HomeMy WebLinkAboutBLD2005-00782 ILDING PERMIT APPLICA•N MRLA05 00739
eview Type: l
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00782 Received Date: 12/22/2005
SITE ADDRESS: 334 PORT HADLOCK HEIGHTS RD
PORT HADLOCK, 98339
OWNER: BRODERS INC PHONE: 360-797-7722
4503 OLD GARDINER RD
PORT TOWNSEND WA 983689778
PORT HADLOCK HEIGHTS MH PARK
SUBDIVISION: Block: Lot: 22
PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR: WASHINGTON HOME CENTER INC PHONE: (800)648-1113
PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHCC770A Expires 3/19/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NEW MAN HM
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 102,632.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: IL •�� clACumw
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $157.00 LYK 12/22/05 -78810 A P I h u V
Potable Water Application $53.00 LYK 12/22/05 78810
Total: $210.00 JAN 31 2006
Jefferson County Planning
C��� &Building nar�ent
I
ON -c,
(rivik,f,_. .JEFF ON COUNTY •
DEPARTMENT OF COMMUNITY DEVELOPMENT
`• `4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4qsp� www.co.jefPerson.wa.us/commdevelopment
Master Permit Application MLA: C)5 '-1 3 1
Project Description(include
��11 separatel sheets as necessary): r t✓J q_1
3 N kV\1. _i. 1 c:1,_FC_ d l l0,,A'\' 1 YlS'kkl f_
Tax Parcel Property
Number: `A CS i S c C c c% ( _ Size: /C 1 C' 4 C T 4. 2-f (acres/square feet)
Site Address and/or Directions to Property: ?i 7 2 pc, 'ri- -i-4 J l o c fK I.--)e� 1 I `?r Rd
Property Owner(s)of Record: t?F`(�1)FRSS t N C.
Telephone: `7 6( _ 7 `) -/-- 7'7 7 Fax 2. Fa email: .
Mailing Address: -45c.� / C--:,,,,,I,-ci /1rr Rd. /.)C? ?C
1-.7- • c_:.ri sr vt el Lr.!A '7 t3KE
Applicant/Agent(if different from owner): R t c h a r A tF r- e.S
Telephone: .'7 GC'- -7q 7- 77 2 Z. Fax: email:
Mailing Address: .SG3 G/c>l (-�4n`�i �lrr /Cd • F�Gr 1 T c• �1{'ril Gti J �j 3�.�
What kind of Permit?(Check each box that applies)
❑ Building ❑Variance(Minor,Major or Reasonable Economic Use)
0 Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
0 Single Family 0 Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
:Manufactured Home 0 Boundary Line Adjustment
❑Modular ❑Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
❑Address 0 Road Approach __ 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes'Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
0 Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable 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 to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later i and t of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: - -"= Date: .2t 0,-c Le 0-5-
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 compjiance with the Jefferson County development code.The Applicant acknowledges that he.she or it holds individual
and non-transferable responsibility.f " dherin o and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature:
_- Date: 2c f9rc 2-4:(-��_...� � � -
t'
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ,
• 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: Dale:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
K�V5'-1 i\-EvA (5" ) 4 qe 74zf (3sc) Sac ByY3
MAILING ADDRESS: EMAIL: NC—1 t2.5
CONTRACTOR'S LICENSE WAINS c n tz
NUMBER: k) 4 5 .1) I fi C b.-7-7 , h 'f p 3 17`c 7 NUMBER t,ti Pk INS C c 7 S 0 s5- 3 t—c 7
ARCHITECT/ENGINEER: PHONE ( ) FAX( )
MAILING ADDRESS: EMAIL
•
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewa
ge Disposal:
T New ❑ Wood Existing: c ❑ Sewer
❑ Addition ❑ Steel Proposed: ? Bank (Community System
0 Alteration/Remodel ❑ Concrete Total: -7 Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Z X Pubic
Total: 2 Name of System: Pu f
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current Proposed:_- Number of ADA Parkin
g 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 ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying fora 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 Of(ice• lnl .,;n:'.* , 3
Y e�k ��
Current Proposed {uX / tev illy r �4 • as' A ~: 'It'
Main Floor t n 4� azi
xT : '
Nu ;'' $6e r 1 1 t 2 k ,at�31, 'v z,
2 Floor `>t, �i Y.* :yt
3r0 Floor .. {;<r < ." .:41.r bialnal Sectrofi ,
: ,.h,Sr- i t},, t i c . < t <Mezzanine:
Heated Basement .. e • r i s 11,, f.
