HomeMy WebLinkAboutBLD2006-00060 • •
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#: BLD06-00060 Received Date: 2/13/2006
SITE ADDRESS: 202 WILDWOOD RD Issue Date: 3/20/2006
QUILCENE, 98376
APPLICANT: WILLIAM A WHEELER 3too- 7 rlc -18(p
P RENEE BUSH
PO BOX 94
QUILCENE WA 98376
SUBDIVISION: Block: Lot: T 36
PARCEL#: 702113006 Section: 11 Township: 27 N Range: 02 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER
PROJECT DESCRIPTION: NEW M/H
MAKE: GLEN RIVER
YEAR: 1983
SIZE: 48X24
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 3/20/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing 7TINUOUS FOOTING, SLAB or PADS USED):
S iP- 6
Stormwater FINAL Approval:
Blockin lumbin �- //
� g: � !q DLo /� rk /1 (4—A 51C.:kJ !Z�l 'v G
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
at: irting/Vents/Porches/Steps: /41 2oo 7
HEALTH DEPARTMENT AND PUBLIC WORKS AP ROVAL EQUIRED 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
• MLA06-00059
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00060 Received Date: 2/13/2006
SITE ADDRESS: 202 WILDWOOD RD
QUILCENE, 98376
APPLICANT: WILLIAM A WHEELER PHONE: 360-774-1861
P RENEE BUSH
PO BOX 94
QUILCENE WA 98376
SUBDIVISION: Block: Lot: T 36
PARCEL NUMBER: 702113006 Section: 11 Township: 27 N Range: 02 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW M/H
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: GLEN RIVER SETBACK:
VALUATION YEAR: 1983
LABOR & INDUSTRIES APPROVAL?
SIZE: 48X24 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL —
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
°V 3/6c
Type Amount Paid By: Date: Receipt:
PApprHOVED
Permit $163.00 LYK 02/13/06 78947 MARS 2006
Potable Water Application $55.00 LYK 02/13/06 78947
cielterson County Planning
Total: $218.00 &Building Department
III p,/dc ^ —Z
7,4-teigi.,LsoN , JEFFERSON COUNTY •
W >a DEPARTMENT OF COMMUNITY DEVELOPMF
6-3 .\ . *4 621 Sheridan Street • Port Townsend • hi g n' i'.8 i
360/379-4450 • 360/379-4451 Fax
• www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: L. L, 3
Project Description(include separate sheets as necessary):
• , 1
,.t;..t'(, 7ZA7e0i, /' ) Jvt k 6'u(:w)
Tax Parcels // f�� Property ..—
Number: A Size: 2 0.-c/ - uare feet)
Site Address and/or Directions to Property: Z Q.)c_, t-Ji f rl L,)--”- k_, (:),< , .,17-.7. r , r'-"
Property Owner(s)of Record: (All i r 11;9 ift (A)N E- L E2 c/uae 3r�E�; lif
Telephone: 360 7 /8 6/ Fax: email:teitf r2[.,if 14 e.gA2t 01%1 t.Ner
Mailing Address: "PO 13 QJt q'q-Y Qcc t L C,EoJe/ Oil 9i3,776,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
I Building _1 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit Ti Conditional Use[C(a),C(d),or C]**
[I Single Family :I Discretionary"D"or Unnamed Use Classification
G Garage Attached/Detached 1 Special Use(Essential Public Facilities)**
yl.Manufactured Home Li Boundary Line Adjustment
Modular 1 Short Plat**
I Commercial* - Binding Site Plan**
Li Change of Use I-1 Long Plat**
Address i Road Approach II Planned Rural Residential Development(PRRD)/Amendments**
L Propane [7 Plat Vacation/Alteration**
❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
ili Stormwater Management ❑ Shoreline Management Substantial Development**
I Site Plan Approval Advance Determination(SPAAD)* I Shoreline Management Variance
E, Temporary Use '7 Comprehensive Plan/UDC/Land Use District Map Amendment
[l Wireless Telecommunication* I Jefferson County Shoreline Master Program Amendment
Li 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 entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. / �JI� /1 j
Signature: (,+(, l,�'1 �.,� ` /cA_ Date: 3.. j /0 v�0 0 G
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 for adhering to and complying with the ESA. 'ne Applicant has read this disclaimer and signs and dates it below.
