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HomeMy WebLinkAboutBLD2007-00112 • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00112 Received Date: 3/16/2007 SITE ADDRESS: 80 N BAYVIEW DR Issue Date: 4/26/2007 PORT LUDLOW, 98365 APPLICANT: JOHN HUPF JR 736 CASPERS ST EDMONDS WA 980202617 SUBDIVISION: Block: Lot: T26+ PARCEL#: 921332027 Section: 33 Township: 29 N Range: 01 E CONTRACTOR/ GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 DEALER 19647 VIKING AVE NW POULSBO WA 98370 360-697-4606 Contractor's License GOLDEHP950KB Expires 5/18/2007 PROJECT DESCRIPTION: NEW MAN HOME W A/G 120 GAL PROPANE TANK (MODEL 6732) MAKE: SKYLINE YEAR: 2007 SIZE: 60x40 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 4/26/2008. CALL IN FOE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Set acks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): 5/,e1p 54/105 OTC //2 -7 Stormwater FINAL Approval: a< 3/4/0 8 A/ Blocking/Plumbing: $L6cKi►� 4TF IJNS at VII*W Propane Tank/Lines() V. mac,t?K 3/4/4$ Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: /Skirting/Vents/Porches/Steps: gy I lei w . veursikel4ES'�Ept 6K-3/4ABffeh HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED F►oa O -4c►- -�'�a1 el& Owe" BUILDING INSPECTION HOT-LINE 379-4455. CALL 2 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 Review•ILDING PERMIT APPLICATION M T0136 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00112 Received Date: 3/20/2007 SITE ADDRESS: N BAYVIEW DR PORT LUDLOW, 98365 OWNER: JOHN HUPF JR PHONE: 425-778-2242 736 CASPERS ST EDMONDS WA 980202617 SUBDIVISION: Block: Lot: T26+ PARCEL NUMBER: 921332027 Section: 32 Township: 29 N Range: 01 E CONTRACTOR: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW POULSBO WA 98370 Contractor's License GOLDEHP950KB Expires 5/18/2007 REPRESENTATIVE: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW 360-697-4606 POULSBO WA 98370 PROJECT DESCRIPTIOr NEW MAN HOME W A/G 120 GAL PROPANE TANK (MODEL 6r-2. TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Ex : Exist: Prop:ist 3 Prop: 3 Total: 3 Total: 3 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 CJZ 03/16/07 89592 APPROVED Add. Manufactured Home ; $34.00 CJZ 03/16/07 89592 Potable Water Application $58.00 CJZ 03/16/07 89592 APR k 2007 Propane Tanks/Stoves $0.00 CJZ 03/20/07 Jefferson County Planning Total: $255.00 & Building Department • • SPECIAL CONDITIONS CASE # BLD07-00112 1.) PRIOR TO OCCUPANCY, REMOVAL OF THE EXISTING RESIDENCE PER BLD07-112 AND FINAL APPROVAL OF SEPTIC SEP07-20 ARE REQUIRED 2.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODE. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on April 26, 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: Eagle; high risk SIPZ. 4.) 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. 5.) The parcel is located within a High Risk SIPZ (seawater intrusion protection zone) according to the County GIS map. There are 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 High Risk SIPZ is defined as: areas within 1,000 feet of a groundwater source with a history of chloride analyses above 200 milligrams per liter(mg/L). 6.) 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. 7.) MANDATORY MEASURES OF HIGH 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. 8.) MANDATORY MEASURES FOR HI RISK 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 requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 9.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 10.) A flow meter shall be installed prior to final sign off of the building permit. 11.) 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. 