HomeMy WebLinkAboutBLD2005-00341 BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00341 Received Date 05/26/2005
SITE ADDRESS: 63 HADLOCK BAY RD Issue Date 09/7/2005
PORT HADLOCK, 98339
APPLICANT: STEVEN YAWN PHONE: 360-379-5301
PO BOX 1327
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: 10+
PARCEL NUMBER: 901122009 Section: 12 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW SFR&
ULos928te40,0 5a> M&250 GALLON PROPANE TANK
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: J)- �V lok
UFFER: 11�')-7-i�
Footing: 12- 21L-Q
Foundation: .' //f �/
Stormwater FINAL Ap / 'rAv t,rr7L"AJE Z /zd/d691� ) ij, PIG 3/2.07,
Underground Plumbin ,A„t, PP/NL Ok q a� vUnderground Insulatio2/ bobShear Wall : S�4E.4+ L A,L,A Z 4.Sr eAlPa orL 0713L1V
Sheathing: Sf/��r' S�,S/ �'
Framing: Q A zz7a6#1'
Plumbing: OK 4507,64, '�/�
51/
Propane Tank/Lines: �ivtE�Q �oyq,�c' /�►n)E OX B/7 AL al'ale 3 �NK 4�4/25
Insulation: /he .S,�A4 dK x/Z?�DZ. I.v,-c.u/✓,.1-J1 G:414 `' Lip --.; -OK) a 06
Sheetrock: ���i""S k /'s °7
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: , 2 ,//p r
HEALTH DEPARTMENT AND PUBLIC WORKS PPPROVAL REQU -ED 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 CA,t BLD05-00341 •
1.) Easement for onsite sewage system required prior to final
2.) 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.
3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
5.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
6.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
7.) 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.
8.) 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.
9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
10.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any 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).
11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
12.) The building height is not to exceed 35 feet.
13.) Setback from SR 116 (Oak Bay Rd) right-of-way is no less than 30 ft., setback from
Hadlock Bay Rd. right-of-way is no less than 20 ft., setback to shorelineas identified on the
revised site plan is 50 feet. Side and rear setbacks are no less than 5 ft. If an
environmentally sensitive area (ESA) is present, then the more restrictive setback shall
apply.
14.) 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.
15.) 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.
16.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
17.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
•UILDING PERMIT APPLICA SO Review T Ty 323
N ML ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00341 Received Date: 5/6/2005
SITE ADDRESS: 63 HADLOCK BAY RD
PORT HADLOCK, 98339
OWNER: STEVEN YAWN PHONE: 360-379-5301
PO BOX 1327
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: 10+
PARCEL NUMBER: 901122009 Section: 12 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW SFR &
A/G 250 GALLON PROPANE TANK �e-al tbt on S 13e.)(v(.0(,,
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION : 298,550.00 '� MAIN: 2,219
CODE EDITION: 2003 ADD'L: HEAT TYPE: RAD
OCCUPANCY: R-3 HEAT BASE: — y 10 HEAT TYPE: PRO
OCCUPANCY: UNHEATED: -4,705— # OF STORIES:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 504 SETBACK: 50
DECK: 2,700 BANK HEIGHT: 21
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 _ Prop: 3
Total: 2 Total: 3
Routing Date: / // G
Type Amount Paid By: Date: Receipt: A proved/Date
Permit $2,108.15 BAC 05/26/05 73219 APPROVED
Plan Check $1,370.30 BAC 05/26/05 73219
State Building Code $4.50 BAC 05/26/05 73219 SEP - 7 2005
Potable Water Application $53.00 BAC 05/26/05 73219 fferson County Planning
Total: $3,535.95 Bull a tment
STY '
(;;;;ON
¢ C �� JEFFERSON C
DEPARTMENT OF COMMUNITY DEVELOPMENT
kill** `Q 621 Sheridan Street • Port Townsend •Washington 98368
360/379 4450. 360/379-4451 Fax
4q e. www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: fls l ,f92°C15
Project Description(include separate sheets ;
Tax Parcel riuitity
Number: 0; /2.20o Y
Size: 3. 7 AcnC s (acres/square feet)
(,3 HADLocic 8Ay .RoPD, poky !-tADLocK, WA. y';339
Site Address and/or Directions to Property: Sk II oAk ( A rf gnA f ¢ I/A o}.ck Bit y RoR u
Property Owner(s)of Record: . STEVEA S. yAWiti
Telephone: I AO- 3 77- 5'3 0 1 Fax: 8.3 I- 659 - E'7 5 I email: yA w,0 6..6340e .cool
Mailing Address: ?CI is K 13,2'7, 'Peer ffR d Lo c_K , (,e A
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
Et-Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
[Single Family 0 Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
❑Manufactured Home ❑ Boundary Line Adjustment
0 Modular 0 Short Plat*"
❑Commercial* ❑ Binding Site Plan**
❑Change of Use O Long Plat**
❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments--
0 Propane ❑ Plat Vacation/Alteration"
E Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
0 Stomiwater Management ❑Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use Cl Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,isle and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fad made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide ar .pss and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any requir t spections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: Date:_
I
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 vi a 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 co ' nce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferab res ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
•
Signature: f - Date:
7
G:\PermitCenter\FO \DRD FORMS\Master Permit Application 7-8-04.doc
R DER SATE
The signer of this statement hereby certify areOWNER the Owners
BUIL of the parcel referenced herein, -y are not licensed contractors and that
they will be assumin r nsibility of the tractor for the proposed project.
