HomeMy WebLinkAboutBLD2007-00155 • BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
Received Date: 4/13/2007
PERMIT #: BLD07-00155 Date 6/14/2007
Issue
SITE ADDRESS: 1770A SWANSONVILLE RD Is Is it a Date 6/14/2007
PORT LUDLOW, 98365 p
OWNER: DONALD TRUMBLE PHONE: (360)437-5192
SANDRA M TRUMBLE
1770 SWANSONVILLE RD
PORT LUDLOW WA 98365-9779
SUBDIVISION:
Block: Lot:
PARCEL NUMBER: 821053005 Section: 5 Township: 28 N Range: 01 E
CONTRACTOR: REALITY HOMES INC PHONE: (253)926-6330
1308 ALEXANDER AVE E STE B
FIFE WA 98424
Contractor's License REALIHI984CN Expires 2/15/2008
PROJECT DESCRIPTION: NEW ADU WITH ATTACHED GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,242
VALUATION 93,296.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: 5N GARAGE: 518 SETBACK:
CONST TYPE: DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT Type Amount Paid By: Date: Receipt:
WATER SYSTEM: PWELL Permit $937.75 KAS 04/13/07 89779
BEDROOMS: BATHROOMS: KAS 04/13/07 89779
Exist: Exist: State Building Code $4.50
Prop: 2 Prop: 2 Potable Water Application $58.00 KAS 04/13/07 89779
Total: 2 Total: 2 Permit $14.00 KAS 04/13/07 89780
Plan Check $9.10 KAS 04/13/07 89780
Plan Check $609.54 KAS 04/13/07 89779
Total: $1,632.89
Directions to Site:
SEE MAP QUEST DIRECTIONS AND MAP
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OF: 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 ATTATCHED
•CONDITIONS for Building Permit# :BLD07-00155 •
1.) The application was reviewed by the Jefferson County Department of Community
Development for the presence of Environmentally Sensitive Areas (ESAs). The
Department conducted a review and has concluded that the property DOES NOT contain
Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA
review and conditions may be added if new ESAs are found on the property.
2.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
3.) The applicant is proposing to create or add 2847 square feet of impervious surface and
2847 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.
4.) 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.
5.) 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).
6.) The revised site plan as submitted on May 17, 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 June 8, 2007 shall be resubmitted for review and approval by Jefferson
County Department of Community Development.
7.) This approval is for an Accessory Dwelling Unit 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.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) 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.
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimum setbacks from Swansonville Rd and Reuben Johnson right-of-ways shall be 20
ft. Minimum side yard setbacks shall be 5 ft.
13.) 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.
14.) Lighting fixtures shall be designed hooded to prevent the light source frorreng
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.
15.) Swansonville Road (C51409) is a county local access. An address of 1770A
Swansonville Road has been assigned to the parcel.
16.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
17.) A building permit (BLD97-00771) for a pole building garage was finaled on January 12,
1998. A building permit (BLD04-00750) for a change of use from commercial software co.
to a church was withdrawn on December 29, 2004. A zoning permit (ZON04-00063) for a
change of use was withdrawn on December 29, 2004. A septic permit(SEP03-00168) for
an EES was reviewed on October 5, 2005. A building permit (BLD06-00294) for a pole
building garage was finaled on November 22, 2006. A septic permit(SEP07-00171) for a
tank only permit was issued on June 6, 2007.
18.) A minimum of four (4) parking spaces are required for the single family residence and
accessory dwelling unit(ADU).
