HomeMy WebLinkAboutBLD2006-00392U . a
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00392 Received Date 07/11/2006
SITE ADDRESS: 123 PONDEROSA PL Issue Date 11/6/2006
NORDLAND, 98358
APPLICANT: THOMAS E JOHNSON PHONE: (360) 774-1274
JENELL S JOHNSON
62 GARDEN CLUB RD
NORDLAND WA 98358-9610
SUBDIVISION: NELSMARK SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 921092072 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: NORDLAND CONSTRUCTION CO INC PHONE: (360)385-1247
62 GARDEN CLUB RD
NORDLAND WA 98358
Contractor's License: NORDLCN953NT Expires: 8/30/2007
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE (UNHEATED STORAGE 575 SQ
FT)
ALSO A/G 120 GAL PROPANE TANK
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
la
UFFER: ili'-el
Footing:
Foundation: l 1•L-(Ci-fib
Stormwater INAL Approval:
rr Underground Plumbing: HYD cug• 4 j.&d S r* ., 7 C7
Underground Insulation: P-1(0 0 IOOf- OK - 7 7,
Shear Wall : Rif SHEAR JAu.1A4 'k Mokse- #6Ab9ce' R/14/07
Sheathing:
Framing: L1(--. S -1•-�,7 t [t--( ( -'c-- 611, 4, F. k )
Plumbing:C"V .5t 64-. i- Z5-c7 vti‘k u614.1ii) t l.UMI N)Z 6K 4/19/07,9
Propane Tank/ Lines: •
Insulation: ak— `.-(:.t-k0t, , ( tLW• kwC-a,)6t 7 .4 k 12-) c -'; -'67 MAbr
Sheetrock: I P3 S 0 k I - L -7 to At
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: 7
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 ii
q-7-7 , , --
_ 1
•UILDING PERMIT APPLICA•N MLA06-00374
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00392 Received Date: 7/11/2006
SITE ADDRESS: GARDEN CLUB RD
NORDLAND, 98358
OWNER: THOMAS E JOHNSON PHONE: (360) 774-1274
JENELL S JOHNSON
62 GARDEN CLUB RD
NORDLAND WA 98358-9610 NELSMARK SHORT PLAT
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 921092072 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: NORDLAND CONSTRUCTION CO INC PHONE: (360)385-1247
62 GARDEN CLUB RD
NORDLAND WA 98358
Contractor's License NORDLCN953NT Expires 08/30/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW SFR W/ATTACHED GARAGE (UNHEATED STORAGE 575 SQ FT)
ALSO A/G 120 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,536
VALUATION 250,000.00 ADD'L: 1,443 HEAT TYPE: RAD
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: 575
CONST TYPE: 5N GARAGE: 936 SHORELINE:
CONST TYPE: DECK: 720 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 4
Total: 3 Total: 4
Routing Date:
I<� A��-
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $2,225.75 KAS 07/11/06 81293 r
Plan Check $1,446.74 KAS 07/11/06 81293
State Building Code $4.50 KAS 07/11/06 81293 NOV
Potable Water Application $55.00 KAS 07/11/06 81293
Total: $3,731.99 ,Inficatagt Gandy U larAin Y
Ari r l';p iartment
• •
r SPECIAL CONDITIONS FOR CASE A BLD06-00392
1.) THE APPLICANT AND/OR REPRESENTATIVE SHALL CONTACT THE
DEVELOPMENT REVIEW DIVISION OF THE PERMIT CENTER (360-379-4462)
REGARDING A PLAT AMENDMENT APPLICATION IN ORDER TO REMOVE THE
SEPTIC EASEMENT FOR LOT 4 ON LOT 2 WITHIN NELSMARK SHORT PLAT. THE
PLAT AMENDMENT MUST BE COMPLETED AND THE FINAL MYLAR RECORDED
WITH JEFFERSON COUNTY AUDITOR PRIOR TO SCHEDULING A FINAL BUILDING
INSPECTION.
2.) 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.
3.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
4.) 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.
5.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
6.) 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.
7.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
8.) A flow meter shall be installed prior to final sign off of the building permit.
