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BLD2007-00324
TytILDING PERMIT APPLICAT•N ML ReviewTy 342 pe:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00324 Received Date: 6/18/2007 SITE ADDRESS: 1035 CARL JOHNSON RD QUILCENE, 98376 OWNER: DONALD P NEWLAND PHONE: (425) 754-0700 ROBYN L JOHNSON 20A FAIRWAY LN PORT LUDLOW WA 98365-9553 SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 701043001 Section: 4 Township: 27 N Range: 01 W CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/15/2009 REPRESENTATIVE: TAMARA HALLIGAN PHONE: (360) 385-2628 PO BOX 862 PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOP NEW SFR (420 SQ FT OF OPEN STORAGE IN UNFINISHED BASEMENT) ALSO A/G 250 PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,269 VALUATION 169,855.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: 715 #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 420 SHORELINE: CONST TYPE: DECKLE 257 SETBACK: 236 BANK HEIGHT: 10 SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 1 Prop: 2 Total: 1 Total: 2 Routing Date: fir, li sit 76-„ Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,385.75 KAS 06/18/07 91317 APPR 0 ,I E D Plan Check $900.74 KAS 06/18/07 91317 r State Building Code $4.50 KAS 06/18/07 91317 AUC 1k-f . ,7 Potable Water Application $58.00 KAS 06/18/07 91317 Jefferson .._. Total: $2,348.99 &Btlildirtfl ?'. f.dfl[lleg � C,ment Jefferson County Building Dion Permit Nur BLD07-00324 Applicant: NEWLAND 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 Erosion Control Foundation Footing LiFra /vlIANd xo Footing Drains Og Foundation Stem Wall �/ Underground Plumbing Under Floor Framing Straps(hold downs) 3/i2/or id— Ext. Shear Wall Nailing 0_,,, '. -" Rough-in Plumbing Framing 3/2/oE D� Blocking 3/2/i Airseal 3/1z/ag-- At- Insulation:Walls 6Insulation: Floors y.023 /of s�f'7/f-'rc:po'fr Insulation: Ceiling 3//5,48 apz.s pj_ 3/R08/ Int. Shear Wall Nailing 3/2_0e ny a` Wallboard Nailing 3/2b/09 Ali Gas Line: Interior 3/ /00 afi le ttf Zwer,ic ji'"41/ /, Gas Line: Exterior Q/ Tj 9/s107 I OK Propane Tank 3//L/OF Ql� Heat/Chimney Clearance 3/fig/off - Drywell/Alt Drainage �" k int Ok 4k1o7 Address Posted /�i!-.�Il2�op^ �ii// t FINAL INSPECTION g/t ht3 ns._ FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR i • CONDITIONS for Building Permit# :BLD07-00324 1.) ANY PORTION OF TRANSPORT LINE UNDER A DRIVEN WAY IS TO BE SLEEVED/CASED OR EQUIVALENT. 2.) A SIGNED COPY OF THE "HYDROGEOLOGIC IMPACT OPINION" PREPARED BY BENDER CONSULTING LLC SHALL BE SUBMITTED TO DEVELOPMENT REVIEW DIVISION PRIOR TO FINAL BUILDING INSPECTION. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on July 16, 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: Conservancy Shoreline Designation, Category III Wetland, Susceptible Aquifer Recharge Area and High Risk Seawater Intrusion Protection Zones (SIPZ). 4.) A Wetland Assessment dated October 2, 2000 prepared by Rupert P Schmitt, biologist was submitted to address the on site wetland. A site visit was conducted with development staff and agreed there is a Category III Wetland on site. As the wetland spans over onto the adjacent property, staff was not able to determine if the wetland is less than 10,000 SF in size. 5.) An Aquifer Recharge Area Report dated October 27, 2003 prepared by Bender Consulting LLC was submitted to address the High Risk Seawater Intrusion Protection Zone. An updated Hydrogeologic Impact Opinion prepared by Bender Consulting LLC was submitted to the department on August 3, 2007. A follow-up e-mail from Scott Bender was received August 8, 2007, which proposed monitoring program for water quality. 