HomeMy WebLinkAboutBLD2005-00439 tUILDING PERMIT APPLICATION MRLA05 00410
TI
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00439 Received Date: 6/30/2005
SITE ADDRESS: 2063 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: ERIK B NORDSTROM PHONE: 206-373-4050
JULIE NORDSTROM
PO BOX 716
MEDINA WA 980390716
SUBDIVISION: Block: Lot: T15 +
PARCEL NUMBER: 721174008 Section: 17 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr UNHTD WOODSHED
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 0
VALUATION 12,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 387 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: LUDLOW
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 0 Prop: 0
Total: Total:
Routing Date: ( (1.742.7
Type Amount Paid By: Date: Receipt: Approved/Date
State Building Code $4.50 SLE 06/30/05 73456 APPROVED
Plan Check $136.01 SLE 06/30/05 73456
Permit $209.25 SLE 06/30/05 73456 SEP 19 2005
Total: $349.76 / J e : • ounty Planning
& c uildin rA artment
'og- p267 4 " A
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00439 Received Date 06/30/2005
SITE ADDRESS: 2063 THORNDYKE RD Issue Date 09/19/2005
PORT LUDLOW, 98365
APPLICANT: ERIK B NORDSTROM A 45° PHONE: 206-373-4050
JULIE NORDSTROM
PO BOX 716
MEDINA WA 980390716
SUBDIVISION: Block: Lot: T15 +
PARCEL NUMBER: 721174008 Section: 17 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: UNHTD WOODSHED
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
/ ' 2k Vz/A5,
UFFER: Ain
Footing: elk 1/2.05,
Foundation: OK /0/%%6'
Stormwater FINAL Approval: N/A
Underground Plumbing: Al A
Underground Insula yon: NA
Shear Shear Wall : V "A
Sheathing: WA
Framing: OK VB�Z�
Plumbing: /(1l4
Propane Tank/Lines: /VA
Insulation: N/A
Sheetrock: A/A
Septic Sytem Final A proval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: /)/< -(far IA4 ttiN/07
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
O
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 CE A BLD05-00439
1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
3.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
4.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
6.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
7.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
8.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative
buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed development.
9.) An additional setback of five (5) feet is required from the edge of the streamside buffer
area to the proposed development.
10.) A permanent physical separation along the boundary of the streamside buffer area shall
be installed and permanently maintained. Such separation can include installing logs,
trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
11.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or
every one hundred (100) feet, whichever is less. Signs shall be in place prior to and
during construction activities. The signs shall contain the following statement: "Buffer- Do
Not Remove or Alter Existing Vegetation."
12.) 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.
•
13.) VOLUNTARY MEASURES OCOASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
14.) 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.
15.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
16.) 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.
17.) 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.
18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
19.) 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).
20.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
21.) The building height is not to exceed 35 feet.
22.) 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.
23.) 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.
24.) Minimum setback from private ingress/egress easement shall be 20 feet. Minimum side
yard setbacks shall be 5 feet. Minimum rear(shoreline) setback shall be one foot for each
foot of bank height, not to exceed 100 feet. Site plan depicts setback to exceed 50 feet. If
ESA's are present, then the more stricter setbacks shall apply.
25.) 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.
26.) A Geotechnical Report dated l�fay 16, 2000 as prepared by Associated Earth Sciences,
Inc. was submitted in conjunction with the single family residence permit. The report
addressed the stability of the geologic hazard area. The proposed semi-heated recreation
building is positioned further landward than the existing single family residence of which
that setback exceeds 50 feet per the submitted site plan.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
• •
SECTION 9 - GDESC PLAN REQUIREMENTS
TABLE OF CONTENTS
9 - 21 DESIGN OF ROOF DOWNSPOUT INFILTRATION TRENCHES
The length of trench required is based on the assumption of providing a bottom trench area sized to infiltrate
at a rate equal to the rainfall intensity for the peak 10-minute time step for the 10-year, 24-hour duration
design storm event, and by the maximum infiltration rate (Im) which is based on the Soil Texture Class by
the United States Department of Agriculture (U.S.D.A.) designation system. The length of trench required
is determined by dividing the required infiltration area (AI) by 4 feet (the two-foot trench width plus-one
foot on either side for side wall infiltration). c1 FAI
AI is computed by using the following equation:
AI = (0.054 Pio AI)/10 IM
Where:
Pio= 10-year, 24-hour design storm total precipitation, inches.