Unheated Basement W ' 4 d.:
t + rr t ,tea ) ' YY. ' ;
Other Unheated ,/
Garage/Carport C- ` ils � � c
Decks _i: S 1 } �. >tiU1 Y h {]S1 Y 1 R tofr
Other . a x::i� ,. t.^ >, t , f �.r
'tssh/Ctiec�k 11ltutrl0el'' ` K ;
1 Li h
ESTIMATED COST(REQUIRED) .:
',Fair market value of all labor and materials foundation to finish ` 1 -�+y { 4
t
G:\PematCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
JACK WESTERMAN III • Jefferson Counter rthouse
ASSESSOR PO Box 1220, Port Townsend.W.A 983611
, 4360) 3115-91115
MOBILE HOME INFORMATION FORM
0
OWNER'S NAME/MAILING ADDRESS:
NAME:ADDRESS: �r? L � X 5��\<<r�� � �t � i�` %�c 13 c; 5 S i,� f : c� e C-L. sg3 /
PHONE NO. D- 377- / SSC
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 from another area.
1)MOBILE HOME DATA:
4S 2L
(A)MAKE C' "l�l,olio i Cti (C)YEAR
(B) MODEL :)� Verc,es� C��SS�c 2<<"6
(D)LENGTH (E)WIDTH z (F)SERIAL#
//
(G)YOUR PURCHASE PRICE(Do not include sales tax) I L` Z, 3 z-- PURCHASE DATE I)ec c S
20 PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No
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? 'es No
(B)IF LOCATED IN MOBILE HOME PARK: ``
NAME &ADDRESS OF PARK p°t I'_1 1 oc K 1—)e h•-/S Lot/S4 # 2 2
(3 7 2 pc^I cK i,hf 5 Rd
(C) IF NOT LOCATED IN MOBILE HOME PARK:
�lc i+ ?}r
NAME OF LAND OWNER:
LOCATION ADDRESS
REAL PROPERTY PARCEL #/DESCRIPTION
fc'r L- IV17111F
Signature of applicant
THANK YOU FOR YOUR HELP!
e_,Z4 SSA
.10� COSSELL. Property Technician
0 •
APPROVED
SITE PLAN
JAN 3 0 2006
JEFFERSON COUNTY to O1.'` )
DEPT.OF COMMUNITY ELO,If,E�NT^ V Rc A�
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•
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00782 Received Date: 12/22/2005
SITE ADDRESS: 372 PORT HADLOCK HEIGHTS RD Issue Date: 1/31/2006
PORT HADLOCK, 98339
APPLICANT: BRODERS INC
4503 OLD GARDINER RD
PORT TOWNSEND WA 983689778
SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: 22
PARCEL#: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (800)648-1113
DEALER PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC0770A Expires 3/19/2007
PROJECT DESCRIPTION: NEW MAN HM (Paul and Mary Gardner) Lot 22
MAKE: CHAMPION
YEAR: 2006
SIZE: 67 X 27
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 1/31/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):/ _p , PQ:AA. Z -0-06 A%1r-
Stormwater FINAL Approval:
Blocking/Plumbing: 8[ocKiu4 `rig-vowus OK. 3/zo6off
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps:4(—k(k=U O K
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
•
8.) VOLUNTARY MEASURES OCOASTAL &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 FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
11.) The applicant is proposing to create or add 2109 square feet of impervious surface and
4050 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal submit a stormwater plan
meeting Minimum Requirements#1 through#5 of the Stormwater Management Manual
for Western Washington.
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.) 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).
14.) The site plan as submitted with the building permit application on December 22, 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 January 30, 2006 shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
15.) This approval is for a new manufactured home installation 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.
16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
•
17.) 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).
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) Minimum setback from Port Hadlock Heights Rd right-of-way is 20 feet. Minimum side
setbacks are 5 feet. Minimum setback from the north (rear) setback shall be 25 feet, per
dedicated 25 foot buffer per plat.
