HomeMy WebLinkAboutBLd2005-00649 •
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 #: BLD05-00649 Received Date: 10/7/2005
SITE ADDRESS: 890 NO NAME RD Issue Date: 11/9/2005
PORT LUDLOW, 98365
APPLICANT: KENNETH R MERRITT
JANET MOORE
PO BOX 884
PORT HADLOCK WA 983390884
SUBDIVISION: Block: Lot: T23+
PARCEL#: 821063024 Section: 6 Township: 28 N Range: 01 E
CONTRACTOR/ BUY RITE HOMES PHONE: (360)479-0795
DEALER 3543 W STATE HWY 16
PORT ORCHARD WA 98366
Contractor's License BUYRIH*0840B Expires 5/20/2006
PROJECT DESCRIPTION: NEW MANUFACTURED HOME
MAKE: KARSTEN
YEAR: 2005
SIZE: 50 X 26.8
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 11/9/2006.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): 065 ip�)
2 DL 3 11�15�OS /P� St elP Fco-rhu4 QK 11 2.1/05r
Stormwater FINAL Approval:
Blocking/Plumbing: Ok 1/0/610 ajt Q 4611/480PSULgT:i.1
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval: ,,//
Final/Skirting/Vents/Porches/Steps: 4Ihltfu/Peetilhors dk(Df'f941 ,y\� If - r_
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL TTINSPECTION
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
MLA05-00605
Priiiiiiii.111111.111.1........-- 0 Review Type: t
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
Received Date: 10/1012005
PERMIT #: BLD05-00649
SITE ADDRESS: 890 NO NAME RD
PORT LUDLOW, 98365
APPLICANT: KENNETH R MERRITT
PHONE: 360-301-9941
JANET MOORE
PO BOX 884
PORT HADLOCK WA 983390884 Block: Lot: T23+
SUBDIVISION: Range: 01 E
PARCEL NUMBER:
821063024 Section: 6 Township: 28 N
PHONE: (360)479-0795
CONTRACTOR/ BUY RITE HOMES
DEALER: 3543 W STATE HWY 16
PORT ORCHARD WA 98366
Contractor's License BUYRIH*084OB Expires 5/20/2006
PHONE
REPRESENTATIVE:
PROJECT DESCRIPTION: NEW MANUFACTURED HOME SHORELINE:
RES MANUFACTURED HOME:
TYPE OF WORK NEW KARSTEN SETBACK:
TYPE OF IMP MAKE:VALUATION 65,559.00 YEAR: 2005 BANK HEIGHT:
SIZE: 50 X 26.8
LABOR & INDUSTRIES APPROVAL?
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date: O C� ma II EMI MI Nell IIIII a V ill wrill
A roved/Date
Amount Paid Bv: Date: Receipt: NOV - .1 2005Type .00 SLE 10/07/05 77031
Potable Water Application $53
Manufactured Homes 10/07/05 77031 Jefferson County Planning
Total: $210.00
$157.00 SLE Building Department
�� � FP !a A
r••
•
4,
NORTHWESTERN TERRITORIES, INC.
' 717 SOUTH PEABODY STREET,PORT ANGELES,WA 98362
Engineers■Land Surveyors■Geologists
Construction lnspecti?nMaterials Testing
(360)452-8491 1-800-654-5545 >� 1498 f;�E- I;iMo@nti4u.com
NTI 110 ll;r»
www.ntilu.com 050649f� E
November 4, 2005 JEFFERSON COUNTY DCp 7 2 �3
ENr
i
�LirEFFF
Al Scalf, Director f CREPT pF RSon,'epic
Jefferson County Department of Community Development �O,v!�tUIVlTY r7EVE OPM
621 Sheridan Street
Port Townsend, WA 98368
Subject: MLA#: MLA05-00605; CASE #: BLD05-00649
Dear Al,
Today I met with Kenneth R Merritt and Janet Moore, applicants for the above action to discuss
the storm drainage plan prepared by Mr. Merritt for application at their property.
This property was the subject of an earlier Geo-technical analysis dated April 15, 2005, which
made certain recommendations for addressing drainage. Your letter dated October 26, 2005
refers to this letter and requests that NTI address the concurrence of the owner prepared
drainage plan with the Geo-technical analysis.
