HomeMy WebLinkAboutBLD2007-00106 31
OML PILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00106 Received Date: 3/16/2007
SITE ADDRESS: 145 MATS VIEW TERRACE RD
PORT LUDLOW, 98365
OWNER: DAVE A GROVES PHONE: 303-776-3822
SHERYL GROVES
6350 EPHESUS RD
LONGMONT CO 805039033
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 970900003 Section: Township: Range:
CONTRACTOR: WALTENBAUGH CONSTRUCTION CO PHONE: (360)385-6105
40-A SETON RD
PORT TOWNSEND WA 98368
Contractor's License WALTECCC12BA Expires 1/1/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GAR/ 120 GAL A/G PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,202
VALUATION 425,000.00 ADD'L: 1,391 HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: EEE
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 559 SHORELINE:
CONST TYPE: DECK: 112 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CMY
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Dater
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,813.75 CJZ 03/15/07 E9584 APPROVED
Plan Check $0.00 CJZ 03/16/07 APr
State Building Code $4.50 CJZ 03/15/07 E9584 MAY cQ 12007
Potable Water Application $58.00 CJZ 03/15/07 89584
Plan Check $1,828.94 CJZ 03/15/07 89584 Jefferson County planning
Total: $4,705.19 & Building Department
Jefferson County Building Division Permit Numb BLD07-00106
Applicant: GROVES
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks L`
Erosion Control V/3/ r
Foundation Footing (f)— i b ) c Y t J
Footing Drains .0'/0 Ort_
Foundation Stem Wall 7/3/07 6 K
Under Floor Framingar/SM
1,A);?,
�/
Straps(hold downs) p 1 7-0 � ( (7 H t)Z ll,sc>( � v (i O C 2
Ext. Shear Wall Nailing •
1 ��� l� L 112CL1� )mil��4��
IU- - 1lAjf
Rough-in Plumbing `/
in et,
Framing ) � g/��7� Iru eRarwc spoke'
��� ,�J tawcfM StA�ignveP6rwut MauiA.40e. ILBSRlvif 41uu6moiJS
Blocking
i l�20/07
Airseal /i/ /07 PA
Insulation: Walls iI/
Insulation: Floors ,///09 fr FltATX
�/
Insulation: Ceiling ,//3/4 I t/era, ( tydXs OK l/��J rtdlas Ox 614/edit
Int. Shear Wall Nailing / �� ,? v
11 '47 ikleLI ICJ t,Jr4 IA—3 A !- / r_ /ci5„.LA![J,(../
Wallboard Nailing ,,'3/G7 �q` D�
Gas Line: Interior l ,,,,/7 l/ d�
Gas Line: Exterior ``�� a y
Propane Tank #709 G�
Heat/Chimney Clearance
le
Drywell/Alt Drainage
li/t/
Address Posted 9/s 0 .-
FINAL INSPECTION //e 4Gf_ ��
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
G/rvoir,e Pc.tot/3 7//8/o7 vl
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MAR-05 07 15:15 FROM:LEARNI NG SERVICES -G11-682-7392 TO:9136037927373475 PAGE:02
•,,- 05 07 01 : 32p • • p' z
r N COG JEFFERSON COUNTY
W \. DEPARTMENT OP COMMUNITY DEVELOPMENT
"3 -' • 621 Sheridan Street•Port TOvmsend-Washington 98368
360/37t�4450. 380/379.4451 Fax
www.co.Jof erson.we.uslcommdevelopment
shixG�c° ^'�
Master Permit Application MLA: C r I — t3 t
Project De non - vela eeparat as ne nceseretr):
Tax Parrot 1 io 9 C) 1 Property
Nurrtbaf F�`?j _ ` ` r. Sae: 6 :re
Site Address ond/ur Directions to Property:� p 6�: J �� Y t-C ) 1 r,sst�_' a A
Property Owns )of Record Do-AA-Q'C . , .e t�-V'e', _
Telephone:3 - 7 " 38� Fax-. 0 smart
Mailing Address: t!a. � I�'1.) s_5 t4 K oc Leincj C C� O 5 03
Applicant/Agent(if different from owner): WIL 1-i-'hit. �f C` IFrr�S CJd'1Bi-. t� C..
