HomeMy WebLinkAboutBLD2005-00780 • •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00780 Received Date 12/20/2005
SITE ADDRESS: 80 WINDSHIP DR Issue Date 02/6/2006
PORT TOWNSEND, 98368
APPLICANT: RALPH B BERRY JR TRSTEE PHONE: 360-385-7156
KATHLEEN COMBS TRUSTEE
1419 CLEARVIEW WAY
SAN MARCOS CA 92078
SUBDIVISION: KALA POINT#1 Block: Lot: 42
PARCEL NUMBER: 964700042 Section: 26 Township: 30 N Range: 01 W
CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156
260 KALA POINT DR
PORT TOWNSEND WA 98368
360-385-3115
Contractor's License: KELLES1150LF Expires: 6/6/2007
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE & DECK
ALSO A/G 120 PROPANE TANK
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
U F F E R: t.A4 C ONO 74 qc.,
1
Footing: 3__VikO'Q /Air ))G94--21?a.ii0
Foundation: /
Stormwater FINAL Approval:
Underground Plumbing:
Undergrou d Insul do :
Shear Wall . /S5G6
Sheathing: -
Framing: p4' 41/?p0j,
Plumbing: ' 4/2 O Lff
Propane Tank/ Lines: /
Insulation: Az i I.C' ��iia ial, . 0744, . )(, �c t;
Sheetrock 5 / 0
Septic Sy m Final Apal (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: `n-1( -Ot
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE :24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE REVERSE
•
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD05-00780
SITE ADDRESS: 80 WINDSHIP DR Issue Date: 02/6/2006
PORT TOWNSEND, 98368 Final Date: 8/16/2006
APPLICANT: RALPH B BERRY JR TRSTEE PHONE: 360-385-7156
KATHLEEN COMBS TRUSTEE
1419 CLEARVIEW WAY
SAN MARCOS CA 92078
SUBDIVISION: KALA POINT#1 Block: Lot: 42
PARCEL NUMBER: 964700042 Section: 26 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE & DECK
ALSO A/G 120 PROPANE TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2003 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 8/16/2006
YrEJ Slo-icv--C Dr-7-
I 0
i 'al Signatur Date
I:\F_BLD_Occupancy.rpt 10/29/19
1
•
UILDING PERMIT APPLICAIN MLLA05 00733
Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00780 Received Date: 12/20/2005
SITE ADDRESS: WINDSHIP DR
PORT TOWNSEND, 98368
OWNER: RALPH B BERRY JR TRSTEE PHONE:
KATHLEEN COMBS TRUSTEE
1419 CLEARVIEW WAY
SAN MARCOS CA 92078 KALA POINT#1
SUBDIVISION: Block: Lot: 42
PARCEL NUMBER: 964700042 Section: 26 Township: 30 N Range: 01 W
CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156
260 KALA POINT DR
PORT TOWNSEND WA 98368
Contractor's License KELLES1150LF Expires 06/06/2007
REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156
DENNIS KELLEY
260 KALA POINT DR
PROJECT DESCRIPTIOI NEW SFR W/ATTACHED GARAGE & DECK
ALSO A/G 120 PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,441
VALUATION 206,655.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2003 HEAT BASE: 669 HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 616 SETBACK:
DECK: 128 BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: KALA PT
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 3
Total: 2 Total: 3
Routing Date:
r'd I !os
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $1,592.95 KAS 12/20/05 78773 APPROVED
Plan Check $1,035.42 KAS 12/20/05 78773
State Building Code $4.50 KAS 12/20/05 78773 FEB ( 1(�fl'
Potable Water Application $53.00 KAS 12/20/05 78773
Jefferson County Punning
Total: $2,685.87 & Building Department
w
�_, , ONC,O_ •
�c JEFFER1tN COUNTY
W 54 DEPARTMENT OF COMMUMT,D / OPME iT .} a---7---7
� ✓ 't r!-/
' 4� ` 621 Sheridan Street• Port Town d o_J8 -_ r �I
,,,1 k. 60/379=4450 i-360/379-4451.F i,
p www.co.jefferson.wa.us/commd vet nt I
l',& `U 2 0 2005 ,/,'
Master Permit Application , , MI A: , ) f.
