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HomeMy WebLinkAboutBLD2007-00507 MANUFAPURED/MOBILE HOME INSTPLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD07-00507 Received Date: 9/18/2007 SITE ADDRESS: 4134 DABOB RD Issue Date: 11/8/2007 QUILCENE, 98376 APPLICANT: RICHARD D KILLAM TINA L KILLAM 34 W PRICE STREET PORT HADLOCK WA 983390202 SUBDIVISION: Block: Lot: TX13 PARCEL#: 701051012 Section: 5 Township: 27 N Range: 01 W CONTRACTOR/ BUY RITE HOMES PHONE: (360) 681-0777 DEALER 259403 HWY 101 SEQUIM WA 98382 (360) 381-0780 Contractor's License BUYRIH*0840B Expires 5/20/2008 PROJECT DESCRIPTION: NEW MAN HOME -TRIPLE WIDE -SERIAL#27542 -MODEL KE-04 MAKE: KARSTEN YEAR: 2007 SIZE: 66X40 Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 11/8/2008. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TQ,YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING B or PADS USED). \\`)'7-0-7 A/of Stormwater FINAL Approval: .e_t_ COr GC (-Q,t!1 54-D Con D fik2t.;� b t-t-wnS Block. lumbing9 l Z- -18` 7 Propane Tank/Lines Nj F Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: / Final/Skirting/Vents/Porches/Steps: hk -cr- -Pi i I Z///og ' HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIO 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 REVERSE IPUILDING PERMIT APPLICA MLA07-00541 N Review Type: I Jefferson County Department of Community Development ype 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00507 Received Date: 9/18/2007 SITE ADDRESS: 4134 DABOB RD QUILCENE, 98376 OWNER: RICHARD D KILLAM PHONE: 360-379-8590 TINA L KILLAM 34 W PRICE STREET PORT HADLOCK WA 983390202 SUBDIVISION: Block: PARCEL NUMBER: 701051012 Lot: Section: 5 Township: 27 N Range: 01 W CONTRACTOR: BUY RITE HOMES PHONE: (360) 681-0777 259403 HWY 101 SEQUIM WA 98382 Contractor's License BUYRIH*0840B Expires 5/20/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW MAN HOME - TRIPLE WIDE - SERIAL #27542 - MODEL KE-04 TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 135,000.00 MAIN: 2,640 CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: 27 SETBACK: SEWAGE DISPOSAL: ALT BANK HEIGHT: WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: , lv /c.l 1 , l Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 CJZ 09/18/07 93226 APPROVEJJAdd. Manufactured Home ; $34.00 CJZ 09/18/07 93226 Potable Water Application $58.00 CJZ 09/18/07 93226 NOV z`g 2007 Total: $255.00 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD07-00507 . 1.) A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASHBLOCK. A SPLASHBLOCK OR A PAD OFC RUSHED ROCK(2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. 2.) The pacel is located approximately 97.5 feet from the western boundary. This location of the proposed residence is located outside the mapped landslide hazard area. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on September 18, 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: Blue heron; landslide hazard area 1. 4.) 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. 5.) The applicant is proposing to create or add 2772 square feet of impervious surface and 9204 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. 6.) 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. 7.) 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). 8.) The site plan as submitted with the building permit application on September 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 November 8, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 9.) This approval is for a manufactured home installation 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. 10.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 11.