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Home My WebLink AboutBLD2006-00261 • • MLA06-00246 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00261 Received Date: 5/16/2006 SITE ADDRESS: 505 JOLIE WAY PORT TOWNSEND, 98368 APPLICANT: MARTIN A LORECKI PHONE: 360-3/9566 CHRISTINE LORECKI 1805 WILSON ST PORT TOWNSEND WA 983689408 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001071015 Section: 7 Township: 30 N Range: 01 W CONTRACTOR/ PRESTIGE PROPERTIES PHONE: (360)681-3094 DEALER: 261533 HWY 101 SEQUIM WA 98382 33Bg gg 33 Contractor's License PRESTP1066CM Expires 1/18/2007980 REPRESENTATIVE: PRESTIGE PROPERTIES/ PHONE: (360) 681-3094 KOZELISKY HOME SERVICE 261533 HWY 101 PROJECT DESCRIPTION: NEW M/H (GOLDEN ESTATE) SER#30341 TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GOLDEN WES SETBACK: VALUATION YEAR: 2006 LABOR & INDUSTRIES APPROVAL? SIZE: 68'X40' BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: 5 J/ o (, 025 - Type Amount Paid By: Date: Receipt: APrôveci@At\fE[ Manufactured Homes $163.00 LYK 05/16/06 81230 Potable Water Application $55.00 LYK 05/16/06 81230 JUN a92006 Total: $218.00 Jefferson Couniy Planning & Building) flenartment • • 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 #: BLD06-00261 Received Date: 5/16/2006 SITE ADDRESS: 505 JOLIE WAY Issue Date: 6/29/2006 PORT TOWNSEND, 98368 APPLICANT: MARTIN A LORECKI (� CHRISTINE LORECKI 3g5 �S�Q`r 505 JOLIE WAY PORT TOWNSEND WA 983689408 SUBDIVISION: Block: Lot: + PARCEL#: 001071015 Section: 7 Township: 30 N Range: 01 W CONTRACTOR/ PRESTIGE PROPERTIES PHONE: (360)681-3094 DEALER 261533 HWY 101 SEQUIM WA 98382 360-681-3980 Contractor's License PRESTP1066CM Expires 1/18/2007 PROJECT DESCRIPTION: NEW M/H (GOLDEN ESTATE) SER#30341 MAKE: GOLDEN WES YEAR: 2006 SIZE: 68'X40' THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/29/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. � Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): t l/'"" Stormwater FINAL Approval:G Blocking/Plumbing: O —2-3"'42 _ Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 2 -/( 07 t/lir 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 • • SPECIAL CONDITIONS CASE # BLD06-00261 1.) The application was reviewed by the Jefferson County Department of Community Development staff on May 29, 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: 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.) 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. 5.) The applicant is proposing to create or add 4200 square feet of impervious surface and 4200 square feet of land disturbing activities. 6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 7.) 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. 8.) 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). 9.) The site plan as submitted with the manufactured home installation permit application on May 16, 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 May 29. 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a 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. 11.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 12.) 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). 13.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 14.) Minimum setback from Jolie Way right-of-way and any other ingress/egress easements shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 15.) Exterior lighting for residential•s shall not exceed twenty feet(20') in heightfrom the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 16.) 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. 17.) The building height is not to exceed 35 feet. 18.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 19.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 20.) An address of 505 Jolie Way, Port Townsend has been assigned to the parcel. Jolie Way is a private road (P183). 21.) A well review(USR05-0127) was approved on March 6, 2006. A septic permit (SEP06-0026) was approved on February 23, 2006. A road approach permit (RAP06-0016) was cancelled on April 26, 2006. 22.) The parcel is served by an on-site individual well. • • JACK WESTERMAN III Jefferson Count,Courthouse ASSESSOR 1'O Box 1221), Port Townsend, VIA 983611 (360)385.9105 MOBILE HOME INFORMATION FOIM OWNER'S NAME/MAILING ADDRESS: NAME:Martin & Christine Lorecki ' MAY 6 2 1 ADDRESS:1805 Wilson St. , Port Townsend, WA 98368 PHONE NO.360-385-9566 _.