Project Description(include separate sheets as necessary):__ _ F
I
1. L.> r-k.-Wit.
Tax Parcel Property /
Number: ---1G -'"]Qb 0 4 JJ / Size: -r"t G�, (acres/square feet)
Site Address and/or Directions to Property: 1(}'/J�.✓_Sr/}i/2 )i�/P ,"/e4 L 4 ,nr,/T
Property Owner(s)of Record: 64 a.'.'�; '11:,.L,+1 l S
Telephone: £ -5- _1 t `�(.a Fax: 5 - . I S email:
Mailing Address: Zia -i=1-Lt1 \ El, 1-,rr ')i2 . -0-,' , •'
Applicant/Agent(if different from owner): _ „.t f ,;-.t.=< • •
-
Telephone: .•ja4. • ' r t- , `�.f.S' 5- � ( "r .»p f111V.)i. 1 r
n �. Fax > email.; _af 'f .�_. �'
Mailing Address: '..-("C: 1:-d u 6, t: r)i.,, ;" L L.L(:,-,;;
What kind of Permit?(Check each box that applies)
U Building J Variance(Minor,Major or Reasonable Economic Use)
U Demolition Permit J Conditional Use[C(a),C(d),or C]**
U Single Fami J Discretionary"D"or Unnamed Use Classification
)Garage kart' Detached J Special Use(Essential Public Facilities)**
❑ Manufacture. Home 7 Boundary Line Adjustment
U Modular J Short Plat*"
U Commercial* J Binding Site Plan**
U Change of Use J Long Plat'"'
LeVd-- ress I Road Approach J Planned Rural Residential Development(PRRD)/Amendments*`
ropane J Plat Vacation/Alteration**
U Allowed"Yes"Use Consistency Analysis J Shoreline Master Program Exemption/Permit Revisions**
U Stormwater Management J Shoreline Management Substantial Development**
U Site Plan Approval Advance Determination(SPAAD)* J Shoreline Management Variance
U Temporary Use J Comprehensive Plan/UDC/Land Use District Map Amendment
U Wireless Telecommunication* J Jefferson County Shoreline Master Program Amendment
U Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference '"'Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate t'-.E `tt.i,!`'; :�,4y�,/�t #..-". / ,� to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ti \ _ Date: '2-'-L.i~J , '2-{,C, 4.'
By signing this application form,the owner/agent attests that the infq ation 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 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 resut of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and Is employees,representatives or agents for the sole purpose of application
review and any required late inspectionns_ Access and right of entry to this property shall be requested and shall occur only during regular business
hours. )
Signature: Date: «F 4-d ' 2'4'0 3
The action or actions Applicant will undertake as a result of the i suance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an en angered 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-transfe brQ le r�spon "bility for adh ' to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: �`/` Jl�) Date: 12'-2-- - tek;..
C:\Documents and Settings\mochul\Desktop\Master Permit Application 7-8- 4.doc
1
' • •
OWNER BUILDER STATEMENT
The signer of this statement does hereby certify that they are-thee Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the Genera1,015ntractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
� :Lt 43 ti 1 Cm .- (t
r ? (7i U) 2*j,,.,S l' ` f (7> U) "2.),Z5 y, , , ';m`.
— --- -MA(UN-6-AD�FE�S: W .‘t•�14 t! ' T 7� —
t f EMAIL
CONTRACTOR'S LICENSE L f
NUMBER: k l..L ' r ( 0 �'.. t NUMBER
ARCHITECT/ENGINEER: ""
lL ,t ac`� ` >_ �, F� 'y ` {' Etioh�,( ) t l$�,FAx�
MAILING ADDRESS: ��//�� `
��� r`7'� � �iS% � t %'/ MAIL..,.- 4`� .,.�'"0` � :+1 .
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
re-New L+YGVood Existing: U Sewer
U Addition U Steel Proposed: Bank U Com�munity System
U Alteration/Remodel U Concrete Total: Height L dividual System
U Repair Li Masonry SEP Permit#
U Demolition U Other. Bedrooms: Water Supply:
Existing: Setback: U Private well U Two Party
Type of Heat: Proposed: f U Public
1j<'._)d- , . Total: Name of System',a°
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:
i Underground Tan_ .:1__Above ground Ta ikC ----, Size of Propane Tank /7.4
Heat Stove Cook Stov I Woodstove I Fireplace Insert 1 Hot WaterTaRk 1 Pellet Stove 1 Other
Is ppliance beinq installed in a Manufactured I Mobile Home? Yes / No J
When applying fora submit r
pplyl g permit to Install a propane tank you must also 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 ) 5""+ {^� 1 nrisisteh y viw r ( �r a c 4 t 1f
NU ���.:
2 Floor Base fee --__. t 1
3f0 Floor Additional Section:DEC q O ,�n5 ,
L. LUU 1
Mezzanine: � Plan Check fee: � � L' �,—., ��
Heated Basement , 1tate Surcharge fee: - 1
Unheated Basement y Pot Water Review fee:
Other Unheated CO/Rd Approach fee: on
Garage/Carport ��
b , 11-451 (.I a TOTAL: $ 1. 7
Decks -7 �' 2 C�r_ p p1 8k) 75
1,. f ,) 1f ri Receipt Number.
