HomeMy WebLinkAboutBLD2006-00113 P • • MLA06-00114
Review Type:
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00113 Received Date: 3/14/2006
SITE ADDRESS: 334 PORT HADLOCK HEIGHTS RD
PORT HADLOCK, 98339
APPLICANT: BRODERS INC PHONE: 360-797-7722
4503 OLD GARDINER RD
PORT TOWNSEND WA 983689778
SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: 22
PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR/ NW MANUFACTURED HOME SERVCES PHONE: 360-631-4151
DEALER: 7228 LAKEWOOD RD
STANWOOD WA 98292
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW M/H INSTALL
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: GOLDEN WES SETBACK:
VALUATION 28,000.00 YEAR: 2000
LABOR & INDUSTRIES APPROVAL?
SIZE: 66X27 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date:
Type Amount Paid Bv: Date: Receipt: ApprovAfLpat� 2006
Permit $163.00 LYK 03/14/06 79190 11''KK
Potable Water Application Jefferson County Planni►,n
pp $55.00 LYK 03/14/06 79190 & '1,.
Total: $218.00 OgS2Q12J-C\?yrrvf3kfL
JACK WESTERMAN ITT Jefferson(:. tr Icesartboose
ASSESSOR • PO sox 12411Piok Toolesser d, .1 [19$ If&
(360)3115-9105
-
MOBILE HOME INFORMATION FORM MAR 1 4 2006 f
r
OWNER'S NAME/MAILING ADDRESS:
r
r- f rft
NAME: K2-k ►1) o Wl a 5 _ C�a `` B R o p E
ADDRESS: 603 O j c�
PHONE NO. 360- t 7— 77 '2.2
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.
l)MOBILE HOME DATA:
(A)MAKE G1)1 rr! tot) c 4- B)MODEL E L I 6(C)YEAR2..0O
(D)LENGTH C (E)WIDTH L / (1)SERIAL it (72 3 2
yeti
(G)YOUR PURCHASE PRICE(Do not include sales tax)2-$)6 bo PURCHASE DATE'Z da S'
2)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 JEFFIERSON COUNTY LAST YEAR?Yes (14/
H Yes, Previous address of mobile.
H 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+ No
(B)IF LOCATED IN MOBILE HOME PARS:
NAME &ADDRESS OF PARK Pc r14- H-e.J. d Cf' /. e Lot/Sporai# �� •
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS
REAL PROPERTY PARCEL#/DESCRIPTION
��- t{a4hy "Chb�nas
Signature of applicant
THANK YOU FOR YOU
R HELPl
el)
Xn SS-e X .
JO COSSELL,Property Technician
APPROVED Stormwater '
SITE PLAN Require .
MAR 2 2 2006 14 QWf"ilP
O I.
JEF4r !i ' 4n pp SEME $ I
SIDGNUFECUJ■L !,:,;:.� 1
,
f
9 014
1 1...b S.T. P.c•
I
I.
(.2511 Pvc
Alt : -.1.111"VIM r.A...-
'
., fwAY 1 s e P `iS- 2 sat)
s �
I
A,X' IA F , 'r! <ock_ U
P`A..0\�. °Mc j SON tT1111`1 '6
• 6 6 I '/ -^+`' 9
1 f.'s'. ' CR•
y , ,
i
/62IJye
Pi es-' r.
1 "---- 254
P 11.14-I"1 r Iflik
MFG. t4O* -- LOT lari 1 IIIF
PORT 14A0L0c1( ii SIGHTS "14P•
9 gq-- 5c 0— oo/ /o., & 2 f/.
3SpoR T HAD6-oc,f; 71.71 ,G/9TS pL-,qc
opekS, INC. D -4wh 101
46-03 0LID Gr4RUJNEP2 Rp, 1?1QtARD 13RoDE' RS.
'PORT -'yowAl END, t d4} 98368
360-. 77- 7?-2-2
•
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#: BLD06-00113 Received Date: 3/14/2006
SITE ADDRESS: 35 PORT HADLOCK HEIGHTS PL Issue Date: 4/7/2006
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/ NW MANUFACTURED HOME SERVCES PHONE: 360-631-4151
DEALER 7228 LAKEWOOD RD
STANWOOD WA 98292
PROJECT DESCRIPTION: lot 41 NEW M/H INSTALL
sue,-v -Pk'') j53(3t5
MAKE: GOLDEN WES
YEAR: 2000
SIZE: 66X27
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 4/7/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTI UQUS FOOTING, SLAB or PADS USED):
5 l l2tn;�L J O)o 1/2 / ,
Stormwater FINAL Approval:_ l
Blocking/Plumbing: Y2V/ I/l2k'
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps:' ofg`ocI
HEALTH DEPARTMENT AND PUBL?C 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
•
SPECIAL CONDITIONS CASE # BLD06-00113 •
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on March 22, 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:
SARPA 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.) 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.
