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HomeMy WebLinkAboutBLD2006-00571 JiJILDING PERMIT APPLICAT�N MRL y Review 555 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00571 Received Date: 10/4/2006 SITE ADDRESS: 7082A FLAGLER RD NORDLAND, 98358 OWNER: C RICHARD KIRKWOOD PHONE: (360) 379-3458 PO BOX 135 NORDLAND WA 98358-0135 NORDLAND SUBDIVISION: Block: 4 Lot: TX 2+ PARCEL NUMBER: 976200402 Section: 33 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW SFR W/GARAGE ATTACHED BY BREEZEWAY (BREEZEWAY IS 80 SQ FT) THIS WILL BE PRIMARY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,436 VALUATION 201,077.00 ADD'L: 576 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: HTP OCCUPANCY: R-3 OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: 80 SHORELINE: CONST TYPE: GARAGE: 576 SETBACK: 240 DECK: 224 BANK HEIGHT: 5 SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 3 Total: 2 Total: 3 Routing Date: IO\l-k\OcI Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,564.95 KAS 10/04/06 85 102 ? ° 1 Plan Check $1,017.22 KAS 10/04/06 85102 State Building Code $4.50 KAS 10/04/06 85102 NOV 1 2 Potable Water Application $55.00 KAS 10/04/06 85102 ietterso i County PIapnir9 Total: $2,641.67 & Biildirm11eoartmerbt • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00571 Received Date 10/4/2006 SITE ADDRESS: 7082A FLAGLER RD Issue Date 11/9/2006 NORDLAND, 98358 APPLICANT: C RICHARD KIRKWOOD PHONE: (360) 379-3458 PO BOX 135 NORDLAND WA 98358-0135 SUBDIVISION: NORDLAND Block: 4 Lot: TX 2+ PARCEL NUMBER: 976200402 Section: 33 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NEW SFR W/GARAGE ATTACHED BY BREEZEWAY (BREEZEWAY IS 80 SQ FT) THIS WILL BE PRIMARY RESIDENCE CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. / SETBACKS: - GARR4e- or rEe_ aii.naf?x.S lPtSeec3s►ci Al.50 UFFER. ,/ -i 0 Footing:/ // - (S-D6 (0A2A(. tW/MOIsoflnu2 51.34B OK 5/07, Foundation: Ok //(1D OLI Stormwater FINAL AAp oval: A?PD 13 Y 3C_ cro 3/12 67 Underground Plumbing: Underground Insulation: Shear Wall : Ott- ')./3 07 F Sheathing: ,, / I s�fp7 Fram ing: ado j7E"iQ Fl2/0M/MC QK l.(/4//L FRA MOIL O"K- W and/100 IF/- / Plumbing }Z° 1 07 �✓6 ,>e I.JA/re ENT dK bli o1 Propane Tan / Lines: Insulation: Blk SEAL r31C G/27- 67 LL ok J/'& Ci7oaJ 6/21/G1 i 41O..,G 4Z Sheetrock: dx 7/!9/e7 � -2-03 Q7f Septic Sytem Final pproval ST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: ? / _ Final/Occupancy Approval: zzrix HEALTH DEPARTMENT AND PUBLIC WORKS AP OVAL 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 0 410 SPECIAL CONDITIONS FOR CASE A BLD06-00571 1.) 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. 2.) 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. 3.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 4.) A flow meter shall be installed prior to final sign off of the building permit. 5.) 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. 6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 7.) Not more than 2 unlicensed vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an autormobile 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 requriements 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. 8.) Minimum setback from SR 116 right-of-way is 30 feet. Minimum side and rear setbacks are 5 feet. 9.) 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. 10.) 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. 11.) The building height is not to exceed 35 feet. 12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 13.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 14.) An accessory dwelling unit shall have a maximum size of 1,250 square feet of gross floor area. 15.) The owner of the subject property shall reside on the premises, either in the main or accessory dwelling. 