6.) 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. 7.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 8.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 9.) Wetland Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 10.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea sitchensis), Shore Pine (Pinus contorta), Douglas Fir(Pseudotsuga menziesii), Western Red Cedar (Thuja plicata), and Western Hemlock (Tsuga heterophylla). Among native tree species which may be used includes: Vine Maple (Acer circinatum), Big-Leaf Maple (Acer macrophyllum), Red Alder(Alnus rubra), Pacific Madrone (Arbutus menziesii), Quaking Aspen (Populus tremula), Black Cottonwood (Populus trichocarpa), Bitter Cherry (Prunus emarginata), Oregon White Oak (Quercus garryana), Cascara (Rhamnus purshiana), Pacific Willow (Salix lasiandra), and Scouler's Willow (Salix scouleriana). Among the native shrub species which may be used are: Sevice-Berry (Amalanchier alnifolia), Red Osier Dogwood (Cornus stolonifera) Salal (Gaultheria shallon), Ocean Spray (Holodiscus discolor), Indian Plum (Oemlaria cerasiformis), Pacific Ninebark (Physocarpus capitus), Red Flowering Currant (Ribes sanguineum), Wild Rose (Rosa nutkana), Swamp Rose (Rosa pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry (Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium). 11.) Marine shorelines and islands susceptible to a condition that is known asitiwater 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. 12.) 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). 13.) A setback of 50-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 14.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 15.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 16.) 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. 17.) 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. 18.) 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. 19.) MANDATORY MEASURES FOH 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. 20.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 21.) A flow meter shall be installed prior to final sign off of the building permit. j, 22.) On-going well monitoring for chloride concentration is required. The property owner shall perform quarterly sampling for chlorides using standard methodology. The meter records and water quality results shall be submitted to Jefferson County Development Review Division and Jefferson County Environmental Health on a quarterly basis. 23.) If the chloride concentration rises above 200 mg/I for two (2) consecutive quarters then the subject well shall be filled with a grout slurry or other product approved by Department of Ecology for wells near sea water boundaries. 24.) If the concentration rises above 200mg/I, and then falls off in the following sample, then the monitoring program will be extended for a yea until use and weather patterns can be determined. 25.) 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. 26.) The applicant is proposing to create or add 1850 square feet of impervious surface and 4000 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology 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. 27.) 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. 28.) 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). 