HomeMy WebLinkAboutBLD2005-00384 i •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00384 Received Date 06/10/2005
SITE ADDRESS: 160 MONTGOMERY LN Issue Date 07/12/2005
PORT LUDLOW, 98365
APPLICANT: BRUCE M EDDY PHONE: 425-643-2160
JANICE D EDDY
4204 158TH AVE SE
BELLEVUE WA 980064524
SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot:
PARCEL NUMBER: 990600132 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW SFR W/ATT GARAGE &
500 GALLON U/G PROPANE TANK
CALL IN FOR THE REQUIRE I SPE� ONS THAT APPLY TO YOUR P OJE
SETBACKS: OIK // 22. es- glior D 4/zc/ Cc4%
UFFER: Ok Oa/As No ��/
GARNG5 olG zS a6d1
Footing: O,l� // iz dS ,¢(
f , , f-N-c� Deck Mu OP-AzA OK ri/�611
Foundation: /( /2/1 GA�ACF o �`
7 ac s 1a Antoppict L� �� nt•Af uO (SEEP&Vo 13
Stormwater FINAL APprova ramNt �LAwsDK�U �CgaerF4lcan�sp A� ��
Underground Plumbing: 0
y44 a ;F �i �1
Underground Insulation: 2- 9 06 dot'/`/od,
Shear Wall : 4aks4 4k .0 a Ce-2e54� 3Lvf�l>
Sheathing: - ,S pL G9-36_ Y( � ]
Framing: /'It ?FL4 Q DcJiVv.St4PPTit/4la) yd 4 NrnyzajV
Plumbing: -
Propane Tank/Lines:- �pp j7Rwi Ok 3 Ire�tkoik.tk EAT �IOF 1 1 id b6c l4UTOK-1"2-T-6(�!r
Insulation: AIR Ss-* D' //Op OL bl�' t,(0/�, IV(y �� �Y-ii 4/ _.e
Sheetrock: Dk [a/ OL
Septic Sytem Final Appro al (If eon sewer): ' /\(
Road Approach Final Approval:
Zoning Final Approval:
Final ccupancy Approval: i'( l Co \AR
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY -SEE REVERSE
S
SPECIAL CONDITIONS FOR CASE # BLD05-00384
1.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
2.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
4.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
5.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
7.) A REVISED Stormwater Site Plan has been submitted and approved by the Department
of Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
Ili
9.) Not more than two (2) unlicens or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
10.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimu setback from Montgomery Lane right-of-way shall be 20 feet. Minimum side and
rear yard setbacks shall be 5 feet.
13.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
14.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
15.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
16.) Per MPR Code Section 3.107, Accessory Dwelling Units (ADU's) shall not be allowed
within the MPR-SF zone.
17.) The receiver dry-well with overflow located in the front of the house shall be eliminated.
The dry-well shall be relaced with a tightline direct to the roadside ditch.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
Thomas L. Aumock
Consulting Fire Code Inspector
2303 Hendricks Street,Port Townsend,WA 98368
Office: (360) 385-3938 Email: taumock@cablespeed.com Cell : (360) 643-0272
MEMORANDUM
To: Bruce Eddy,160 Montgomery Lane,Port Ludlow
Fr: Tom Aumock,Consulting Fire Code Inspector
Dt: 14 May 2008
Re: Bi,lii6 -,g4
Cc: Ed Wilkerson,Fire Chief,Port Ludlow Fire&Rescue
Site inspection was conducted on April 24,2008 to your property at the request of Fire Chief Ed
Wilkerson on your behalf,to examine the installation of your LPG container,and review the
options for installation of a fence,as stipulated by the Port Ludlow Architectural Committee
rules.
The existing installation is the container parallel to the property line.
After review of NFPA 54 and having consulted Jefferson County Department of Community
Development,it is our combined finding that you are hereby allowed to:
1. Rotate the LPG container perpendicular to the rear property line,and;
2. Install an open frame fence at the easterly end of the container to meet Pt.Ludlow codes,
covenants,and restrictions.
The resulting variance from the strict application of the setback requirements from the
International Fire Code is approved as it is found that the purpose and intent of Code remains
after the site inspection fire safety analysis was made.
Finally,changing of the color of the container is not allowed in this case,as the subject container
is open to sunlight,and a change in color would negatively affect the rate of heat absorption
from solar radiation,and a consequent pressure change in the container.
MAY 1 6 2008
4PU
ILDING PERMIT APPLICA•N M Review eviewT0360
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: -' BLD05-00384 Received Date: 6/10/2005
SITE ADDRESS: 160 MONTGOMERY LN
PORT LUDLOW, 98365
OWNER: BRUCE M EDDY PHONE: 425-643-2160
JANICE D EDDY
4204 158TH AVE SE
BELLEVUE WA 980064524 PORT LUDLOW NO. 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 990600132 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW SFR W/ATT GARAGE &
500 GALLON U/G PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 356,978.00 MAIN: 2,121
CODE EDITION: 2003 ADD'L: HEAT TYPE: PRO
HEAT BASE: 1,260 HEAT TYPE:OCCUPANCY: R_3
OCCUPANCY: UNHEATED: 1,138 # OF STORIES:
CONST TYPE: 5 1 HR OTHER:
GARAGE: 1,205 SHORELINE:
CONST TYPE: DECK: 312 SETBACK: 21
BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: LUDLOW
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 3 .