9.) On-going well monitoring for chloride concentration is required. The property owner shall
allow access to Jefferson County PUD or approved contractor to take samples as
required.
10.) 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.
•
11.) A stormwater plan for a medium project has been submitted and approved by the
Department of Community Development. Once the subject permit has been issued the
applicant shall fully implement the provisions of the submitted plan and contact the
Jefferson County Department of Community Development to arrange a schedule to
inspect the property for plan compliance. A Certificate of Occupancy will not be issued
until the Department verifies plan compliance. No clearing for roadways or utilities shall
occur on the project site until clearing necessary for the installation of temporary
sedimentation and erosion control measures have been completed.
12.) Roof and other intercepted precipitation shall be routed to on-site detention ponds,
cisterns, and/or other approved means and allowed to be released to the soil slowly per
plat condition 10a. The applicant has stated that roof and footing drains will be utilized to
collect and direct stormwater into the man-made pond as identified on Lot 1 per subject
short plat.
13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
14.) 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).
15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
16.) Minimum setbacks from Garden Club Rd right-of-way, Ponderosa PI right-of-way and any
ingress/egree easement is 20 ft. Minimum side and rear setbacks are 5 ft.
17.) 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.
18.) 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.
19.) The building height is not to exceed 35 feet.
20.) Water withdrawn from wells shall not be used for watering of lawns and/or gardens per
plat condition 10c.
21.) Ground water withdrawn from this lot shall be restricted to a rate of three (3) gallons per
minute per plat condition 10d.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
• SON �U JEFFE•N COUNTY a
': .,.a DEPARTMENT OF COMMUNITY DEVELOPMENT
` w 621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
p www.co.jefferson.wa.us/commdevelopment
1S•ntING�S
1111
Master Permit Application 4.3 L. MLA: 0 (te,-3 7
Project Description(include separate sheets as necessary):
61-- _ w�,�rfi&A e0 JEFFFRSi1t [Ail/ UCD
Property
Tax Parcel Number: e7 Z I c 9 7-0 7 Z Size: 2•b 1 AG2 ES (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: "77e6MA S -- zre Kt e-Pi- Se HkUSoIJ
Telephone: 366-771/ - /Z7kt Fax: 36,r,- email: A/ag.bIANb coAISTRuc7;orviv tile
Mailing Address: (>A 20 a-.(8 Rak ` IVn R Al M h/4 g 3.5 /1a7r(A1J- colt
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
N Building I Variance(Minor, Major or Reasonable Economic Use)
JI �emolition Permit I Conditional Use[C(a),C(d),or Cj**
vt Ingle Famil i Discretionary"D"or Unnamed Use Classification
VIVGarage Attache Detached I Special Use(Essential Public Facilities)**
I Manufactured Hme I Boundary Line Adjustment
I Modular I Short Plat**
I Commercial* I Binding Site Plan**
IJhange of Use I Long Plat**
%A ddress 1/Road Approach I Planned Rural Residential Development(PRRD)/Amendments**
Propane I Plat Vacation/Alteration**
I Allowed"Yes"Use Consistency Analysis I Shoreline Master Program Exemption/Permit Revisions**
I Stormwater Management I Shoreline Management Substantial Development**
Site Plan Approval Advance Determination(SPAAD)* I Shoreline Management Variance
I Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment
Wireless Telecommunication* I Jefferson County Shoreline Master Program Amendment
I 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: /69.1 L1 L —' E t lid*'/� Date: / 3 0 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 response ' ty for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Q yid r,1� yam' Date: 7- 3
C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-30-05.doc
6
A • 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: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
//a R4 i- Is cvlUS`fl ctio4 AA' ?C I (%o ) 7741- (2-7Y 6o ) %1 1 - 5/84.
MAILING ADDRESS: bZ Rp ( cime kb, Al046 b Wli v,,358 EMAIL: /Vopf L/AJO co/V s t .croak kW e 1.4.7/'9`)@,Q
CONTRACTOR'S LICENSE /lIh/F/�1-L N 9sJ 7 NT WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Prect Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New y Wood Existing: ` ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System
❑ Alteration/Remodel Li Concrete Total: f individual System
Repair ❑ Masonry /Usk- SEP Permit# 0—dZoB
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: VPrivate well ❑ Two Party
Tye of Het: Proposed: fl ❑ Public
p/hT j 14 lQQ r Total: l Name of System:
f IZ..ri'IU•L- /> v/I-e P.