29.) The site plan as submitted with the building permit application on June 18, 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 August 14, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 30.) This approval is for a single family residence 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. 31.) The parcel has beenLand designatedUseMapa ect uraliveAugust Residential28 1:5 under the Jefferson"linty , 1998. 32.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 33.) 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. 34.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 35.) The building height is not to exceed 35 feet. 36.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 37.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 38.) 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. 39.) 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. 40.) The proposed development is located greater than 200 feet from Ordinary High Water Mark and thus is not required to maintain the shoreline setbacks identified in the Shoreline Management Master Program. 41.) Minimum setback from the edge of Carl Johnson Rd right-of-way shall be 20 ft. Minimum side and rear setbacks are 5 ft. Environmentally Sensitive Areas further impacr setbacks. 42.) All stormwater shall be infiltrated entirely onsite. All stormwater discharge shall be routed away from the shoreline buffer area. In addition, the water shall not be discharged over the bluff. If stormwater is unable to be infiltrated onsite, a separate shoreline permit is required prior to tightlining stormwater to the beach. 43.) Carl Johnson Rd (C347509) is a county local access road. A road approach was reviewed under RAP00-00098, and an address of 1352 Carl Johnson Rd has been assigned to the parcel. 44.) A septic permit (SEP93-00280) was finaled on October 24, 2003 for a 3 bedroom system. SON 0o�� JEFFERSON OUNTYtR1IFV'if411��DEPARTMENT OF COMMUNITY DEVELOPMENT S `-C 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax J,, ;y 2t,); �S, O$ www.co.jefferson.wa.us/commdevelopment MLA:) ff Master Permit Application [[ - If Project Description(include separate sheets as necessary): ` eal NC3'"L.0 Pj'Vt t L' i ay(sce Tax Parcel 7vt ..-043 Goff 6t.t,tLD;nj6, Property j Number: •701 .—04 3 _ice, t7 10 ptt-�i� ( tct' Size: I.23 ss.,1 53 56 I SF.. (acres/square feet) Site Address and/or Directions to Property: i v 35 OWL"-Tbii NI Q'cf\-C cu i,t►L e{ u.).& 18 37t7 Property Owner(s)of Record: :� 11 ;t As' () , .4S,f ti `y`y . i.+— Telephone: 42.5 754 —O7oG Fax: ou /y- email: C�i,i_ ( .net- Mailing Address: ZOfic 'FAA V.. iA W LANt3 1T 1-I,.t17ll,w cc;R if-3 .6c. `1' Applicant/Agent(if different from owner): 1►i4 14Pr1.4,1 :YPc J; 4 f t j r Telephone: EO,. 91/&/2-- 7Z 5ja'Y l� Fax: r-- y'{email: � �IIGc�1�a:GrI�dLlptjS,{/E� Mailing Address: "I` I J 1 What kind of Permit? (Check each box that applies )anuilding 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** I2 Single Family ❑ Garage Attached/Detached El Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular El Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use El Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry El Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** El Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management El Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance El Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment El Wireless Telecommunication * ❑ 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: DESIGNATION OF AGENT I hereby designate i t- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE , , 1 Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to prov ccess and 'ght of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any t uired la r inspecti s. Staffs and right of entry will be assumed unless the applicant informs the County in writing at the time of the applipati h e or she w nts pr r notice. Signature: 1 Date: {n1 '; j '7�QQ S-- 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 violat the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even f you I compliant with the Jeffe n County development code.The Applicant acknowledges that he,she or it holds individual and non-transf r, le ns iibil for dhering o and c ' with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 7 �, \ _v • Date:3\At G tg zc,0. - 1 G:\PermitCenter\###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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: i a(..u,;F9. o M tLDt S, IN c , (;�O ) 7l /-ioto (3w ) 732-4 1 MAILING ADDRESS: P.c. 69( too q+llilAtuxv(.t�l ft4 S EMAIL: '�vl‘e(5„A COo i wip&S. %lejj- CONTRACTORS LICENSE / WAINS NUMBER: 'T()l.i.. . & 'S '77 N 9' NUMBER ARCHITECT/ENGINEER: TAO AVA. l-tlklLio&.J PHONE (:3i;CI )3bc 426 FAX: ( ) MAILING ADDRESS: 'r ecs, sahZ Pca:T ---owistehia th:A / Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: yf New ,d Wood Existing: I l Sewer ❑ Addition ❑ Steel Proposed: Bank I l Community System ❑ Alteration/Remodel ❑ Concrete Total: (I.5 Height: / A Individual System ❑ Repair ❑ Masonry IC-i2. SEP Permit# r. ,j-2 ii:C' ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: )tQ Private well ❑ Two Party Type of Heat: Proposed: 2 / 11 Public Vet-7Q e Total: 1.0 7 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 andlor Appliance Installation permit,mark all items below that apply: i Underground Tank ✓Above ground Tank Size of Propane Tank: 250 i Heat Stove $Cook Stove i Woodstove ireplace Insert i Hot Water Tank i Pellet Stove i Other CF Is this appliance being installed in a Manufactured/Mobile Home? Yes / No' When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated 124 S� EH Bld App Review: 2n°Floor Heated �� R o sib •, R view: Other Heated Base fee: S- . ,1 q A.. Mezzanine ,.' ._ .a. Additional Section: _______ Heated BasementIiiPt 1 :: 07 q Do. '"/`7^ Unheated Basement �at rf,lttate Surcharge fee: 7i5 I `f `t' 4-5�; Other Unheated Pot Water Review fee: Garage/Carport qA SUBTOTAL LOLI I 9 Decks (- 911/Rd Approach fee: '7-57 W G 51 F El )- ( rl Other tq, OTAL: $ e t L,.-t i 17 Receipt Number: (I 01 7 i Cash/Check Number: a ESTIMATED COST(REQUIRED) 10L1 Q'_(, /Date: p .Fair market value of all labor and m a s founds ion to f tiisb-` j/J o U7 'S Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc F / • . sON c° JEFFERSON COUNTYR & EFU1J a' DEPART �t MENT OF COMMUNITY DEVELOPMENT U p �. n,�n ,_.,� , . 621 Sheridan Street • Port Townsend •Washington 98368O 360/379-4450 N. 360/379-4451 Fax Nq http://www.co.jefferson.wa.us/commdevelopment/ ,��� ��������III��' '�I�I' STORMWATER SITE PLAN SUBMITTAL TEMPLATE IMLA# 6 ^L J 4 D PROJECT/APPLICANT NAME: REfite_KI,Eilot.A.41,30# 0.0119.16/1/4) )HA:6/9 iji 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 is 4eirvsiii Obi 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. Gaass-W.14 'Pr 2 S'T 120 sF MIni P n._ SttuCte fltrf.t 4 ' I PPr C) 0I.) R i' .2 3 AcIa ► Lo t ri4 eric tsrt tJ 6 Dle-to St'M le- PA vri woof?.e0 UK) ii , .. S��TIt S Ce P 6 Y% ► uNn era- c6 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. Sire $LQ Des Pitzlot W j .oftro TAt2.. r SHD12eu f P, 14 I-P 41-0) i' p_' A 3W ti1b49-wt�t-er- IA ehs-r- - 01 f i is AP?ito,,G 1 ' Iry i o 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. mil., e-Sc-' 1S P7,eeoM l i sc.ri' V EGA w tiw '0 3 4 P I & H twclL AtT ► .11n12TW Iv. 1 i L' t"JEs - 4. Describe the existing soils. Indicate soil type on the site map. L•t&wr iiii r.3 GtS VI i;7W. VEL. ik) POC,1=wry,- 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. 