HomeMy WebLinkAboutBLD2005-00468 1
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MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD05-00468 Received Date:
SITE ADDRESS: 160 BLACK BEAR RD 7/19/2005
PORT TOWNSEND, 98368 Issue Date: 8/18/2005
APPLICANT: BARBARA SMITH
P.O. BOX 381
PORT TOWNSEND WA 98368
SUBDIVISION: Block:
Lot: T75+
PARCEL#: 001321030 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR/ C & J EXCAVATING INC PHONE: 360-683-7741
DEALER PO BOX 430
CARLSBORG WA 98324-0430
Contractor's License CJEXCI*099PC Expires 8/15/2006
PROJECT DESCRIPTION: New MFH
MAKE: SKYLINE
YEAR: 2006
SIZE: 44 x 28
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 8/18/2006.
CALL IN FOR THE REQUIRED INSPECTIONS THATAPP .,--a OUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTINe LAB •r PADS USED,'- �'
Stormwater FINAL Approval: P/p/<)G 1,0;4 6-19s
Blocking/Plumbing: /O-/Y-o3
Propane Tank/Lin s
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps: S/.0X2-v'/6-a1_0cis, /Q_,gg ,45-' tO-) -I-4(i
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR T 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 CASE # BLD05-00468
1.) SEPTIC PERMIT IS FOR 2 BEDROOM. BUILDING PERMIT IS FOR 2 BEDROOM
MAXIMUM
2.) The application was reviewed by the Jefferson County Department of Community
Development staff on August 16, 2005 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Seismic Hazard Areas.
3.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
4.) JCIA is a community airport for civil aviation and has been designated an Essential Public
Facility by Jefferson County in accordance with the provisions of the Washington State
Growth Management Act and the Jefferson County Comprehensive Plan. Properties in
the vicinity of the airport may be subject to potential discomforts or inconveniences from
noise and vibration associated with aircraft takeoff, landing, over-flight, and normal ground
operations at the JCIA site. The County does not consider these inconveniences and/or
discomforts arising from such operations to be a nuisance as long as they are consistent
with Federal Aviation Administration regulations and standards. It is acknowledged that
areas lying outside the fixed boundary of the Airport Overlay I may also be subject to low
level noise and vibration. This information is intended only as a disclosure to property
owners and potential property owners of their proximity to the JCIA, and the potential for
low-level noise associated with airport activities.
5.) The applicant is proposing to create or add 3270 square feet of impervious surface and
3270 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal submit a stormwater plan
meeting Minimum Requirements#1 through#5 of the Stormwater Management Manual
for Western Washington.
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.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
8.) The site plan as submitted with the building permit application on July 19, 2005 has been
reviewed for consistency under the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to
the stamped, approved site plan dated August 16, 2005 shall be resubmitted for review
and approval by Jefferson County Department of Community Development.
9.) This approval is for a manufactured home only. Any future permits on this site are subject
to review for consistency with applicable codes and ordinances and does not preclude
review and conditions which may be placed on future permits.
10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
11.) 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).
12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
13.) The building height is not to exceed 35 feet.
14.) Minimum setback from Black Bear Rd right-of-way is 20 ft. Minimum side and rear
setbacks are 5 ft.
15.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County
Comprehensive Plan Land Use Map effective August 28, 1998.
16.) A septic permit (SEP05-00155)was approved on July 17, 2005 fora system of 240
gallons per day.
17.) Black Bear Rd (P17) is a private access road. The road approach is existing and an
address of 160 Black Bear Rd has been assigned to the parcel.
18.) A minimum of two (2) on-site parking spaces are required for the manufactured home.
19.) A stormwater plan for a medium project 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.
MLA05-00438
1 tILDING PERMIT APPLICATI �� Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00468
Received Date: 7/19/2005
SITE ADDRESS: 160 BLACK BEAR RD
PORT TOWNSEND, 98368
OWNER: BARBARA SMITH PHONE: 360-301-6309
P.O. BOX 381
PORT TOWNSEND WA 98368
SUBDIVISION:
Block: Lot:
PARCEL NUMBER: 001321030 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: C & J EXCAVATING INC PHONE: 360-683-7741
PO BOX 430
CARLSBORG WA 98324-0430
Contractor's License CJEXCI*099PC Expires 8/15/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP New MFH
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,188
VALUATION 60,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: 5N GARAGE: 216 SETBACK:
CONST TYPE: DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT __
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
ui...)\
7 .G6_1
Type Amount Paid Bv: Date: Receipt: p
Permit $157.00 SLE 07/19/05 76186 AUG 1 4 2005
Potable Water Application $53.00 SLE 07/19/05 76186
Total: $210.00 Jefferson County Planning
& Building Department
JACK WESTERMAN 10 Jefferson 11111ttt Courthouse
. ASSESSOR PO Box I127frPort Townsend. U11'.% 98:U 8
4:160) :185-9105
MOBILE HOME INFORMATION FORM
4.OWNER'S NAME/MAILING ADDRESS ,441 l i et tO3 k- ' I �,
i+tr: JVsi a
NAME: '�
kitc9reld; R C4 X-- S C
ADDRESS: I L� 'BOAeg)(?nr-71' 1A A�eill
-, in 4 sn�,Lod
PHONE NO. 30 3Ol - 6 7 6s
CUTON gA 1:73Voniu a
The purpose of this questionnaire is to obtain informa>( aldinither the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determ"'i 'wDVl Cher h r • "7_ .'
