,that they are not licensed con rapt and that they will be assuming the responsibility of the General Contractor for the proposed project. pp t MAY 1 q �;i�� i Signature: Date: • ltt V GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: , pT C r •rNt t i r,t; .- vei i reen I c' .lcir l/-'m63 As-3.) sue--.3 �3 r` '66-6ss MAILING-ADDRESS: t Q7a/ fk j(j Ve 5 EMAIL: �- CONTRACTOR'S LICENSE La t;.etz..'00 A. q8-4/ cl WAINS NUMBER: SUER Gn'1 14,2Y3c7 g/3o/2Eo6 NUMBER ARCHITECT/ENGINEER: Andl`eWS Eh nderi PHONE ( 53 ) 2- l FAX:( ) MAILING ADDREss 02.- k, Li1 D n M EMAIL nr i CLkc ; wA .p 8'3667 Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New (Wood Existing: Li Sewer LI Addition Li Steel Proposed: 3 Bank LI Community System LJ Alteration/Remodel a Concrete Total: 3 Height: 'Individual System Li Repair LIMasonry z � SEP Permit# Bedrooms: LJ Demolition LJ Other Water Supply: Existing: Setback: X Private well LJ Two Party Type of Heat: Proposed: 2, U Public Total: -7 .766i t 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: �� ` i Underground Tkj Above mound Tarn Size of Propane Tank: (l-, 13G � Heat Stove i Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove I Other (1Qn , Is this appliance being installed in a Manufactured I Mobile Home? Yes I 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 _ For Office Use Only Current Proposed Amount Main Floor ,/ C stency Review: „�y 7 5 �� 7• fee: "`(G{`•00 2Nu Floor lase 311'Floor Additional Section: Mezzanine: Plan Check fee: �� . � Heated Basement 11 C �OV.,,,,,,,. State Surcharge fee: Unheated Basementtlf Pot Water Review fee: (}7 ` CO Other Unheated 911/�Approach rvs i 9 .C)b Garage/Carports3 Z TOTAL: $ 253.5L1 Decks t Number: 1313l Other 1 six/Check Number: =��.r! ✓ ESTIMATED COST(REQUIRED) Date: /' A .Fair market value of all labor and materials foundation to finish I1 [1:5 -- 1 i 7s, c� oa ' Initials: cf){2%....... C:\Documents and Settings\mochil\Desktop\Master Permit Application'-Ii-04.doc • StormWat 's APPROVED Require STORMWATER PLAN vt.,soN ca JEFFERSON COUNT li I JUL 2 1 2005 :.ti DEPARTMENT OF COMMUNITY DEVELOPMEN1 4 621 Sheridan Street • Port Townsend • Washington 983E-8 !EPEE oN UNT e 360/379-4450 • 360/379-4451 Fax DE PT.OF C , E E V E L . E i' http://www.co.jefferson.wa.us/commdevelopment/ stGNATUR . STORMWATER SITE PLAN SUBMITTAL TEMPLA MLA# M L A V b V PROJECT/APPLICANT NAME: o H!`1 4 C7 rfm E. A LBE R T 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. 0 1401LO A ' 6EDkoom fl�s1 DEN CE W1 N ,A 3ASEME/fr 45 9fOIL) vOA/ Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. R5rE-R TL 7)4E. $VaR,Nl ruH'r 2 SiTe P1 AW. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. /N Lo )3 TALE ENT// t- A/a 4 f Rdii /D rlig rLOINa., 7 ' Wi RA T 0 EL.EVATIOA/S 5-WA A) Ok! l fE5ITE PLHN! I7 'PIM 5-7/ N 13-"Vi Ep Lvi7 D 11 II>007ED ClZMti'S AND O/tim AM-77U.:6/ J&t/' d o 11OP 4. Describe the existing soils. Indicate soil type on the site map. RL I O ,5H/-N1V 6i r/L. _c/Vt 6:ED1 EC✓f REPORT PA 6-L S /" 6 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below,and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. ,t c u iz Ac• WATER DRAW 3 7'0 Ut/A IZ1? 771C 17ITCH A-4 oAk: 5/L � rrf L e/V vifisy'E 8"f /'15 o' ,7Ik"6 S fe2A10p i V/fit TOP OF Si ECp S20147 P vL N.r 8IZ ' /GAS C OiE 'i.Of c , /EFER TV SMR.M(,r:;;'j E- . ir& PLi3iJ. 6. Describe any excess levels of noise generated by the proposed use or activity: ill -- [i i{l '1..1 , rf 1 i i ____________ 4_11 l _ stormwater site plan template—rev.10/1/2003 L I_ . _ ._y_. __ .,--- -- 5 • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. -TO v 577) i4/47 r72 ,$/jE /'i-A W A-A/r7 S zf W ce-c i k ell gEPO 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.). l2 -ER IW A/ Ai P. 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. 9. 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. . 