6K5 MtCr (AS(wr� TEtZ lot i°1 1 e. S t m { .S ro NO le 4 IC e•Lis r1 iu�l iAi K 5 Hre:%, 1001 ' 3k I w 4 DA/voat. T -t�— t� +uNc-rt,cr) I,0 ptiA-FrAui D n `) oNT 6. Describe any excess levels of noiseI Ai PRO Y j, ^, generated by the proposed use or activity: STORMWATER PLAN AUG 1 4 2UO7 Derr OF JEFFCERSONUN COUNTY NtY kMM VF.IA stormwater site plan template—rev.10/1/2003 SIGYATURE: �7 '�5 - A 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. -weal lc A SriIn-t.l, 17` .26' VEU r akes Wet uPsNO b j - tt, Imo/ Moan 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.). _lte S t T L c Ckiel, aD 1kr si -' (2 c*D U 1Tb- N l& nN, IteS1 Cei'V it ht. 9nut,C or-) F1 I�t QX 4 Wer Th �p il �j -Nit�6 ems'[- A DN Q. t.acri o Tb Sour 64 . i 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 theee plan and differentiate proposed facilities from existing facilities. AU,' S1IMr i Li‘,i -sere- 14nu_ 4 MLu t D1S sto c is k I.23 Ac-wes Silt. of, cApt,'NcA- 'tarPL viststit<16 t PeZt1 At ostks SU e WILL 6e Po.l9 yd tikt, c�,srut are, "11) e 10 T rnism ezix 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.] 1 01-o?o 10 �tn. tOeceN M1%tr Ji' �Aca uTt es P* i l' t try 11. Describe the performance goals and standards applicable to the project. t t9T'3 1MT r I -10 Illififr The 5t`1S h, USTLE ft5 cbSS► ,- .►Pare 'The PC - D "et.cDer 9 rt.w a it= tM i 1'!ke iSr►ro h Get.)OL TIr-rv-S 11. LU,esc"ribe the flow control system.- S AAR 9 1.�Yb1- 'Pl.&n0. 1 sit N 6 � -to l "7 1 t r\j`r, FULL r)1 S fr*l 5 Leyv.. . i. ,-„,‘ ,...Amt , + I v,,,,ai Li t!,,1 i a Ng QUA YI;#.1A).) VtV::+.Fl 46 1A, rrlt.'Vtt.t►v:Eti �.[t�•. :-t,:.=,C)�. ;‘, T't.-1Ct 1 ��.�����.. J • • 13. Describe the water quality system. 6tsnt tiV L Ptosw 't,Tt L17,p eMST1 r Jc G,,It Sc S 1, , uxt'ftGt} 1S Pu N--.k1A)Q1 i0-b P11Ai'cti h �;A t- .t tos toe.)ft/ w sTrLot, t►S L„,t LV v ()l 1 11.E ?. 0 n? QLt Dam.) (`HLL avvrs--- Pt, V 1arc t*S wyt., ttctk-Se 51'T 14. Describe the conveyance system analysis and design. . P11., Gt:w1v 5P13wcs +Poo l t+Q. p rvS $j, Ou, d o lsr1 r•s. 6064, 5m -L8 M 50u;V Pitabf 1.1,�s. W tca fi 1-toLOs A i.) rPv,� bts ' -se— twits cir(o P ows 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. PILL vivrei24 At cat n4 -of t 3 e<i +vr Q WiD;)— Sr c.UST t r3 C C.ux v►'j,k-41e44t. R4 u nroA-n.A-K3 wt l.,�.. -f 99 6124 v-ew 3�, 1)t I r .s L`r' 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 4vt, 5V o/P #UEL) DO V wt(:4> r7a 4 4 vh w S tuot e w t 1v} 12 oLLe1g 1' 'e 4" s io Cawa -ec. tAnt- w Sty Psi c a1p>j 17. Describe the proposed surfacing material. aM,I ©ram 400 sr. PW114. € S P lotT oP d to c_R tI 4.1b1. w t 6114)01S e-pi t),(4sripJ-10 Scat L, 18. Describe methods for restoration of the site. -c-ems' PEW—, •Tiki5 Ito u-SB tiQUeLoVB sal Si 1 w 1LL /.3oT- ' r7tStUR.6e P ,ts>V MVb S w�f�n k��N6 frn. S Aa Pc c.E;r.5 4 GeryzAlu .,1-ticr.) SC$b� k, 11( - 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. RECEIVRif 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plart'.U4 6 7 20 AFFHVIEOONIY t1 .i, 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. 