Jefferson County Building D3fsion Permit Nu,: BLD07-00155
Applicant: TRUMBLE
BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 Sign re Notes
Setbacks
Erosion Control
Foundation Footing /45/0 LIFFEE2_ NOT 11Us-rA 4 D
Footing Drains ! v
Foundation Stem Wall 6'4047
Underground Plumbing N A
Under Floor Framing g 99/0 D,‹
Straps(hold downs) f/24/07
Ext. Shear Wall Nailing 941l151 d� /NCtGDES WALL- Igo CAR}1(.e
Rough-in Plumbing i /07 G4
Framing
/41/7 47617
Blocking
113�/a �r
Airseal J4/ai ,#
Insulation:Walls !��'
!l/6/v7
Insulation:Floors II/G
Insulation:Ceiling � 0/0
Int. Shear Wall Nailing 10940
Wallboard Nailing I//i9/a aG
Gas Line: Interior �lN//�
Gas Line: Exterior N/A
Propane Tank WA
Heat/Chimney Clearance
Drywell/Alt Drainage 00/68
a1.RTEfts, vou4-6POlICS1;Gl4?t-11-V'Te>72/►YL1GliT
Address Posted 4/I0/0
FINAL INSPECTION 00/68 Qg 40,- e/o t/to/o.0,
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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•UILDING PERMIT APPLICA N Il'lReview
viewType181
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00155 Received Date: 4/13/2007
SITE ADDRESS: 1770A SWANSONVILLE RD
PORT LUDLOW, 98365
OWNER: DONALD TRUMBLE PHONE: (360)437-5192
SANDRA M TRUMBLE
1770 SWANSONVILLE RD
PORT LUDLOW WA 98365-9779
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 821053005 Section: 5 Township: 28 N Range: 01 E
CONTRACTOR: REALITY HOMES INC PHONE: (253)926-6330
1308 ALEXANDER AVE E STE B
FIFE WA 98424
Contractor's License REALIH1984CN Expires 2/15/2008
REPRESENTATIVE: CHUCK MILLS PHONE: (253) 232-8715
509 VALLEY AVE NE #42
PUYALLUP WA 98372
PROJECT DESCRIPTIOP NEW ADU WITH ATTACHE[) GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,242
VALUATION 93,296.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: 5N GARAGE: 518 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
1\ 1 (4.GrTlC1)
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $937.75 KAS 04/13/07 89779 APPROVE'State Building Code $4.50 KAS 04/13/07 89779
Potable Water Application $58.00 KAS 04/13/07 89779 JUN /d 27
Permit $14.00 KAS 04/13/07 89780 JeffsrsonC T
Plan Check $9.10 KAS 04/13/07 89780 &building nty Planning
Plan Check $609.54 KAS 04/13/07 89779
•
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�4.1m c-- % JEFFERSOIJUNTY •
'ice3 DEPARTMENT OF COMMUNITY DEVELOPMENT
`- 621 Sheridan Street • Port Tow se W n o,�y� 6g
360/379 4450 • 360/379-4451 fax
gS, NG�O www.co.jefferson.wa.us/commdevelopment
Master Permit Application QpRQ7
MLA: p'-1 - 1l
Project Description(include separate sheets as necessary):i 1 `� ; f j p�i 1 j{i r
/j, 4' Avv w'T4 a�c1„.„, a. I. ',�ltJl]IE! 3l,Mi
Tax Parcel
Number: C L l C�is c Property _ ca
Size: :5 78 (acres/square feet)
Site Address and/or Directions to Property: //n
/ 17 /L 5 LC;rf(1) a-7 C%i V 'ti /j� f� j,/ Qi /'fi g/, ( U_` (LJ C L 7 :.;) ' .
Property Owner(s)of Record: I)F>N,6 I tl 1 s_ eh /i / c. or, (-,ice rt ,i iN.,.. co, rr t' ,. /L` -1 0'r ; i i I *,
Telephone: /,-: '
'r... 7f, j ;1/ y' ,z.. Fax: email:
Mailing Address:/ 7 7L ?r "�� it.4,; to �",�(, iE•'! 'i.-) ..7. / ,
Applicant/Agent(if different from owner): C'h t`c-ft /1"1, 7/S
Telephone: c),5 3-1 a- g ?/c-- Fax: C/)A S��
email: 70 111,544 <(:'_M
Mailing Address: 6C,7 VALL4-Ey A t, A C 1-/-- Po'Y/4 LL vI) 1•-r'4 /t_72 2-
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
0 Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
X.Single Family fk ).. %Garage Attache. Detached 0 Discretionary"D"or Unnamed Use Classification
O Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
0 Change of Use 0 Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
0 Home Business ❑ Cottagelndustry 0 Long Plat**
❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
0 Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication * 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*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:
/� , ! i DESIGNATION OF AGENT
I hereby designate �/I t (' to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE t 1 c- -7 y
e'll . 4/,'I ' 1 .- ,'_ Date: - /3 0 7
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 'iabilities,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 applica n that hee r she wants prior rote :
Signature L 1''-'-' /s t_ /� tote
,/ a;'f'"C'". / 3 c 7
.r•�-7 cr,—r—.rb �-�"� l�� k 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
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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: / ;
.ems - .'• ,/ l/4/ . -/ Date: / .3- c 7
G:\PermitCenter\###FORMS###\DAD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Rf , 1, Ii-- c)m 5 -,v (-)'-;3) 1 1 < ).1: ( )
MAILING ADDRESS: j 3 t t'l ri I e K ►icy t.P r +e g I":Fe lt,r _EMAIL:
CONTRACTOR'S LICENSE i 5y1 WAINS
1�
NUMBER: kJ(L k(�(? I {.14 i Lig'f C N NUMBER
ARCHITECT/ENGINEER: Lt "r.; PHONE O � -s) 9 �.,4i f UFAX: ( )
MAILING ADDRESS: /1 ,on r. Li7,,q 1y,zy EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: ". Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: „ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# rl;._i L 7 5
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ( Private well ❑ Two Party
Type of Heat: Proposed: [.0 Public
Total: Name of System:
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 Sery c,� ? es i +
II u
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 't • I. ' +
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove I Fireplace Insert i Hot Water Tank i Pellet Stove i Otf}le f�� 7
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 scptic,,system ongrlts,
including the reserve area. rtF"'\ f` ;nj h j i,
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH BId App Review:
i V:2 Slc77r—' 2 -cc
2nd Floor Heated Consistency Review: '
135. co
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: 19 12./„[.f,.