5.) 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.
6.) The applicant is proposing to create or add 2142 square feet of impervious surface and
2800 square feet of land disturbing activities.
7.) 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.
8.) 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.
9.) 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).
10.) The site plan as submitted with the manufactured installation application on March 14,
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 22, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
11.) This approval is for a manufactured home only. Any future permits on this site are subject
to review for consistency with applicable codes and ordinances and does not preclude
review and conditions which may be placed on future permits.
12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
• •
13.) 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).
14.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
15.) The building height is not to exceed 35 feet.
16.) 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.
17.) 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.
18.) Minimum setback from Port Hadlock Heights Road right-of-way is 20 feet. Minimum side
and rear yard setbacks are 5 feet.
19.) A minimum of two (2) on-site parking spaces are required for the manufactured home.
20.) 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.
21.) Port Hadlock Heights Road (P516) is a private road. The road approaching is existing and
an address of 334 Port Hadlock Heights Road, Port Hadlock has been assigned to lot 41.
22.) This parcel was created through the Port Hadlock Heights Mobile Home Park Binding Site
Plan on 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.
23.) The lot is served by a community drainfield system A(SEP95-0289). A septic permit
(SEP06-0073) for a tank only was issued on April 6, 2006.
24.) Jefferson County PUD provides potable water to this site.
FROM :OCFCU FAX NO. :3603E51479 Mar. 13 2006 09:43AM P 2
GENT 9Y: GOLbEN MaT arRVICE:410 1SdiaA1144si; WI-i4•+ 0:00u11; FAbE 1!i
rp
I
I
I o� ..
�
i '
� vP #.
rrt a
Na 1 _ ,
i .,
T ;
5-4.J. P ___71
Y z � ° a •
`� , 1. li .ino
. l
'
lZ;
it 4). r
ntJ. :
; 'i s;
-1
'1 Q � I tv�
s
.
t �8 .,..
! C 14 r. ■[ice'. 1
liir
: ...7C 7 i, 1 N :.i 47;1!t. I Eir CIAll .
.; am le*.., . .3 .FT
--;I .-7..... -g 0 : 3 .....• :1 1
1 , 11
■NI.Il _�a'-1etr.�C�i S
*J11i .
t. l .
►„ r
ki
.-'11..i !.. p , , Asig..,. .r--;,. . ,f,
iI Cry L�■■■■ i .A. 1 ._-''''
ro
il ,I z,.1 i •
,� r O
r...++++���
. .
/SON cfew,
JEFFERS COUNTY , f
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
qs 1-ZING www.co.jefferson.wa.us/commdevelopment
MAR 14 2006 '! /
Master Permit Application -- j
Project Description (include separate sheets as necessary): �-
/VIf3• . Pom-c 7,1 '57If1/ * _
Tax Parcel Number: [ g`� sOProperty 2
0 (2.07L
oo� '�i Size: )l��'�„ F�r (acres/square feet)
Site Address and/or Directions to Property: 35 poi-4-
Property Owner(s)of Record: F.le0 D ER.S, �'- c C.