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. Mt G,I ttst IS 1l .G 2. Establish Construction Access. �tSTI h)1. Del VGn FY/0-• C •1. I m s 3. Control Flow Rates. }Le5 SILT - c e (AL PIt t -f, f � N 1J d h ow$ ISf, pU 3v 3 . 4. Install Sediment Controls. 5. Stabilize Soils. 5Tll �? Nett_ P tSTWY-� h er 6. Protect Slopes. 54-T S LOVES 6 �l 1 T Na c� P St-of es Oa au told. 7. Protect Drain Inlets. 4 ►J tet5 Z vi. PIC�;�7A� ►•` i P11051-rt .RECEINE1 i� ,„„7 „R! . it stormwater site plan template-rev.10/1/2003 AFFEMR 41� �1 \ �� 8 • • 12 Required Elements-Construction SWPPP(continued) iRJ ( i' 1 ATM' f� 8. Stabilize Channels and Outlets. j 6 zopt• 9. Control Pollutants. IEFfn .u4n1 l ? t J13 rb i s o Ors 611- a t ite Mt to t V 4AM.— eP- , 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). CO-MS `T o f g Nth p - P r.9 41.4, f wmiptj, (AI+Ltr3tP) VJ LL Pst �1 L'S$Q,t 11. Maintain Best Management Practices(BMPs). Slke7 e- Cxa12- t/10 tLL C45, 11317uU j 0,.f St 4141\9*6 DItief4r I L Li&o 1,0 b c (304-tom 0--c*1 $Pet>0 L1 M t C;-► tizAlitt .tom tot-t xt.6g moo. oe, my o 17€3 tsu. -no,a% , 12. Manage the Project. pp E'=i .kt . Ct i7'1, It Q1L_. C��t% e (..al Ll �$ 1 ere 36' vw0-1 Ps1-3-- c J /Aibr ..(, ' o r'{M 1�3 AiA S 'h s `DL, 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). �Q► e (3`Pitc - AU. t(ti,LL C lJ O t eNrc V-4'1 LL 13.1. 1 itiL6 teefJ 1 NLut t bib 31( tL DELL i )$.n-ram PO01\+ Jtf So t W_. 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 environmentallyrsensitive areas that are on or adjacent to the site. 5 11401 ..L l -� X'2-61 Pet. I NexikIke N Gt Pittsizin Ht.() sty AS Sbto,.-) b-1,1 Si V VL J • stormwater site plan template—rev.10/1/2003 9 S • b. Description of special requirements for working in or near environmentally sensitive areas. OA' 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, ermeability,depth,texture,soil structure). Felt 5. Construction Phasing. a. Construction sequence LTu �L 1t-ot,�A3 M i McU. 2-Mg- RAMAN 4 V--o-O� GaMttei- a*z- ?9- 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 co struction schedule. Si-m P -• - :, .?-eo7 - F 1 �' i` U t h- A,u..&T • 'fi t ittc tt to .gr/setcE , .2 .7-- II. Wet Season Construction Activities. a. Proposed wet season construction ctivities. 1� -i2tct>et rvAS , b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. 'den the property o ner responsible for the initiation of bonds and/or other financial securities. EL. © b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. �*C.. aeSfiflQ5 Irgl L i rt 8. Engineering Calculations. Provide Design Calculations on a h ¢separate s ee f r(t laq gl l �Il ble. , a. Sediment Ponds/Traps. p \.t , \fit 'f b. Diversions. c. Waterways. {a d. Runoff/Stormwater Detention Calculations w 't� AROVAIInil ,o stormwater site plan template—rev.10/12003 S • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan,a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map / b. Jefferson County Approval Block / c. Erosion and Sediment Control Notes ✓ 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. r cEIVF4 e. Provide typical'details of gravel cone and standpipe, and/or other filtering devicesR )i f. Detail stabilization techniques for outlet/inlet. g. Detail controVrestrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams asrequired. k. Provide front and side sections of typical rock check clams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. storrnwater site plan template—rev.10/12003 11 • ! N. 