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HomeMy WebLinkAboutBLD2005-00304 0 0 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00304 Received Date 05/11/2005 SITE ADDRESS: 861 THORN DYKE RD Issue Date 07/18/2005 PORT LUDLOW, 98365 APPLICANT: ELAINE M MORGAN PHONE: (360) 698-1274 TERRY ELLINGSON 5145 NW EL CAMINO BLVD BREMERTON WA 98312-1129 SUBDIVISION: BRIDGEHAVEN DIV 5 Block: Lot: 8 PARCEL NUMBER: 935100007 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: ARMSTRONG HMS BREMERTON INC PHONE: (360)373-5061 2531 PERRY AVE BREMERTON WA 98310 Contractor's License: ARMSTHB307QL Expires: 5/70/2oo75063 PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE, DECK 464 sq. ft./42 sq. ft. COVERED PORCH CALL IN FOR THE REQUIRED IN ECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: DEC q% -,� UFFER: /J, Footing: OK e/ Os ,e- r Foundation: '!" OS/ Stormwater FINAL Approval: Ok 7/04 p Underground Plumbing: Underground Insulation: Shear Wall : OX ///�.oS Sheathing: �� Framing:Otipgmace4M-Y Ok-?/94 -02Amiot £, 00 4 P ,�! Plumbing: 0( /Z�B/ps 1 id( pL Propane Tank/Lines: mi- Insulation: �i�SFisft 4& bZ �G10t.�s) VAu/�fEAG°ElL1�tx�a�AID FAe BAS�tc�l,C OK-(C � AL Sheetrock: .r �/ OtP Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: ®k -%r- e/d 7/4:5/4G / HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL IEQUIRED 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 UILDING PERMIT APPLICA MLA05-00294 N ReviewT :I . Jefferson County Department of Community Development Type:Port Townsend, WA 98368 lik PERMIT #: 621 Sheridan Street BLD05-00304 Received Date: 5/11/2005 SITE ADDRESS: • THORNDYKE RD PORT LUDLOW, 98365 OWNER: ELAINE M MORGAN PHONE: (360) 698-1274 TERRY ELLINGSON 5145 NW EL CAMINO BLVD BREMERTON WA 98312-1129 SUBDIVISION: BRIDGEHAVEN DIV 5 Block: Lot: 8 PARCEL NUMBER: 935100007 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: ARMSTRONG HMS BREMERTON INC 2531 PERRY AVE PHONE: (360)373-5061 BREMERTON WA 98310 Contractor's License ARMSTHB307QL Expires 5/7/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOl NEW SFR W/ATTACHED GARAGE, DECK 464 sq. ft./42 sq. ft. COVERED PORCH TYPE OF WORK RES SQUARE FOOTAGE:: TYPE OF IMP NEW VALUATION 261,221.00 MAIN: 1,473 CODE EDITION: 2003 ADD'L: 306 HEAT TYPE: HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 OCCUPANCY: UNHEATED: 157 #OF STORIES: CONST TYPE: 5N OTHER: CONST TYPE: GARAGE: 938 SHORELINE: DECK: 506 SETBACK: SEWAGE DISPOSAL: CON BANK HEIGHT: WATER SYSTEM: BRIDGEHVN BEDROOMS: BATHROOMS: Exist: Exist: Prop: .2 Prop: 2 Total: 2 Total: 2 Routing Date: ! I j72/0 Type Amount Paid Bv: Date: Receipt: Permit $0.00 BAC 05/12/05 RD Y E n Plan Check $0.00 BAC 05/12/05 V" State Building Code $0.00 BAC 05/12/05 JUL 2005 Potable Water Application $0.00 BAC 05/12/05 Jefferson Count y Planning Total: $0.00 MtBuilding Department OWNER BUILDER STATEMEM i t 15 f. i ~ E4 t -x i tf h E i The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein, at they __ _. _ _nsi!, 1 they will be assuming the responsibility of the General Contractor for the proposedthat are not Ik ensn'd contactors and that project. I 1 Signature: MAY 1 1 209r 1 11-) Date: GENERAL CONTRACTOR OR MANUFACTURED�� HOME INSTALLER: Y W.S- -r VY) k'1 vY r UC.S Q;c.' bre O_i- (3 W 3 tt _FAX MAILING ADDRESS: 1i-or) ct7 L1�X t (�l0 �� � � � 25 i Pzrlr 0 L P . ar^t�rvl t � EMAIL: OW�(`()IDV GY1 YYlSVI. C YYI CONTRACTOR'S LICENSE WAINS �NUMBER: C'�YYY1S=t Q a �1ti ARCHITECT" c-� � �J `3� L NUMBER t��, q �_y� ARCHITECT • T ii! .�7 _��k it`� CIA 1 t 1 ZY5\ �Y S PHONE (Z�✓J)L� ' 1L4 l I FAx:( ) L 9 0' 5 Li o i cv Or.