IM=the maximum infiltration rate, in./min.
AR= area of the roof tributary to the system, ft2. (Note: a typical single-family residence has a roof
area of approximately 2,000 ft2).
Therefore, the trench length required is:
L =AI/4
Maximum Infiltration Rates for Roof Downspout Infiltration Systems
IM (in. /min.)
1. Coarse sands or cobbles 0.333
2. Medium sand 0.138
3. Fine sand, loamy sand 0.040
4. Sandy loam 0.017
5. Loam 0.009
Actual soil logs and measured percolation rates may be utilized if documentation is provided with the
design.
The system shall contain a basin or sump well prior to inlet. These structures shall include a sump and a tee
on the outlet side. - ` m
April 1997 k O f r •
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. co�� JEFFERSON C • I I. I ; rl 1i/' - t-�
w� DEPARTMENT OF COMMUNITY DEVELOPMENT r
�a - - f;i I
621 Sheridan Street• Port Townsend •Washington 98368 �_ �UN 2 2���
360/379-4450 • 360/379-4451 Fax , t,E,
4,, iiii
4. rO www.co.jefferson.wa.us/commdevelopment L
�?N� ! Tlci SCP4 COUNTY
_TFT..P165,41!r,--, , -, ,
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
t An_f'n n-1/-6 in 6.-1
Tax Parcel mot, Property
Number: 1 Z 1 17 "t cZ) Size:
(acres/square feet)
Site Address and/or Directions to Property: ti /� 4 �,% -__ -
Property Owner(s)of Record: :�C Et: t- ),,1*i k E'O 0i'yi
Telephone: Fax: email: _
Mailing Address:
Applicant/Agent(if different from owner): C. r t r -Ire (..">)i VT
c
Telephone: :--?A-:;(', . 1 j --7.-i c j Fax: i(rI i'-4A-7 .`sti c o email`O y�e Gx ri `if
Mailing Address: J (J
What kind of Permit?(Check each box that applies)
pl Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑Demolition Permit ❑Conditional Use[C(a),C(d),or Cj**
❑Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**.
❑ Manufactured Home ❑ Boundary Line Adjustment
0 Modular ❑ Short Plat**
0 Commercial* 0 Binding Site Plan**
❑Change of Use ❑ Long Plat**
0 Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)IAmendments**
0 Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 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 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 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 access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later Inspections.Acra cs and right of entry to this property shalPl equested and sha occur only during regular business
hours. / �j/
Signature: V [ Y'�r�.f LhJ II-D r;:9 -1✓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 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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
WNER BUILDER STATEMENT •
he 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
iey will be assuming the responsibility of the General Contractor for the proposed project.
ignature: Date:
iENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
AAILING ADDRESS: EMAIL:
:ONTRACTOR'S LICENSE WAINS
DUMBER: NUMBER
kRCHITECT/ENGINEER: PHONE ( ) FAX:( )
JAILING ADDRESS: .: EMAIL _
'roject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: ❑ Sewer
1 Addition 0 Steel Proposed: Bank ❑ Community System
] Alteration/Remodel ❑ Concrete Total: Height: D Individual System
Repair ❑ Masonry SEP Permit#
7 Demolition 0 Other. Bedrooms: Water Supply:
Existing: __ � Setback: ❑ Private well ❑ Two Party
type of Heat: Proposed: ❑ Public
Total: 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 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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove U 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 t:eieOftiee UsaiOnly
Current Proposed Amount
Main Floor Ccxtsisstency Review:
3r0 Floor r~ • '�
Mezzanine: Plan Chick fee k
t
Heated Basement '_ ` ,+Y c i', 4
t
Unheated Basement W ,, 4.. ` � ' `-;-„. �
Other Unheated 9 dAppm ` e r ,,� Y° p{ , . }r
C
Garage/Carport t 1€ .