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 12.) Not more than 2 unlicensed *cles shall be stored on any lot unless total reened 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. 13.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 14.) The building height is not to exceed 35 feet. 15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 16.) 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. 17.) 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. 18.) Minimum setback from Dabob Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 19.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 20.) An address of 4134 Dabob Road, Quilcene has been assigned to the parcel. Dabob Road is a county minor collector(C348808). 21.) The parcel is served by an individual on-site well. Well review was finaled on September 26, 2007. 22.) A septic permit(SEP07-0314)was approved on October 16, 2007. A well review (USR07-0024)was finaled on September 26, 2007. A road approach permit (RAP07-0132)was approved on July 12, 2006. 23.) The road approach permit(RAP06-00132) 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. • • m 1- m < * N\ 1...-4 a "--,,--j, 1. 46x39P Til 1" ......... ,,......4 ---1, •.., 1131166.1111t1 e a- !rail • ' '''' ,4..-- i - .PAILI r-*:14 •'', 1.." 46x58V r 46x58V -r 7 46x56V •6x58V (2/ X y i it WM ,T I Ei 11:1 p i tn co g 0) D ® 5 .<,•,, 11, Ng Cl_<-1- --,- . .. „ 577. Vordrobe • r 0 1 ;t1 11 - 2,,.`, IX 5:)n . _ a rr14oa cMUinr gN' •4 1fr/:I• 11104:2:;3.80.6,i , Q_ if:Mr,111111 - (.1-1 < J 1r9•Iv 30 •, cr, Co > • -ri 70 < Al. . ril cr.▪ rs) • `2 AD cri : ' ' .-, ,n •3 § 2 a, En < co i rn -" ....... . I $I-1 11::::''* \ . . - -' , t ' lk III aPt aTt'd,..( I Raised Snack kr GO co 1111.11=1 i IMMIMMI11111 CI 11.111.110.111.1111 ...... CS CL7r ,,, Ramo •-° ; \I )•• 2 -:-•'`'.' sID a-, x Q3 a imlinam — < CD •x, '3- n — k i g- ,'1 in N.-. 1. -- 1111iimie7— .. ri-4 ill 3 Ininam mm I IIIMENNwiIMIIII 1— • -.. . .. . immomumo t_wmr* \ ...--....... P-b-Y min •••• ."." .c-, 1:211---.0,, --- P " i — -' mimm..• CO '',.. 01 rn 20 i i —i :.• -...+4 r'-2'-• M C.--7-_-,f,I --) ci -,..- :67 .7,-- ____) _•_.__ _ ___ ..... _ - --- — „.....„..0ACK WESTERMAN ISJefferson !peaty Courthouse _ ASSESSOR Po Box t Port Towtiscq (360) 385-9105 MOBILE HOME INFORMATION FORM SEP 1 8 2org OWNER'S NAME/MAILING ADDRESS: '°NAME: 2, _z-f,-, , (-7?�,i' �-� % 4 ADDRESS. ` i1/ PHONE NO. 3t o - 77- ';c%6 I IY OEVELU The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been m oribi this county from another area. 1►MOIIILE HOME DATA: (A) MAKE (B) MODEL (C) YEAR i UD (D) LENGTH �o (E) WIDTH Y// i C -O `t e) (F) SERIAL # 2 75/ ' (G) YOUR PURCHASE PRICE (Do not include sales tax) /54-000 , PURCHASE DATE S/Z/0 7 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No 1 (If)IF LOCATED IN MOBILE HOME I'AIRK: NAME dr ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: �/ LOCATION ADDRESS 4L ''//3` ./( db "f' a i t /(1, _ ,_ //)a- 9S.. 7 40 REAL PROPERTY PARCEL #/DESCRIPTION 76/ 6 /4/2 /l THANK YOU FOR YOUR HELP! natur.,z - / e of a plicant //- dI ;) SSELL, Property Technician _ -. . • 7 \ -._ ^,._. •-•--„,...., ------- g :414 ft' It - Illb tillig. ?1 ;-r- 4111W, ,.. 11 1Peallp. .,-i / il.II 00:1"4 C) q•Nit.W150 CiPOjilli 0 g a ',7), cl, til - -- . i ••:::.---,:z.iiiii 41 ' c/1 .8 1 0...., i:ii 48.a (D 2 ii Z ^ a ....... .4 1 \ e \ ill e8 N s. ‘. ----- - --------- , C% — R - r pc ,....._T.,- L.i..... \ 11 L \ \ . / I 1:3... LLI a) it 111.0 , • , ---•••••- \ / •._ .: ..., ../ ' ... 9 pieri ir_it ILD — .... - ...._ -$ 0 5 0 7 _ .... . A0 7 l 3Z il .h6i " `t,'""r r 1 * jEfr igoluL 'i.,uIlli if OCO i Ai ) I .. 7 *- ct C14- ot `R -----------" fl----;17-----3-37.-------- 410iill i # 1..= t/3 ai ' it • ._ja. 