If this is a Commercial Proiect 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 a p�l -a 7.P
i Underground Tank ✓Above ground Tank Size of Propane Tank: 1 ��1�
I Heat Stove I Cook Stove i Woodstove `/Fireplace Insert 'a✓}iot Water T i Pellet Stove i Other
Is this appliance being installed in a Manufactured I Mobile Home? Yes No/
When applying for a permit to install a propane tank you must also submt a site plan showings N the tufrdings,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:
2na Floor Heated Consistency Review: ,.
Other Heated Base fee: a�C\ _-.-
Mezzanine Additional Section: �F- J
Heated Basement Plan Check fee: q 4
Unheated Basement �, State Surcharge fee:
ted KAe A1'f4) Pot Water Review fee:
gi,,�_k- -CtitLe 41-0, ac;-F S 7 S 1?, 57`6 `'10 .
Garpge/Carport SUBTOTAL
5 93,b Z c152 31c64.gq
-mks. 911/Rd Approach fee:
b+cl'_�PRTJa/e/JT/�1 72.0 Ilog7C,.tjv 6E � i52. c0
Other
TOTAL: $A 13,
Receipt Number: Q'( g9 3
Cash/Check Number: Ct3
S' b 7
ESTIMATED COST(REQUIRED) 31CI all Date: �7
.Fair market value of all labor and materials foundation to finish ( ( l --6
Zs-6 /
orb Initials:
C:\Documents and Setti gs\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-30-05.doc
,
6 f
�'2roN CG
!: \ T � ' ,)
w, �� JEFFERSON COUNTY
F-, .1 DEPARTMENT OF COMMUNITY DEVELOPMENT -
621 Sheridan Street • Port Townsend • Washington 98368 9 t
O$ 360/379-4450 • 360/379-4451 Fax J 1 ''. . r I t ;,f,r,
q`tITN0' http://www.co.jefferson.wa.us/commdevelopment/ Lll�"' y _` `L+N � t)Id
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
4,2-7-2_ -/u c/stliixw S//or7pL,A7 - 5rk
MLA# Ob-31 l PROJECT/APPLICANT NAME: 'Thi U A-I A.5 J G Fi vi s G li(/
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.
f '-
Project Overview L- 7 2. /lel c 1'ARfl. S/-ia /01A"T
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the I
site map. _
- _r
PERMIT ain
Existing Conditions Summary 0 6 - 0 3 9 2
2. Describe the existing topography. Indicate contours on the site map.
77-T si-�+. S-it / I L. ,\ - , :<1,,1,,-ILAFFf ONICa .w OCt
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
1Pr
'C f`Rc, P P,(Z'T Y r S GG-c•�i/sC-R t-y f , f i- 6.3' ,
o%/P 6-kr9 L4 I- or c'.-(9)1)1-' i, 11 CZ /� , F -;,c ; . AI;IV f' l'( P) w, I L S7A'/ s
4. Describe the existing soils. Indicate soil type on the site map.
c'(F1=" '>' i-c/I" As0vj is c LA- C1 _ _,
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.
No PG/— 1) I ki 6- /A/J q I ki LivA!/ & rr Ai 1_c,";f
6. Describe any excess levels of noise generated by the proposed use or activ'
7YP /CAL (c,././S1121,tc `r.n :i 5-C i„I ' J PROVED
sAt/✓s / IA/I-(_1-iNc e7C - STORMWATER PLAN
Jtiu 3 1 ono6
stormwater site plan template.doc—rev.10/12/2003 , _4_ 5
JEFFERSON COUNTY
DEPT.OF COMMUNITY I> '- .OP. 'T
SIGNATUR . 1_
• • 77
t1._r
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such qs wetlands, streams,
steep slopes, etc.)on the site. Indicate location on the site map.
iN0 c{,t, J .' f V-e- 4/t C/1 C C7v �.