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 • the best of knowledge. I also certify that this application is being made with the full knowledge and consent of all owners loaffected perty. _ , . c L2`�3-- (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: RECEIVIE1I) FAC jjii id 2007 IE fkiilUraUUN1VuCP stormwater site plan template—rev.10/1/2003 12 z N = O O O O A CA v, _. w N = Oiz, 0 0 0 0 Kr N a D D a A D D o rn r' 6 _ 1 ,� N N N N N r rn z Z z G C� U1 r a y o 1 -1 ��T1T11 1 -1 rn rn r r r p Z D y \ rn 5 -C V1 ~ Ill itl i(7 Z S i9 70 7J 70 -i y G G G y N Z7 1 Z Z Z � Z1 Z O 0 0 0 S 71 T 4 a Q Q Q Q Q rn Z 1 Z 1 Z1 12 -< 3 -u , En En% z •X -a v v X 70 A xO x 73 Q r11 RI x rn .- -1 rn �-f11 7J Z Z 1 Z Z jll � y C 1 7 S) 7 A �1 A rn rrnx,Tl X D N N N v N " N Z I C in _ c O N G 1 1 in Nc. 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A to to o — 7 g y 1 X g=d r. g ' N �CTn.! 11 =a I g 1 1' \ li 4'�" 11 K - II 5-0"x 5-0 I/r 4 ^it id I r--.I RI'. i°a -� R a a i I. R� 0Y-d' � I tri Y z 4�. S-d'x 5-0 14" \ I RO. ter, 5-d' , A'-1' 5-0' 1-5' a rig it-'• ro• • 15 Y la- +-a' r �--0- W' NEW RESIDENCE 1=OR ,ITF_GT SA" �'�-o7 = = I PETER NEWLAND & Pau. WA --7-07 MAIN FLOOR PLAN & a! SCHEDULES A = ROF,YN J01-1NSON �368 a 940985142 5 4-0-07 PERMIT t . , 3 Nc„a „v R o >c-'c) a=� 2 Oo �viz�a - �` zzZ s111 'motoN 2 Q o• `.o �7 a <N 2a> > > o o 2 N 0 S..N a 'N O a N O 9 j C 8--s 2 O Z7 E N V -•S-w ITl N l m v N o`< 2 2 0= f Ec0o o 0 3 z� m mzgo . -a"' am=� a— 2gm o zOo .3 .�.nc�i� - - - -, -.v • cm o ado `;o o*'za -..i zvco Tn g 0 o c)0 o 0 0 3 o No 3 0 = z O 6 E 5�a -y o N m n�a =..y«a 2 5 • a <a 5 N 2 D- ri a*2'� d 2 . a a -a ,0 ,-..n m 3_ 0 N 2 a z 2 0 j a 0 rt '-'3 OC 2 2 a to -d a `G _ 2 .. a N p a C a 4 �a l 2 • N 9 o U z d z d d r 3-d I3'—d' rn 9-I" I o , 14 L z i 11 . 4-4 W �� W Z-D"/Z-O"/ 5-0' / ZN -is C7 M 0a 13/::)" ‘L' I :A N \ % a y yle0 ''A Z: El 4 RaSI1 OPEN jj`` / u i I,-4. 5-1 , 4'-O I — I 3 N 'N J 0 g / 15'y' Ids! , 4-1 r / �d� Comm. MH____A / T U C .a Z n a TAMARA HALLISAN 5-2 —07 NEW RESIDENCE FORT PETER NEWLAND & PO EOX 862- No, WA ' 5 O7 LOWER FLOOR PLAN n Cal ROI5YN JOHNSON ce 360.38526215 /-j -07 PERMIT 6 0 in ' 0, �SMNT EXISTING EFFLUENT LINE pl I wnp I PAM I EXISTING G ELE T LINE PROf'0'3f-D 250 GALLON L.P.0 . TANK EXISTING 5' X 2' WELt H W ELE4 METER PROPOID SINGLE FAMILY RESIDENCE EXISTING SEPTIC TANK W/ GRAVITY PUMP Stormwater BMP's Required SITE PLAN AUG 14 2007 JEFFERSON COUNTY DEFT. OF O,[1 UNITY D EUJF SIGNATURE: v 00VT LOT 2 701-043-00( APPROX. TO TOP OF HANK APPROX. HIGH WATER MARK r :r. 100' SETBACK TO 5EPTIC DRAINFIELDS -� � oWNE�s I \ PETER NEWLANP RO)YN JOHNSON z V 2OA FAIRWAY LN. PORT I LUDLOW 983/v5 n ,p� �FXISTAJ6 GRAVEL DRNEN/AY / vN ON PHONE w (425) 25�-4455 I 57GRARNATER _ =� ��` LEGAL PE�GR PT I ON n� z 1 AO-e THAT PORTION OF THE SOUTH 100 FEET OF .'. `.".I GOVERNMENT LOT 1, 5ECTION 4, TOWNSHIP 27 NORTH, RANGE I WEST, W.M. LYING EA5T OF ` THE COUNTY ROAD RIGHT OF WAY PER REAL z°° sr d ' r%a WETLAND ASSESSMENT ESTATE CONTRACT UNDER AUDITOR'S FILE NO. YEAR of woo'Z 3 47 RECORDS OF JEFFER50N COUNTY, LD L WASHINGTON. 5 — TAX PARCEL NUMBER � s 701 — 043 — 001 BUILDING SITE c� I� denim 701 — o4-5 — OZO DRAINFIELD 1 :" - � PASTLrzF/6RA% I � n_ _ EXISTING GREEN110U`�E � �50ARE FOOT AGES z LOT AREA = 55,300 + %UILDING = 12(o) 6q. FT. HEATED MAIN FLOOR UNHEATEP PR"'` I bs- ' = A20 OTHER UNH ENT TEP � EXISTING CA6IN DECKS = 257 Y 5, X 2' 701 04 00 &OVT LOOT od-d' 701-0�3 -003 WOOPEP �5 1 TE PLAN Id MONK 4d-d' 5 W-d' O" — J" = V — O" 56ALE N z zoo W LLj� O W LD Cn O I Q LU CILU O.. � Q o � w w � � 4 O ULT z� O� W WOz WzLLJ F— LLj z�Cx z A-2 of la