rGr1 a d to ck N���/ifs 1d cC'
r� ,,� - j97-771-z•
Telephone:9
h ax: 7(47-7i33 email:
Mailing Address: 4.503 D/d Ge.,d rnra- R d• P,7 o f 365"
-Appl►cant/Agent(if lifferentfrem- mer).- Ka 4/I y 717 e ry/a 116,Y1e Q 1...n e,-
Telephone: Fax:
Mailing Address: email:
What kind of Permit?(Check each box that applies)
LI Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan **
❑ Change of Use ❑ Long Plat**
❑Address LI Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management ❑ Shoreline Management Substantial Development"*
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication * ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal,,iftknown:Conferenceion
I hereby designate DESIGNATION OF AGENT
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. ,./
D
Signature: „,„/„..,ti 7� ti-
Date: /0 M 4r411 241'o 4
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 adtle;ing to aryl complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: (" - / ��
'' Date: !D Al)eeb 2ao6
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
II
f 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. ' A H R
Date: r 46 f
Signature: _ i
t '
GENERALL� `
CONTRACTOR OR MANUFACTURED HOME INSTALLER: (C•M•.rl•..) PHONE: 7FAX`;
(344,t1Vol a I v s 6 I s U 5 R„ J iviv itt 44 u f. N O Mt.,Se.r.a .tf ( 4 2'S) ?1..1r li-' 6,5 3 2,, F r i )-r r r r!r_'
MAILING ADDRESS: f d 2 l l ii -t S+. N w 10.4,4 3 01 v EMAIL:
CONTRACTOR'S LICENSE w 10- et Q1 7/ WAINS
NUMBER: N W M A NM }4 9 S°(/V1 6o NUMBER W A t N 3 2 (G 8
ARCHITECT/ENGINEER: • . ' PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 2 Bank Height: X Community System 7
❑ Alteration/Remodel ❑ Concrete Total: 2-- [1 Individual System
❑ Repair ❑ Masonry SEP Permit# 95-2-81
❑ Demolition ❑ Other: Bedrooms: Water Supply: -7 5
Existing: Setback: I] Private well ❑ Two Party
Type of Heat: Proposed: 3 p‹Public
Total: _9 Name of System: PO D
Tr- AY<..
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 1 Underground Tank H I Above ground Tank Size of Propane Tank:
LI Heat Stove Ii Cook Stove H Woodstove I 1 Fireplace Insert ❑ Hot Water Tank I] Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: r 5_cc)
2"° Floor Heated Consistency Review: 1 5 ( 'C"
Other Heated Base fee: 4 10 . , GO
Mezzanine Additional Section:
ee
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: ^ �.N
q � _
Garage/Carport SUBTOTAL 7 i G c-;
Decks 911/Rd Approach fee: a°c•
Other TOTAL: $ L -76400
Receipt Number: -76
71 Icj Q
Cash/Check Number: '1 G,
ESTIMATED COST(REQUIRED) Date: �� i"1 I J Di„
•Fair market value of all labor and materials foundation to finish {
Initials: C �
v
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
' • •
QN
k�S 1 e° , JEFFERSON COUNTY __
i
1401 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street - Port Townsend • Washington 98368 MAR 1 w )
O 360/379-4450 • 360/379-4451 Fax _
` ''IN http://www.co.Jefferson.wa.us/commdevelopment/ I
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# ( I LI PROJECT/APPLICANT NAME: 1TIC D 0 C K S /7-/401VI A-} C /,€ /7//)
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview �‘a r ,„„� ._
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
Aka hu-'ac. vc-4 140WLC or% a lb+. ih a 1,yult vio fac-f.rvI hemC
farK1 _
•
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
Btiildinl Ake.t o . /of f'1a-1- , s A -Alx be/• i e cle.
of 1acj'<C144- )-o ad . Rear. O C /a-. 1 wes,/) S/e/oes +" Q..
henGhf a,!) oTc L 1�
�1itieh t•5 h'een- 5/4ce / .,11-4e of t,,,,k;1 /JdmtlotrR.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
E;ieildih 1 A-re., oc lef Is c lea rod A., -11 A a re45 -f'o
ilf o r`f't`� a.n A LI/.[,SII-- i h y a 4.1Ye_ V e q x71-e 111-0 ah
4. Describe the existing soils. Indicate soil type on the site map.
Set n dy — arave-1/1. Soil.
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.
G,cnC.-4t/41 c.,t?Lek' L h{/71at s i h -/h
iC �y-..',7 cl o r7
-FA is_s s1' liva t dots *, o-1 dr4 h fee.en
Q,4/4 CtA - l-o.t d a n d Cev/ de-..re C tS i-1 t'5 a f
"i-41'Se I— wife " conS1Fvc-f,or, "i nd dra;teed 7/'e pre-- arAiS Al
6. Describe any excess levels of noise generated by the proposed use or activity: S f or.y, GI/47 /xc;e! I.G1.
Ales n<.
APPROVED
STORMWATER PLAN
Storrequirm�edater BM'' -� MAR 2 2 2006
stormwater site plan template—rev.10/1/2003 �jt i
� . 5
JEFFERSQ UN '
DEPT.OF CO. N T EV: PMENT.
SIGNATURE: II,,
• •
i
1 I
•
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. MAR i , '
1 . -
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.).