16.)jj The existing cabin located in the uppermost northeast corner of the parcel shall be decommissioned prior to final building inspection of the proposed single family residence. 1V) 0 I:\F_BLD_Permit_Buildng.rpt 10/29/19 • ill k4� NII kis',i. OO JEFFERSON COUNTY - ' DEPARTMENT OF COMMUNITY (0 .��1I ti ' ''4 621 Sheridan Street• Port Towne cl ` 'srliti9 131� 4360/379-4450. 360/379-4451 Fax q www.co.jefferson.wa.us/commdevelopment rNCi . GC T - 4 2006 Master Permit Application MLA: 0(p —• 65.5 Project Description Include separateQ sheets as necessary): rjf,j k } j'rj'I fli`, ,, JI-� H ✓11`1�le- rQhiI I1 r1,pl7idP.Yl[,e- l�{,�rth lC y`flyc `)`� ��tJrE'ti:7-Li,_t.�G.s!} TaxTarcel nn I Property Number: Li 1(O ZOO 407- Size: 2 i 243/ a 71 12D-; (acres/square feet) Site Address and/or Directions to/Propeerty: OS LA - Iex R Worci Ia✓►d Property Owner(s)of Record: C. K 1C1i12 r^ irk el Telephone: ape-31 3458 Fax: email:C r'k tt kl d rya R' v D ii.t.Dryr Mailing Address: PD box 1.3 I lLOrd(Qnd,u-i 4{t35$ Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building ❑Variance(Minor,Major or Reasonable Economic Use) li Demolition Permit ❑Conditional Use[C(a),C(d),or C]** lISingle Family' P. ODiscretionary"D„or Unnamed Use Classification Garage •ttached deri i .M (it/ ['Special Use(Essential Public Facilities)** Q Manufa ur-. : e °Boundary Line Adjustment EI Modular °Short Plat-- Q Commercial* OBinding Site Plan** 0 Change of Use °Long Plat** Q Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** Q Propane ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ['Shoreline Management Substantial Development** OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ['Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment OWireless 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appycrion that he oe wants p or raotise Signature: C.. tin. ) Date: kt 13'L C: 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-transfIra le,1re)sponsi ility fof dh ring to and .lj.l • with the ESA. The Applicant has read this disclai a and signs and dates it below. Signature: ` u v Date: I O\3\O(0 D:\PemutCenter\FORMS\DRD FORMS\Muter Permit Application 12-30-05-2.doc 4110 III ---, If-1 lc, ,, ‘? - ,, [, i Y�� _, BUILDER STATEMENT The signer of t •s 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 s u •ng th spo ility of the e4-ral Contractor for the proposed project. Q G I — 4 2006 Signature: .,4- '. Date: (0\.Z\0 Co GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ILL rf '` iT n fin i r[ 'T f MAILING ADDRESS: EMAIL: G ,. WAIN'S Noit,�C/�JRrlPtr 1-a,l�tprte.LJ{et.UR.V`t,Up04 umu.fsl(K,PI- OteixNHMSER 3410 3S -1142_ ARCHITECT/ENGIN a_ Kirk Doi ke.,s4601 Ntk40o mil-. Pt roam eiw!, PHONE ( j)355-Io 14o FAX:( ) MAILING ADDRESS: WA ii$Nei EMAIL {-(, t 6 iJf- be f,',let Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ,.2'New fd'Wood Existing: ❑Sewer ❑ Addition 0 Steel proposed: ['Community 3 Bank System ❑ Alteration/Remodel ❑ Concrete (ft,let5) Total: 0 Heiyht: 14 Individual System ❑ Repair 0 Masonry ZQuil,2.kal-e h SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well ❑Two Party Type of Heat: Proposed: 2. / ❑Public eire rl Lglheatpu-mr Total: .2. 2�t7 Name of System: ❑ If this is a Commercial Project you must answer the following: NA. 