Telephone: '3$ —(a(Q Fax. 2.-7�1 email:-tit A)Q hken,A. S.old
Marling Addruea: n S.Q �'h Y1 2 (i�l n►�=rt _ Gy Q.A CV
_
What kind of Permit?(Check each boa that applie►) II'
JABuiwing 0 Vadanm(Minor.Major or Reasonable Economic the)
v 0 Demoaeon Perms U Condt/otal use jC(e).C(d).or C)••
piC.gkgle Family 0 Dieeretionsry'D'or Unnamed Use Ciessiticattom
0 Gaiuge Misdate r Oufrdhed 0 Fpedal Use(Falderal PmMC Faddism)•�
CI Manubdu.od Hume 0 fiotandary Lino Adjustment
0 Modular 1 :non Plat••
0 commercial• ]fin Site Plan••
0 change of Use 0 Long PM••
0 Adore:- I Reed Apeman n Planned Rural Resldenual Development(PRRD)/Ameadmefts••
C Pmparw 0 Fist VeceiosVAReradon"
0 Agnew!"vas-use Consistency Analysis O 6Mnot1te Metier Prorate EnempMoiVP .mt Revisions**
ci Stornwater Management 0 fftoreine Management Substantial Development"•
I] Siao Plan Approval Advance Oetemain on(SPAAO)• 0 shoreline Management Votsnoo
0 Temporary Use 0 C:enhprehanalve PIeNVOGland the Obeid Map Amendment
C Wireless TetecemmunIcation• 0 Jefferson County Shem i ne MederPregrem Amendment
CI Fared Pradlces Ad fnIasse rd Star-Year Moratorium
•May require a M-ARpYeadon Confe ertee `Requires a Pee-Appikarlort C.ntrrancs
Please identify any other local,state or federal permits required for this proposal,tf known:
TION OIP AGENT
I hereby designs ad as my agent In molten nefatttg to Una for for pertnN(5).
OWNER Slcx+n7VtE Date: < /� 7
By sigt4ng etas application ttn>•, ne erne amen nal ma 4tbrriniat paraded hareem,and in any etedenenb,in true and convict to ttte Dell of
his.14•(or Iry ofoort olue. Any motedof attiseod or any antiwar,Of a mandrel Pad made by Ina ownerfagerl lean respect to this application packet
may result In lids perms toeing nut end wed_
further agree to saw.Indemnify and hold hertrdscs Jefferson County against It lietillities.judgments.court costs.reasonable attorneys lees and
expenses which may In any way accrue woes Mention County es a testa af or hi consequence of the granting of ails perm*.
I further agree to provide access and tight of entry ttt Jaffaann County and Its employnra,representatives or agents tar the sole purpoes of application
review and' ter ilipadions. ht of entry to Ws property shall be requentisd end shall occur a durkt repulse business
Routs
,mac Signature: - Oats:
The action or actions Applicant Mil under-Ulm mi a Harp of the Issuance of this permit may flees***Impact upon eie or afore tweatensd ex
endangered spades and could Mad lea potential lake of an endangered spacers as those term*ere defiled In eta federal fa*known as the
'Endangered Spades Pcr or'ESA.'Jefferson Carty makes no assurances to Me applicant het the Actions that site be Undertaken because this
permit has been issued was not violate to ESA. My individual.group or agency can Ale a iswsull on behalf of an endangered spades regarding your
adaunts)evert if you an an compliance with a.Ylfareon County development axle.The Applicant acknowledges that he.she or It holds I diwidual
and nav-t i. a aspires !y to to and complying with the ESA. The Applicant has mad tie and m end dates it below.
Ste: `e�i Cate 7j7
f._\I kxwnenu ant xn.vgitn,idat\lhdwietM eta Pnuur Application y a-Ol do.