Signature: W; 14„,, ` Date: ?z,6-# /C , L00 (,
C:\Documents and Settings\mochil\Desktop\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 licets®d cjnt&ctt d that
they will be assuming the responsibility of the General Contractor for the proposed project. r CC u
Signature: W J,L_ar.,_y.., a Date: -7 .,,W 30 ,2 00
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
- ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
X New ,Il Wood Existing: �e' f_7 Sewer
H Addition ❑ Steel Proposed: Z Bank ❑ Community System
Li Alteration/Remodel ❑ Concrete Total: 7. Height: g Individual System
;; Repair ❑ Masonry SEP Permit#561Paf—Dc.N,c
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: . Setback: 1% Private well n Two Party
Type of t: Proposed: 2.- Li Public
e(,,EC, R/'(, Total: S. 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove I Fireplace Insert i Hot Water Tank i Pellet Stove i 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 _ (,00
Current Proposed `f'i QkV t-
Main Floor Consistency Review:
5 -
2ND Floor Base fee: i C?C)
t ( c L �
3fd Floor Additional Section:
iief
Mezzanine: Plan Check fee: a
40
Heated Basement State Surcharge fee:
....itlerugr
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
Gx 15+i
Garage/Carport TOTAL: $ . C
Decks Receipt Number: F 8LiL)
Other Cash/Check Number: L ,3
ESTIMATED COST(REQUIRED) Date: �/ '
.Fajr market value of all labor and materials foundation to finish
7°00 1/ L7.SDO �j%LC Initials: 5LL
C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc
JACK WESTERMAN .Iciierso ut, Courthouse
ASSESSOR PO Box I 0. Port Townsend, WA 98368
(360)31)5-910 i
MOBILE HOME INFORMATION FORM
F 1 3 l JL 'i
OWNER'S NAME/MAILING ADDRESS:
NAME: (A) t (( 4^,� , (OH€E L.Ci& "/V) P Pe Ai E (AS'
ADDRESS: .p O. R c)C CI'(./ q IL_c.E.,o aiii) 78,776,
PRONE NO. 'R U 2 7-/ 18 6,I
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 0MOBILE HOME DATA:
(A) MAKE CAL EN iZ (B) MODEL !-7 C L f R (C) YEAR /l R.s
(D) LENGTH 4/8 (E)WIDTH �� G/fW �) 5 ~3I e,3
(F► SERIAL # V.�/ �UAS O??�;j �,�
(G) YOUR PURCHASE PRICE (Do not include sales tax) ??, S-c C0 PURCHASE DATE �34�/O4.
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE JAW;C. G INd
ADDRESS ( O° L./n/C 0W. A 4)E pc Ll LJ eo {�;R %8 3 7d
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY CAST YEAR? Yes
If Yes, Previous address of mobile._
If No, What County was Mobile assessed in last year. kW:VIP
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes
(B)IF LOCATED IN MOBILE HOME PARK:
NAME & ADDRESS OF PARK Lot/Space#
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER: 60)/6,4,, 63/fie eLe-A l P. te6 N E. F •etcg Gi
LOCATION ADDRESS O-� (.Z.)! L C>60 e p'Q 'R.7D ((A,i(,,C,6/1)E 8376,
REAL PROPERTY PARCEL #/DESCRIPTION 7CJI 6/ S"it Ta7 R2 LO
ti) o 06)„
Signature of applicant
THANK YOU FOR YOUR HELP!
CJODI COSSELL, Property Technician
• •
SPECIAL CONDITIONS CASE # BLD06-00060
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on February 17, 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: Type
1 stream; conservancy shoreline designation; seismic; landslide hazard area; flood;
erosion; SUSC aquifer recharge area.
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.) Jefferson County has determined that the use of real property for agriculture and forestry
operations is a high priority and favored use in the county. The county will not consider to
be a nuisance those inconveniences or discomforts arising from such operations, if such
operations are consistent with commonly accepted best management practices in
compliance with local, state, and federal laws. If your real property includes or is within
five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20,
Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to
inconveniences or discomforts arising from such farming and forestry operations,
including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the
operation of farm and forestry machinery during any 24-hour period, the storage and
disposal or manure, and the application of permitted fertilizers and permitted pesticides.