12.) The applicant is proposing to create or add 2449 square feet of impervious surface and 2449 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. 13.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 14.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 15.) 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). 16.) The site plan as submitted with the building permit application on March 16, 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 26, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) This approval is for a manufacturd home with 120 gallon above-ground propane tank 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. 18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • 19.) Not more than 2 unlicensed vehicles snail be stored on any lot unless totally scree ed 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. 20.) Minimum setback from North Bayview Drive right-of-way shall be 20 feet. Minimum north setback from adjacent right-of-way shall be 20 feet. Minimum east and south property line setbacks shall be 5 feet. 21.) 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. 22.) 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. 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) The building height is not to exceed 35 feet. 25.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 26.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 27.) An address of 80 North Bayview Drive, Port Ludlow has been assigned to the parcel. North Bayview Drive is private (P111). 28.) Per email dated February 6, 2007 from Shelly Ament, WDFW biologist, an eagle plan is not required for this parcel as it is greater than 800 feet from the closest Olele Point Territory Eagle nest and not a shoreline property. 29.) Because the parcel is within a high risk SIPZ area, a Hydrogeologic Assessment report dated December 18, 2006 prepared by Aspect Consulting was submitted with the permit application. Environmental Health reviewed the report which stated that"...it appears that there is reasonable assurance that pumping the Hupf well under low discharge rates will not cause impairment to the existing wells in the surrounding area..." The report recommended that the applicant follow the mandatory measures for High Risk SIPZ per the Jefferson County Code. 30.) The parcel is served by an individual on-site well. Lekingtb. 0 Triple Wide Series C....... _ �� MASTER BEDROOM , L KITCHEN B 18'-8" is B FAMILY ROOM T—..—...- f vim 11., I 1B No.1 18' ONUS o ROOM DININ8"G 14'-8" I RO12'OM ,._4.. I • ri BEDROOM I BEDROOM LIVING ROOM - No.3 UTILITY A No.2 24' 14' I 12'8" iii I 1t1 J 6730CT/6842(2,715 SQ.FT.)3BEDROOM-2BATHS II i I L I .7 COVERED PORCH V. r. COVERED BONUS BEDROOM PORCH ROOM No.4 B 10' 14'-8" DEN i .Limp rEmin L 12'8" J. I1 J FAMILY ROOM 18' OPTION PORCH OPTION 4TH BEDROOM OPTION MASTER BATH ALTERNATE OPTION PORCH OPTION DEN II C BUTLER PANTRY . i DINING ROOM OPTION PEDISTAL SINK OPTION 112BATH I 10'-8" C Your local Lexington® dealer is: L li L ri OPTION HALF BATH/BUTLERS PANTRY/GUEST CLOSET NI Member [IF li 41 ! i MAY - 7 2007 ,NAHB I SK'-ILENE NATIONAL ASSOCIATION TV Ca) OF HOME BUILDERS .JIB 1 DEVELOPMENT BRINGING AMERILA HOME. BRINGING AMERILA RR JACK WVESTERMAN I� ASSESSOR Jeffervon Ilk Courthouse`p_ PO Box 1220, Port Townsend, WA 98 368 (360) :311 i-910:3 (�------�_ MOBILE iiOME INIi'OI�MATION F�rIR�( - r� f e il � OWNER'S NAME/MAILING ADDRESS: - f NAME: IA $ ADDRESS: 3(0 i sr 5T., rnpcit � VI. ci8 �nTY PHONE NO. v�-� - n��l(n,.;�c ;'t1.�(3(op) loci 7 . -3y � 1 . The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already tax rolls in Jefferson County or if it has been moved to this county from another the er area. 1)MOBILE HOME DATA: (A) MAKE (B) MODEL�p-]3n CT (C) YEARA(M3 (D) LENGTII___G (E) WIDTII 4O ---�(F)SERIAL # , -1.