HomeMy WebLinkAboutBLD2007-00164 UILDING PERMIT APPLICA MLA07-00191
TION Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00164 Received Date: 4/19/2007
SITE ADDRESS: 86 OLYMPIC GREENS DR
PORT HADLOCK, 98339
OWNER: OLYMPIC GREENS LLC PHONE: (805) 345-6700
650 EAST CLARK AVE
ORCUTT CA 93457
OLYMPIC GREENS
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 979900100 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: T L CONSTRUCTION PHONE: (360)763-3886
PO BOX 627
QUILCENE WA 98376
Contractor's License TLCON**036N9 Expires 8/5/2000
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW ATTACHED GARAGE TO GARAGE READY MFH
NO HEAT AND NO PLUMBING 1_. /, I ' I
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 25,000.00 MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 400 SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CMY
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
4 , a�1oJ
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $391.25 KAS 04/19/07 89791 APPRQJEc
Plan Check $254.32 KAS 04/19/07 89791
State Building Code $4.50 KAS 04/19/07 89791
Total: $650.07 JUN 5 2007
Jefferson County planning
& Building Department
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD07-00164 Received Date: 4/19/2007
SITE ADDRESS: 86 OLYMPIC GREENS DR Issue Date 6/5/2007
Expiration Date 6/5/2008
OWNER: OLYMPIC GREENS LLC PHONE: (805) 345-6700
650 EAST CLARK AVE
ORCUTT CA 93457
OLYMPIC GREENS
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 979900100 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: T L CONSTRUCTION PHONE: (360)763-3886
PO BOX 627
QUILCENE WA 98376
Contractor's License TLCON**036N9 Expires 9/8/2007
PROJECT DESCRIPTION: NEW ATTACHED GARAGE TO NEW MFH
NO HEAT AND NO PLUMBING (LOT 7)
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 25,000.00 MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: SHORELINE:
GARAGE: 400
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CMY
WATER SYSTEM: PUD Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $391.25 KAS 04/19/07 89791
Exist: 0 Exist: 0 Plan Check $254.32 KAS 04/19/07 89791
Prop: 0 Prop: 0 State Building Code $4.50 KAS 04/19/07 89791
Total. 0 Total: 0 Total: $650.07
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 OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE ATTATCHED
Jefferson CountyBuildingDiv lion Permit Numb BLD07-00164
Applicant: OLYMPIC GREENS LLC
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 " i
Erosion Control
Foundation Footing IV 1_(97 \Arli t,
Footing Drains
Foundation Stem Wall
Straps(hold downs)
Ext. Shear Wall Nailing 0/07 44---/
P6R iPu9R1
Framing ,/2/o , 1-e (Z:- 13 wAL-t5
Blocking
Drywell/Alt Drainage
Address Posted ''--��
�( AakSe
FINAL INSPECTION Odlor Q( car 43
110,'
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD07-00164
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on June 5, 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:
pacific lamprey; SARPA aquifer recharge area.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1) All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
5.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
6.) The applicant is proposing to create or add 3094 square feet of impervious surface and
8164 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.
7.) 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.
8.) 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.
9.) 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).
10.) The site plan as submitted with the building permit applications on April 13, 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 5, 2007 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
11.) This approval is for a manufactured home and 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.
12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
13.) Not more than 2 unlicensed vehic•hall be stored on any lot unless totally seed
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.
14.) 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.
15.) 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.
16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
17.) The building height is not to exceed 35 feet.
18.) Minimum setback from Olympic Greens Drive right-of-way shall be 20 feet. Minimum side
and rear yard setbacks shall be 5 feet.
19.) The lot has been designated as RR 1:5 under the Jefferson County Comprehensive Land
Use Map effective August 28, 1998.
20.) The lot was created through the Olympic Greens Retirement Community BSP on August
8, 1997 under AFN 402752 and is subject to plat conditions and CC & R's.
21.) An address of 86 Olympic Greens Drive, Port Hadlock has been assigned to the lot.
Olympic Greens Drive is a private road (P506).
22.) The lot is served by PUD#1 public water.
23.) The lot is served by PUD#1 public water.