One or more of these inconveniences may occur as a result of agricultural and forestry
operations which are in conformance with existing laws and regulations.
6.) A Type 1 Stream (Fish and Wildlife Habitat Area) has been identified on the subject
property. The stream will require a setback of 150-feet. The setback shall be measured
horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas
shall also have Buffers and Building Setbacks established.
7.) Buffers are areas that shall be maintained in their natural condition, however, minor
pruning or alteration of vegetation may be permitted as long as the function and character
of the buffer are not diminished.
8.) 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).
9.) 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.
10.) Landslide Hazard Areas and t•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.
11.) 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."
12.) All construction activities shall not encroach upon the landslide hazard area or stream
buffers. This includes the storage or preparation of materials.
13.) 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.
14.) 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.
15.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative
buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed manufactured home.
16.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed manufactured home.
17.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
18.) Stream buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
19.) The applicant is proposing to create or add 2680 square feet of impervious surface and
4900 square feet of land disturbing activities.
20.) 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.
21.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
22.) 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).
23.) The site plan as submitted with the manufacture home installation application on February
13, 2006 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 March 1, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
24.) This approval is for a manufacture 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.
25.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
• •
26.) 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).
27.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
28.) The building height is not to exceed 35 feet.
29.) 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.
30.) 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.
31.) Setback from the private access easement rights-of-ways is no less than 20 feet, setback
from the parcels zoned Rural Forest abutting the south and west property lines is no less
than 100 feet, setback from edge of OHWM from the Little Quilcene River shall be no less
than 155 feet. Other 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.
32.) A minimum of two (2) on-site parking spaces is required for each single-family residence.
33.) An address of 202 Wildwood Road, Quilcene has been assigned to the parcel. Wildwood
Road is a county local access (C340409).
The parcel is subject to a recorded ingress/egress easement that was recorded under
AFN's 361061 & 345301.
34.) A pre-applicaiton (PRE04-0031) for construction of a covered RV pad and sunroom was
finaled on October 22, 2004. A SPAAD (ZON05-0002)was approved on August 5, 2005.
A septic permit(SEP05-0148) was approved on August 3, 2005. A well review
(USR03-0096) was finaled March 14, 2006.
35.) The manufacture home is more than 200 ft. from the Little Quilcene River and therefore
out of shoreline jurisdiction.
36.) The applicant submitted a letter from WDFW dated November 26, 2003 stating, ". . . the
canal is manmade and does not support fish life.. . . "
WDFW sent a letter to the applicant dated July 28, 2005 finding that currently the irrigation
canal does support fish life. However, an HPA is not required for the conduit crossing of
the irrigation canal.
37.) Staff conducted a site visit on January 27, 2005 to review the SPAAD and to determine if
the position of the proposed building envelopes in relation to the flood plain. Staff
concluded that the proposed building envelopes are at sufficient elevation and sufficient
distance from the river as to be out of the mapped flood plain.
38.) This parcel is served by an individual well.
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& JEFFERSON COUNTY
kiiii.
1 DEPARTMENT OF COMMUNITY DEVELOPMENT 1 6 ^ n-n „ n
ii► . ,1 621 Sheridan Street • Port Townsend • Washington 98368 F E B 1 1006
��c Q 360/379-4450 • 360/379-4451 Fax �-� Itf�1SUl a 11 �2 U
'"rt1NC6. http://www.co.jefferson.wa.us/commdevelopment/ L ° 1 C! !J
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# t^' G,/ PROJECT/APPLICANT NAME: i;1) //,r i"-, /'.. 60/?c�C�le?4,
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.
(X/ri,)r_�- e9t, ems E:/✓r: %, ` k'00-r-�;i, ..S-c:/ f /v'f.e-e" /�. ,j' (Z. i.,.1.� (12t�^t._. • 4v-`fr//r7ir •.t
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.J(Tx-, i,s _Ara Lc 4.) '( 5 r:3 t t.rJr c. )-i l ", / A a;L_ol; 7 c l C
/ / /
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
rcr�' �;v& (-c,,t) 0l'(:c�ti
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. ��
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i APPROVED
6. Describe any excess levels of noise generated by the proposed use or activity:
7)/A STORMWATER PLAN
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stormwater site plan template—rev.10/1/2003 e DE PT.OF(' T EVE( �'. .NT 5
SIGNATURE: �, ) ( i
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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.). . + ,i
5(4/`<2L�i.civet �UAi �� /J?ik<? IT<.'Q � cL/r j f/J•� ekec'_ �!/rv✓ � /L:_ IC sy/4/4i,'J
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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 facilities on the site plan and differentiate proposed facilities from existing facilities.