The Geo-technical analysis was not specific in how the drainage was to be controlled but
identified that minimal impact upon downstream properties should occur. The Owner has
proposed the installation of a perforated pipeline system to collect the roof gutters and create a
sheet flow distribution system. This technique is addressed in BMP T5-10 in the Department of
Ecology Stormwater Manual for Western Washington which also addresses the minimum
amount of pipeline per square foot of roof area.
The use of a technique that accomplishes the same sheet flow characteristics as T5-10 in a
sloped wooded or grassy area is consistent with the April 15, 2005 Geo-technical analysis.
Sincerely,
NTI Engineering and Land Surveying
• 4
Robert A. Leach, PE MBA
Principal Engineer
c: Kenneth Merrit
G:\Gen\Bob\LTRS\Kenneth Merritt Drainage-No Name Rd.wpd
•
SPECIAL CONDITIONS CASE # BLD05-00649
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on October 26, 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, the following ESAs were
confirmed to be present on the subject property: Susceptable Aquifer Recharge Area
(SUSC), Landslide Hazard Area- Moderate and Slight.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) 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.
5.) 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.
•
6.) A geotechnical report dated/April 15, 2005 prepared by Northwestern Terrifories, Inc. was
submitted in conjunction with this application. The report addressed the stability of the
geologic hazard area and concluded the site is suitable for the proposed residential
development, provided the recommendations in this report are incorporated into the
design. The report recommended "that the proposed home, garage and septic system be
located on the east half of the property, at least 30 feet east of the line where the slope
increases from approximately 10 degrees to approximately 20 degrees, which is about the
400 foot contour line".
The report also made the following recommendations:
"1. It will be necessary to maintain ground cover on the slopes and on the flat areas in
order to reduce erosion from surface runoff. Existing bare areas and any future bare
areas that develop should be revegetated. Native deep-rooted vegetation that requires
little or no irrigation would be the most beneficial. Please consult the enclosed
publications for further information.
2. Heavy irrigation or other activities that would contribute large quantities of water to the
soil should be avoided.
3. Surface runoff from hard surfaces such as roof, driveways, walkways and patios should
be controlled and routed to a drainage control device such that surface water discharge to
adjacent properties does not significantly exceed predevelopment conditions. It may be
feasible to control release this water to the existing natural drainage swale with quarry
spalls or perforated pipe.
4. Surface water should not be allowed to flow freely down the face of the slopes and
cause erosion of the slopes and/or conveyed to a safe discharge area, possibly into the
swale mentioned above.
5. Silt fences or other sediment control devices may be needed during construction so that
sedimentation to adjacent properties does not significantly exceed predevelopment
conditions.
6. Drainage control devices should be maintained in good working order and inspected at
least once a year.
7. All drainage control features should conform to the current regulations that apply to the
development of this property and be constructed in accordance with standard engineering
practice in order to insure that surface water discharge or sedimentation to adjacent
properties does not exceed predevelopment conditions."
Northwestern Territories, Inc. submitted a supplemental letter dated November 4, 2005
stating, "The use of a technique that accomplishes the same sheet flow characteristics as
T5-10 in sloped wooded or grassy area is consistent with the April 15, 2005 Geo-technical
analysis."
7.) 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.
8.) 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."
9.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
10.) 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.
11.) Among the native conifer species which may be used in buffers or for re-vegetation
include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis),
Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar
(Thuja Plicata), and Western Hemlock (Tsuga Heterophylla).
Among native tree species which may be used includes: Vine Maple (Acer Circinatum),
Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus
Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa),
Bitter Cherry(Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara
(Rhamnus Purshiana), Pacific Willow (Saliz Lasiandra), and Scouler's Willow (Saliz
Scouleriana).
Among the native shrub species which may be used are: Sevice-Berry(Amalanchier
Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean
Spray(Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark
(Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa
Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry
(Sambucus Racemosa), Snowberry(Symphoricarpos Albus), Evergreen Huckleberry
(Vaccinium Ovatum), Red Huckleberry(Vaccinium Parvifolium).
12.) The applicant is proposing to create or add 1,350 square feet of impervious surface and
2,250 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal comply with Minimum
Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of
Ecology Stormwater Management Manual for Western Washington 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.) 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.
14.) A Stormwater 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.
15.) 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).
16.) The revised site plan as submitted on November 4, 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 November 9, 2005 shall be resubmitted for review and approval
by Jefferson County Department of Community Development.
17.) 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.