„q,ci(6i-1 C;Cj EMAIL Project Type: Frame Type: Bathrooms: , .' New __ Shoreline: Type of Sewage Disposal: ❑ Addition0 Sewer ❑ Aerann/Remodel 0 Steel Pam: 2- Bank 0 Community System 0 Concrete Total: 2- Height: ❑ Repair 0 Masonry Individual System ❑ Demolition ❑ Other: Bedrooms: SEP Permit# O tj._ a Existing: _ Setback: Water Supply: Type of Heat: Proposed: i 0 Private well ❑ Two Party Total: .:;�. Public Name of System:'f id CLt-{-VR c v 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 IBC Occupancy: IBC Type of construction: Pooposed Nhave If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply;Service? Yes / No 0 Underground Tank ❑ Above ground Tank Size of Propane Tank: 0 Heat Stove ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot W r Tank ❑ Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /(No a s When applying for a permit to install a propane tank you must also submit ite 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 I Current Proposed , }Z - t aY 7 .r, Main Floor p ". oihf �� Li-� �}f, onslstletc, �� �y ' 2 Floor --...3 i.7)\-Y ..:211124`,--ff,.."c'' . •• ' ', s ,* .1 qtym:-.: ••, 7*.'.-P:.(.'.tw.,-.32:.:,-qt14:Wsif,4A, „' -,,';-:-: _ ! eas y y '` xww j 1 z � rt it 3, a f- y , � aMezzanine: Plan'`Checkfee: t . [ ` Heated Basement .; x _q` {" y y�},,` • Y-.•� .t*far: State Sutchae fee F Unheated Basement r x • a x � ' ir sr 4 911 r` , e - c-"P a . :Other Unheated i J k.: 1 -w- ,1y AtisGaragA/Calpo 1 U 6.'V .t c TOTS $ y y 1, , k �..: .•,:v r'rRy��.j�i Decks �` f ` �"�� r ^- .���� ���,.:: ._ Number µ . �A 1 .: ESTIMATED COST(REQUIRED) 3l rOther } • •Fairtusricefvalue of all labor and materials foundation to finish /( " } r r r� •, [// i` '�.�1`'L ` .? ^ ��• ♦'C� �^� �Z���Y$. #t'r�a"�}x'� �A`2�'* r 57, tt Ni, ._l C.\PetmitCente NFORMuc,,\43p Fp ter Permit Application 7-8-04.doc /2 l/1bb5 14:by .ibb,i/..:I"-1bl l AKMS I KUNd tSKtIvv--'I UN I-"HOC_ CJJ 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. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: _ _ „� � PHONE: FAX: MAILING ADDRESS 2C �- �)O,iNTIE. MIL: i `M� ( D� _. y CONTRACTOR'S LICENSE` • �1 j� A1N3 kV r` 1b�)r `din'c�' 'NUMBER: �y �t� � i 1 NUMBER ARCHITF NGINEEF�I n _1 ` y� yt�-� MAILING RC,S �� 1 ' l ,' , Q --, PHONE (.21-5 r L-3! `� a .( S. 'Y C_:bk t EMAIL Y3 Project Tom: .T, me Type: Bathrooms: Shoreline: Type of Sew ( New Wood Existing: age Disposal: ❑ Addition 0 Steel Proposed: LZ Bank ❑ Com 0 Alteration/Remodel ❑ Concrete Total: 0 CommunityaSystemem ❑ Repair Height: lndlvidual❑ Masonry SEP Permit#❑ Demolition 0 Other. Bedrooms: _ Existi Water Supply: Type of Heat: Pro Suck: 0 Private well 0 Two Party posed: Total: Public Name of System: 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 IBC Occupancy: Proposed IBC Type of construction: Will you have Food Service? es / No If this is a Profane Tank and/or,rgpptlance Installatffl permit,mark all Items below that aooly: 0 Underground Tank 0 Above ground Tank Size of Propane Tank: o Heat Stove ❑ Cook Stove 0 Woodstove U Fireplace insert ❑ Hot Water Tank 0 Pellet Stove C Other Is th installed i ufa,ctured a Home? Yes / No When applying for a permit to install a propane tank you must also submit a siteplan showingall of the buildings,all lines, tank location and size,distances from the propane tank to all property 8 property including the reserve area, lines,buildings and septic system components, Square Footage For Office Use Only j Current Proposed I Amount G?- •;rW•c�,{Q,, 4; .' � ;; Main Floor �`� Consistency Review: ( 2Nu Floor I Li J_ _ l`'v`bal,g` [ A 1 lqab sz4 tip• Ba se fee: . 3f'Floor i l . Additional Section: Mezzanine: Plan Check fee: ` pleated Basement 1 la �cp State Surcharge fee: Unheated Basement Pot Water Review fee: D Other Unheated it 1 AX?