HomeMy WebLinkAboutBLD2005-00513 •
BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00513 Received Date 08/4/2005
SITE ADDRESS: 3914 E QUILCENE RD Issue Date 09/28/2005
QUILCENE, 98376
APPLICANT: STANLEY M NEALEY PHONE: 425-883-8382
LINDA A HERZOG
16210 NE 116TH ST
REDMOND WA 980522264
SUBDIVISION: GLENVIEW SHORT PLAT Block: Lot: A
PARCEL NUMBER: 701311020 Section: 31 Township: 27 N Range: 01 W
CONTRACTOR: ARMST HMS REDMOND INC PHONE: (425)885-5552
2709 AU AY N C ,h0ow_ cnor,rIP���
AUB WA 98002 94 11 - !-*N .'e.'. ,-A,•- k(t..Wc(
�Ckkviv , 1\Ctnt.*Pic
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PROJECT DESCRIPTION: NEW SFR W/ATT. GARAGE & BELOW GROUND 500 GAL
PROPANE TANK
CALL IN FOR THE REQUIRE 4 INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: Qx 2/ 4*
UFFER:
Footing: Acl,LraG
Foundat on: 0 7/'7 04,1 "
Stormwater FINAL Approval:
Underground Plumbing:
Underground Inflation: I
Shear Wall : wOn1Qs//�/C6
Sheathing: CC 74.,/
Framing: f ,vDroz. t24T6re 5Ysr OP a✓pi- VOL 4ak 5J31/4 lam'
Plumbing: A 'i aC S I , itr `(STe —a-sr re) 8E4,P016204,416731/41
Propane Tank/Lines: �NSriou.7 I1CW, K1,J Dirt& . Lr�r,EYi,onr9C.p/Ci�t?1,� '-/1/'
Insulation: 4Le Ai, a< /25� 4 t /ik < l)X 5�3��D6 / (UU/�
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: 1017 _ J/ —,Z - '
HEALTH DEPARTMENT OD 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
1UILDING PERMIT APPLICA•ON MLA05-00518
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00513 Received Date: 8/4/2005
SITE ADDRESS: 3914 E QUILCENE RD
QUILCENE, 98376
OWNER: STANLEY M NEALEY PHONE: 425-883-8382
LINDA A HERZOG
16210 NE 116TH ST
REDMOND WA 980522264 GLENVIEW SHORT PLAT
SUBDIVISION: Block: Lot: A
PARCEL NUMBER: 701311020 Section: 31 Township: 27 N Range: 01 W
CONTRACTOR: ARMSTRONG HMS REDMOND INC PHONE: (425)885-5552
2709 AUBURN 191I
AUBURN NA 98002
S2G.ho M e. Sock)b c e-S
u'% 1C,ene l w
REPRESENTATIVE: " `
C I( .1 G PHONE:
PROJECT DESCRIPTIOP NEW SFR W/ATT. GARAGE & BELOW GROUND 500 GAL PROPANE
TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,456
VALUATION 121,635.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 528 SHORELINE:
CONST TYPE: DECK: 600 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL --
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: Sioc (� c
(Z
45
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,497.75 SLE 08/03/05 76377 /� p P R O\1 r
Plan Check $973.54 SLE 08/03/05 76377 �1 p
State Building Code $4.50 SLE 08/03/05 76377 SEP 1 8 2005
Potable Water Application $53.00 SLE 08/03/05 76377
Total: $2,528.79 ?t1CH_6W1ty Planning
& Bu di partment
L
r0 2 e) 5 A
SPECIAL CONDITIONS FOR CE t BLD05-00513
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.) 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.
9.) 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.
•
10.) MANDATORY MEASURES • 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.
11.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
12.) 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.
13.) 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.
14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
15.) 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).
16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
17.) The building height is not to exceed 35 feet.
18.) 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.
19.) 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.
20.) Minimum setback from East Quilcene Road right-of-way shall be 15 feet. (Variance of 5
feet approved by Al Scalf on 8/25/05 per UDC Table 6.6 Note 6). Minimum side yard
setbacks shall be 5 feet. Minimum setback from shoreline is approximately 235 feet. Per
recorded plat, parcel has a depicted triangular shaped building envelope due to open
space, streams and associated stream buffers.