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.) Setback from No Name Rd. right-of-way is no less than 20 ft., setback from SR 19
(Beaver Valley Rd.) right-of-way is no less than 35 ft.side and rear setbacks are no less
than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive
setback shall apply.
25.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
26.) This is a legal non-conforming parcel designated as Rural Residential 1:10 under the
Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998.
27.) This parcel is served by an individual private well.
28.) A septic permit(SEP05-00080)was approved April 14. 2005 for a capacity of 360 gallons
per day.
29.) No Name Rd. (P119) is a private local access road. A road approach is not required and
an address of 890 No Name Rd. has been assigned to the parcel.
30.) This parcel was created through a survey under AFN 249009, recorded April 6, 1978,
Volume 2, page 148 with the Jefferson County Auditor's office.
31.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
32.) The applicant shall follow all of the recommendations as stated in the Geotechnical Report
prepared for this site by Northwestern Territories, Inc. dated April 15, 2005 and their
supplemental letter dated November 4, 2005.
JACK WESTERMAN III* Jefferson Coularourthonve
ASSESSOR PO Ilox 1220. Port Townse WA 911317;11' i rT
060) 385-9105
MOBILE HOME INFORMATION FORM OCT - 7 ?Q05
OWNER'S NAME/MAILING ADDRESS:
-7-
NAME: F�t�/27/ WENT
ADDRESS: /7c1X i - f /%. //fl1il c/( � ,'.7 7`I CoFily
PHONE NO. 76 o -A' y 79' e//
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county front another area.
1)MOBILE HOME DATA:
(A) MAKE/4 if f FJ� (II) MODEL S C(' "S) (C) YEAR c 5
(D) LENGTH f„l / (E) WIDTH 2 G (F) SERIAL #
(G)YOUR PURCHASE PRICE (Do not include sales tax) 6 f-. 5 S/&`PURCHASE DATE( ' S /r
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE fay ///L'-
ADDRESS r7 S/o7 A4 / /0/ L`Qu/h G✓�} � 7�Z
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3►WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME P K:
NAME OF LAND OWNER: 7�N7v/ 7/7 t�r A/,;e; /,7/
LOCATION ADDRESS iT7O /JO �'l��7L x� l�"' 1Z//1jOt✓ C�%A YJ ?(I
REAL PROPERTY PARCEL #/DESCRIPTION!'Z-/ o '7 D Z
■ atare o pplicant
THANK YOU FOR YOUR HELP!
4JO COSSELL. Property Technician
• OWNER 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: - Date: /1 D.f�
1-
/, OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
/ft/y A.-( l Y �� (.))‘-Co ) , u rL
MAILING ADDRESS: �Val � E IL: �� �,� � (�` ) b 0/ G��J
y V Md./ /c/ }C-Q p /..W /.y,,G/ l `'d/hf') , (-LP,/
CONTRACTOR'S LICENSE fo FZ WAINS
NUMBER: J NUMBER WR'c O p.)O
ARCHITECT/ENGINEER: PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
'New ff Wood EAlsting: --Sewer-
0 Addition ❑ Steel Proposedr� Bank ommunity System
❑ Alteration/Remodel ❑ Concrete Total: __- Height: ?fr.-Individual System v '
0 Repair ❑ Masonry SEP Permit# '" , - (Yv
0 Demolition ❑ Other: Bedrooms: Water Supply:
9' �=7-1 Setback: ,p- Private well ❑ Two Party
Type of Heat: Proposed:/ T_ `Li Public
f C e- t//(' c Total: — Name of System:
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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove LI Cook Stove ❑ Woodstove Li Fireplace Insert 0 Hot Water Tank L Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
2Nu Floor Base fee: i
5-7 3`°Floor Additional Section:
Mezzanine: Plan Check fee: - -
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee: Ca -
Other Unheated 911/Rd Approach fee:
Garage/Carport _. ac r.�,
TOTAL:
Decks
Receipt Number: 71:0-1 10 3 1
Other Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair ma t value of all labor and materials foundation to finish 60 l0
-T"� GC".L..—` Initials: l
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
(:,,ii0N----6.o JEFFERSON.UNTY '
'kilo
��' DEPARTMENT OF COMMUNITY DEVELOPMENT )CT — ] ZOOS
�' `4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
' p� www.co.jefferson.wa.us/commdevelopment