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: NA C]Underground Tank 0 Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove ❑Fireplace Insert ❑Hot Water Tank 0 Pellet Stove p 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 143 EH BId App Review: 2nd Floor Heated 51c� �. Consistency Review: l�� 51 lria . Other Heated O Base fee: ,f �C '- Mezzanine Additional Section: ,—__- 0 Heated Basement O Plan Check fee: Unheated Basement State Surcharge fee: cJ. c Other Unheated Pot Water Review fee: CID. Garage/Carport Si i351 3a SUBTOTAL �� � / L. 91 , tG Decks C O Y e,re. P D f elle 5 2 2-1- 5a71.r� 91 /Rd Approach fee: 5 ^O Other e.DJ eira bree2 fp l c6s5,b? TOTAL: $ oZ s.q q.L-7 Receipt Number: $5 ID DI Cash/Check Number: 5 3c8 ESTIMATED COST(REQUIRED) Date: T\ .Fair market value of all labor and materials fou on to finish — -- tv 46 IgCID©o "ii �i�7./�_Ini GIs: (� — *Ref fiSeA fatafLetr s ueute foot-v- e . IAtOfur srAre_ f c title = tg3Zid e14 Plu,t, r1.\u.....:.r..,..a F(14 A/C\TrII • • PERMIT # 1 �; 1 ggON Q 6 ` I) 5 7 kw °,,% JEFFERSON COUNTY $444, .11 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 ". �q , U� 360/379-4450 • 360/379-4451 Fax " IIN http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# av 656 PROJECT/APPLICANT NAME: , , I a kr-A 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. firer,-w-)etra to i-C-r may' alp (Vet � �,r�d rt.c Ccv S o l+a..ho-v j1C.�.�j IO/2/p(o ff 1 Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. `3 I U c.4-E FAA,1 L 1.. 1-t--c c c-Lit✓ i 3 Z 1 L=E T P Tipi - ST& C CP T1 AdVaLi. 1 AtUD PCAZ R. L tiVlij 019 11)e-10 ACe-03 z, 'TO tit 1,9 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 1CIt -DiJiC ITE C17`:7a4T1A LA.;- &RA-re: 1 -2 i� cic - PE i i.veeg p I I 4 1 re A;tt WA-1 072. L L )rrl M,A-S' 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. V�ZA c_A ID 114cam, t C 'i iq i 0 `5 4. Describe the existing soils. Indicate soil type on the site map. BUR Ik ? I z- 1 5 1�;i at c-i-A A-uo OP-n`5v&701 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. (� 7TA I\lb 1.46: Lki\ ( L-1 t%i .Pf)-H-I Plat C-L PA-Tie e-- N i t CT L-It N D`> 1 T ►4 &A TM t t_` i ��E-A L: S. APPROVED • 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN • irk i � ti 4 L1.1 6 OCT 2 4 2006 StorrnWat Require 1EFFER WIC() Y DEPT.OF C'¢ , TN D V LOPM NT stormwater site plan template—rev.1W1/2003 � SIGNATURE(( �� s • • 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. 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.). Jtc - k� :-i tj( pl��� ta5tme+ - b,,ydi�r vJ 4 c k c'- pturrc_c ( . hi► St I a;� We.A. Ov fli.1l k0;c Se..1A4-ChAqCat t�`tcct( Xtrt 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. / r/(th Will 1 eat b ii d,,r7.(.v-A-+ p,.ru)Wier)r; 1-) , k1 o r uiJi Df[ h1t i ab� .0'tie A (AA 1f (AhAtil 'S bit pro r il Wag r,/,u-i rie. 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 contaf i.natt .]v IL \ '' 11. Describe the performance goals and standards applicable to the project. ti Li Lt 1 W L tA T ht'dLG'-iu,a f 12— . 12. Describe the flow control system. 1.f- i dM ti 1.4)1 61 `luaus) b4,ke burr , 1w,, aA'Ictic."-i 9c�I � traf stormwater site plan template—rev.10/1/2003 6 • • PERMIT # BID 13. Describe the water quality system. i\i, r. _ 14. Describe the conveyance system analysis and design. PEA rtr,s+vq;t , n 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. No all iv tot_tA.`F1 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. k/k 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the site. ke--ie 4 i n tv kWir'. AMA YlOk1 —1 !sij 1 ibl ►ret A t✓tiro p LG,A.(3 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 hole. �4k 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. 7 stormwater site plan template—rev.10/1/2003 • • 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 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. e tY L:1-4- 0, will tat_ d- v- 2. Establish Construction Access. p 1 yf vitt 4. • i i.