Unheated Basement State Surcharge fee: 4. 50
-Other Unheated Pot Water Review fee: G c7
Garage/Carport i 's'" SUBTOTAL
4ttt, 4,,:6' V . , „ Sib. Ito iA, 18. 01, %tcf3•1E361
I 911/Rd Approach fee:
Decks N•D[k. 15 0C;
Other TOTAL: $ t q D5.69
Receipt Number: 3 c fl CC i3 q g �D
Cash/Check Number: a3 64 5ciC �
ESTIMATED COST(REQUIRED) i (i5 t,,45e: } ` 7 L�� �Ja l D�✓
.Fair market value of all labor and materials found lion to finish 1 -' ' LA' j 5'L r ` ` ' 5! c
i nA, +-' - -
-Initials: C
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irilike , JEFFERSON COUNTY
, Ki DEPARTMENT OF COMMUNITY DEVELOPMENT APR 13NV
621 Sheridan Street• Port Townsend •Washington 98368 T::1\1:LI:\TI:
��t`�Ghttp:llwww.co.'efferrsonwa.s/ommdevelopment/ IIP 1STORMWATER SITE PLAN SUBMITTAL
MLA# 0'— ` " 1 PROJECT/APPLICANT NAME:
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 ' ~O
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map. SiO‘ rs
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Existing Conditions Summary let"2. Describe the existing topography. Indicate contours on the site map. J
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.tiAv'rf G/2A5ES RECEIVED
JUN - 62g07
4. Describe the existing soils. Indicate soil type on the site map.
. 54^'h/ LdA,si . JEFFERSON COUNTY HO
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 acti ity:
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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.).
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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.
SP/A 5 BLoCKZS J S`IGRM wATCR LA/ 13.e l=v Lc,y D1SPER Sit. .
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 dispersjep qf, sJ
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11. Describe the performance goals and standards applicable to the project.,U'f f i l �;1, I f C 1 i i(`I►
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12. DetjbeEthe flow control system.
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13. Describe the waterquality system.
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14. Describe the conveyance system analysis and design.
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. iR IHYE \V (1 I[ ))
18. Describe methods for restoration of the site. APR 13 2007
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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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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.
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2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils. , ' 1T; \�\J �� 1)
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6. Protect Slopes. i
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7. Protect Drain Inlets.
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stonnwater site plan template—rev.10/1/2003
8
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12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
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12. Manage the Project. / APR 1 3 1107
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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
9
40 S
b. Description of special requirements for working in or near environmentally sensitive areas.
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing. APR 1 3 Ztir17
a. Construction sequence ^///4--
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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.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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.
8. Engineering Calculations. Provide Design Calg ns 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 terrplate—rev.10/1/2003
•
• •
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 c;eltfy that this application is being made with the full knowledge and consent of all
owners of the affected property.
_ d'
(LANDOWNER O UTFIORIZ D REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
NPR 1. '3 2
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stormwater site plan template—rev.10/12003
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RECEIVED APR 21101
PERM
Jefferson County
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Environmental Health
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SITE PLAN
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IEFFERSON COUN�
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��.t//nal Stormwat r BMP'
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