�`�HINc�' .PFdENT
Master Permit Application MLA: 05-6 1.0
Project Description(include separate sheets as necessary):
;"ih,(�✓f;ALfv't(1 `76 77- //47 //
Tax Parcel Property
Number: �� / (.'E 1 /% 2 lj Size: 5`„ 2 /( ( (acres/square feet)
Site Address and/or Directions to Property: U //O, ///' /�� ,/ G 1--W I✓/ 4
Property Owner(s)of Record:�i/Fivfr z/ /i"y/-iZzt/' 1/ 4 i 7 /r►lfC/4/(e/ //Lr ec"" (--
Telephone: i/6 0 1'. / Y c// Fax: email:
Mailing Address: 't . /' ,7 Mgt)/)/'' (/ w L4 Pt ?3
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
,'Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
rg Manufactured Home Cl Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ..ceding Site Plan**
❑ Change of Use ❑ Long Plat**
address E l Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
' u eropane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis D Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management D Shoreline Management Substantial Development**
'ite Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
u 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:
�,e/'c f i"Iq sct o v(,ve-� �;,,c-cc /v J 7 0`/ i.d )i, ) 1_ --)-
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 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 required later inspe 'ons.Access and right of entry to this property shall be requested and shall occur only during regular business
Hours. / J C, /�
Signature: Date: / J
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 ring to and complying with the ESA. The Applicant has read this d' aim r and signs and dates it below.
Signature: ! Date: J
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
S i _.
4 r71144%, JEFFERSON COUNTY OCT - 7 005
k ,: ` DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
4.O 360/379-4450 • 360/379-4451 Fax'Atiii �EN'_..
Nar http://www.co.jefferson.wa.us/commdevelopment!
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPU.(CANT NAME: f 12-74 ..4'/" <f /( /"i/k" /'/'7
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.
L.Z,,+t`-!t £ ✓i ( l=/t/e* .� (:a,4 7e,t 7 t`1- ✓ -
.. .lfa-
%7/r` zz, , 7e d44''r� o t7.---1---A- ' c_*,c s 7c 't''/", 7 ..,t_r,,�, /-,
ficc t-s 3 ,./ C=/ ,r4-4 =i j .. 'f= °'r et/S� r- r,,j. .1,ot./y .("C_cff l
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
/ /4".1 /7r'c;ff/ ,d(Y ,I
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.
/ Clt f A-4-"( Cry/fit y ,4.,7* r'
6. Describe any excess levels of noise generated by the proposed use or activity:
APPROVED ___�..
STORMWATER PLAN
NOV - 9 2O5
stornn,,ter site plan template-rev.1a112003
4
JEFFERSON OJiNTY
DEFT.OF C•,*.Li DEVELOPMENT
SI iNArt RE. ,
1
• •
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the sitg. Indicate location on the site map.
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.).
�','r'-f '/) r,l/.i 1"` r: /et tlje '7( eit 1: c/4/4(j . t'••[ t r 7e1 L'Al4
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,ii 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.
/c7(6 iiieze-,pf tiv4e00 tc:/ ree jz, ‘/Z-.,.A-146Ait7./V) c-1/etff
fr/
7c 4.m i -z 7te, de. s is4: -" J L//L.4 t,;1' G't a)/1,://ga 2
a i7C,i'f,y /A-le J ;A > fold
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]
11. Describe the performance goals and standards applicable to the project.
tile: 14/17e ii -( Y ,/ I`«4, 7=-. .,a/<' _ 6:. . . e4,1
•z //t L°tL', i t.`› a/es t A"4 4 1 </ /e-- . ../ ,ar7 E./.-7 C a'1 / .
8rr.1` /1,K- 4'/I.-Y cev►.f A:" t 'ra v% : >`, 11i.'', C'e'1z, .,�'t(;' T
Aie? *f7,,v .IA:/) _Foie t<a AZ-6/7,AZ-6/7, ,, i-
//Y .4( ('rr . ./4 ii.I
12. Describe the flow control system. -
A/"-t ti/ /'- ' 1 'T,4• 2r 1/1" ' 1,'er
f..... — , , ^r tie t • r ; I
I
VA. . {. , VI%
t
of
s1orrnsmtersiteplan emplace—rel,30/1,20M---- -- —"'"4 i 6
y, :+" v` -`c t-1a-1t.
1 Vollti4t=:,li tt! 4,1i itit.-.0; io 141ti Iii
tY
i "rI ,1
//:1r
• •
13. Describe the water quality system.
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.
