HomeMy WebLinkAboutBLD2006-00406 AMINIMINEMON
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BUILDI
NG PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00406 Received Date 07/14/2006
SITE ADDRESS: 1794 UNDIE RD Issue Date 08/17/2006
FORKS, 98331
APPLICANT: GEORGE S BEREAN PHONE: (808) 521-8888
THERESA L BEREAN
1010 KOLOA ST
HONOLULU HI 96816-5102
SUBDIVISION: Block: Lot: T 5
PARCEL NUMBER: 713022001 Section: 2 Township: 27 N Range: 13 W
CONTRACTOR: J M GRINNELL CONTRACTING INC PHONE:
325 E WASHINGTON #238 (360) 681 2328
SEQUIM WA 98382
(360)
Contractor's License: JMGRICI972JS Expires: 4/10//20073 5721
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE
CALL IN FOR THE REWIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:/
UFFER: V/
Footing: t-ZZ-O7 etc;rulrt '
Foundation: / Z 07 I t 6-066
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall : 6 -2 c-f1 r v✓el
Sheathing:
Framing: tUNQOIXUX y - .6-1L1-0( T
Plumbing: 2.D O ��lNV/ LJ/CoQAft\ 6 12 4D[ ; rt-X3 off- 3--LC=?
Propane Tank/Lines: ilki t pk- w
Insulation: (AMA- 7-Z -O' A lr< 5e1 L. 7- 2-v7'V'
Sheetrock: ' 7t>�
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: (-VA_ �..��_(�( fj Ih
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL QUIRED 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
PUILDING PERMIT APPLICATPN M Review eviewT0391
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00406 Received Date: 7/14/2006
SITE ADDRESS: UNDIE RD
FORKS, 98331
OWNER: GEORGE S BEREAN PHONE: (808) 521-8888
THERESA L BEREAN
1010 KOLOA ST
HONOLULU HI 96816-5102
SUBDIVISION: Block: Lot: T 5
PARCEL NUMBER: 713022001 Section: 2 Township: 27 N Range: 13 W
CONTRACTOR: J M GRINNELL CONTRACTING INC PHONE: (360) 681-2328
325 E WASHINGTON #238
SEQUIM WA 98382
Contractor's License JMGRICI972JS Expires 04/10/2007
REPRESENTATIVE: GEORGE WITTLER PHONE: (360) 779-6699
17791 FJORD DR NE, STE N-140 (360) 697-5400
POULSBO WA 98370
PROJECT DESCRIPTIOI NEW SFR W/ATTACHED GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 280,000.00 MAIN: 1,427
CODE EDITION: 2003 ADD'L: 855 HEAT TYPE: EEE
OCCUPANCY: R_3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER:
GARAGE: 583 SHORELINE:
CONST TYPE: SETBACK:
DECK: 411
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
7J ! 7/
17k 606-.,
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $2,001.75 KAS 07/14/06 83726
Plan Check $1,301.14 KAS 07/14/06 83726 AF'PFO\E1
State Building Code $4.50 KAS 07/14/06 83726
Potable Water Application $55.00 KAS 07/14/06 83726 AUG 1(4. 2006
Total: $3,362.39 Jefferson County Planning
& Building Department
1111
SPECIAL CONDITIONS FOR CAS• BLD06-00406
1.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative
buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed single family residence.
2.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed single family residence.
3.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
4.) Stream buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
5.) 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.
6.) 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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) Not more than 2 unlicensed or inoperable vehicles shall be stored on any lot unless totally
screened from view of neighboring dwelings 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
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 or Chapter
18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) Minimum front setback is 20 feet. Minimum side setbacks are 5 feet. Minimum setback
from the Bogachiel River is 155 feet.
11.) 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.
12.) 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.
13.) The building height is not to exceed 35 feet.
14.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
15.) A minimum of two (2) on-site parking spaces are required for a single family residence.
