HomeMy WebLinkAboutBLD2006-00386 ! 111,.
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD06-00386
SITE ADDRESS: 821 THORNDYKE RD Issue Date: 08/21/2006
PORT LUDLOW, 98365 Final Date: 4/3/2008
APPLICANT: RAYMOND STELK PHONE: (360) 437-8043
VERA ARLENE STELK
813 THORNDYKE RD
PORT LUDLOW WA 98365
SUBDIVISION: BRIDGEHAVEN DIV 5 Block: Lot: 11
PARCEL NUMBER: 935100010 Section: 9 Township: 27 N Range: 01 E
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003
EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes ( no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/3/2008
I:\F_BLD_Occupancy.rpt 10/29/19
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10 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00386 Received Date 07/10/2006
SITE ADDRESS: 821 THORN DYKE RD Issue Date 08/21/2006
PORT LUDLOW, 98365
APPLICANT: RAYMOND STELK PHONE: (360) 437-8043
VERA ARLENE STELK
813 THORNDYKE RD
PORT LUDLOW WA 98365
SUBDIVISION BRIDGEHAVEN DIV 5 Block: Lot: 11
PARCEL NUMBER: 935100010 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE
7 CALL FOR THE REQUIRED,IINSPECTIONS THAT APPLY TO YOUR PROJECT.
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14/14/94111
04 �w tormwater FINAL Approval:
1�, 1 Underground Plumbing: fli< q/N/� it
Underground Insulation: 'E. ,,! .3/- 6 10 ' . :e
Shear Wall : 0 _ /i o
Sheathing: , •1,6: el
Framing: Wr OK, t0j3TotP (�l_ /-f-L7 - O-2 0 '''3b '';1 fy,aI •1
rfc
Plumbing: V Gi-Ek4 OJT- a t�rvM.--
Propane Tank/ Lines: `,UrtI /yu laws Dk 4/07
-
Insulation: (NIll (.-- OK- -27--o-1
Sheetrock: ene (Nes7 fr
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zo g Final Approval: /,��
ccupancy Approval: q
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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
SJILDING PERMIT APPLICATSV MRLA06w00pe372
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00386 Received Date: 7/10/2006
SITE ADDRESS: 821 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: RAYMOND STELK PHONE: (360)437-8043
VERA ARLENE STELK
813 THORNDYKE RD
PORT LUDLOW WA 98365 BRIDGEHAVEN DIV 5
SUBDIVISION: Block: Lot: 11
PARCEL NUMBER: 935100010 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW SFR W/ATTACHED GARAGE(, _*R°""'"`a' —+O1Dfi^5 /441 f o�
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,814
VALUATION 248,000.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 486 SHORELINE:
CONST TYPE: DECK: 59 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: BRIDGEHVN
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: , l Prop: 3
Total: /a. Total: 3
Routing Date:
`1 ja10c0, 2_ __
Type Amount Paid By: Date: Receipt: I Approved/Date
Permit $1,822.55 KAS 07/10/06 83710
Plan Check $1,184.66 KAS 07/10/06 83710 44Il e ) V hL?
State Building Code $4.50 KAS 07/10/06 83710
Potable Water Application $55.00 KAS 07/10/06 83710 AUG� 2006
Total: $3,066.71 Jefferson County Planning
&Building Department
•
SPECIAL CONDITIONS FOR CASE BLD06-00386
1.) A vegetative buffer of 25-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.
2.) A Geotechnical Report dated June 12, 2006 prepared by Gary A. Flowers, PLLC was
submitted in conjunction with this application. The report addressed the stability of the
geologic hazard area. A setback of 25-feet shall be measured perpendicularly from the
top or toe of the geologic hazard to the proposed single family residence.
An addendum to the Geotech report dated August 13, 2006 was submitted that addressed
additional concerns of the department regarding (1) the extension of the retaining wall, (2)
location and depth of footings along the north end, (3) existing soils conditions at the
northeast corner of the site, (4) staking the top of bank, and (5) verification of the top of
bank at the site in relation to the site plan.
3.) Landslide Hazard Areas and their 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.
4.) 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."
5.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
6.) 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.
7.) 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.
8.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
9.) VOLUNTARY MEASURES OF COASTAL&AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
•
10.) VOLUNTARY MEASURES OF (,ASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
11.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
12.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
13.) 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.
14.) 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.
15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
16.) 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).
17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
18.) Minimum setback from top of bank as identified by the geologist shall be 25 feet.
Minimum side yard setbacks shall be 5 feet. Minimum setback from Thorndyke Road
right-of-way shall be 20 feet.
19.) 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.
20.) 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.
21.) The building height is not to exceed 35 feet.