-ES( (G) YOUR PURCHASE PRICE (Do not include sales tax) 5 0 / 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IFPURCHASE DATE SI� O NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No If Yes, Previous address of mobile._ If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes Cy:, (B)IF LOCATED IN MOBILE HOME PARK: NAME it ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER; `tea l-i_-L E LOCATION ADDRESS eo REAL PROPERTY PARCEL #/DESCRIPTION 9 2.I - THANK YOU FOR YOUR HELP! Signature of applicant .�bT1. 'SI ' I / JO I ! COSSELL, Property Technician 7d JEFFERb N COUNTY f __ TA DEPARTMENT OF COMMUNITY DEVELOPMENT ` l 621 Sheridan Street • Port Townsend •Washington 98368 MAR i 1 E sr, � "� 360/379-4450 • 360/379-4451 Fax .414S. rN0,SO www.co.jefferson.wa.us/commdevelopment Master Permit Application r') _ _ `` Project Description(include separate sheets as necessary): MLA: �� id of q_.�, —)—rr ST t -- A�nrr.J k a.,.J d�E.. 7cgr-T- L__�.�p(� t�i,1 a-.c..r F- .4..4 Tax Parcel Number: �4— Property 2. —C) 2. Size: 13y X 2ki 2,X l cI Z X Z�ti " i I . isq Site Address and/or Directions to Property: (acresrsqua�C fe - Property Owner(s)of Record: �� �o� �./ �b t�11.1 � Telephoner "1 V a...)-24 ' Fax: l 2 Mailing Addresses CcZ — 1 3 '7 $ -(q email: Applicant/Agent(if different from owner): ‘ TeIephon C) "4.,c' - 3 Fax O (p �6 0 Mailing Address: a L email: What kind of Permit?(Check each box that appli s) • ' Ou/C � �� Building 0 Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Conditional Use[C(a), C(d),or CI** 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ,Manufactured Home 0 Special Use(Essential Public Facilities) 0 Modular ❑ Boundary Line Adjustment ❑ Commercial* 0 Short Plat*" ❑ Change of Use 0 Binding Site Plan*" 0 Long Plat** ❑Address 0 Road X'Propa Approach 0 Planned Rural Residential Development(PRRD)/Amendments ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Allowed Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Dete rnation SP * 0 Shoreline Management Substantial Development** ..''6'I';� t7 Temporary '+ ? -' - ( gyp) 0Shoreline Management Use r- ��� I V.►,.� Variance �� ❑ Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May requite a Pre-Application Conference quires _ Conferen Please Identify any other local, state or federal permits required for hi proposal,Appl,cation if known: ce nwn: ce I hereby de ' ate ` J DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). OWNER IGNATURE �eC• - Date: -Y/o/(/ By signing this application form,the owner/agent attests at 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 m 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 attomey'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 la inspections.Access and right of entry to this property hours. P perty shall be requested and shall occur on during regular business Signature: to e l Date: 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 perm has been issued will not violate the ESA. Any individual,group or even if you are in compliance with the Jefferson Countydevelopment agency ThenApplicant lawsuit on ackbehnolfwledges f that h ,endangered speciest individual your actions non- transferable responsib-• f r adhering to and complying with the ESA. The Applicant has read tis disclaimer and she or andlds mdiiitt beuloow.PIY 9 Signature: - Date: 2 O -7 GApeKmitcenter\FORMS\DRDFORms\M'etarne....:, A--.1:_-:__ „.• . 