Signature: Date: g`a2 /- 05
GENERAL.CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
D-New O-Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: 3 Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: .3 Height: f3'Individual System
❑ Repair ❑ Masonry �i' SEP Permit# SEP Q S- S,G,
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback:
❑ Private well ❑ Two Party
Type of Heat: Proposed: ._-3` @-Public
IRA D r la,-1 - f LooA- Total: 2 5 o Name of System: Dun Jisf/
wrH. ioi4,4.
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:
0 Underground Tank ❑ Above ground Tank Size of P @pane Tank: 2 5'o A &
❑ Heat Stove V"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 For Office Use Only
Current Proposed Amount
Main Floor oil Consistency Review: 1
N� 'mil? ln,4gg • ,.
2 Floor Basefee.
3`°Floor Additional Section: --•--"
Mezzanine: Plan Check fee: Q, _ 30 ,.., a/�f try'_
Heated Basement RW t•5��6 State Surcharge fee: ' E ��FK SO
'1�lo(o / 7 . . . f„ 1.
Unheated Basement ;;I Pot Water Review fee: ---
/7aS 4 . .i
Other Unheated / ' 11/Rd Approach fee: 2w S`
Garage/Carport SO / - .,�cY
CC fatAie 4: 3 1r-E 1lg1.910
�
Decks
Recap Number
Other '' Q h/( teck Number: `2
ESTIMATED COST(REQUIRED) 'ate: { 5/c)� J OF.•Fair market value of all labor and materials foundation:finish = .- I
lif 2o1 o0o aot Qt.' ai aa(:4- '' . amY:al g 2 s` au
G:\PecmitCenter\FORMS\DRD FORMS\Master Permit Application 7-804.doc U
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JEFFERSON COUNTY
11 DEPARTMENT OF COMMUNITY DEVELOPMENT
4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax MAY 2 6 2005
O http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 05 — PROJECT/APPLICANT NAME: S T C Val Y c(,J,J
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. �?Yy • 2ZJq rn- H 1Q O t �'f
`Ae¢Arhe Mgr 0 -tit e 1. 1 tacat syur �1�r� is rre en„tl d devolac e i �,�
S }rfJD ft Wftie 4ro �f .20 .RANk 4AGIn� {1 small Gaye. .
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
Af luA-lerr ecf, fkere 15 /� �o4 c.l- bAN1c u-fk 'Ire"; ern v 4o- `.a-�,.
q - tip✓. K. $ „Ivp.J1va1 5loft /. J,? -f 74 4'1S.C.- p roI,:yrd AV•lef
1_s--F-t r.-cJu-til Sloes �. �rn�as. or ,�e �a,✓:l �i^i .cr/
3. Describe the existing vegetation. Indicate natibe vegetation are s on the site map. �J
3 /r1,¢-t LvrK Celli,4 .4r. ! 3 �S d'1,4 t 1 -4 ploy L0.044 _A/44 ✓( /in cl we,-,
r�. ._CR,,4,55`/ PA/4 rat �j011,Qi, s.f((r wi*L act f�:- ('erQA,ts -f-o F�.)iIT-iNIG ROAi) rA PP t
n nr l',r.d
lro A-�.411 aes.c -{ esf n' ,4v '`�•"J Fiv waft, YOMr /Al 1P 6 Lwir berr• Sce.J� b ram.,. , .q' L
4. Describe the existing soils. Indicate soil type on the site map. j w��>.
_SAteitIA )nfirn ak b i, IAt•� 5cfe L.)I1I 5nh.r 1114,, AI ,/✓ �Sf✓v7�S.
fit .SCA;'i,, -1 j1rGi' -/to aJs 3'. t f' k q'c A-r•r./M�/.f-+�i� i./ - .4-n a.�s rJn z i l7
�t>a617 Jn A-M
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.ri tre 15 no JisnAi.'. g-r/AJA S�Jrllct w3fr,e etvrin7 ,>r i}44-e�' A,Avtf 1'YF
rr✓i //Ir See
/r re ✓ t"•1JJ.4r1 ALf� 1�. -Rb-i-F-S W 41e,- -+1-tiro&%. -' Q J Ct1� Qnl 1 R-r�u
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o d rci �., Ld-}a 41 1.1.4, �r , Pa-AA-S� _� o lv /0 f 9 c i e/yar,;-
6. Describe any excessl levels of noise generated byYhe proposeleuse or activity:
'ii e re. f3-Lt�1 n0 r n.tie . r c.5,Qa n}5 ,41,,w1 So o -N ra -,n < o
i
s ct h o v s— oipprolcln.+1r, ,ion �,,15 7 h /f-
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stormwater site plan template-rev.1 0/112 0 03 J U L 2 6 2005 S tormwa to 5
Required ,S
JEFFERSON COUNTY
DEPT.OF commuNiTY ncvr.l no..