22.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
23.) GEOLOGIST SHALL DETERMINE THE TOP OF BANK OF THE LANDSLIDE HAZARD
AREA AS WELL AS STAKE THE 25 FOOT SETBACK FROM THE TOP OF BANK. THIS
STAKING SHALL BE PERPENDICULAR TO THE TOP OF THE BANK AND
ESTABLISHED PRIOR TO POURING OF ANY CONCRETE AND PRIOR TO
EXCAVATION OF FOUNDATION.
•
24.) STORMWATER DISCHARGE FUR THE PROJECT SHALL BE PIPED TO TIPTOE OF
THE SLOPE AND EITHER INFILTRATED OR SPREAD LATERALLY AT THAT
LOCATION. THE EXISTING HDPE PIPE DOWN THE SLOPE FROM THE STELK .\
RESIDENCE LOCATED ADJACENT TO THE NORTH SIDE OF THE SUBJECT SITE L � .
SHOULD BE SUFFICIENT FOR THIS PURPOSE. THE EXISTING CATCH BASIN ON 01 1 , ,.0L
THE STELK PROPERTY SHOULD EITHER BE REPLACED OR MODIFIED TO
INCLUDE A SEALED CONCRETE BOTTOM.
5.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT A WRITTEN �` ~11Qv
0LETTER FROM GARY FLOWERS, P.G., P.E.G. STATING THAT THE STRUCTURE �1$`
� �j�g AND EARTHWORK HAVE BEEN CONSTRUCTED IN ACCORDANCE WITH THE
' GEOTECHNICAL REPORT DATED JUNE 12, 2006 AND THE ADDENDUM TO THE
121
GEOTECHNICAL REPORT DATED AUGUST 13, 2006.
26.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT A WRITTEN
LETTER FROM BRIAN HARRON, PE STATING THAT THE STORMWATER FACILITY 9.1 A__,
PX HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE
tiS F "DRAINAGE FACILITY" LETTER DATED JULY 30, 2006 AS SIGNED BY BRIAN L.i.c-`F '
HARRON, PE OF PATRICK HARRON &ASSOCIATES, LLC.
27.) THE CURRENT PLANS IDENTIFY A CONCRETE PATIO NEAR THE NORTHEAST
CORNER THAT REQUIRES FILL WITHIN THE 25 FOOT SETBACK ZONE.
THE FILL SHALL NOT BE PLACED IN THIS AREA AND ALTERNATIVELY, A WOOD
DECK SHOULD BE PLANNED FOR THIS AREA AND FURTHER GRADING
ELIMINATED.
28.) APPLICANT SHALL CONTACT GARY FLOWERS, P.G., P.E.G. FOR FOLLOW-UP
INSPECTIONS ONCE ALL FOUNDATION TRENCHES ARE COMPLETED AND PRIOR
TO INSTALLATION OF REINFORCING STEEL FOR THE FOOTINGS. FOLLOW-UP
INSPECTIONS CONDUCTED BY GARY FLOWERS SHALL BE IN WRITTING AND
SUBMITTED TO FRED SLOTA, BUILDING OFFICIAL.
29.) NO FOOTING DRAINS OR PERFORATED PIPE SHALL BE PLACED ALONG THE
WESTERN FOUNDATION WALL OR ANYWHERE WITHIN 30' DOWNGRADIENT OF
THE PRIMARY AND RESERVE DRAINFIELD AREAS.
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I:\F_BLD_Permit_Buildng.rpt 10/29/19
IR �C i v q t rah
4� �Nrni CO JEFFERS COUNTY I' ' � , _,
,\ DEPARTMENT OF COMMUNITY DEVELOPMENT
:t ,.,.
621 Sheridan Street • Port Townsend •Washington 98 8 I. U LIM
360/379-4450 • 360/379-4451 Fax
•gS1pe www.co.jefferson.wa.us/commdevelopment
N JEFFERSON COUNTY HO
Master Permit Application MLA: NO-3-1�,
Project Description (include separa sheets as nece,)sary):
S r— V ____c..-U( A-- ti- Cu-‘cL 9.___,
Property i ,GUc5
Tax Parcel Number: 3 j 5 1000010 Size: 73 x 26? = /6:E 75 (acres/square feet)
Site Address and/or Directions to Property: c 1 .1 V\o(\1&y e -�k L. i 0 :i y J t
Property Owner(s)of Record: /,?/Tyf-ti,CAo 1 A RLt/,. t L (Z.;-L h..
Telephone: EGG i f 7 e 6`� Fax: S i{M G email:
Mailing Address: (cI12, TH62,kik;O'fit c'- A7{11=1n Portz( Lunt. i., oiWQ n 36 5-
Applicant/Agent(if different from owner): / A
Telephone: =,(,-G 't3 7-COt '3 Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
rBuilding ❑Variance(Minor, Major or Reasonable Economic Use)
O Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
,0""Single Fa ''�� ❑ Discretionary"D"or Unnamed Use Classification
Garage Att e�LPDetached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
O Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane 0 Plat Vacation/Alteration**
❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
O 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 _ **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.
