HomeMy WebLinkAboutBLD2007-00475 MLA07-00493
UILDING PERMIT APPLICAON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00475 Received Date: 8/28/2007
SITE ADDRESS: 3O S BEACH DR
OWNER: WAYNE A PECK PHONE: 360-437-9117
SHIRLEY A PECK
281 S BEACH DR
PORT LUDLOW WA 983659523 TRAILS END 1ST ADDITION
SUBDIVISION: Block: 10 Lot: 6-7
PARCEL NUMBER: 950101005 Section: 16 Township: 27 N Range: 01 E
CONTRACTOR: SOUND BUILDING SYSTEMS PHONE: (360)437-1219
3546 THORNDYKE RD
PORT LUDLOW WA 98365-8229
Contractor's License SOUNDBS027NM Expires 8/19/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW POLE BLDG/CARPORT - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 19,320.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: GARAGE: 1,200 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Rouu'`tiing Date:
Type Amoun v: Date: Receipt: Approved/Date
Permit $321.25 LYK 08/28/07 93030 APPROVED
Plan Check $208.81 LYK 08/28/07 93030
State Building Code $4.50 LYK 08/28/07 93030
Total: $534.56 OCT a,2Q07
Jefferson County Planning
&Building Department
Jefferson County Building Dion Permit Num.. BLD07-00475
Applicant: PECK
BUILDING PERMIT INSPECTION APPROVALS applicabie Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:CO 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 V
Erosion Control
Post Hole ,/-1469
Footing Drains `7 ``� w FB-OMS
Framing
3/2405 yi/
Drywell/Alt Drainage
Address Posted
FINAL INSPECTION
/'
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
CONDITIONS for Building Permit# :BLD07-00475
1.) Non-native or hybrid tree species are not recommended. Mitigation measures shall be
accomplished by planting an equal area of NATIVE TREES within the buffer or wetlands.
2.) Planting shall occur now or no later than February 2008.
3.) PRIOR TO FINAL BUILDING INSPECTION, PROPONENT SHALL PROVIDE AN
AS-BUILT PLANTING PLAN CERTIFIED BY A WETLAND BIOLOGIST.
ALTERNATIVELY, PROPONENT SHALL PROVIDE RECEIPT FROM A NURSERY
SHOWING THE PURCHASE OF THE PROPOSED NATIVE TREES.
4.) The application was reviewed by the Jefferson County Department of Community
Development staff on August 28, 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 inspection, the following ESAs were confirmed to be presentlew on the subject property site
Modified and Unstable Shoreline Designation, Category II Wetlands, Seismic Hazard
Area, Susceptible Aquifer Recharge Area and High Risk Seawater Intrusion Protection
Area (SIPZ).
5.) 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.
6.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
7.) 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.
8.) 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.
9.) 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
(Rhamnus purshiana), Pacific Willow (Salix lasiandra), and Scou ea Willow (Salixra
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).
10.) Marine shorelines and islands All usceptibleto a condition that is known asSwater
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.
11.) 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).
12.) A setback of 90-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.
13.) 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."
14.) 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.
15.) 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.
16.) 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.
17.) 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.
18.) MANDATORY MEASURES FO I�GH RISK SIPZ: I
•
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.
19.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
20.) 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.
21.) The applicant is proposing to create or add 2490 square feet of impervious surface and
2490 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.
22.) 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.
23.) 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).
24.) The site plan as submitted with the building permit application on August 28, 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 October 1, 2007 shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
25.) This approval is for an unheated, no plumbing pole building/carport 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.
26.) No plumbing has been reviewed or approved for this project by Jefferson County Public
Health. Additional requirements may apply if plumbing is proposed.
27.) The parcel has been designated as 1:5 under the Jefferson County Comprehensive Land
Use Map effective August 28, 1998.
28.) A Declaration of Restrictive Covenant has been recorded on October 2, 2007 under AFN
527879 for the purpose of consolidating the lots to meet minimum land area requirements
for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building
and septic purposes only.
29.) Outdoor residential storage shall maintained in an orderly manner and sha•ate no
fire, safety, health or sanitary hazard.
30.) 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.
31.) The road approach permit(RAP07-00150) must be inspected and finaled by the Jefferson
County Department of Public Works prior to the final inspection/certificate of occupancy of
this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the
final road approach inspection.
32.) The building height is not to exceed 35 feet.
33.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
34.) 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.
35.) 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.
36.) Minimum setback from the edge of S Beach Dr right-of-way is 20 ft. Minimum side and
rear setbacks are 5 ft. Minimum setback to the edge of the delineated Category II wetland
edge is 90 ft.