iM.. h`.
,-T., .. i �. : �. arr ild - the
tax rolls in Jefferson County or if it has been moved to t i 4unfy front • L rea.
1 OMOIIILE HOME DATA: JUL 1 9 2005
1
(A) MAKE 3 I l k(e..__ (B) MODEL VI .• ' "`01:4::
1.� ` —' YEAR Z .
(D) LENGTH /�[ .:...,„,..;.,
"► - (E) WIDTH 2 K • (F)SERIAL.#11 is
(G)YOUR PURCHASE PRICE (Do not include sales tax) Lk/600 —PURCHASE DATE
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE( I WLVL, 4-6oks .S c .
ADDRESS 2-(12 F_AI i�� t.�; Wk "` c� .
(B) WAS MOBILE HOME ASSESSE IN JEFFERSWN COUNTY LAST YEAR? Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year. hC&c.4-1pd6 &al-a
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes (Nod
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS 16%0 6iacX-Iecur- Pg.)�o (ouz,hSen 1 Uaa.r
REAL PROPERTY PARCEL #/DESCRIPTION C ( 3.,..R.,1 03C)
ignature of applicant
THANK YOU FOR YOUR HELP! L1i rt P BID
Cass-eQ . p
ds-,-
OSSELL. Properly Technician O 5 - 1�
JEFFE S C0 7;1 t.CP
,ii,;a N oo6, JEFFERSON�UNTY •
ti F ' 'ice ` j DEPARTMENT OF COMMUNITY DE' PMENT r._ - ; ,
"\ ''4 621 Sheridan Street • Port Townsend• aShin nl9$3i68`,L it -NI
360/379-4450 • 360/379-4451 Fax 1 {T'-
�qS IiIN p� www.co.jefferson.wa.us/commdevelopnleht E
JUL 1 9 2005 I
Master Permit Application M J-- LIi8
Project Description(include separate she is as necessary): t
Tax Parcel Property Number: COI 32, ( c 30 Size: 5_A c R Q 5 (acres/square feet)
Site Address and/or Directions to Pro rty: /&) 36C_t d(co.r- l l),< \(,Lam,- c vic N c Cc,
Property Owner(s)of Record: ,r• c� �-(3` - m i.-n— t lsS 34,`y.
Telephone: S(p O - 3 0( - (o3 O?Fax: 3 f,0 - 3$S• i'S$3 email:
Mailing Address: ?t .0 .13ft.x. 38), enr-t`rownSeng)l 6:6CL, / Lo8
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
1043uilding 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
❑Single Family 0 Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
%Manufactured Home 0 Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* D Binding Site Plan**
❑Change of Use 0 Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Propane D Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis D Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
Cl Temporary Use D 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 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 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.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. jf�Z4�
Signature: f, _g. tiMAZ,- Date: 7" 7- U S
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 res onsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 13 i g• ► • Date: 1 7-0 ^
G:\PemvtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
IPOWNER 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: /1[1 g .2)nil Date: r ,9 L_ yl
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
�lccc,vAw- _`f0,�� 5u,tl r,s � �r�` vc Wyk ('SL-c ) 6, 3- '774// ( )
MAILING ADDRESS: 1 , 'f ( EMAIL:
CONTRACTOR'S LICENSE _0/ I (I;)3 , t-L 7 t t d WAINS r.51.y 7
NUMBER: , p A !), 4 4 S 7 NUMBER .' ' - ,
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: r/ - EMAIL
Project Type: Frame T,y'pe:y '''lathrodms '-Shc rekne: • Type of Sewage Disposal:
ie New ;11c.i lck*c,.. ' re 14''.,, v Wriei`a i- • • Existing' •'e'�' s- t 1 i'4A` , •.. , u`Sealer
0 Addition ❑ Steel Proposed: .q Bank ❑ Community System
0 Alteration/Remodel ❑ Concrete Total: f), Height:Bedrooms: Water Supply:
System _ �
❑ Repair ❑ Masonry SEP Permit# - �- I5 5
I
❑ Demolition ❑ Other: PP Y:
Existing: Setback: ❑ Private well ❑ Two Party
Proposed: Z
TypE(f Heat: Total: Name lof System ] r t R
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:
11 Underground Tank ❑ Above ground Tank Size of Propane Tank:
VHeat Stove i(Cook Stove ❑ Woodstove ❑ Fireplace Insert [l}-'Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? 'esj/ 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 Consistency Review:.