21.) 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.
22.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
•
23.) Building and soil disturbance is restricted to the buidling envelope area. Except for
landscaping, beach path maintenance and tree cutting an pruning as detailed below:
a. Removal of trees shall be limited to a maximum of 10% of the trees. No stumps shall
be removed.
b. All trees greater than 6 inches in diameter of breast height shall be retained.
c. Selective limbing of trees to enhance views may be prmitted.
24.) Pesticides and Herbicides will be applied by applicators licensed by the Washington State
Department of Agriculture consistent with the requirements of RCW 17, 21 and RCW
15.58.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
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1514314
423\\
..iAJEFFERSO�OUNTY r... 1 .0
1, ; i
DEPARTMENT OF COMMUNIT r
lr'DEVELOPMENT
621 Sheridan Street• Port Townsend - 'i-`
Washington
360/379-445o - 360/379-44 I asses AUG - ,
7 Fax 3 2005 ! r
162117401...., wwnu.ca.jefFer;orti.wa.uslcommdeveiopment I
Master Permit Application I
.___ MLA;._ Q .--�"
Project Descdpfion(Include separate sheets as necessary):
(k M (' LIC.=( (_L FV l-i/L C{ ,Q wi r cMi% �A'r
Tax Parcel C E%lV t f
Number. L .3%/ C�a C} Property /
Size: U AC-,
Site Address a (acres/square feet
and/or Directions to Property: 8 9/ )
Property owners)of Record: • r h c5 i C_C ,Q �: 7
Telephone: `) - �'�:: '� .7 DA `l4 1
Mailing Address: i
ax email:
AppliCant'Agent(If different from owner):
yu
Telephone:
drest;s. 3 t.4- Fax: S 7 l email:__CQ; �x f:AYl tart' r 2�� F
-—g - )Ste.-- ry -
What kind of Permit?(Check each box that applIes)
0 Building a Variance(Minor.Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use jC(a),C(d),or Cl**.2—Single Faffirity
-Mer Chad Detached 0 Discretionary`D"or Unnamed Use Classification
a nular ase age( t toed Home 0 Special Use(Essential Public' Facilities)**
o Ma 0 Boundary Lira Adjustment
D Commercial* 0 Short Plat**
CI Change Use 0 Binding Site Plan**
(
o Address Long Pot**
) 1 cad� a Planned Rural Residential Development(PRRD)1Amendments*"
_0-Propane 0 Plat Vacation/Alteration**
0 Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management D Shoreline Management Substantial Development*"Site Plan Approval Advance Determination(SPAAD)* D Shoreline Management Variance
0 Temporary Use * 0 Comprehensive Plan/IJDC/Land Use District Map Amendment
a Wireless Telecommunication0 Jefferson County Shoreline Master Program Amendment
Cl Forest Practices Act/Release of Six-Year Moratorium
--- *May require a Pre—Application Conference "Requires a p plicatfon Conference
Please Identify any other local,state or federal permits required for this proposal, if known:
—I hereby designate (gyp DESIt3NATiON 4F AGENT
-
� my agent In matters relating to this application for permit(s),
OWNER SIGNATURE
/r � ��,�(i l�� to act as
Date: €'.- ` - 0,5
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 wile 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,jedgnyents,court Costs,reasonable attorneys tees 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 r®quired,later trispeCtyons.Access and right of en to thisshall be
hours.
/1propertyrequested and shall occur only d ring regular business
1 Signature: t.._ Ge.i.,, e.i2ie ,t'(,'1/„�J
The action or actions Applicant will undertake,es 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 this applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. My Individual,group or agency can file a lawsuit on behalf of ee endaBlared species rewarding your
aatton(s)even if you are In compliance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds Individual
and ran-transferpble responsibility for adhering to and oomplyIng wan the t?Sr4. The Applicant has read this disddirmer and coigns and dales it below.