¢SON cow JEFFERSON LINTY K' \,
`,k, t11.214 ,i
rt DEPARTMENT OF COMMUNITY DEVELOPMENT
` 621 Sheridan Street • Port Townsend • Washington 98368 A ,•..a At � r+rn`
360/379-4450 • 360/379-4451 Fax a c ,
NIShfING`SO www.co.jefferson.wa.us/commdevelopment
,.
jUfr.,;,;*1)1,1011( i
.Master Permit Application MLA: ...
Project Description (include separate sheets as necessary):
,� ik Le
Tax Parcel
�- 7�, , Property
C' �Number: Jc�, /o O Size: l r Y (acres/square feet)
Site Address and/or Directions to Property:
ii
Property Owner(s)of Record: OL YAI PJL Cez,ENs .,c t:.C.,
Telephone: o.? 13 7- bY i �/ Fax: 60'5 S'1.7.-Oi .23 email: CNi,-1\u t
Mailing Address: 6.5tt Cam.-jL L, , 6/Le-Lk-Lt.i Cdi 73 AY 7
Applicant/Agent(if different from owner):)(
Telephone: 8c 3)1,14 7 oo Fax:SOS `I377--o S Z 3 email:5c L c---5 Ck.lac.; '
Mailing Address: 4,56 ?., deter } -,.z- 0.,4.u.L- , C,4 9.3 157
What kind of Permit?(Check each box that applies
jil Building 0 Variance(Minor, Major or Reasonable Economic Use)
0 Demolition Permit ( d.� 0 Conditional Use[C(a), C(d),or Cl**
❑ Single Family Garage Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address 0 Road Approach ❑ Binding Site Plan**
0 Home Business 0 Cottagelndustry 0 Long Plat**
0 Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
0 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
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑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:
AA ` DESIGNATION OF AGENT
I hereby desig�J4i ,at_ K. e,j to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATUR R
Date: I/1 7-0 7
By signir> this applic tion fo he owner/ ent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's-knowtet e. Any material- sehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permitl5eing null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provid and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and ny re. ired later ins ections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of j.anii catio 'that,he or he wants prior notice.
Sig.. 're: . /Date: /- 7-6 7
ir
T action ordir • s Appli . t will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endr"'TTr Olite .- - • 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 bee . ill not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s) you are n compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and -Ira e4esponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Si(7, ?,,v6„......0.jse
t e: Date: 17-/ 7-o 7
G:\PennitCenter\###FORMS###\DRD 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 ass re onsibility of the General Contractor for the proposed project.
Signature: / Date: `Y
GENERAL RfOR MANUFACTURED HOME INSTALLER: PHONE: FAx:
T/M L.CU(` CC) s1i2t./C'T76'NI _ ' ,
MAILING ADDRESS: -'„, ;k ?Kx- (l_; L EMAIL:
CONTRACTORS LICENSE C)« rY2K ,.�-TT (-{'+, `I I!- )`' ;"•, WAINS `�'t •
NUMBER: r. ,�7(•, NUMBER , fl . . .h, Al 4 i � U UtJ
ARCHITECT/ENGINEER: PHONE (, ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
I$-, New tit. Wood Existing: 0 Sewer
❑ Addition LI Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: (/ Height: ❑ Individual System
O Repair ❑ Masonry 7 _LL4 SEP Permit#
O Demolition ❑ Other: Bedrooms: ( Water Supply:
Existing: Setback: ❑ Private well [1 Two Party
Type of Heat: Proposed: [] Public
Total: i 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 Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
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 Other
Is this appliance being installed in a Manufactured I Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: _
Floor Heated Consistency Review:
Other Heated Base fee: 6i� a
r
Mezzanine Additional Section:
Heated Basement Plan Check fee: i
�5,{. a
Unheated Basement State Surcharge fee: Q �r,
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL ,�
• 1��' CI112S.5,T - (5C . o
Decks 1 911/Rd Approach fee: —_____
Other T TAL: $ ( 5C); G'7
Receipt Number: s G I
- Cash/Check Number: t
ESTIMATED-COS7lREQUIRED)� ) Date: ' L l 1
t(I'0 rJ
.cair-market value of all labord materials foundation to finish
._
` , ono: Initials:
G:\PcrmitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
1 • .