1 ' r,"). /s ; �-t �� .ir .. Vr' /45T' S% 7) -(.1, -.-h
f m a L. -A 4 "ee.Ce-'17f*,#C72 7a-- -',c 6;1
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
/.// yj_j r // / j y) J/j� „try`
{,,.���t f��,V--- 74 kt Cc) f
17. Describe the proposed surfacing material.
/ - t41'� `L i/—Ls�`f2 2 iiC-:, %//7 calle e/-
18. Describe methods for restoration of the site.
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
restrictionsrhere. _
ft? 7'c yi"z / rer l' Cie` tie
stormwater site plan terrpate—rev.1CY112003 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.
2. Establish Construction Access.
I;{ r , r '�44 C4,t-ems.. -g z, 1 Z/ vcr
�cA,1i/ . 1' '!fe r�s -I1-» . -'c- `f`
3. Control Flow Rates. ,�/
vt/11 c'IZ. r y''!ztit o /!�/ /r/�' ,,f(rt e�,./ 4)4-� rl' 5 e - E L"
f /L'.rl,7 I', 1/L ,y 4,1 7`✓f " -... ,fr 37-7 1177f
4. Install Sediment Controls.
/t,, ��� ,�� r/2,1,- o// 1'C- ei 'd
5. _Stabilize Soils.
re:V Z 'f . /S 7G%z <i '', /ram:'(' xer / 7,-3'(7i' ✓1 /.. .P/ .41)764)
6. Protect Slopes.
J .1-.3} c 4 'e C tl 4 C7l'`,� > 6. c J
7. Protect Drain Inlets.
8
stam ester site plan template-rev.101112003 r
• • •
12 Required Elements—Construction SWPPP(continued)
8. ,r�Stabilize Channels and Outlets.
. , l � If�r�'.��s�
h �r :4�r /f� "� tc �G.� C c9/4"jfx / 'r' .t yt� t% �j1.�Z v
9. Control Pollutants.
200
10. .Control De-Watering(the act of pumpingJ�� ��groundwater or stormwater away from an active construction site).
Jt
11. Maintain Best Management Practices(BMPs).
�'` 7xt'i s fit;r�►3.�-I -r ' -'c7, r, �.
12. Manage the Project.
2, Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
t
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or ad
jacent to the site.
stomnrater site plan template—rev.1 OJ1l2063
9
411/ •
b. Description of special requirements for working in or near environmentally sensitive areas.
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 ^...Alai') /0 / 2 e' t j.e/C/tz1t. l`' !Z'4-:a ,a ,/'26:: '".
6`rf 71' Sf Try' Zfr 14 1 c(-` c‘,.+i, /C-li/a
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
1. Provide a,proposed construction schedule.
74 eAreitk
II. Wet Season Construction Activities.
a. Proposed wet season construction activities y.
C41S31,. C/2/�,4' } 'L4:> /L'L 44.,1 Ili+'
kt.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Descnbe 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
to
stormwater site plan template-rev.1 0/112 0 03
• •
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.
(tANWWNER OR AI THORiZED REPRESENTATIVE SIGNATURE) (DATE),f
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
C 7 2005
JEN '
12
stormwater site plan ternpiate—rev.1011/2003
•
•
vl
NI
r •V
„:„.. , . ........
... _....
, , ..
c, , .
, ,,,,,,,A,-„,,, .
.,
,.... .....
. -,... —
.„_---------' ,
.4 z v 4,,e Aig free ..5 .k"‘s,,
,.,
J f y L6'f`�',-✓4-o a ts.
w,"`... .. ,
Jl 0r'e j,r '_ z
U
C./ a.
ce
' Vb-",471/7/0 .6/4446:4 6 t,, , 'k,,_ L1J ,;,1.,j ,‘X
tA.Ara 1/4le/z�AI
a
v,,y, �. o
co
a
1 L
Q
>z:,,,, g \ ,,,
h �t
I
�c iJ
Ct
tio:,.
C7s•tj ,
J Le- c) P ' I, .
. .
,.....7.:,:-.,---7-•—•:3..-7—,—.,__ ,,
v.
:/
o i,1 11 ,
f�
a ! .
co
Z t p r r {
q:k0 o
CM CZ
*4t ,Ay LA-
Ce
04 8 It� ilk
•
CI 0
yet
cue