Total: 2 Total: 3
Routing Date: •67(( c//cc ei--24,›
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,432.95 BAC 06/10/05 73269 APPR
Plan Check $1,581.42 BAC 06/10/05 73269
State Building Code $4.50 BAC 06/10/05 73269
Potable Water Application $53.00 BAC 06/10/05 73269 JUL 1 2 2005
Total: $4,071.87 Jefferson County Planning
p
i g Department
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6, JEFFERSO OUNTY P i " t ` :, \ !
14 . ,,- - DEPARTMENT OF COMMUNITY DEVELOPMENT ' I L; N1o2ojj
SndWngton98368 I ,Master Permit Application M OPM
Project Description(include eparate sheets as necessary):
�'F� �� r
Tax Parcel Property �,
Number: � `1� � c`ts / 5 j
Size: 8 �/ /.zycl&(r (acres/square feet)_
Site Address and/or Directions to Property: /Go /Ntca,)r6cti6q , iq,V
Property Owner(s)of Record: BAAt c C /2-7. / .3,4A);c,C 1 . ,E51)r,,•
Telephone: y.2S= L 4' F-, /e C _z7 Fax: email:
Mailing Address: �,,,20g--/5 9 ,4U S eti:l t'!/t(•' ()A ic?C06
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
B uilding :_: Variance(Minor,Major or Reasonable Economic Use)
:: Demolition Permit • Conditional Use[C(a),C(d),or C]**
,- ingle Family : Discretionary"D"or Unnamed Use Classification
VGarage Attached/Detached Special Use(Essential Public Facilities)'"'
Manufactured Home Boundary Line Adjustment
:'. Modular i:: Short Plat**
Commercial* :H Binding Site Plan**
` Change of Use :: Long Plat**
Address 1 Road Approach Planned Rural Residential Development(PRRD)/Amendments'*
Propane CH Plat Vacation/Alteration**
Allowed"Yes"Use Consistency Analysis :: Shoreline Master Program Exemption/Permit Revisions**
::: Stormwater Management : Shoreline Management Substantial Development'*
Site Plan Approval Advance Determination(SPAAD)* Shoreline Management Variance
Temporary Use Comprehensive Plan/UDC/Land Use District Map Amendment
Wireless Telecommunication* Jefferson County Shoreline Master Program Amendment
Forest Practices Act/Release of Six-Year Moratorium
*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 t" h 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,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney'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 access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any re uir asef inspections.Access and right of entry to this property shall be requested and shall occ only d ing regular business
hours.
Signature: G Date: �� 6 -����%�
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
'
action(s)even if you are in rryliance with the Jefferson County development code.The Applicant acknowledges that he, a or it holds individual
and non-transferab "Tes orrii§G for adhering to and complying with the ESA. The Applicant has read this displ ' er an signs and dates it below.
Signature: / _ 4 1 -
Date: 61/G�`,�' , --
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C:\Documnvs and SettinFps\mochil\Dcaktop\Master Permit Application 77-8-04.doc
• •
OWNER BUILDER STATEMENT
The signer of this stateme oe�hereby certify that they are the Owners of the parcel referenced herein,that iiiey a"re.7fbtlicensed contractors and that
they will be assuming tonsibility of the General Contractor for the proposed project.
Signature:�lll . �,r Date: 6 /G�. -2Li' j '— __... • .I
/ . 1
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: G ,I J N 1 ,n '
PHONE: # FAX: ''' '''
( )
MAILING ADDRESS: �� ,-
, ._,....
EMAIL: , . ._,
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: Aisr'c,i5 h. Jp%c 74 �nl� .PHONE ( ) FAX:
�/
MAILING ADDRESS: ( )
/`�y Srr ,AJ,l cej A,A. fir Tc 40.Ai it t'6-"ge S EMAIL/kA7 e J('Sip-1l/�
Pr9ject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:New ( Wood Existing: y 9
::. Addition ::. Steel Proposed: _3 Bank Sewer
Alteration/Remodel -: Concrete Total: ,j Height: Community Systemem
_' Repair :: Masonry �/A Individual
Demolition Bedrooms: SEP Permit#
Other:
Existing: Water Supply:
Type of Heat: Proposed: Setback: Private well ; Two Party
'2 •` 'r ie Public
Total: f Name of System: ei.k i)c-
G44712. e" f41
If this is a Commercial Project you must answer the following: i
Number of Parking Spaces: Current: Proposed: Iv 1 Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees, P p oyees,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:
l4Jnderground Tank i Above ground Tank Size of Propane Tank: ..5'c+ C
I Heat Stove XCook Stove )(Woodstove Fireplace Insert tg,Hot Water Ta i �
Pellet Stove T Other /9,46FAid, 64 j;'�_L,
Is this appliance beinq 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 Ont:/
Current Proposed
Main Floor Amoun#
'' Cons s:ency Review
�.