16.) A buffer enhancement site plan dated March 7, 2003 was submitted in conjunction with a
SPAAD application (ZONO2-0104) to address the cleared areas within the stream buffer.
A letter from Al Latham of the Jefferson County Conservation District dated March 6, 2003
provided expert opinion that the proposed planting of conifer trees on a 12'x 12' spacing
has benefits for fish and wildlife.
17.) The applicant shall adhere to thebuffer enhancement site plan dated March 7!03 and
the letter from Jefferson County Conservation District dated March 6, 2003.
I:\F_BLD_Permit_Buildng.rpt 1 0/29/1 9
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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
Al Scalf, Building Official
PERMIT #: BLD06-00406
SITE ADDRESS: 1794 UNDIE RD Issue Date: 08/17/2006
FORKS, 98331 Final Date: 7/6/2011
APPLICANT: GEORGE L BEREAN TRUSTEE PHONE: (808) 521-8888
T BEREAN REV LIVING TRUST
1010 KOLOA ST
HONOLULU HI 96816-5102
SUBDIVISION:
Block: Lot:
PARCEL NUMBER: 713022001 Section: 2 Township: 27 N Range: 13 W
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 CB.Q,>
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON7/6/2011
I:\F_BLD_Occupancy.rpt 10/29/19
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�gsoiv �O� S ) `U Zi )02-- 4
JEFFE 'ON COUNTY l' L.R 02-(o�(�
al i,,` DEPARTMENT OF COMMUNITY DEVELOPMENT
~ ' 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450. 360/379-4451 Fax
%s,,- NGC"-'17.."O www.co.jefferson.wa.us/commdevelopment
Master Permit Application /
MLA: 0i.0 --`
Project Description(include separate sheets as necessary):
WE Lam. tAtIA VLli 14.Dri\r r- (t/Aiwn EA) (MY A('E
Tax Parcel Number: 7 7�? Property
Size: 74' 4 s (acres/square feet)
Site Address and/or Directions to Property: vNINL a J Ieksi )A . (; 6�
(
Property Owner(s)of Record: ( O�12, ej1 � L f
Telephone: !O -5Z1- M•+-) Fax:
email:- i>lleA►..1C 0441-6.CvW\
Mailing Address: („D, W/4-T(n 1{)t) liMSCOp ��.��DIJOlU(.t4 r Ng ,4i` 2�
Applicant/Agent(If different from owner): t (1.)('f J -I2
Telephone: 3(0(3-11 -U,ncri Fax:
g (`)/ I12 6/1 I Trr, email:o0'a .A q •t�15
Marlin Address: I SQ(TI"z; -KO }Dau rfA �' 3�b
What kind of Permit?(Check each box that applies)
I Building 1 Variance(Minor,Major or Reasonable Economic Use)
Demolition Permit I Conditional Use[C(a),C(d),or Cj**
i Single Famil i Discretionary"D"or Unnamed Use Classification
i Garage ttache /Deter►ed. i Special Use(Essential Public Facilities)**
I Manufactured Home i Boundary Line Adjustment
I Modular "11Short Plat**
Commercial* JL L 14 L Binding Site Plan*"
Change of Use I LongPlat**
I Address I Road Approach j _
1 Propane J 4 r f to S II N C(� {Tanned Rural Residential Development(PRRD)/Amendments**
i Allowed"Yes"Use Analysis l r !1 ` Plat Vacation/Alteration**
i Stormwaterlllowed"Yes"
s"Use Consistencynst Shoreline Master Program Exemption/Permit Revisions**
I Site Plan Approval Advance Determination SPAAD * i Shoreline Management Substantiala Development**
I Temporary Use ( ) Shoreline Management Variance
i Comprehensive Plan/UDC/Land Use District Map Amendment
i 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-
Please identify any other local,state or federal permits required for this proposal,r iftknown:Conferenceion
I hereby designate DESIGNATION OF AGENT
to act as my agent in matters relating to t is appli ation for permit(s).