9 I 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 a ming t responsibility of e General Contractor for the proposed project. Signature: Date: VI r y d 1 „r GENERAL CONTRACTOR OR MANUFACTURED EDD/HOME INSTALLER: PHONE: FAX: —j)6 ./Y, n > ©�- ° d\xs ' e97-.34�s� .3�e'6 'aG 9.7- MAILING ADDRESS: 1 9 6 C-`-) LI/ tk/ yZQ /U,W EMAIL: CONTRACTOR'S LICENSE J©6,Le 3 I3 d a 6 -,c7 vs-3 -7 e WAINS 101 NUMBER: G,- -t,I- 1 S p IC- iS NUMBER 4 ARCHITECT/ENGINEER: �l /��-T PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Prsjeet Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: z � Bank Height: ❑ Community System ❑ Alteration/Remodel --eoncrete Total: t tYlndividual System 0-1- ❑ Repair ❑ Masonry MA- SEP Permit# -.-fb 6 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well rTwo Party T pe of Heat: Proposed: ' ❑ Public Total: Name of System: ti�.c .4�1 �Cov�_ If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 12-D. 1 i ❑ Underground Tank- Above ground Tank :ot�ne Tank=. ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home Yes No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines buildings ands tic system components, including the reserve area. • r'`r+r .1" c _ . . . .._.mot J_�..t . • . Square Footage Current Propoaed <. parr --.t c r= :. Z ° ` Main Floor Heated r EH Bid App Review: IOU DO `3 2f°Floor Heated ,': Consistency Review: I 3,5 00 5 I Other Heated Base fee: I 0 C /� Y ,. fr Mezzanine - - '~-, -4.-.. Additional Section: L/ CO Heated Basement 'x-" Plan Check fee: Unheated Basement ,ter--, a....' , r State Surcharge fee: rq Pot Water Review fee: ��I Other Unheated a ,.,, k co tom f44: Garage/Carport ,? :. SUBTOTAL ,y Dd e 1 Decks ," ??, ; ' 911/Rd Approach fee: Other -u:. wrs It: TOTAL: $ (c6-3 - - Receipt Number: C11 1-D 6611 9 1 `l t .}: Cash/Check Number: 30\a\ %I ESTIMATED COST(REQUIRED) Date: 2 •Fair market value of all labor and materials foundation to finish V/!(0 /07 All'01 Initials: emit A lication 12-30-05.doc G:\PermitCenter\FORMS\DRD FORMS\Master Pe pp - c elnik%, JEFFERSON COUNTY 1 DEPARTMENT OF COMMUNITY DEVELOPMENT E __ Y {{ 621 Sheridan Street • Port Townsend •Washington 983681 OF! ._0rf EN 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: 'i..JO t44j Misrl 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. San& , Lovn480►1. Apzx ZO t (viches t-1ou sc- Lvccd-) 5 , i S Cal I 1301 v i t act l.q, G arc i - 1 lh� d o'-e LAfa4 ( A p lea a G 1� to Victy►-ce avto b(- Mee- a vt oo Ru.� �o f f: Jima v--d +- e. h � Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. s C 4-V\t Vwwte c p(�s . c_e_a f-1 ; -c i.c a c l l k- I�� l 1 . m 1Qvvp e4 K X2- dt I-C S ' s a b., 6 -f v,)✓N vlavAs apt G Pa ii-h-e fq' 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. q 12 GSS, \o vU s 1/1 , P \,e to c�{2.e_cri S', ,a.t a t-S • 4. Descnbe the existing soils. Indicate soil type on the site map. lA,tAkt-e V OMQ circt U 'u 1 La ct►/ e A-j r to ca 4-e d ( t- I s d ky . Na r a r m 2Y i s H-lM c I j1 f e(d -f-AcLf vzA 5. Descnbe 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. 110 vvt� > ,�t I lo e p La act a 61 1 t h i 1( t i cpcu f of vR � e o � ►-.Q i tea,l--of s -� 1,>2 b zi oc, 1U+'�'�V to o t-a per r� hr a t-e- se M-E- to44-eirV Uvt 6. Describe any excess levels of noise generated by the proposed use or activty: rnoaer,te o►'s�� 1,10 •h� V1 uv� notSe� vv l APPa :WED fi PLAN APR 2 6 2007 's Stotannntef site plan template—rev.1CV7/2003 Stormwa r uire 1EFFERS IOU � 5 Req DEPT.OF C: DE ,, T SIGNATURE. IP Al • • 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. S I t�G< s �u 1:6111 d( 1/1 -11)w a►-d s l'�- N o R� -icst a►ca 17101- .