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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.
_ 1
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12. Describe the flow control system.
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stormwater site plan template—rev.10/1/2003 6
• •
13. Describe the 'vater quality system.
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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.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. > / p(�
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17. Describe the proposed surfacing material.
18. deU (L Q,���l pc(2(C.,v;c a i 9CC
scribe 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.
jam.
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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stormwater site plan template-rev.10/1/2003
7
• •
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I-CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements-Construction SWPPP
1. Mark Clearing Limits.
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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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stormwater site plan template-rev.10/1/2003 8
• •
12 Requires.. Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs). 1 b
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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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stormwater site plan template-rev.10/1/2003 9
• •
b. Description of special requirements for working in or near environmentally sensitive
fi are/�.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)
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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c7A - `i'P4%6 / /p.12/L /S /, 1T // /7h/-?e-
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.
.44 7. C�h E>� e,�
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. /
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. ✓�fi'
b. Diversions. A)/4
c. Waterways. /1_//i
d. Runoff/Stormwater Detention Calculations ✓J/y"r
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stormwater site plan template—rev.10/1/2003 10
• •
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems, treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
t•� `,
14.1
i I
12 stormwater site plan template—rev.10/1/2003
a
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Parcel 702114035(Christmas Tree Farm)
$ Parcel 702114034(Christmas
Tree rm)
9
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co
memr
w Little Quilcene River
1
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teuMOa••.:-Ivey M,h •ter
•
Contour 15'above River High Water
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Contour 15'above Rivet. W . �,�AM&
f:, lil.
Contour 10'above River High Water
7 '"""ii,
Note: Stormwater Drainage from the proposed house 15uilding site is generally
west toward the..canal then south-east to the lower elevations of the meadow,
then south. Soil is sandy loam and gravel;during storms surface water
/ -�e�- - does not flow but collects in depression where is it rapidly absorbed as soon
i10" -as,signifiicant rainfall stops.
'
H.
`oho Stormwater drainage from the proposed storage buildi g and ADU drains west
• eye
3�j N• Q, into the fire'pond and irrigation canal where it is carried way south, eventually
of reentering the.Little Quilcene River appoximately 2 mile downstream.
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9e /
a roar a apaye River High writer
r 1...
Contour 29 above River High Waal(I.. �...,... Qlukere 'I.I<alCaaal
( _ . - bole:The owkeno Irrigation Canal Is n man male waterwayrY" has been inspected by Fish and PAltltile who have provided a
r)i letter slating Mal work Involving the canal does not require a
+' hydraulic permit.
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with ► '
o ;Se,tictnnk
�, o Sfd a Storn�watIOW.
Required
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1
s" N s
s s
�" APPROVED
PLAN
Reserve dralnilal0" I Pnmrry 1101 0Ml—� onlour 7s'n0ov eoj4gv.Waler --
_— - - MAR - 1 2006
E R • • "UN Y
Utility and Access Easment— DE' 0 'O, 'EVE P NT
Utility Easment SIGNAT r L.
ivi cf
-
Note: All roads on tie property, incuding the Access road are Gravel.
\\... ......._....
Royale Road Easment
To Wildwood Road(lilt Easment
C-
C . .
T _
T 9 —
e=� O — - I
ass
0 25 50 100 150
Fair Lea Tree Farm Residence .......+
CDj 1 tie = sod W. A. Wheeler and P. R. Bush
= o
-mot Drawing Prepared by: 202 Wildwood Rd. Quilcene WA 98376..._. )
a William A.Wheeler Tax Parcel: 702113006
202 Wildwood Rd
C".
Quilcene,WA 98376 —— — 20.V
Acres C Wwv (360731-4147 Perm 702113001 Commerdel Forest