Other Cash/Check Number.
r) ll )
ESTIMATED COST(REQUIRED) Date: ' 361
.Fair rawrket value of all labor and materials foundation to finish t{ CI ,'1 0
n c' Initials ( -"r
C:\Documents and Settings\mochil\Desktop\ ,er J F.Ap lication 7-$04.doc
• •
v N
ID
#
n (
_MO tA) g
tl
� I
SL/
s iU
o` v CZ
V
o'
N
e)
I
,.4,
P
K0/5-0/G 140/5-0/4 K0/5-O/4
0
„ ...__I O 1 o
11,
. A
a
o s i
o
0
4177
WG+d Oi/90/5
—R.,
VN o
d 1\ xx _� O - O,...,.....a Q
o
DEC 2 0 2005
o
L
L
?•- -J
c\I o
9 (' 8-'‘- Cill n
1
I5O/5-0/5 K0/5-0/4
Wndship 0 .
ve
0.1,,.,-,..):
,.0,„.„,
- (.____
i \ /25I , ,-,
is —4) N
,..,,,i. .r\ \32
1
1011 \Illi Fq ( #
1 1 zN -
1
7% \ ', g , 0
f'.›-_. \ ,,...-
a1
71- 1
L--4111011-11111.111/1°\ i
\Q b
S N�
ONJ I v
OS
o
b
b !7 cm
CO
CS—
VI
r. p tri /O `O
A
O
A- 1 g › -, g
z til z
tv
CM
c —q
��� )
+mil° ,1.. ���S N --
0 � �
CO
i M
cji
•
r ---------- /90, v
rn H
N pA_.,,
O k
--__ "I''
4
•''''----11 --....\\ ' —) 1 7\;.
a.
77
SPECIAL CONDITIONS FOR CASE # BLD05-00780 •
1.) 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.
2.) 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.
3.) 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.
4.) 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.
5.) MANDATORY MEASURES FOR AN AT RISK 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 requirements:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
b. Installation of a flow meter.
c. On-going well monitoring for chloride concentration.
d. Submittal of flow and chloride data to the County per monitoring program.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
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.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) 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).
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Minimum setback from Windship Dr right-of-way is 20 ft Minimum side and rear setbacks
are 5 ft.
12.) A minimum of two (2) on-site parking spaces are required for the single family residence.
13.) 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.
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
•
APPROVED
� �,ON cellItz
STORMWATER PLAN
' JEFFERSON COUNTY
�� DEPARTMENT OF COMMUNITY DEVELOPMENT JAN - 3 2006
4.440;
621 Sheridan Street• Port Townsend •Washington 98368
O 360/379-4450 • 360/379-4451 Fax
11111-G http://www.co.jefferson.wa.us/commdevelopment/ --JEFFERSON-COUNTY
DEPT.OF COMMUNITY DEV 1.0 NT
SIGNATURE: �' -
STORMWATER ���
SITE PLAN SUBMITT -t TE t
MLA# � PROJECT/APPLICANT NAME: /i f-,t(d it Riq y 74.4 Cc,"(��//
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 chodse 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.
, .J C �ti. ' _m"t�-3^,2 1����t Ir,'r i�r.
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. 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.
I -0 77-7
l
6. Describe any excess levels of noise generated by the proposed use or activity: I
9-EC 2 O 2OO5 f.
stormwater site plan template.doc—rev-10/12/2003 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.
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.). Lh
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.
4.4"r" / kd 1 f._ .fir•
0f-7 ! 'a Yen. 1 3fi'1to,..),
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.
12. Describe the flow control system.
‘X`1•''; "t £ C- M e : J,� . I k)L. f G t4a9
r1 f Yf rr
� r 1
f ft`•
DEC 2 0 2005 i
stormwater site plan template.doc—rev.10/12/2003 6
•
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.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material.
r: �� ��� 1� '-
18. Describe methods for restoration of the site.
k
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.
f DEC 2 0 2005
stonnwater site plan template.doc—rev.10/12/2003 i 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.
3. Control Flow Rates. t
tV .�+:- �� t i 0)-1 f Az-4 t. :,,f 1e4 •
4. Install Sediment Controls.
4-1
5. Stabilize Soils.
V "� 4
�',a�-t,�"��" � F�'? ,j�,��•-��: � E
('`""
6. Protect Slopes.
7. Protect Drain Inlets.
11pl
DEC 2 0 2005
stormwater site plan template.doc-rev.10/12/2003 -
g
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
jk-r7- W CA i.) A-_j 1
9. Control Pollutants.
,r
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
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).
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 adjacent to the site.
r-7N, E it t � c
}i
DEC 2 0 2005 ltk
stormwater site plan template.doc—rev.10/12/2003 t 9
b. Description of special requirements for working in or near environmentally sensitive areas.
- 04:12 )A #''t�i` 1 41 1.y`"i E p3 mow j y •
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
t xA in
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
.l'.` �";� ( 4. � •s � i !ram Fir at .L.4:.
It. Wet Season Construction Activities.
a. Proposed wet season construction activities.
ws , I
b. Proposed wet season construction activities for environmentally sensitive areas.
r 1
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.
4 1 Pr- ,,,t t-1 i I ;.. I-
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/Storm V[
water Detention Calculations r t, ' r �`' t 1 \ t
i;
DEC 2 0 2005 •
stormwater site plan template.doc—rev.10/12/2003 101
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.
40 1.t. \r‘ ,AZ4,1 )4_
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
P �� ry �(
r_
I
DEC 2 0 2005
stormwater site plan template.doc—rev.10/12/2003 ... 12