Signature; • e
z l .,.. Date: ;/ : 5
G:\FexrnitCenttr\FOtiMSLDR17 FORMS\Molter Permit Application 7-8-04.doc —�
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QWIdf=R BUILDER STATE
11^ ' !a
The signer of this statement does hereby certify that they are the Owners of the paroet raterneed herein,that they era not
lat
they will be,assuming the responsibility at the General Contractor for the proposed and tt
Signature: �° t- AUG " 3 2005
I° )
GENERAL CONTRAGTgR Oft MANUFACTURED FLORAE bVSTAL�ER: ! '`—••��
MAILING ADDRESS:
>�( • .f R i '6 F�►yx: � 1
CONTRACTOR's LASE R 1. C�1` J t �`f b`J I � —�- -
86, Ass �' r �^>'z��A>, �
N�ER: �' y1 1 N �---+ -� C"
A r�1,�S1�'/'�acre)K,l7 NuM9ER
ARCt1rrF_CT/ENC�IfYE6R: A � .. �, � ;
MAxING AcoR ss: ,. `Ii5.� •4 0 . k� ` �Nt'a?� .t VL fit.PHONE ('�iCz' ) 1 .., f* FAIL( )
-
.Pso e�;yp4; f-�Type: Bathrooms:LZ'
New wood _ Shoreline: Type of Sewage Disposal:
❑ Addition ❑ Steel Proposed: -, � Sewer
❑ Alteration/Remodel l l Concrete Total: :'2- c ❑ Community System -❑ Repair 0 Height: ❑ individual s tB , C 5' •�
Ct aemo4klon ogler Bedrooms:
'- SEP Permit# C
t=xis6n�1: Setback: Water Supply:
Tyra of Heat: Proposed: - 0 Private well ❑ Two Party
PQt.'(- 1 kw: Total: __. �Put�i+c
— Name of
rain' 7-4
'7-11:11itclairmtpmemlol_pilivect Vgu mum answer the f>ollowrno;
Number of Parking Spaoes: Current —
Proposed: _. Number of
ADA
Number of occupants(includes owners,tenants,employees,etc) Current - Pfoceding Ste;
If Is aOccupancy: an IBC Type of construction: Will you have Food Service? Yes / No
I In atlo rm all
o Underground Tank 0 Above ground Tank Sire of Propane Tank
Cl Hest Stove , -Cook Stove ❑ Wmove ❑ _ C�1 ,• � 1�R�;�iZ 'S i ZC,
Fireplace Insert ,er Hot Water Tank 0 Peet Stove 0 Other 1'-,',(C�-
this (hen eta fn anu�factured/Mobile Home? Yes •1 6 i3C-_ .-
Wire»applying fora permit M Install a L-t�C.�/l`t''t=�-
W he tank location t distancesinstalla propane
nnethptank you must also submit a site plan showing all of the buildings,all pro pony
Mc! . , the►eserye area. Propane tank to all property lines,buildings and septic system components,
S•uareF• , . . f ,''�^a- "a 6 e 5
Current .; rx • ..c.°t:'.`r'e
Main Hops i • •:, 1_. r t r ,t {. ;r5.
�'y�,� �' -4�• r pT• ^ •., ; a y. V env (y�iJ n+. an'A •�
2 • Floor
.4 r •• • k, .4-A +•fir�, ., t-: ; fi a d!i t (
3 ` Fkor _ f vo ta� >rt
• 1-,n Ir, - y
Mezzanine: . , • t,. •�. r, `- } 'r p .r ,« !
•
'- r S •tr fy» t, � ttr�u t
•
Heated Basement $ 9 3 k R • '
—
1 ♦ T) 1 W ,
Unheated Basement 111111.p. ?�. w.s ri. 0 s.; 4L
..:;
—
s � 5 ;r` -J Mari r ti�, jt ,t Pik•r f ♦i¢ ;414.1kf'ii6t.
Other Unheated
y '1Y y t '•''''''',---� � °4„"� tie 14
�: !v f 'P &S r .'if swat F.r1
3.. 1 t �r.-.� i7 '' r�._
Garage/carport
t r'1 „ S q�Y1 Arrt iNf �r
Decks t ' ., . S•��iF "'tr R Y 'r.q t ky J .......
j^:',s•' S ±�.: - . _ + ' �- Y'?L i ,�, 'kit.�.��.FS�c�
`t /� ,
s.