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.).
t2 6 J Ac2r=A(r //j7P GtfS / Narz7-11
91�i Vt w/k, ,Zsi141) G!v t Il ,,13 E .o
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.
c- ,^; vt )&j 17C rGl fcti L`/ b9; P-St` w,47 11.
lfn wrLL I/11Y1-(1 kc,nr.. . x e'u- ik6, l)K/) ')// •
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.]
NC) tr`eA-7 ' t 'v^/ t1/f:et3 IcR ' S e7 ,
11. Describe the performance goals and standards applicable to the project.
PAC=J C .i ! r <, l 1 ( : )
A;e eIL\ 'C l,1KAl bR: :> ? C n/t/ `: t" sTolZ/1G✓�}1r-/c'
12. Describe the flow control system.
KG O1 ro6-7 iN6- L _.;-) k/ J I� l!c'1 / l cAmi-
To CSAe GF e ( I -r�il(r S VAL- )
stormwater site plan template.doc—rev.10/12/2003 6
• •
111, E13. Describe the water quality system. ( �Ell
�'
=N� i v'/d Ltd i, Art
�fFf
14. Describe the conveyance system analysis and design.
L- 5 i/'c-G€ fr\ GOse $76,et(_kv,ter cam.,tt_cc7fo%1
-614Ve ( Tip-tit ::<< Tc, 6vt-f C
S7be v r Nett/ lac e' ,
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
C
f c-c %//J r:S" t/t//LL t/�'
Fcc•-T7 J --
16 Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
No S;C. X /'1 ;. ); . PERMIT # BIn
2 17. Describe the proposed surfacing material. O O 9
6-kA JEFFERSON COUNTY DCO
18. Describe methods for restoration of the site.
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, A
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
M A
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..SI,I/&—Le F,�) , IL / !- o J t (t`. j'(/'_1`t/`- (a e e° yiKitir3
stormwater site plan template.doc—rev.10/12/2003
• •
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•SWAFP e Wil&A 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). c ua r!
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
2. Establish Construction Access.
s/ 4 72., C
3. Control Flow Rates.
4. Install Sediment Controls.
'A'/ !i1%0�—( i.,j S wa)l E a t 0E' C4 l•/N
5. Stabilize Soils.
C L re. T cGIAJ "lG &)(cAtIA Qr .
6. Protect Slopes.
UtG S LC
7. Protect Drain Inlets.
stonnwater site plan template.doc—rev.10/12/2003 8
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants. 1 r F r ry I
1 `/" ` r'`%}s �jZeS At ✓'` 10 R SF�//.cAf'r �l� rf �: �+ i!
;<re;pily 6-- :14 iu ppLI e 'a /,`-r/JE CJ.J `iiJek
pc- ice -to G�.4iz_,c
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
/ /, r. J,1-'� i „, /r - � L ;" �J
PERMIT # RID
11. Maintain Best Management Practices(BMPs).
? ,4/Al -//V 7J,4 • ;.; :; Ems, 0 6 - 03 9 2
JEFFERSON COUNTY DCD
12. Manage the Project.
t� nlS7 .kirc- !v ✓tr', 'L pe,pr(I+NG Iok✓ rr Tom'
NS-1 ALL-C o
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
,4 Wr v 1r Itr ,7 -`f, rv/7�j' �,' A1°A f 0 _.
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
a' `y • ,` J. l
r )
(pve Ct I c GL/ o/ I ,k)/ r: .rrh I� r/., �1d-Jl2FJt° �G` J
G'
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
, Q 5-(1/ /'/ i f ". • 4 E.' •Ahl)C - e
r .
-4l •
stormwater site plan template.doc—rev.10/12/2003 9
• •
1-, Tr
b. Description of special requirements for working in or near environmentally sensitive areas
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
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
t (?—7
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
)nl 1}) + =fi �>t
b. Proposed wet season construction activities for environmentally sensitive areas.
0 1-`<
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. _
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions. /1.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template.don—rev.10/12/2003 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. 1
(LANDOWNER OR AUTHORIZE EPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
�IbV 1in`I
stormwater site plan template.tloc—rev.10/12/2003 t2
•
--I ./ \ \
/ / \ �
1I / I
I
1
\
\
II _ ` I\ / / \ \
i \ / / \\
4
' �\ro \ / / Ii \ /
. \J / I
/ ....... I
, •
6 / 6 r �R / \
/ { h
N \ I
/ _�
N
/•
,, �f 199'"'4y2"
/• 6 ( .�
j r.