21.) This parcel was created through the Port Hadlock Heights Mobile Home Park Bindig Site
Plan, filed of record April 15, 1998 under AFN 409746 in Vol 1, pp28-32 with the Jefferson
County Auditor's office. The binding site plan was reviewed by Jefferson County
Department of Community Development under BSP94-00001.
22.) This parcel is a legal non-conforming lot designated as Rural Residential 1:5 under the
Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998.
23.) Community Drainfield "C" (SEP95-00290) serves this site and was finaled January 4,
2002. A septic permit (SEP05-00428)was approved on January 16, 2006 for a septic
tank and pump chamber to be connected to Community Drainfield "C".
24.) Jefferson County PUD provides potable water to this site.
25.) Port Hadlock Heights Rd (P516) is a private road. The road approaching is existing and
an address of 334 Port Hadlock Heights Rd has been assigned to lot 22.
26.) 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.
27.) A minimum of two (2) on-site parking spaces are required for the manufactured home.
28.) The 25-foot wide buffer shall remain in its naturally vegetated condition. No constructed
or erected facilities shall be placed within the buffer with the exception of utility lines,
fencing or security posts.
29.) MANUFACTURED HOMES INSTALLATION SET UP MANUAL MUST BE ON SITE FOR
ALL INSPECTIONS AND A ADDITIONAL INSTALLATION MANUAL MUST BE
SUBMITTED ON JEFFERSON COUNTY DEPARTMENT OF COMMUNITY
DEVELOPMENT
•
SPECIAL CONDITIONS CASE # BLD05-00782
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on January 3, 2006 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Special Aquifer Recharge Protection Areas and Coastal Seawater Intrusion Protection
Zone (SIPZ).
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.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
4.) Marine shorelines and islands are susceptible to a condition that is known as seawater
intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in
an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater
suitable for public consumption without significant additional treatment and cost.
Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater
withdrawals (primarily through wells). The Washington Department of Ecology is the
agency with statutory authority to regulate groundwater withdrawal for individual wells in
Jefferson County. New development, redevelopment, and land use activities on islands
and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to
the maximum extent possible by infiltrating stormwater runoff so that it recharges the
aquifer.
5.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according
to the County GIS map. There are voluntary and mandatory measures identified in the
Jefferson County Seawater Intrusion Policy (Resolution 44-22, effective September 23,
2002) that apply to well drilling proposals and building permit applications on existing lots
of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources
within 1000 feet.
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.
• •
4.ifff
JEFFERSON COUNTY
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DEPARTMENT OF COMMUNITY DEVELOPMENT
„ ,. 621 Sheridan Street • Port Townsend • Washington 98368
0 360/379-4450 • 360/379-4451 Fax
http://www.cojefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# •
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`� PROJECT/APPLICANT NAME: E R C
J
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview •
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the sit,map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map. Jl
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4. Describe the"ling soils. Indicate s i1 type on the site map. / /
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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, nd indicate acreage of eaph.
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6. Describe any exec st levels of noise generated by the proposed use or activity: APPROVED
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STORMWATER PLAN
JAN3O200t -
stormwater site plan template—rev.lar1f2003 JEFFERSON COUNTY,
DEPT.OF COMMUNR t>rF EIACME t 1 s
SIGIIATUR
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual)or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilifieq on the site plan and differentjate proposed facilities from existing facilities.
n' i l l { 1 ly d i 5p- r 1'-cal,
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.]
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11. Describe the pert rm goals and standards applicable/to the project. / /
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12. Describe the flow control system.
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13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
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.
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18. Describe methods for restoration of the site./
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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.
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siormwafer site plan template—rev.10/1/2003
7
IP •
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 1—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 gearing Limits.
2. Establish Construction/Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets.
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• • •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Contrgi Pollutants.
10. CoAntr9l De-Watering(t1he act of pumpling grow er or stormwater away from an active construction site).
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11. Maintain Blest 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).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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9
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b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
fql a
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. N/4
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stone Ater site plan template—rev.1Ql1/2003 10
! I
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-bunts")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 y kn ge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected rope
I
(LANDOWNER OR A ED , ESENTATI E SIGNATURE)
C
_ (DATEE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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