• •
OWNER BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Dale:
GENERAL CONTRACTOR OR MANUFA TURED ME INSTALLER: /� PHONE: - FAX:
Q.L a2 p� C' 6,,.,G. �Zhc. (O3?�—b/&5 (?. 7 -(1737
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS r `�
NUMBER: Ga'J_Q_rrc,01 D- /f NUMBER
ARCHITECT/ENGINEER: w j ^ p ^ ,.�,/ ✓ .. inn PHONE 6�C)38" ?A8`FAX:( )
MAILING ADDRESS: -�•/ �Jt 7`�' ,(� EMAIL '
Project Type: Frame Type: Bathrooms: Shore ine: Type� of Sewage Disposal:
`� New try Wood Existing: 0�R � Sewer
LI Addition ❑ Steel Proposed: -4---- Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 3 Height: Li Individual System
❑ Repair ❑ Masonry SEP Permit#
11 Demolition ❑ Other. Bedrooms: Water Supply:
pp y
Existing: C) Setback:
T of t: Proposed: _ ,3 ❑ Private well ❑ Two Party
d A-I I- Total: Public f°C)
Name of System:,
If this is a Commercial Project you must answer the following: kj 4
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:
I Underground Tank Above ground Tank Size of Propane Tank: i 0-0
I Heat Stove 1.4,Cook Stove I Woodstove I Fireplace Insert I Hot Water T I Pellet SZe I 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 site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all properly lines,buildings and septic system components,
including the reserve area.
Square Footage For Office Use Only ���
Current Proposed C�+ I�' .,..
Main Floor 421._OON I Gir3/ a(P Consistency Review: 1 53
2 Floor �3 Q I [Girl
a9 �v 3�Base fee: �
ro ,VI5. a, 13 .13
3 Floor Additional Section:
Mezzanine: Plan Check fee: t ��` '�
Heated Basement State Surcharge fee: t -i6
Unheated Basement Pot Water Review fee: 1
Other Unheated 911/Rd Approach fee: EXI66 nc2j
Garage/Carport I°3 TOTAL: $ j )C1
Decks Re 'pt Number: Qj Ct 5�4
Other ash/Check Number.
33
1 �
ESTIMATED C EQUIRED) Date: a`b�
.Fair marke all of all labor and materials foundation to fini z`ISI 0-7
/s[-,( f ) '- GC Initials:
C:\Documents and Settings\mochit\Desktop\Master Permit Application 7-8-04.doc
CONDITIONS for Building Permit# :BLD07-00106
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on April 25, 2007 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Coastal Seawater Intrusion Protection Zones (SIPZ).
2.) Marine shorelines and islands are susceptible to a condition that is known as seawater
intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in
an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater
suitable for public consumption without significant additional treatment and cost.
Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater
withdrawals (primarily through wells). The Washington Department of Ecology is the
agency with statutory authority to regulate groundwater withdrawal for individual wells in
Jefferson County. New development, redevelopment, and land use activities on islands
and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to
the maximum extent possible by infiltrating stormwater runoff so that it recharges the
aquifer.
3.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according
to the County GIS map. There are voluntary and mandatory measures identified in the
Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23,
2002) that apply to well drilling proposals and building permit applications on existing lots
of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources
within 1000 feet.
4.) 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.
5.) 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.
6.) 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.
7.) MANDATORY MEASURES FOR•ASTAL 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.
8.) The applicant is proposing to create or add 2726 square feet of impervious surface and
2758 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the
project applicant submit a stormwater plan meeting Minimum Requirements#1 through #5
of the Department of Ecology Stormwater Management Manual for Western Washington.
The stormwater plan shall address measures to control stormwater, erosion and sediment
during construction and shall address permanent measures to stabilize soil exposed
during construction, and in the design and operation of stormwater and drainage control
systems.
9.) A Stormwater Site 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.
10.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i).
11.) The site plan as submitted with the building permit application on March 15, 2007 has
been reviewed for consistency under the UDC, and has been approved by Jefferson
County Department of Community Development. Any modifications, changes, and/or
additions to the stamped, approved site plan dated April 25, 2007 shall be resubmitted for
review and approval by Jefferson County Department of Community Development.
12.) This approval is for a single family residence with attached garage only. Any future
permits on this site are subject to review for consistency with applicable codes and
ordinances and does not preclude review and conditions which may be placed on future
permits.
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 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.
15.) Minimum setback from edge of Mats View Terrace Rd is 20 ft. Minimum side and rear
setbacks are 5 ft.
16.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
17.) 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.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) A septic permit (SEP07-00104) wlpproved on May 17, 2007 for a tank comity
system for a capacity of 1000 gallons per day.