- df.Sfiu.Va-e04 b{ e 6YI i- m (Vt rrt, a h(' ura j . -t}- WI 11 v1,(1 SSess et pvt toLi:V 40V +kJ ylpidu V Yv'J ( %7 d va l vtt Lo( (A a 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.). VuYldi Olt a td 1 �- ,1- Gl re-G. vc Axon& 5p -- f'ytwo a r tx k(IYYULI (IRA GI Qk " Q,for cu-en (9614 L( V pi a 1-e 2 S avt C.Oca1�7 tad za a o yalii-uyl 'fllWavd b+ftQr (no WIT S 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. 4-1 t/At Vlt wi (,I bt (hc[al LPa rz Csu1- e'-- a 't61 C10uhSOOLa- 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.] NJ,a- 11. Describe the performance goals and standards applicable to the project. oxclavantVi jS fiU - n' iv1(wial avtof So► I -I-Vt&f is dLO-u.0b-ei oflai I(9 "fb►2. oth_ot pale.l_tvi9 alga 12 13VYVp vv oe (Asect of .ivy -tn. s v(�\er*- roveRWi r�� Spo\1S civ,rt i �F cev\GLv�Lj avid cfiya W v\1 it used cc, `tn eioltot 12. Describe the flow control system. ; v W V��� VoC4 1dce� _� 1�V�s Avid 1Ct uo w+ U ie used as hap eLg� ( • 1 stoml4vater ate plan teMpla►e rev.uvipoQ3 ,; ... y7r F:( - fl • • 13. Describe the water quality system. r R OSiO vl avkok Wa.tea- PQ ut.v1 o LI lot ai t (it!'h i- l s pa c-f- St , 14. Describe the conveyance system analysis and design. l/l Q S ��►C Q y t c'f7 q ?2A vl S -J � � + , R 1 6 2007 L ' , JT 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. can d1 , ,e Lk- a.vt_o( 6 vi L-1-c) 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. CCV \pa vw cet ct 9-e_Gs \Ai V b e la vvl I It c! 17. Describe the proposed surfacing material. to WI a VI of D uta.RA eiv VY1 t Vl LI s) @ kit a(Q V m G h vvl I vl L1.0 C_Az US 18. Describe methods for restoration of the site. S'NA w CM-CC S Cad 1 avt RIl IlArl t,l lot_ 6 Ea frtd Vv1 a l Cvi a( Gt ►n ,4.-osto Vvo p er d►tea t►�a e. a N\to VI d fit' CA-u i€ 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. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. /,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. Nl- stormwater site plan template—rev.10/1/2003 7 • • 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. 1,es 2. Establish Construction Access. 3. Control Flow Rates. V\or . 14-0-10-L12-12_ 4. Install Sediment Controls. ItiSL VY1,P 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. NO- a stormwater site plan template—rev.10V1/2003 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). NIk 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). N(l\-- b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). "V I� 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. Nf/t- 1 6 2067 ;_:✓' '\ ►y -�stormwater site plan template—rev.1 at/2003 .;Y 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. kfrk- 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 ►�c� C.uk Pfb►�- ebil c Q h t vi c �-Ct LI In u vv - 4-1 h is h P"YthC t4 i 1 *vI ve w a j t R vi g I ,v-A OLL 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. nika vc irl - Jrtd ve._ IL Wet Season Construction Activities. a. Proposed wet season construction activities. fvl or 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. It- b. Descnbe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. A� 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev_10/12003 • • 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 . ' ed prope-ty. 4 r07221 (LANDOWNER OR •r,•R R RESENTATIVE SIGNATURE) (DA THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: 12 stormwater site plan template—rev.10/1/2003 g�°oQm #►vlDi ►I Qm �pQn1 (/1 sgr, i-*'v+ �iR gtA .. �1CT>WoN gt60!, \ NN ' tp ' V� '� l�I ' N ZOO � g-( mmy _p m mF.> 1 •n�'- �`C -1.y ttRi -.-1-. \ ~O c%~ Op %~ O s~ c~ of � zr' nj =2 n1 5g,z)3 w x 0 0 6; 0 tn% x I:3 C) R (I 1.6%1821 %4Inti.1)§ tRii° -A t§t x'17.) ri-' trtig::w 0 -1% Wi5„, 0 2 S. 00 -<W f> ,300 ..6.,. 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