�. ON ° , JEFFERSON COUNTY RECEiv. COMMUNITY DEVELOPMENT DEPARTMENT OF p t�
0 � 621 Sheridan Street • Port Townsend • Washington 98368 /P C 1 0 20,17
IU 360/379-4450 •• 360/379-4451 Fax
(WHIZ 101118110
"bilNa' http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLAT
MLA# lJ - l q 1
PROJECT/APPLICANT NAME: .-C,!/1
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contour onthejt� ' �C.1c-_-
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3. Describe the existing vegetation. Indicate nati a vegetation n the site map. tc n-Gi-
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4. Describe xisting soils. ndicate soil eon the
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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
plicable,and indi ate acreage of each.
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6. Descrfe any excess levels of noise generated by the proposed use or . tivi : IP
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7. Describe significant geographic features and critical areas (i environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.) n the site. Indicate loc io on the site 0I.{j('�f��, f
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas
st�(-<.)- r�s,wetlands,lakes, eep 9lopesr,1-I'/Jd-, -1 ✓-1
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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. L ate these facilities on the site p n a d differe tiate propo ed facilities from e istin facilitie .
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10. f the project requir the use o tormwater 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 p ojects that involve the potential for dispe ion of contaminants.]
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11. Describe the performance goals and standards appi able to the project. Q�� 1
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12. Describ� the j )
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BM 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. M rk CleAg Limits. rI 6.}1.1(4C,
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2. lish oust ion Acce .
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4. Install Sediment Cont o s. / 7 �
5. Stabilize Soils. _ •
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6. otect pes.
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7. Pr ect Drainl)nlet ,y)J-t'6
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stormwater site plan template—rev.10/1/2003
8
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13. Describe the water quality syste . i
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- 14. ribe the cony yance s stem m analysis and design.
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15. D scribe p source of fill aterial,ph sisal chaaracteri tics of fill matey' I,and deposition of excel material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material. —/, e
18. Describe metho 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 ny special reports pr tudi s conducted to prepare the St water Si Plan.
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21. Lis 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. V V,-(I
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stormwater site plan tenplate—rev.10/1/2003 7
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12 Required Elements-Construction SWPPP(continued) C I( ( (�
8. S abilize Channels and Outlets. /� I 1 11U�`1t1�� ��I�l�f'
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9. Control Pollutants /,
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1 . Control De-Watering(the act of pumping gro 'dwatgr,or stormwater away fr m an ac ive constriction siter1 '
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Best anagemeent Practices(BMPs).
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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
s, roads). ,
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b. Description of the downstream drainage path leading from the site to the receiving body off water(minimum distance of 400
3. Environmentally Sensitive Areas.
>24_a. Description of envir nmentally sensitive real that are on or adjacent the s'e. - f�
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stomiwater site plan template—rev.10/1/2003
9
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b Description f special re uirements for orkin in or near environm nta y set Rive eas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soills(e.g.,erodibility,settleability,permeability,depth,texture soil structure). �Z� /
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5. Construction Phasing.
a. C�on`struc�seq�-`�C c��, r w6:a, _ li ,Vnl..�r-�r-ems6
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b. Construction phas ng(if roposed
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6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Pro idea proposed construc'on schedule
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II. Wet Se-son Con truction Activities.
a. Proposed wet season construction activities.
RECEIVED
b. Proposed wet season construction activities for environmentally sensitive areas.
,; 1 x. r, L., •i
7. Financial/Ownershlp Responsibilities. (tf ftUNO K(r('(titt l V OD
a. Identify the prope /o er re,•a nsible for the i•itiation of bonds and/q� • her financi•I securi s. �-
?1 / "A • 0 f - ,a_,.._ �� T r L6. -
/ ,I .
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))1.P A b.. Describe bonds and/or other evidence of financial respo 4bility for liability associated with erosion and sedimentation
impacts.
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 Calcu Lions
stormwater site plan template-rev.10/1/2003 10
• •
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct tot t-e my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owner o the affected p •petty.
7
( t •'• AUT (DATE)
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THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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