Signature:(""" Date: el--(7, 6
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. The Applicant has read this disclaimer and signs and dates it below.
Signature: —_-- ,:-{_/ Date: G, (, cJ
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• BUILDER STATEMENT 41
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:--_� ---- _„L/, Date: (,- • 7c: 0(
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Pro' Type: Fra ype: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: G ❑ Sewer
El Addition ❑ Steel Proposed: Bank Height: ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: .Individual System
❑ Repair 0 Masonry SEP Permit# 90`S 5 7
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: _ ,Public
�ul 1p Total: _j Name of System:
A'A
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
❑ Underground Tank 0 Above ground Tank Size of Propane Tank:
11 Heat Stove ❑ Cook Stove ❑ Woodstove i I Fireplace Insert ❑ Hot Water Tank ❑ 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 Bid App Review:
2nd Floor Heated Consistency Review: ch. (
Other Heated , - Base fee: ` as 55
Mezzanine tt Additional Section:
Heated Basement JUt. I 0 2 Plan Check fee: 04, r
l
Unheated Basement , State Surcharge fee: �
Other Unheated Pot Water Review fee: r�
Ld'CO
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee: t�
( 1 4 up c[.iY-
Other a� � --�
C\l�c� C1cC_�V =7�� I G (per TOTAL: $ �
J
t K _._
Receipt Number: c 31 1.0
Cash/Check Number:
c)\4(4.
ESTIMATED COST(REQUIRED) �'1' 'Date:
•Fair market value of all labor and materials fou to finish t 1 W l O(G
2 `i0°,000�' J Initials: t
G:\PermitCenter\FORMS\DRD FORMS\Master e cation 12-30-05.doc
• •
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4 JEFFERSON COUNTY N
I 64 144iii:t
+ DEPARTMENT OF COMMUNITY DEVELOPMENT ��
1, 4 . 621 Sheridan Street- Port Townsend•Washington 98368
.1 IO 360/379-4450.360/379-4451 Fax I"'" 1 30
5
http://www.co.jefferson.wa.us/comm�development/ ifffifi
v 1
Stormwater Calculation Worksheet ' iN CliliNfCil
MLA# C)6- --Ia
PROJECT/APPUCAwr NAME: R l�`-/rt C F.;0 i eVC-- I
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium,"or large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required.
PARCEL SIZE fl.E,SITEZ
Size of parcel f '% acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet / / sr ‘-T
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing sod cover(both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation,and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,elderberry,salmonberry,
and salal;herbaceous plants such as sword fern,foam flower,and fireweed.
LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL•
Calculate the total area to be cleared,graded,filled, Answer the following two questions related to
excavated,and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for
Construction site for structuresDoes the project convert Va acres or more of
3.5/' sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. sq/ft Circle: Yes No
Well,utilities,etc.
sq/ft Does the project convert 2 1 acres or more of
Drivewa native vegetation to pasture?
Y,parking,etc. 7-U sq/ft
Lawn,landscaping,etc. sq Circle: Yes `Flo)
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance /26-11' sgfft Cut '{CI Y Fill (cubic')
1
[over]
stormwater talc worksheet—REV.10/1/2003
• •
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include,but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW EXISTING
Structures(all roof area) .f sq/ft Structures(all roof area) 6 �' sgfft
Sidewalks 67) sq/ft Sidewalks ~- sq/ft
Patios ✓ 0 sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks sq/ft
(without infiltration below) (without infiltration below)
Driveway 75-0 sq/ft Driveway I sq/ft
Other sq/ft Other sq/ft
Total New �‘4S, sq/ft Total Existing // 9'7 stint
TOTAL NEW+TOTAL EXISTING* 7 f sq/ft 'This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v.REDEVELOPMENT
Divide the total existina impervious surface above by the size of the parcel and convert to a percentage: .67S %
Does the site have 35%or more of existing impervious surface? Circle: Yes r-No 1
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no,the proposal is considered new development and the
attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Mnimum Requirement *2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices(BMPs) Packet. Proponents of"medium"projects—those
that must meet only Minimum Requirements #1 through #5 and for large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the :•: .T�c nm_ne i�itegetlYt{e rtformation provided herein is true and
correct to the best of my knowledge. I also certify that this :.r w:tibil is fierng made with the full knowledge and consent of all
owners of the affected property.
2DD6
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
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stomnwater calk worksheet—REV.10/12003 2
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AUG 16 2006
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