7'4 2>j-TF iP/1 'r T L Eli P.,-li't v' -? N 7- 4 P4 i9 Al • 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. //f) 12. Describe the flow control system. d\'` y E1,1 h-L 5 / J OP4-iN466 0/r —h 4 �N� r p� IJ9z/i/�-lUr a 11.0 Ltt /1111 I t E J U� 1 9 2005 stormwater site plan template—rev.10/1/2003 13. Describe the water quality system. /AM/i///) tr'c 6v"cL1- /N> PI A/di'2c`v�� 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. F .K" TOgEOTEC P&PD/ZT (>vs7--ee2 i/ON PiAAS 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. / CF E7 '7 O (, 61 TE—C 17. Describe the proposed surfacing material. R-r=L-'K 'ro &5i rEC SEPc/21 18. Describe methods for restoration of the site. TYc QN` 'AR 'A pE UJ/Zi,\f .;=415{�J' E S7- ZA.7` %,/ 56AT-iJC 1.7 co vt- /Ai& TI/c r/CI< F/L L 41VPA D 7-HE RA 5 c i 'N/ t)(C>i/i T/D/ R""CTL7( CGr cR PoiT 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. tv/A 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. S niki A/cr`- vv 4_ h ti e'r FE PA FGRJ'1 N774-iY ��' ;N ��I/vc i Iv c. (fir.,c > 4 G 4 9- C n- .LALC 4--if 17O Al s . 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. 1111 041 A A`c%i f)Ai A T 7-2/7 5 % .-re r c7,: [ ,,, ---;) t` JUL 1 9 2005 i `), i stormwater site plan template-rev.1 W1/2003 ' 7 • CONSTRUCTION STORM WATER 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. NO c.Lc_4 fiJc kCQ(J!RJ) 2. Establish Construction Access. COW S;PVJCTION ACG65'9 £ is TING' 3. Control Flow Rates. 4. Install Sediment Controls. /✓/A 5. Stabilize Soils. 6. Protect Slopes. A7A 7. Protect Drain Inlets. i.. JUL 1 9- 2905- 011 g stormwater site plan template—rev.10/1/2003 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). h A 11. Maintain Best Management Practices(BMPs). NM-tn' i i r, A s /JC_ 5 12. Manage the Project. Amtv4-6---c- 13y c-0v►� 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). /9I16-71 -1A-f- b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). /VAP 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. Jeer /<<(5-/76Rrf n r -- '' J U L 1 9 2005 €` ) L stormwater site plan template—rev.10/1/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. /'1/1-i/ 'TA I A/ ;4l:: 0 s%--h N z is f t•v)- -h--I . S 1-0 )' 4 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). c 7 R 7 f 5. Construction Phasing. a. Construction sequence 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. NG CON Pi_ '1Z & erVf}-TiCA> Aivi0/A4��/'iv'T' J/JOAiloft t} .4 iJrL ✓'7/)&/& S( t /z , -/VO /'OC>F II. Wet Season Construction Activities. a. Proposed wet season construction activities. NE)l��IL c1 ��`�i I It/i Cry`1 r F� �� I 1� ► •,\ v b. Proposed wet season construction activities for environmental eeinsitiv areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. rA A(No z-A i3 L NO 1,36,,A P s / '-zr b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. C,Piv7-72_4 ,2,5" Tr /3E / e'%rt,' Jl) 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Pond s/Traps. b. Diversions. c. Waterways. • d. Runoff/Stormwater Detention Calculations �� 'ri=Ar,` it/J '14-f �t j C 'L / Ai stormwater site plan template—rev.10/1/2003 10 SECTION II-EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan,a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe,and/or other filtering devices. f. Detail stabilization techniques for outlet inlet. g. Detail controVrestrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling location" to sed%or on)tonn ter--)11ty er--)llty on the construction site. Sampling stations should be located upstream and downstream �l proWet site. I )JUL 1 9 2005 stormwater site plan template—rev.10V1/2003 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 affected property. ;2-ez9( :1/2 i? (LANDOW OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: 11 { JUL 192005 {{. stormwater site plan template—rev.10/12003 12 , ....... 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