OWNER SIGNATURE O /'ai//J_
Date: J 6'
By signing this application form,the own /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 quired later i pections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signatur • "e) /
J Date: (I/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."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 'bi for hering to and complying with the ESA. The Applicant has read this disclaimer an sign and dates it below.
Signature:
Date: 6 ./t (u
C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-30-05.doc
' :05/25/2006 10:39 3603794451 JEFF CO DCD PAGE 04
`"ay 2 06 dA:S?a fLearge Wittier 360 75400 P, 3
6UILliaR BTATPAIENT
to signer of this statement does hereby thatthey wig be assuming certify
General
l they are the to Owners of the panel referenced herein,that they am not tcen8ed contractors and that
urning the responsibility of the General Contractor for fFs propoead MOO.
armature;
__ pats:
GENERAL CONtRACTOR OR MANUrAC7uRfio
ifonffi INSTALLER: PHONE:
i ki 0�iN; co / ('60 c FAIL:
w,ft. Ao sa: ? ti�� . !J C i 2 3 t 360-G� Sj
CoNnuterai'R ILIMNSEbilk EMAIL:
1.NunrgER: & 9 Z u5 . N rt�ls
A4CrC7tFjvGMEL
• MAIING ADOAEgg 7 79 FJo 11 f G'(z • PHONE( �,q1 Z FNG(36d S7 bzN
r?react AType:D011e r- oi, S 6 a Ai' ,, , �ls
New Runs type: �rlsothe: ' tnir' age Uis sal:
o woad Type Sew I p
Addition o steel Proposed: Z0 Sewer
13 Alteration/Remodel O Concrete Total: Z Bank Hit' 0 Community S System
I7 Repair ❑ Masonry, �(individual System
Qacrlatltion O otherBedrooms: SEP Permit# h_y_an.±9
Type of Neat: -.-.___ plating: Suck: Private well u T
Water Supply:
Proposed: 7Two Party
`� I 1 Total: /LA' a Public
1Zc _ ' Narne of System:
luurnber Of Parkinga win':
Spaces: Currant Propoeed:Member Ora cupaMs MOON owners,tenant°,errNumber of FDA se Parking Spaces:
! ?OC employees.Mc) Current
Occupancy: IBC Type of conetr On, Proposed
a Service?
. i if this(B a P►ao�nene Tank ard/tu MDlraooa Instal by MI(yam+have Food ServlCel Yee / Nq
Underground Tank i Above gr IM Tank a b
I Heat Stove I Cook Stove I Woodetove t Fireplace insert a Hot Propane Tank
1s Ma Ilan halo Installed a Matt Water Tank I Pellet stove I Ofhor+
' Wh®n�����eMo to T Yes / No
f Ihtt';s, Meagan sod siren to distance*hem the pine tarot to propantank you meet �prsuoperitty
a site p.anbr Owing al/of athe system
co all components,
Mee. P"sPe14r Hose.ba and aspEto sys{arrrettalt
Square F. . ' • Current Pro. • ad For Office Use On Main Floor HeatedAmount Revision
_ _ MUM EH Bid App Review: // ��----
nor I-llasted
(n'-).
CO
' S ����� latency Review ��ii^^--'�
eted
i Rase fee: r.
mezzanine �..rr • `✓
man Addttlonal section:
Heated Basement ---�.
_ Plan Check fee;
Unheated Basement a f L!
State Surcharge fa:
ME
Other Unheated 4,53
Pot wa ter Review tee:
Geroge/Carport (4O,c .
58MU $ TOTA` , 15.