21.) Mats View Terrace Rd. (P481) is a private local access road. An address of 145 Mats
View Terrace Rd. has been assigned to the parcel.
22.) This parcel was created through Mats View Terrace under,AFN 400252, recorded May 6,
1996, Volume 7, pages 63 - 65 with the Jefferson County Auditor's office.
23.) A stormwater management system was developed for this plat during the Mats View
Meadows PUD review process. The specific dedication is not shown on either plat. The
stormwater detention pond is located on Open Space Traci B of Mats View Meadows
PUD.
24.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
III I i
ONE, � i1rl - -
4. I
(110‘1%, JEFFERSON COUNTI( 5 .-
DEPARTMENT OF COMMUNITY DEVELOPMENT i I 1
621 Sheridan Street• Port Townsend • Washington 98368 i 4
O� 3601379-4450 • 360/379-4451 Fax � ;,=:'r ti____ J
$ING http://www.co.jefferson.wa.us/cammdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICANT NAME: DaW # g 1C/Y y I e VOWS
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.
S vie (e_fe..41;414/ kvs(..a CL)
Existing Conditions Summary
2. Describe the topography. Indicate contours on the site map.
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STORMWATER PLAN
3. Describe the existing vegetation. Indicate native vegetation areas on the site ma
APR 2 5 2007
N.\04-W-L) MOSA-&tt_o-y\
4. Describe the existingsoils. Indicate soil type on the site map. JEFFERSON COUNTY
YPDGPT.Of C0�1NUNNn Y EV t•IY
SIGNATURIs
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.
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6. Describe any excess levels of noise generated by the proposed use or activity:
Imo-► Pc —
lit ttiAN i,u u►N b , '�.
stormwater site plan template.doc—rev.10/12/2003 5
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streamer
steep slopes,etc.)on the site. Indicate location on the site map.
I N A _Y.Op;;1E T
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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.).
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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.
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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
1goals and standards applicable to the project. _ _
evvvk ,( a 5 pottie) ,dair1/1,6.
12. Describe the flow control system.
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stormwater site plan template.doc—rev.10/122003 6
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13. Describe the water quality system. +
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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.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
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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.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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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.
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storrnwater site plan template doc—rev.10/122003 7
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(S (YI PPP)
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The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant indhe
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible fdr'' NY
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.
Mark. i.
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2. Establish Construction Access.
3. Control Flow Rates.
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4. �Inssttalll R�Seediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes.
7. Protect Drain Inlets.
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stormwater site plan template.doc—rev.10/122003 8
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12 Required Elements—Construction SWPPP(continued) r';1 ' !`'''
8. Stabilize Channels and Outlets. s•
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or storrnwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
As cuotive,
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
R.P. tleAdiaY a ra_a — t►14 faC4- 4 is
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.
stormwater site plan template.doc—rev.10/12I2003 9
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b. Description of special requirements for working in or near environmentally sensi ive areas" .-, "_; --- -__ _
'
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics ofhe-on-site I
soils(e.g.,erodibility, settleability,permeability,depth,texture,soil structure). '_[0P1.it_!V'
NIA
5. Construction Phasing.
a. Con truction sequence
NI A
b. Coq$truc ion 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.
0(\•Ci.Lf ,1 CA — 'tr) C t O
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
B-n--- LA.)
b. Proposed wet season construction activities for environmentally sensitive areas.
tJ/a
7. Financial/Ownership Responsibilities.
a. Identifylt to property owner responsible for the initiation of bonds and/or other financial securities.
a
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
Il Pc
8. Engineering Calculations. Provide D 'gn Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions. 1)A
c. waterways. I
d. Runoff/Stormwater Detention Calculations 0 4
stormwater site plan template.doc—rev.10/122003 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 SWPP• •rksheet, I as the applicant/owner attest that the information provided herein is true and
correct e best of my knowled:,- also certify that this application is being made with the full knowledge and consent of all
owners he affe property.
1,:///ji '
` /5 6 7
REPRESENTATIVESIGNATURE) / n ATE
(LA OWN OR A THO I ED (D�- //
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEE ED:
` y R 1 5 .. .'
OEVELUPMEN
12
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