37.) A Wetland Field Visit Memo dated November 5, 2004 prepared by Hagen Consulting was
submitted to partially delineate a Category II Wetland. An updated Memo and Habitat
Managment Plan dated August 9, 2007 prepared by Hagen Consulting was submitted to
address the proposed pole building location and the wetland buffer.
w4SON co JEFFERSOI3UNTY S
W r ,, ,`�.3 DEPARTMENT OF COMMUNITY DEVELOPMENT
1' v ` `4 621 Sheridan Street • Port Townsend 11 sjiingf t 836 ;_,4
360/379-4450 • 360/379-4451 Fax
.ySNGC.p"� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: Or?_A q 3
PmiPrt nescription (include separate sheets as necessary): ������� 1����
CAP,Po RTi/ t 1 NJ I� , 1 D ('LLJ f�(BI N G
Tax Parcel D I on Property
Number: I Size: V ) yCO SQ. FT (acres/square feet)
Site Address and/or Directions to Property: I-I I61.{ WAY IDlI AT NIII r P[i�)T Iii TAKE c;OUTFI FDINT
ROAD 3 Mil Ft; TO SDU7W PEAL-1 DTIYL,TURN RIGHT GO APPROX qLu FT..
Property Owner(s)of Record: WAYNC 4 S�i IRLE.Y A A . PECK
Telephone: Li 6D) t-I3 7-_9 I I 7 Fax: email: W PECKSR eDLYPLA.CDIO
Mailing Address: FII SGl.1T I-1 EEJ\CH-I DRIVE J PDRI I'I IDJ OW WA . _93F 5
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit \ 0 Conditional Use[C(a), C(d),or C]**
0 Single Family t� Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
0 Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
0 Commercial* 0 Boundary Line Adjustment
\❑ Change of Use 0 Short Plat**
'tE Address Road Approach 0 Binding Site Plan**
❑ Home Business El Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration** ,J ,,,,/t
❑Allowed"Yes"Use Consistency Analysis 61 Shoreline Master a of gram Exem_p oo1Permit Revisions*.�w,,r,.t
0 Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
El 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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 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 a. . st Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and ght of-ntry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later ins.: tions. • affs access right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicati.Aiiihe o• he wai for noti Q 7
Signature: ., "- Date: 8/ZCa' L() )7
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."J s County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not viol e the ES . Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in co ance with e Jefferso unty development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer I pon ' I. for ering t complying with the ESA. The Applicant has read this disclaimer7 an s)irnna dates it below.
Signature:` Date: 8/28// t A I 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:
SDUND MILD IMG IY ITEM c(��� �y� j ��D)1-/31-'( 1219 ..3EO ) 43T1?I a
MAILING ADDRESS: 5L1 6 THDRID/ K[' RD.. , Mkt WEE Ill, HA 3f C)
CONTRACTORS LICENSE� [� •` WAINS
NUMBER: SD(_ENDBS OZI7 N M NUMBER �p 7 ( p 77
ARCHITECT/ENGINEER: A LEJ AN-rr 11 L1 G/� I J EER�I IJG 7 PHONE (cfR )5 3�-}1�7L7 FAX: ( 0 )_5a5-I T.
MAILING ADDRESS:Z7W MAST S1. NC_J � De. `37301 EMAIL W J\).AE RG(3DL CUM
Project Type: \ Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
1 New ' i Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: $ Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: C3 • Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: -f3- Setback: 11 Private well ❑ Two Party
Type of Heat: Proposed: -, ❑ Public
NDtJL Total: 0 Name of S stem:
NO ?U 114111Z—
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/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 !!(( �y,,Amount� Revision
Main Floor Heated EH Bld App Review: ram^'`' . .
2nd Floor Heated Consistency Review: CO
i
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: y1Sj •S 1
Unheated Basement State Surcharge fee: •
Other Unheated Pot Water Review fee:
Garage/Carport 112CD cc1320
SUBTOTAL 3/
-Decks 911/Rd Approach fee: ` --- 1 �1
Imo_
Other TOTAL: $ S 3q,
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: c` • -
.Fair market value of all labor and materials foundation to finish �✓
1 a
, O-2 ,67 Initials: ,)
,.._______/;____, ________)
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• •
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JEFFERSON COUNTY
1.4
DEPARTMENT OF COMMUNITY DEVELOPMENT ECEIVE
AB 2 8 2007
621 Sheridan Street • Port Townsend •Washington 98368
O 360/379-4450 . 360/379-4451 Fax
http://www.co.jefferson.wa.us/commdevelopment/ JEFFERSON COUNTY BCD
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# O 17_ _1 3 PROJECT/APPLICANT NAME: W A N f' &/'1 IRLE Y PECK
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.