`•' 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: (A)MAKE Golden West Homes Golden Estate 2006 (B)MODEL (C)YEAR (D)`LENGTH 681 (E)WIDTH 40 ' (F)SERIAL## 30341 (G)YOUR PURCHASE PRICE (Do not indade sales tax)119 , 0 45 .0°PURCHASE DATE 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE Prestige Properties , Inc. ADDRESS 261533 Hwy. 101 , Sequim, WA 98382 (B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. N/A If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes 0No (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:Martin & Christine Lorecki LOCATION ADDRESS xxxx Jolie Way, Port Townsend, WA 98368 REAL PROPERTY PARCEL #/DESCRIPTION 001 071 015 l %gnats& of applicant THANK YOU FOR YOUR HELP! jSIR Q JO COSSELL, Property Technician __ _— • • R E I m Y Q O 3 it ` n O O 3 n (0 o 0 O e-- cc cr ¢ 00 • V 31 rn >- ¢ � O a W F p C.CO / > w .� > F coP 1. _/c;) ''' c; - Imo: vio.)WEI CZ .10 5 a 0 = .,..; _c m -I -1 COca, ..... ...... F- P : .- lu CIO) 0 CD PIZ CO -- 1,4, A btsxn i.1 r: — - N 2 E C4 0 • • 0 cG CIO 1' cc v Z in Z :7 0 M O _ 8CC Y� n 6.0 `?e 111 N n IWO _W.-i.1*.t` I 1 \'it CC in 1 --'-Y" �— <: wetda13IdO O cu ,.,? — —+ .,...„ .,.... .z. O I Si co � cc u. 41 y00 ¢ s 1. $ m MEM i -al m _ C r<14 a-7- 133 4 0 T 1&7111 As ,_,N: _j---,... ,, i • s V. .-y 3 �HMM 4 r, / E� / .g-.e► / -.ElCD Ca7 , 1- ..:':I W A 03 10 N$ Q I lll o 6 1 -:: 't 8 ' q I I. _Ade • • 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: •,z at mi Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: r C TW.,, Acre 2 t rY-S (k-r ) 4 r.-1- 7)c-'7L, ( ) MAILING ADDRESS: Z L /S-2 3 y l C i ci.,,, 4,,4 9t3g EMAIL: CONTRACTOR'S LICENSE / WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type L�'" New of Sewage Disposal: jINood Existing: 2-- ❑ Sewer ❑ Addition 0 Steel Proposed: Bank n munity System ❑ Alteration/Remodel 0 Concrete Total: Y Height: Vindividual System ❑ Repair 0 Masonry SEP Permit# c-k. - 3=:4, I 1 Demolition 0 Other: Bedrooms: Water Supply: Existing: .. Setback: irivate well ❑ Two Party Type of Heat: Proposed: �— 0 Public ro.Tc,-i /l,n. Total: 3 Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank 0 Above ground Tank Size of Propane Tank: ❑ Heat Stove 0 Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 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 � ) I 1 r Current Proposed �'( R�'___ 25 Main Floor Consistency Review: . 2""Floor � �' ` Base fee: (� 3r°Floor "' 3 Additional Section: �--- Mezzanine: Plan Check fee: - Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: c„", j Other Unheated 911/Rd Approach fee: Garage/Carport c"4 — - TOTAL: $ -ietn \ Decks _.._.- Receipt Number: 11' __ g i a 3- Other Clash/Check Number: ESTIMATED COST(REQUIRED) Date: MAY 1 6 2006 (cv ck-A .Fair market value of all labor and materials foundation to finish r(p f 66 Initials: 0)75- __ .rt WPM ENl G:\Pem itCenter\FORMS\DRD FORMS Master Permit Application 7-8-04.doc • • .4;¢,gON co — JEFFERSON COUNTY r----`-• -----"��' n, '� ' �'j DEPARTMENT OF COMMUNITY DEVELOPMENT `+ '' ' 1 4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax l`SBING� ��yy p www.co.jefferson.wa.us/commdeveloprrl1fit ++ J Master Permit Application : c _a ` co Project,Description(include separate sheets as necessary): fex Parcel Property Number: ' t 10 7 1 6 ! S Size: 2 I - l; S- ,i,.¢ (acres/square feet) Site Address and/or Directions to Property: ?;•/,C„.-*,i. v;)c(` l a.:T /4,,,:N s t•L.4 im, Property Owner(s)of Record: MA,/ "E- Ch IV c'r'j u.+ L e at-c.C-fc i Telephone: ''6C 3 g-Z" `I 5'1' • Fax: email: Mailing Address: / sl GO6 tt/e yt/41i PO 2 / 1-2,c,"-s- -.A?_ Applicant/Agent(if different from owner): 1 -r i Tic !1 �'Zela '/r"t s Telephone: ?C C' (< fi t- 30 'II Fax: email: j Mailing Address: C'(S 3 3 i1.,/ /e'_t Sly.i i p-: t-t. `/C ?S 1 What kind of Permit?(Check each box that applies) ❑ Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑Special Use(Essential Public Facilities)** E -t anufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat'"' ❑Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address [1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ 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 0 Wireless Telecommunication* El 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: /� ESIGNATION OF AGENT I hereby designate/2hJ .L' i ' ' i4,t�'-I to act as my agent in matters relating to this application for permit(s). " OWNER SIGNATURE 1-,.--' ;r`-1 - Date: '--c" 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. CM-------- - M------ . -';:-,.