2�' Floor �f:2C, � PA� 1,�L# ..:< _ ��
Base fe: ""
3" Floor .:24�+.
Additiy tal Section: ,+.'
Mezzanine: Plait Check fee
Heated Basement : State Surcharge fee:
Unheated Basement l�60 0 t :,
Other Unheated ;::::»:::»::::.:;;.:;.;>:::::<>:::< :::.:.:.: ::>::>::»::»»:?::;: :::>:<>::> <:. ;>;;;:.;.;;:...... _:::..„„.:._........... ...
Rd:
: :.;<:;<:;�1?1?.:;::e�!;fee_:..::,.:;;. ;;;; .;>:.;:,.::;.;:. :;<:<.:;,,:<:: :.;:.:.:.;;:.:.;;:.;:.;;;;;:.;;::.::...;:.
Gara
9
e Car
P
ort
f Zo`i:S$ � Tf Tip,L $ �Y `Decks.
Other ..........:.. r..:....:. ::>«<:<::<:::»:<::>.::<:>::>::
chic Hurnner 5 ',r : „ `
ESTIMATED COST(REQUIRED)
t..
'Fair market value of all labor and materials fou da tro n to finish
nrs
1 S✓caCc } • «initials:.;:;-::::::::>:.;;:;:.::.;;:.;::;::»::.;:«.::.;:;<:.: ::.
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C:\Document.and Settings\mochil\DesktopVafaster Permit Application 7-8-O4.doc
Sc�N c° JEFFERSON COUNTY JUN 10 200E
DEPARTMENT OF COMMUNITY DEVELOPMENT
J, 621 Sheridan Street• Port Townsend •Washington 98368 .. {` ' ''.
jr� 360/379-4450 360/379-4451 Fax l__ . ..._ - L --------
.... http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 0 c� PROJECT/APPLICANT NAME:
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.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
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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.
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6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
Ne0A-1.,I STORMWATFR Pt AN
1-- '00-ttisl f-e JUL - 1 2005
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JEFFERS CO TY
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DEPT.OF C \1 Y DE .LOPM NT 5
;torrl� ater SIGNATURE: A
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, strearr I
steep slopes,etc.)on the site. Indicate location on the site map.
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical arc
(streams,wetlands,lakes,steep slopes,etc.).S // /�
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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.
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.
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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 lar e"projects or projects that involve the potential for dispersion of contaminants.]
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11. Describe the ormance goals and standards applicable to the project. r' "-�-
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12. Describe the flo control s
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sIormwater site plan template—rev.10'1/2003
6
13. Describe the water quality system. Z/5(O 5——
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14. Describe the conve ance system analysis and design. f i
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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 consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. �j
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17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
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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
here.
Ai/14
20. List here and'nclude any special reports or studies conducted to prepare the Stormwater Site Plan.
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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
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible 0
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.
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3. Control Fl w Rates.
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4. Install S iment Controls.
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5. Stabilize Soils.
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6. Protect Slopes. A : i i
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7. Protect Drain Inlets.
stormwater site plan template—rev.10/1/2003 8
12 Required Elements—Construction SWPPP(continued)
4 8. Stabilize Channels and Outlets.
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9. Con of Pollutants.
N/A
10. Cont I De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs). "r
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12. Manage the Project. j
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2. Adjacent Areas. 1
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.
ofa. Descri 'tion of environmentally sensitive areas that are on or adjacent to the site.
stormwater Lsite plan template—rev.10/1/2003
9
b. Description of special requirements for working in or near environmentally sensitive areas.
dA ' 161
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).
N/A
5. Construction Phasing.
a. Construction sequence
CLk4,' , 4,ec,}Jq: , ,�v,t.,J1I,�-7/ J/ /&t,�-
b. Construction phasing(if proposed)
AiiA
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Nil
I. Provide a o osed constructio s edule.
e (p ^" /2 1 Zoc55—
II. Wet Season Construction Activities.
a. Proposed wet season construction activities. — ..----- -`�`1
Fg,gti1,co ,^1 OWL,9I4 ,C 7,Ji T y '.
b. Propo ed wet season construction activities for environmentally sensitive areas.
Al A 0Ka)
i
7" Financial/Ownership Responsibilities. "i,: t` _�
a. Identify the'roperty owner responsible for the initiation of bonds and/or oth financial securities. -` _
hi
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
lU/A
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. Ili 4
a. Sediment Ponds/Traps.
b. Diversions. N
d I
c. Waterways. I
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/1/2093 1
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revis
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 ap�'toperty.
/ r ?
o /0/voos---
(LANDOWNER OR AUTHOR REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
\.....____' JUN 1 0 ,.._,J;,') '1
, t" ' -i_ ..... ' '
•
12
stormwater site plan template—rev.10/1/2003
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