-&L-- ctit L Je-ck., Pro o Si-L.Ji tioi II GI • 4 e pcLW • .0v el ctA o'ri +ra.eicebt ro dd ri I! ,)ift,wvtt F i 4Y 6 t)e f on a� GVtly� 3. Control Flow Rates. �y_F•.. I l V tk 1 L? I.l 4. Install Sediment Controls. l /�►'e- 1d', l i 1/t-�iG� `>Q{� t evv14 1.�j t -hi !•- Y ed t'i?IE rr;! 5. Stabilize Soils. • r7 tr<r.-AA) ViiLu fat I �/t�l�-L'r p I ay:,1 L`�- DVt4 vVL�0,td :2v� J-I r 6. Protect Slopes. 1 X1`i+10a1 a_LAJ"l_a_tA drkttii u'9av4-- lore- 7. Protect Drain Inlets. - tiJ F f v t eti'-fi 844Arf et t o W t,th phi ,A.)Etc=A to `; ton 5 7 LWINDD DCR stormwater site plan template—rev.10/1/2003 8 • • # BLD 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. tYrI Vl v+ l �z 6,itc jGvl' - iNi 11 vt 7-6 G i t n.�e,1 k4— iZ4t� ut itt IDa lieti cm tf i�vC-te- t,, L1 9. control Pollutants. • o i l(!� e (Ant 1 Vl t L 1�yh,t-i►�U ot_Ad a. L°LE 4'jam t it L�1'ltinetA ) �f J. u . 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). g D t r\,L(:jt t.Ur 11. Maintain Best Management Practices (BMPs). tik1I I_I A ..ems#- A41, rrti -�t r�.' A. 1,1 P�Nit P. Yr eri t.Ve- � 1narr tali 4'a( 5 1 e- �f t co ea- ` J 12. Manage the Project. g Pk G7NAtt - c.v1 ' �tz.-+.11 10 Cu ri t S t tiV--1-1 Ct r_ C. %O r A L nk-4 Z c-n Alta J 01') /V)d rt, f e✓kw . r. en r'}- IA`try lz 0i1 d.t c i,01 t ' l � 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). - 2 Y'IkfrA.-1 �`1-ttLl �t'tG -it 4rn15 . IA1✓�51 E'i'v� >r f ✓ TF I✓u t i O e t ‘--;.dam. b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 y rds). j� f) 4itrectil`vc, p+C i rir, 2 CC 0( 1� 1"Go(!etl en\ iYix0.1 FEZtf-t- c> c1 dirati-11. e U'1 Gt�1 . �4,tir'ftt--ti- dra_ r , - 7t; c\bP iu t (' ��n ti i r��.ct t.an ' ,fe- 4 ‘d-tit.1 k c ` : J 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. r%. 9 stormwater site plan template—rev.10/1/2003 9 • • b. n 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 st cture). r n 5. Construction Phasing. a. Construction sequence , "1L1 f i t 4-1 d,wzIt fril K L f.3e.tr/ -vl e.-- b. Construction phasing(if proposed) I14,. 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed copstruction struction schedule. E X ac.t-t-67'1 t AVIiA-4 d i ticr-n (AAA.d 'kit.rrl- 64i nl roes c.�. at,5 c�:iccn IL 17 p 'I 'bt.I- t, P roitik . zAt rV �L t-e_- i� r t. I-- j4�L`'ei-fit.-c'Q to 1 ell A N G'1 II. Wet season Construction Activities. a. Proposed wet season construction activities. Ai I A-9ra i--- 1 b. Proposed wet season construction activities for environmentally sensitive areas. 't 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bons an` or other financial securities. f. , R,u:.-vA.,Y K i(viL.-(7t d (MA)ne�l4),>. IA64 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. NA 8. Engineering Calculations. Provide Des' u Calculations on a separate sheet for the following,if applicable. A a. Sediment PondslTraps. l�tt- t b. Diversions. ,4,,; c. Waterways. A.A d. Runoff/Stormwater Detention Calculations k1"i 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 my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. �s c�WOW? (LANDOWNER OR AUTHORIZED REPRESENTATIVE (DATE) SIGNA RE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: s ; ( 7Ii �uUV PERMIT # DLD 0 0 - 057 JEFFERSON COMM E1V storrnwater site plan template—rev.10/1/2003 12 a a a 44-0" /4.0" 16=o" i¢=o" 7'-o: 7 Lc," 4l-0" 2-6"3'7 4" Z"-G.' 41o" /'`Z-G' G-a. 2-6" /-G _ C ,•1 ill ,,... N -, N, i� Pf o, £ . poi- - T.0 2`4 Zr4- \ - - _ _ __ _ y 51{ n sµ vJ . P ,v- , r o. . $ a. - C s`;• I i S O, G , \,r.---2,44 i • 71 0• 0 $ and tL.m� 0, o Z t. 6 d �' �' m z CI y E. x, G _DE a 1 I v v:UI ,8 T C. o• So I t I �- ` J �"`- 1 a gi iJ G wrL 0, c / -I / `ter N2 . Ul �,I!v OW \ s/ 4c' /- "�', S'oIF av"II Fo4 ? T/ t . 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