Mil •Qci , 94 'el ,-.Ap, ii: • fie:
Oilier '�}�y-�.�. . '.1-4MOarr� .Mili
-a)
+ "tit'` � • ,g0.43 TOTAL:
al Receipt Number:
Cash/Cheat Number:
ESTIMATED COST(AEQutRED) ` • , ateal 0
,2&) Wo .a9 Initiate:
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.. , Locum81w01,016\Mumr PamkAppliation 12.70-05.doe - r
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JEFFERSON COUNTY 1�EC V j[��
4' kki,1 DEPARTMENT OF COMMUNITY DEVELOPMENT
a!L 14100e
1jo.tt, „ , 621 Sheridan Street • Port Townsend • Washington 98368
C`443 360/http•3www.co.jeffe sons a4 s/ommdevelopment/ IIrt
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STORMWATER SITE PLAN SUBMITTAL TEMPLATE
I MLA# () (0 et )
PROJECT/APPLICANT NAME: Jlr�� p ayigio..1
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,,(, , 9� y
r !IKtict e W {e. I`c_ i v. irkor MAT \i .5--T'�'1 t 4kA 9 ( t �"! we+V 4z 1!4e
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Existing Conditions Summary
2. escrib the existing topography. Indicate contours o the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map. PERMIT # OLD
ffi-t'ec� to rZ'ci\--3 _ PERMIT 1
06 - 0406
4. Describe the exi ting soils. Indicate soil type on the site map.
C�� �c a L. Ti L,- JEFFERSON COUNTY RCA
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.
t V' 1 r 1�,v VA 4eiv w�GC
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APPROVED
6. Describe any epess levels of noise generated by the proposed use or activity: STORMWATER PLAN
VI/A
AUG 1 6 2006
Stormw-, ` / /it % JEF 'NI
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stormwater site plan template—rev.1 OJt/2003 Require' r:'`so DE PT.OF 1 Y F l N
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7. Describe sigpificpnt geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
n ,he site. Indicate location on the site map.
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8.1S (Anig a the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
:(stielA srwetlands,lakes,steep slopes,etc.).
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.
WCt. -1:191Cte.-41' VAC"( '5 '—it inc0,11 mtpc,
10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for"large"projects or projects that involve the potential for dispersion of contaminants.]
11. Describe the performance goals and standards pplicable to the project.
r`L c es
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12. Describe the flow control system.
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6
stormwater site plan template—rev.10/1/2003
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13. Describe the water quality system.
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JUL 1 4
14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
t\)/A-
16. chneth cement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building- ode. 0 t}
17. Describe the proposed surfacing material. PERMIT a,
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18. Describe methods for restoration of the site. 0 6 — 0 4 0 6
JEFFERSON COUNTY DCO
19. An Operation and Maintenance Manual is required for each Clow 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.
AiA -
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.
Gkti
PO 4-L1
stormwater site plan template—rev.10/1/2003
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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
yid
1. Gonstru�ctior'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.
3. Control Flow Rates.
4. Install Sediment Controls.
I- o '
5. Stabilize Soils.
t
6. Protect Slopes.
AA-.
7. Protect Drain Inlets.
Jul. 14 24
l f f Hs m COUNTY IV
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stormwater site plan template-rev.10/1/2003
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12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. it FC CC `'
JUL 14 2006
9. Control Pollutants.
Jr
A 4-
WWR►SOM ODMN '[p
10. Control
gDe-Watering(the act of pumping groundwater or stormwater away from an active construction site).
I 4-
11. Maintain Best Management Practices(BMPs).`
12. Manage the Project.
PERMIT # BLD
06 - 0406
2. Adjacent Areas. JEFFERSON COUNTY DCD
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).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003
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b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils`(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
' ':'...- M;")\--' r
5. Construction Phasing.
a. Construction sequence
'� i
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.
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b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. h
/I
8. Engineering Calculations. Provide Design.,Ch Iculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. 1A-
b. Diversions. A___
c. Waterways. A; �' T
d. Runoff/Stormwater Detention Calculations A;
JUL 14 2006
stormwater site plan template—rev.10/1/2003 J[[f RSI i t! WOO i;C{{ 10
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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 shpwing 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 Rf the affected property. /
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(LAN NER AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE
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