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, S
steep slopes,etc.)on the site. Indicate location on the site map.
. 51g 6P 5_1 ofe A 4- -t4,c. 13 a uk w i+{. I'r ,,2-i -U I r 0 e j-,. - W k-k s e.<Q'..e ArZso y
j m p-II .6e&ar m I 5frf it „j k, W/f A fi r tr r7 )4, p r x«f �•YO ii,,_L✓ ,•••
1r ot.,./n 1,-�.o.,_ P-41. R/3 y �2.±7_0 Al dill)Z 0 Lk /.B V /e6/2.0# /D ' ?Al, 7Z4 _
7-7;ffia 0f fill/DcA env .Ao 6e_".
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.). AA �
74 e re ,4 AL b L2 1'S LN Se/L r i ss,,/7 .v// "it c,;�y de___lifl1 e" (e-NE/la,/ !i[fY61/en/
/la 12/1_, /9-If/P /1edf Ai -d i, if Lz fr� i dt. 127Lt -u//G/ >as�e,-,,>,,,4
4-ov {power. e1nrb 1�/t4er YS�pN,a raIn,,� •F-�- _I' -iik2 16-e4-O/kh. ot cQi r 4-14._.-
}-o A-A L,i4,k I -1-1,k-o i, +-{w•_ 4Jr.csMi_ -ru4 D A/ " , 411431 2cie` / A-,f_ 1IA.4 4 -
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.
7lir fs S /lo 1//5,, k titer ire/ Z.i4 // 7 L e dc,A-/.. h-r./av4/ �,/.d1. Tic
Qt-.7oiec /le( i)!..4ec w/// fill/,' .3/n f ,A.IL," .r, f'�rv� L✓•/^ //4.'' J5/l,,.,/
"1e%✓/A] /,.. /! .1ioYM/rgle v' /.oe,Jrn/ d/f <1-4./ V'P,./ w/14A. le,.74--4-ye-r-,1 P ." ,.v-.. /
Tyr.¢✓-®/ /'"DnJ/r•u/�/Q.✓ 74. �j//f-itA�c //icv4 li;// /�to le �r.//y �ff�rr �
(/ a 4 L .,/ q ft ‘...// 4 C/, ,✓e'v/r.J X„ A .�n r6.�/.¢-r.11 7 i r75�/ !! ivr',a -f.,
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10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facildies pro used
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.]
f _rA
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//l1 .c0✓✓$II' /4JL¢. /n/,// it eonf/Y.Aic.,7I /i_ „cihst-t
11. Describe the performanceL goals and standards applicable to the project. 1--(4....-
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/D ie o�,.,e..r/ ffr i,be //, TILL ie e r/:X r,re 0-'144-- I .// /e /21 n..,/ .,
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12. Describe the flow control system.
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistelai/with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material. MAY 2 6 2005
18. Describe methods for restoration of the site.
Iv a l-1_L/E- U C C.IE TYFT e o 4 j. A n, a sr et..A r n.G e.,t c-a- S u sr o -e.eSt2vtTe.�✓ MA-t R/.oL5 !✓/�L .?i / Lot`
`aA
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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
ill here.
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.
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.
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2. Establish Construction Access. 1
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3. Control Flow Rates. // AT- oNe is a re_ .
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4. Install Sediment Controls.
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5. Stabilize
-Soils. 11
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6. Protect Slopes.
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7. Protect Drain Inlets.
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8
stormwater site plan template-rev.10/1/2003
•
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants. t
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
/4 o )1"r 4e 4-e -, /
/S �XBretfr� {ate '�-f.f n.4 s.fr .
11. Maintain Best Management Practices(BMPs).
•
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas. //
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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ov-r ;Stec? r3A-pk"_ _
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MAY 2 6 2005
storrnwater site plan template—rev.10/1/2003
9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
FIN`I ruNo#4 W. 11 4L r >f Ili 0110Nt4-eve.4 A,tJA e.I.1 In"utof AS
Aetes1#1-n.1 . AIi ja° it °÷-1'1.‘/ 41r0 ir. EDA54-euef'or. eo41 be
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
e. I /S .S/4-pill y Le,4 w'� . . Eito 5 t a n/ i. ,L/ ,4-.-- fi / . /7a s/ "./ /91 f f4i .i. 1
f 1 hi 44.-- eai fnvV 11 ue►-y �rwat'a-f . 6 ra uejj/� Eu,Ll f e us.e4Q
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5. Construction Phasing.
a. Construction sequence //�� 1
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b. Construction phasing(if proposed) i(// �i
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed
construction schedule.
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II. Wet Sea€on Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Wen'fy the property o er resp9nsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/12003 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 knowled . I also certify that this application is being made with the full knowledge and consent of all
owners of the aff to erty.
( R RIZ SENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
MAY 2 6 2005
stormwater site plan template—rev.10/1/2003 12
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