f /8� �""`.'j
2"u Floor Base fee:
1C31. C
3fd Floor . _ — ,,_/Md$il Section:❑. [ u. FS f P
Mezzanine: I '" i' 4"-Plart heck fee:
. �__
Heated Basement j j Ste v rcharge fee:
JUL 1 9 205 �L
Unheated Basement P t Water Review fee:
Other Unheated ,-911/Rd Approach fee:
.E
Garage/Carport TOTAL:rd$'' ' :.;ti'�,.;:I ..
�5 ' n.
Deck —
s
fi r;, : Receipt Number: 'l
• -
Other Cash/Check Number:
ae1,
ESTIMATED COST(REQUIRED) Date: - 1/�W)
•Fair market value of all labor and materials foundation to finish (
4 ` Initials: F1,..",:, • x. t •c -' -- -,
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
• • PERT # BID
.goN
05 - 04 � ;
�co JEFFERSON COUNTY JEFFERSONi TY B
ptrz7 ,,4 DEPARTMENT OF COMMUNITY DEVELOPMENT �D
,et 621 Sheridan Street • Port Townsend •Washington 98368
fiO 360/379-4450 • 360/379-4451 Fax
tiociNhttp://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# - t PROJECT/APPLICANT NAME: 1 l2 C.E. J•7-1
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.
Existing Conditions Summary
2. Describe the existing topography. Indicate coptours on the site map.
l
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
i.C' � i1ON-• t(`co�5 f 3,arZ
4. Describe the existing soils. Indicate soil type on the site map.
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.
-------W1111.•••••••• •••••••••• •
6. Describe any excess l'vels ieR
���'��use or activity:
kJ I - JUL 19 z0u5
AUG i6 .� ' '>
�► 3
JEFFERSON COUNTY
DEPT.OF r� MMUNITY DEVEL0p1 ENT
SIGNATURE: .L :z
stormwater site plan template—rev.1 O'//20BY —77 5
• •
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
1 ;Nc
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.).
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.
D t\iAct
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.]
Liz I 1
11. Describe the performaivegoals and standards applicable to the project.
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12. Describe the flow controd system. , 'rF a 1'
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stormwater site plan template—rev.10/1/2003 ^"^�^ '" "�" 6
. • •
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13. Describe the water quality system.
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14. Describe the conveyarSce 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 consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed su¢a6ing material. t c �
18. Describe methods for restoratio of the site. rl
j
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.
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. ,9 , Fi "h 5U A f
1
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.
ye-
2. Establish Construction Access.
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3. Control Flow Rates.
4. Install Sediment Controls.
A)
5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets. JUL 1 9 2005 )
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storrnwater site plan template—rev.10/1/2003
8
• • •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
/4
9. Control Pollutants.
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
✓Ii
11. Maintain Best Management Practices(BMPs).
r� 5
12. Manage the Pr�`�fri
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). 1
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JUL 1 9 2005 ,_:'i,
3. Environmentally Sensitive Areas.
a. Description of enviiRrentally sensitive areas that are on or adjacent to the site."- r,i'r 1,4 II'
stormwater site plan template—rev.10/1/2003 9
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•
b. Description of special requirements for working in or near environmentally sensitive areas.
I . IA--
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).
5. Construction Phasing.
a. Construction sequence
b. Construction phasing(if proposed)
tai
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
-/0 -CS—
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. Identify the property owner resRonsible for the initiation of bonds and/or other financial securities.
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b. Descnbe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. 1(/4_
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the f
a. Sediment Ponds/Traps. eV F�,Th 'r' l ~': (—`; -�,
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b. Diversions.
c. Waterways. 11
d. Runoff/Stormwater Detention Calculations L,c> U U 1 9- 211o5 i_ 1
stormwater site plan template—rev.10/1/2003
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 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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(LAN DZfr4.--.NER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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