Decks l 1311cc2
rY �,n q` y'r
Other l� a 3 ` k -1 s.-' r :,,,y'f:'" �,i+.�..,,"mob
ESTIMATED COST(REQUIRED) pats. . , ."��' '44,,' �? .: `
*Fair u..*et r -. d materials foundation to finish • ' ti ma's ti n% ,.s
• 21 Duo Initials`: 4 : z..rt >e'r.- Y..�., .,
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3:\Pemu t---, •'4'k DRD FORMS\Master Permit Application 7-8-04.doc
• •
. .�,g" 0N G'Q
JEFFERSON COUNTY
�, o� `�K! DEPARTMENT OF COMMUNITY DEVELOPMENT
&0. 621 Sheridan Street • Port Townsend • Washington 98368
tO 360/379-4450 . 360/379-4451 Fax
NG'49$1http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# /7G/4 0 " 476`j1/0 PROJECT/APPLICANT NAME: f(',"Zel i,,--1
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. f 7�r4M,14, , .1r, 5,,,
e7.7'r .Ic-> 4 t.t r/re: e*-, SI- —f-(5- 7,
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.
.Cl :.—A.17,7 -
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 t 1, 1, I` _ � ,,t 1
�TOR1b4WATCft PLAN - ,
A \
rmwater
Sto , SEP - b716 !
Required SEP - 7 2005
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stormwater site plan template—rev.1 0/1/217 0 stormwaterj 5
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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.
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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.).
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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 T5.30
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 posed facilities rom 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 large"projects or projects that involve the potential fordispersion of contaminants.]
' ,/14---c: "<.<' .-,
, ' ' ,� .` 1 11. Describe the performances� goals and standards applicable to the project. //,
.12. Describe the flow control system.
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13. Describe the water quality system. .////ei
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.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. y
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site. 7e
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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.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
40 rt
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 oc contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
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stormwater site plan template-rev.10/1/2003
• •
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.
2. Establish Construction Access..
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3. Control Flow Rates.
4. Install Sediment Controls. //
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5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets.
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stonnwater site plan template—rev.10/1/2003 8
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12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. ,Ai
9. Control Pollutants.
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10. Control De-Watering(the act of 0pumpinggroundwater or stormwater away from an active construction sfe).
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11. Maintain Best Management Practices(BMPs). e
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12. Manage the Project.
2. Adjacent Areas. ''-it4
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
;: .
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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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b. Description of special requirements for working in or near environmentally sensitive areas.
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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).
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5. Construction Phasing.
a. Construction sequence
b. Construction phasing(if proposed)
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6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide proposed construction schedule.
AP
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Ide ti a property owner responsible 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
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8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions. (� •" ^s
c. Waterways. I,�)�'
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d. Runoff/Stormwater Detention Calculations C t I )
SEP 6 2005 0 1i----
stormwater site plan template-rev.10/1/2003 i"'"" ""-•'---- ----- - 10
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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 constructo of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site sto agement BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These shout ing 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 p erty.
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(LikNDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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G.B.W. 0 GE B.WITTLER um.DESIGN •PLANNING •ARCHITECIVRE •CONSTRJCRON MANAGEMENT DATE STATE OF WASHINGTON PORT L U D L O W, WA S H I N G TO N
06/22/04 I791'F ORDADRIVEA N.E.°. a. PH.360-779-6699 SITE PLAN
PR No. 7-30-05 gUliE N-140 FAX.360-697-5400
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