\3 12. S'7.00 (311/Rd Approach e-- )' Garage/Carport1`i/ ()C c-Vs , ID11C(P TOTAL: $ Decks (�1 g 11 (9 I©CflodifeceiptNumber: Otter o Ch\)eit�,7 r_pkv\ .), % q`+ Cash/Check Number: ESTIMATE COST REQUIRED `i' 4 Date: .Fale . = value of all labor an• -• . .: -. ,datbiin to finish 41 .282 j -� I -3 ` t-t ) DR:I/ Initials: G:\PeatritCaucr\FORMS\r)RD FORMS\Master Peauir Application 7-5-04.d« • SPECIAL CONDITIONS FOR CAS t BLD05-00304 1.) PRIOR TO THE APPROVAL OF THE FOOTING/SETBACK INSPECTION AN ORIGINAL LETTER STAMPED AND SIGNED BY THE ENGINEER OF RECORD SHALL BE SUBMITTED TO THE JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT STATING THE SETBACKS TO THE STEEP SLOPE MEET THE REQUIREMENTS AS SETFORTH IN THE GEOTECHNICAL REPORT PREPARED BY GEO RESOURCES, LLC DATED JANUARY 17, 2005. 2.) A Stormwater 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. A Certificate of Occupancy will not be issued until the engineer of record verifies plan compliance and submits an original stamped letter to the department. 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. 3.) The development will be serviced by public water and a well will not be utilized. If a well is required for potable water the applicant shall meet all of the Aquifer Recharge and SIPZ conditions. 4.) 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. 5.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 6.) 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). 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.) Pre-existing legal lots of record less than one acre in size in Rural Residential districts are subject to the stormwater requirements in UDC Section 6.7 and must meet the "Area of Impervious Surface Coverage"to the maximum extent practicable as determined by the Administrator." Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 10.) The building height is not to exceed 35 feet. 11.) Setback from Thorndyke Rd. right-of-way is no less than 20 ft., side setbacks are no less than 5 ft, rear setback from top of bank is 30 feet due to Landslide Hazard Area. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 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 perking spaces is required for the single-familyr ence. 15.) The road approach permit (RAP05-00112) must be inspected and finalled by the JeffersonCounty Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact the Department of Public Works at 360-385-9160 for the final road approach inspection. 16.) No footing drains shall be located within 30'downslope of the onsite sewage sytem or the reserve areas. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 "&.4. S©N as I r--z i f zc t t'JEFFERSON COUNTY ,,i �C DEPARTMENT OF COMMUNITY DEVELOPMENT4/AV ' 4. , „ , 621 Sheridan Street•Port Townsend • Washington 98368 360/379-4450 . 360/379-4451 Fax 1 `W' INO O http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0 G f 2ct 4- PROJECT/APPLICANT NAME: tVI02-6 D4J Please answer all of applica t may choosett a following incorporate the elements into the general plot tpl n ere t for the Master Land Use he question calls for pApplication oriction on atto 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 ,1 •}�Cb41 �Jt.C ` �jG \Q �U.5MI�`') t. F• x(c t C.ZL V 1 .11ii1(,ti 'aL !i. , 1 Existing Conditions Summary 2. Describe the existing to ograp . Indicate contours on e to ma i S " • 0 ._.i '""�1 3. Describebe the existing vegetation. Indicate native vegetation areas on the site ma . J� ct-Wroe P •r tC 4 aVC,SSA J 4. Describe the existing soils. Indicate soil type on the site map. , is 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. 