Lo+ 'in of fbi4 44-A VG ct, Hcr;,/A4S /U4i) J)1 n.e ps-i‹ ($5p 941—eoo/)f
Iv.e - is I.de..4- opt* S &o I44.I / '4 q '.
i1 / a+ 4,dloch 1447ihJS AtorIli
Oho iS �open 4cey So k ; L s o2 .4rc4 445 a A.•reJ
EaS4- ,. 11-h-e 4CC- tom c( and cam.)- dr-S4c.
Permanent Stormwater Control Plan
This portion of the Stomiwater 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.
lV/i) be fug/ Ir*Sperred 4n aC %9 fi'/7rc,&e .
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]
n,ont r<¢uircl.
11. Describe the performance goals and standards applicable to the project.
7 ft.I1 trrf;l4Ycie sTor.r► w.�.fer .
12. Describe the flow control system.
None-
stormwater site plan template—rev.10/1/2003 6
•
13. Describe the water quality system.
one, MAR
1 4 2006 ! i
14. Describe the conveyance system analysis and design. •
Non-e.
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
At ale.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
/R
17. Describe the proposed surfacing material.
C►-�She1 /^oG be) driYeWa7
18. Describe methods for restoration of the site.Ate e�r.$!"`bOt yet.tririf,, rQS71o't'r`JJ
gs°n ctrc Con-lent/0144.0
44. %f rl,eed Sec.dtn� cvi-/h t 5.S ld I"
clone.
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.
N )
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
oh e
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.
N owe.
stormwater site
e plan template rev.10/12003 i‘Eto
• .
11
CONSTRUCTION STORMWATER POLLUTION PREVENTION1 PLAN(SWf 2aQs
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated-by the._applthant i 1 the
template that follows must be installed on theground during all constructionphases of the project The ygpp 4¢ d psp 4
9 P 1 -P fit ir, � onsib for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult th Constructi.4rl Storm_ater
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.
Ar•ea 0E Nitdr0-fic-f.db-ed ljome w;ll le lelihi'eieci
and 4 i 3 are4 wi/l he ,7 rut led for" h6mc
{ono e-/torr.
2. Establish Construction Access.
-'he coil s-froc7lio*I a.cc,c.ss 13 -fhe v.>(i 5-/r N el Afth
el f d f "pn.� f�01/0ck f-1 e2,i is to l.c ce c., h� 6
Lt,i,!1 he re-- s,.,f t a,d �.,i e; c,f•-S 4 e d F-e ch1.
3. Control Flow Rates.
NO.,.
4. Install Sediment Controls.
5. Stabilize Soils.
Re S•e€.c1i4, c..ii4-h elr4ss i f f..efr;red.
6. Protect Slopes. 1 No sA es .e s/L`S')) 0 /-bee -Fhdh na.4,r411j.,
V�fe-f-t4ed arets -to Gvesy` a •74 ,Vo.-.h wJje4
A. ►!1 h0-1- Ix. d,;l�.-bed.
7. Protect Drain Inlets.
N/A
stormwater site plan template—rev.10/1/2003 8
•
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
NIA' 1.
""f' 2OCv
f
i
9. Control Pollutants. Ir
n'c c o✓ 4-e rr,Ip 1 t
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
N I R
11. Maintain Best Management Practices(BMPs).
/-thy a cedes ►3-/i,. b.sci ..L h 4-1- fret ,,de r r—vest �;o�
w. �d doe see d � h o �,e ver �-�f;s ;.s n o-f
C °erieMpl4-fed. _
12. Mark
ge the Project. l
"'e Yylfg- 7o 11,S AlIQr/ Con+v4c40Y^ Gvi([ to
+he for
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
/Vbnc
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
/Vo wc4 4,- bnLi,cs n at.,. by .
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
None.
stormwater site plan template—rev.10/1/2003
9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
•
MAR 1 4 2006 ij
" I
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of thelon-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 1
ND L 0Si°v1 pee,&en" a.re4$ .-)!iST'.
5. Construction Phasing.
a. Construction sequence �1 I, flreP'YC sije -fDr hr1f�, hhome ) dvhere,711'on �C• r15Tt4//
h?o bi
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.
l,eptre s,-ld appr•z rni Alord, 7n$t-4/I ;I) M.me
-�herea f 1er.
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
As PI (I) 4 bout'.
b. Proposed wet season construction activities for environmentally sensitive areas.
NJ-
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
ti IA
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
R
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. N f i4
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/1/2003 10
S
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.
l� Afiebo4 • b6
(LAN NER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
:pc, A 4 20
•
L
1p stormwater site plan template—rev.10/1/2003