G1\RAGE/CARPORT/ POLE_ BUILDING J IiD HEAT, !JD
PLL)NI3ING
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
FLAT
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
LAWN AND fKEL
4. Describe the existing soils. Indicate soil type on the site map.
'A1JD
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.
WELL I>KAIMEJJ _COIL
APPROVED
.D
STORMWA_ _ .
6. Describe any excess levels of noise generated by the proposed use or acti .
IJ D IJ E OCT - i i
JEFFERSON COUNTY
DEPT.OF 'OMMUVITY D V.(,O
SIGNATNR • a ,
stormwater site plan template—rev.10/1/2003 _
5
•
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.
1-J ET up,c 7 D 1 H , CFF AlfAC H ED
DEAL D IU REPUR I
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.).
HD J CJT I D TE-1IE 1iDK7 H , VACANT LAND AITLIN.P
BALANCE OF PRDRICED _CI TE
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.
DRY 1-4 ELL
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.]
N /A
11. Describe the performance goals and standards applicable to the project.
/UD KU L UI-I- TO ADSACEN I PRVI1ER__1 Y
1. Desotit a the flow control system.
•
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stormwater site plan template—rev.10/1/2003
•
•
13. Describe the water quality system.
EcEry
AN 2 8 2007
14. Describe the conveyance system analysis and design. ��� � �
SlIN
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15. Describe the source of fill material,physical characteristics of fill,material,and deposition of excess material.
•
LDCA PI
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
COIU T2/1CTD E H I LL .BE I)(IILLD TD FDLLl)N COIL
17. Describe th the surfacing at a
vV IvCLET DUDDF HLL I ILD I U1 , GP fWF-t OIU DPJVEhI A Y
18. Describe methods for restoration of the site.
k)F����N�6�l�I �rc�Cr A►uD �u I /IBC► UF
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.
N1/A
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
hI ET LAIC ! WKT 1WI UD AU( 3 ,7( 07
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.
ROAD A PPRDACH RI I I L ) I U6 PERM 1 T S}-IDR E LI IUE
EXEMP 1 I DU PLAM I
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.
_i"TAICIA AUD F LACLIA)G
2. Establish Construction Access.
A(( f. CC
3. Control Flow Rates.
•
IU/A
4. Install Sediment Controls.
IF IM IAEU N A Y ISALEC AU) _CI KA Ire'.
5. Stabilize Soils.
LOVER M1 F Ss LAN N I F Vila]I LED
6. Protect Slopes.
lU/A
7. Protect Drain Inlets.
U/A
stormwater site plan template—rev.1 W1/2003
8
', •
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
ill) ECEIvED
9. Control Pollutants.
AM 2 8 2007
PEPLA �- If)n A L _
_ JEFFERSON COONIY DCD
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
U/A
11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
PROPL.I Y DWI\J WILL EL UU CI IL
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
kJ/A
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
1U/A
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
tJ Ll L-A NULL 1 .(i I N L N DK.I I-I SJE PKUJ LCJ _LI I I-
C _C_LL rvLlLANJc RLPJJkJ
stormwater site plan template—rev.10/1/2003
9
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b. Description of special requirements for working in or near environmentally sensitive areas.
PLA UT I IUU Of- I KEE_C_ W 1111 I IU EU I-I- UK h1 EJ LAMI I I C
1 ' `i y t; -, : ,I((L. WEI LAN(LL. KLYUK1 J
4. Erosion Proklem Areas. Description of potential erosion.problems on site in the context of the characteristics of the on-site
sc ,(e g ergdjpility,settleability,permeability,depth,texture,soil structure).
-1 t
5. Construction Phasing.
a. Construction� sequence
IJ/
b. Construction phasing(if proposed)
U/A
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Pro((A pro ose ALT fconCOMi�E.le I-I P CT PACT 0 F CET.
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
CDIU PLk IL .f I iliglai FVIXE S TOCLIJUIK(KG I-Lam.)K
b. Proposed wet season construction activities for environmentally sensitive areas.
0/A
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
UM.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
IU/A
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. 1U/A
b. Diversions. WA
c. Waterways. IU/A
d. Runoff/Stormwater Detention Calculations l /A
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 to the best of my k • edg:. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected pr..erty.
F ./28/Z eD7
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
12
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