6. Describe anA excess levels of noise generated by the proposed use or activity: APPROVED STORMWATER PLAN I'FRMIT # RID stormwater site plan template.doc—rev.1012/2003 JUI. 05 - 4304JEF 5 JEFFERSON COUNTY OCO °EPT ��Rso r��:rTY r 31GNATURF: 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, stee slopes,etc.)on the site. Indicate location on the re map. , l ew, C��s/t� r\ .tor. v�-- S • 3o s:e c_ove 1/4CV11V5lMi 0+'� 'cl UEy1 'VA.V\iC0-k. f ltI Per — g.ove. VV'C Q S 'rvt.L,. Iktt-cicv‘a- 8. Describe the genera ' ' ity of the site, including adjacent�and,useS structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes,steep slopes,etc.). P..�St .,. t 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 Ian and differentiate proposed facilities from exist'ng faciliti-s. ` [i.014--, VO SV. —.60 i k riot 44.-Vvell`kvIt - + `� 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.] NO tnk. 11. Describe the performs c oals qnd standards applicable toyie project. v— wti vkd eiroScco+ 12. Describe the flow control system..'yy,,,,,, 41)K.Q_ • PERRI ti _ ND stormwater site plan template.doc—rev,t4t12/1y0Ci _Y - _�' 1 V f} i...',1 6 I Jf FFf RSON ICJ. ' MAY 1 3 2005 COUNT}, DD D -- 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 Clgarir%imit 2. Establish Con tructio Access.% , + Q vim v 0C�� 'S t,1.�-Z S r()C.-11_i,ovt P v�}vimv�l'�C' v- vva 4..2.St 100 c) 3. Control Flow Rates. g i it- 4. Install Sediment Controls. \-j_, �(� 1 Tevt-a0._• 5. Stabilize Soils. \ SPr' a k5�'Jvr - GLv .ot--S— 6. Protect Slopes. e 5\"f s. 7. Protect Drain Inlets. RP v .Q_ PERMIT # ND I L MAY 1 � 2I��J ' r stormwater site gantempk/le.doc—rev.10V12/2003 ,I3 030 , 8 JEFFERSON COON TY DCD • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Out s� ��1 p 5L5e1 C \1&v1 tv.. ,9. Control Pollutants. i1_ 10. Control De Watering(the act of pumping roundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). C ~k%C1 Q 43r U CA TO O LAU0colr— Ac. WIQIvl i!�v- 12. Manage the Project. /� l mwL —cam e2s Via; i;iti 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). nn b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). �^ ,Xrc113-(U vrovlo v \( 1eS 0)44_ SiI — 3. Environmentally Sensitive Areas. a. Description of environmen ally sensitive areas th�at arj,o�cent to the site. PERMIT # BID ______-- stormwater site plan template.doc-.reev.10/122003 ----- - - 1 9 JEFFERSON COON I MAY 1 3 2005 TYDCD 1 b. Description of special requirements for w in n or n ar e�ironmentally 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,pe eability dep text ,soil structure). i d d 5. Construction Phasing. a Cogstructio sequence /1 • �� .,i r '—Lve.�Slo� Covt EVO\ ;131 ra, al Evo • b. Construction phasing(if proposed) °i �� r`lCJlA-42_ • 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. Wl WO_v— D d IL Wet Season Construction Activities. a. Proposed wet eason construction activities. vt is b. Proposed wet season constru activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initi Lion of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility fo liability associated with erosion and sedimentation impacts. `fib b �� okr DES 8. Engineering Calculations. Provide Design C Iculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. , b. Diversions. At c. Waterways. ti A- d. Runoff/Stormwater Detention Calculations _ IC-) I2S-fl PERMIT # Ain I _ _ . '1 stormwater site plan template.doc—rev.10/122003 j _ ` MAY 1 - 2du, 304 _ 1 JEFFERSON _ - COUNTY DO r • 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 control/restrictor 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 locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. PERMIT # B stommater site plan template.cop—r$v.1N12J2003 //] '7l• J4 MAY 1 2005 EFFEDSON CDONTY DCD 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. 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