1\ � Cn
it
1 \ 0 -Tcq
I
N r ,:
O AL991 I
( 1 va'' I / Z \\\, Oc - ,1
N , Li
\ a n uaadOnd,bo• _ �; +b� a
\ -id,69'95 - - — rs \ u
r 1
P /1/I
N., `- ti 1. ,f (. -• 1-7
.....;.3°_______$\'. ,2:%,\ .,•"' : .1.1 7\ \\\\'\.\\\ A\'`\\'''s"\\ '''\'''\ Xts??1\\\\\\\\\Nvtia,
o \./.,.,.,/,„'... - .4 '\ '''''t X
4/_____________ ,
J;t
w Cam.., Q 1 �� �� \
•L' . . _ . . .
. — .— %5.06'PROPERTY LINE ..' — I� I•— ``�r
Z3 ‘
o
I +
IIVIF
II 1
73
ePS > 7-1. '4, ,
n li
b ° °�n e /',/
f-
+, ° I /Z] -� [�r N T LL O D r
Q N err rn c A ti A nl
Q ar 2 - Q . r_
rn
b•-0' Z 1 5-zeow
c's ›, .:,-,-- ,:, z - Y. -'v>.-1Z Q
^-r ri
� _ I L It AA t�N 0 Di
Cg a $� zv
C/7 3T'_O. x N * 0
ti
a9 C:7". p.,,.r� •• $
6 1 i . i-esign:s bv, - . ! JOHNSON RESIDENCE
164 Swanson Ay.Port Town.end,Washington 96066
' Voks(380)379-6336 Fax(360)379.1327 hannigidasignsboottaccom
1l
a
la-0' r
ill 1
4 n o
7 r
,T. QGJ
saP-1PiiNo p Vri;
: r74 ;; il il 061 AR; 2 I - O 1 GO gs - 16
1 1 iq 0 ! 1 p 1 0 i p all; i 11
r D II
�
r •
� r 1
fi
IP
LD L-J
0
r i *_ M3,-0'
Ove I I Ifs" 4o I I ove= :-lr �,-l.
rib 0Ao
BARrbE DOOR I I B,ARI,6E DOOR I I A.�RA6E DOOR I / 4'-0• / 4'-0' - 2-e'
I I I I I I
I I I I I I (1_
4
_� i-'-1 iII:" $ I _ ; a . .
Ld
Iz' !1
a
]�-e' 9's P.O.
' 12, i
9'-0'R.O. ;-T 9'-'!'R.O. 44. Iti I i
0 6 11 i
II
la r $ c; N ii
ilif 1
, s
, 1
. b ..0 � 0
, 1' 1
d0 1 6
$II I 3
�6 888 .. : : it yam. 4 TTk
tt \ �7�+ u tP
p sly t�; .
—Til
a N • aU a rn 0 6r—r
$
wlri
0
%xl1
'T
"T
T 4,-0' 4,-0.
;_7=2 .�- 10'-]' =1o1f la'-O' '
I Cr) I===,1
C',
C,
I
,
I
i
1
I
1
• 4
1
1
r c
rn
` $
•
54-0'
1 500' 6
rn n rn (2) 12,3446 t
(4)
III BETWEEN TFUSEE5 1).
1 to
li i ;.:
sb _ 3 , ® w
I tO ,
. —, 7-ii---
rfr.R.e.
I 9-�4 12-b'16.611\j‘,
O u3 -
g 0 71 $
1 Sr'? I ®,,,L, ic*i T___, A-
Lir
�t i L IlOI ��
ppp _ ,
Srl1l �. 1 I
LO
A t
7c
( `4�yy r
® � I-
O
`N x
I I ,N T f 7'-10•,
s I !_4
i�I i0 tU 0 E L A .J
-. _
414
u 1I X
-
5�' 4'-O' 14-8 / / 5,-0' 5,4'
9 0'
C—
T
T
_^ C
T �od TM
r..
`I
G7tIL
V
G