- Signature: re Date: /2— 7— ,/ 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."Jeffersonnty.,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 complian with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-�` s#e(able re sibili or adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. /2- -' - �5 Signatur . �?��.u. Date: ; . IP • pEftimr # -$t11 - - 4 o DEPARTMENT OF COMMUNITY DEVELOPMENT tERSti 'C 6 621 Sheridan Street • Port Townsend • Washington 98368 pin 0� 360/379-4450 • 360/379-4451 Fax 87N http://www.co.Jefferson.wa.us/commdevelopment/ ,vsci.oPMENT STORMWATER SITE PLAN SUBMITTAL TEMPLATE ..... ...... urfOJEI iiAPPLICANi NAMc: A.g/y4.— 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. lleKS-e, S'E��: C/rtcea , S�Yfnn !0-.aj1JJ�.- J 4et.e? Rv4-clie re) &1t� 1S5r fics • Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 1-r,.-t/ EX c-cP r 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. • 4. Describe the existing soils. Indicate soil type on the site map. _ !'' "- t4 so i 1 `e S y/Ti r✓ N-. t 5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. i'4 Ca-e 5 L+i r1i'in /Vart f�K Yi 0 12►4 t r-tr 9'f- APPROVE') 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN MAY 2 9 2006 1 r !EPEE N StOrrnW U TY p DEPT.OF ' E l: OP ENT storrnwater site plan template-rev.10/12003 Require SIGNATURE. • • 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. Ato 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.). 4// 2-c 5 i cX 4 N 141-/ r4 i� 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. Irk" 2 i i - cC y C ..� . . i�i2r;> .-r2ry 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.] A." )N'-C 11. Describe the performance goals and standards applicable to the project. 'F2 cG,—t7 c 1 9i(-C p -cr4 Ae.ve t2c'n-- a,40- 'Vt.. rc ) y w•4-L� 12. Describe the flow control system. 6 stormwater site plan template—rev.10/1/2003 • • 13. Describe the water quality system. •� 1/ MAY 1 6 2006 14. Describe the can e yar,ee system analysis ana design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. At(( nit 14-ir4_.iz yf i e&et. S ' Ex r4tve4 T i;cid it f�c - t' 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. ��' I�I�J if rAC I i.i l`�-r 17. Describe the proposed surfacing material. h�� 18. Describe met ds for restoration of the site. 5. 'f ace cat . k ZSs' A-acme... %ate( ezeoun.41 /4.4-3,, a r 7Z c ".L #41 sly 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 includedjist the Manuals here. k/A 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. A// stormwater site plan template—rev.10/1/2003 7 410 • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I-CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements-Construction SWPPP 1. Mark Clearing Limits. 2. Establish Construction Access. C e -*-15 c.t.5 l'% h t.v 3. Control Flow Rates. A-(ef 4. Install Sediment Controls. /(f// " • 5. Stabilize Soils. A-V/4- 6. Protect Slopes. otf ,K--C 7. Protect Drain Inlets. s slormwater site plan template—rev 10/1/2003 • • 12'?equired Elements-Constrctirnr cln/POP!ro. tjn,LJed) I 8. Stabilize Channels and Outlets. AY 2006 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). • 11. Maintain Best Management Practices(BMPs). reit Cp;A,wri� /4-/L-6e 5 Si 12. Manage the Project. -lie f .5 j pf-m..a gt Cf S I al 4 _r L/V Yr 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). A-///4- 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. /VA stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. A./714 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence /4-0.2 z. 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. II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. i'7 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. it//14- 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. A /1 c. Waterways. r d. Runoff/Stormwater Detention Calculations 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 npr knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. A\ot„..s:52, ` (LANDOWNER OR UTHOR E REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • 12 stormwater site plan template-rev.10/12003 .N1 \\ /NI .._f:' . , , n , . •,, . ,.....„. , % ,,t i -\--) � �1 f ‹,,, — , -5 rc); • ,.. ,67, -r; -- i ..( 7 f1 NC 1- , . , ,_;,,Y‘'• / .),-,f- . ).9 LJ\ \ • t l') 'N ‘ \'N d I .zol W o 1 \ 41# 8c0 Iowa= . rarraisi \ .,„ , ft. , \,,, N‘,,, ii ..,; - ....___ , ., Tal low ' 0 . 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