Other7
0111111"
'i. Q ,Y., rr� �,,, Y± .l ✓ev�j f 1, . e i R r' * t
.V!S }: ~stir ti �' din ' ,r' y y S�/t
"'ii�- ,� At!` , Y P IdT Any i , V i
(REQUIRED ` a,. < r7, £ wA.i 'a t« r a f 'h Ct
yr-airESTI ante( - _. . . . - . { ti L
ES1 ma/rfef �� 'Y F v t3 rL . '4 '.�
r � pry
errand -4 •• . k'S.At �rF. . .r t �. "! �i k '�
a ` t �� r'a�u"'p'�y`� it ,d
• , 'sit' .� ttt x 1
\b oa\FaRl.ms\DRn ,4S\MasteK Pctmit Application 7-8•0440c
• 'FAQ 74 Pam; lK1 CA C_. :
. ,SON O,
" , OO JEFFERSON COUNTY
,., y DEPARTMENT OF COMMUNITY DEVELOPMENT • M
cf
621 Sheridan Street• Port Townsend • Washington 98368tI1iritl ; r
rq�, 360/379-4450 . 360/379-4451 Fax
RING http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# !11 J 0 -[ /r PROJECT/APPLICANT NAME:cj i f VEA(,...c-y Z//13a ik-Icx
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 Maste.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.
5_F I4 /LIhO L w i n t 5-Ag Q`I )(Mc-el-et' M66 - �T��OE
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
�3'/e A.l c5'ol06- :TA) nt EVC&L) �cScc�I 5/Des J 1/5(,C
7 O 8 F.eoiU I 72 eitZrC
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
1,0 Ec--D 5/ / / s5 e
4. Describe the existing soils. Indicate soil type on the site map.
7)1(-T 5tik n
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 s,te map. Depict separate drainage basins on the site map, if
applicable, and indicate acreage of each.
4-1-0L0 i J 7 t'r Leff Au LON 'kJ A . bt,26--k -
.. v l QJik PLC' ) SJ
Ltii- (JttN�1C� (fL()r
6. Describe any excess levels of noise generated b e proposed use or activity: APPROVED
Akwe &°T �� /16'5 -Lt) STORMWATER PLAN
AUG 2 5 2005
Stormwa 's
stormwater site plan template.doc—rev.10/12/2003 Require JEFFERSD C U 5
DEPT.OF I DE •P1�/EN-
SIGNATUR .lN�/
13. Describe the water uali system.
[try-
14. Describe the cony/��ystem analysis and design.
15. Describe the source of fll 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 C7e,/1--
17. Describe the proposed NA----
material.
/
18. Describe methods for a toration of the site.
f
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. /L) /,
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.doc—rev.10/12/2003 7
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 m p.
5i— /3 <L JJ&5 W& a0YD al72c X(ell — 1 c-L_ O LT D P-
8a(cam 'Ai 0 '6 ti Lc-U/,c
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.).
tei.-V 0ry q U(CCJ� r(A -grail ifAI<
LI)A %--- E=2L 'kJ T _
Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
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.
(-6.{tLC o Li LIioL [
,0 �t Lk: TLr (`Z, 4 I`\j 1 ( jZ>
1>tA-Z , Ai IQ 1 ,L_'-;: Ak t RI? i I t C-�?(Z� or IN. L o, Ai�S
.--To k co) Lc ( tom( i `j 41-' ici, i 9 Ai-6, 1 /,LL&) 0(
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.]
A •
11. Describe the perforr��nce goals and standards applicable to the project.
12. Describe the flow control system.
stormwater site plan template.doc—rev.10/12/2003 6
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 C earing Limits.
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2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Control
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6. PrO ct Slope ' <
1 7. Protect Drain Inlets.
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12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control k 7 atering(the act of pumping groundwater or stormwater away from an active construction site).
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).
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.
I a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template.doc—rev.10/12/2003 9
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
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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).
I. Provide a propo construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet son construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the 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
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 ---
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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 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.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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stormwater site plan template.doc—rev.10/12/2003 12
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