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W - ' \� A DEPARTMENT OF COMMUNITY DEVELOPMENT `' >• `d 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax _ _ ��yS, O/ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Oil S t ' Project Description (include separate sheets as necessary): �`l;,:(-d, Lt is ci eY i/t`'hic ' e_eiC4.'z _. .. Tax Parcel Property _ _ �� Property Number: 7(/(, /e/z Size: :// 4,,,,,,,.(.,J (acres/square feet) Site Address and/or Directions to Property: 1 UJ`,z,e,e& (•r J-} (I,: - // L Property Owner(s)of Record: /':-� flil-9-2) i if./7'a.2a xin.L- �, e__ Telephone:,5h0-,3/ -Y'c c Fax: email: Mailing Address: 3i %/,, ,'� / //(/('CY r/ /(/ 3 3 6 Applicant/Agent(if different from owner): L ekzi-, 4-. -,r. „,t 4,.-) Telephone: �( 6 - 66'I- 6')7 7 Flax: 3 l')•- lc '!- C)7 6r) email: Mailing Address: 25% /C'. 2.�r-et, -/l.07 (ji y,«,. 1 LC%Z_ 1,'::1 2 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 0 Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification d Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities) ** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration ** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions ** ❑Stormwater Management 0 Shoreline Management Substantial Development ** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑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: DESIGNATION OF AGENT hereby designate e `t --i,' ',' to act as my agent in matters relating t this a plication for permits . OWNER SIGNATURE r 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 or 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 provide access a right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any req,ired later in edtions. Staffs a ess and right of entry will be assumed unless the applicant i1forms the County in writing at the time of ttr-appf.r, ion that he r s wants prior n ice. 11 Signature. .-- + I C �: - /�l\ i / / >. J — Date 4L [`, c L r- The action or actions Applicant.will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual, group or agency can file a lawsuit on behalf of an endangered species regarding your actions ven if yo. 'are in compli ce with the Jefferson County development code.The Applicant acknowledge that he,she or it holds individual and non ransfef le reonsibir fosadiering to anfl complying with the ESA. The Applicant has read this disci imer and signs and dates it below Signature. t ` .,.tG . . 1 %'_z_.e. ` �GDate .,� El7 �..)/ r. c G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT Alr- The signer of this statement does hereby certify that they are the Owners of the parcel referenced hereir., that they are not licensed contractors and that they will ss ing the responsi lity of the General Contractor for the proposed project. (14/g1 Signature: Date. 7 t. GENERAL G TRACTOR OR MANUFACTURED HOME INSTALLER: PHONE FAx (3&) 1 /-077 ? (360 )48/-0780__ MAILING ADDRESS: 2SGI vUJ ,CJL.C�G� ,!'/ NS/az;r, 943,56z EMAIL. -- — -- -- —.- -— CONTRACTOR'S LICENSE 6// C WAINS NUMBER: 5u yifriloaRszo6 NUMBER /4)4/1tJS02-SO ARCHITECT/ENGINEER: 82!,D PHONE � }t) y( /3 5,3/ 0 ) - FAX )g }Lka���.� �L�� D lS� --- --G 1� 88-7/i5 MAILING ADDRESS: �L{ .. t. , 9-7.3g3 -9161 EMAIL , -- — — — Prpject Type: U Frame Type: Bathrooms: Shoreline Type of Sewage Disposal: re New at/Wood Existing: . Sewer ❑ Addition 0 Steel Proposed: __ Bank Community System ❑ Alteration/Remodel 0 Concrete Total: Height: /individual System O Repair 0 Masonry SEP Permit#_C21=317 ❑ Demolition 0 Other: Bedrooms: Water Suppl rL Existing: — Setback ( Private well - Two Party Type,;of Heat: Proposed: 3Public Total: :3 ----_ Name of System: L - 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 ✓ou 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. — - - ,` � Amount ,ReOision;�_ i Square Footage Current Proposed For ff0 ' U§ rbr ly.a • --- Main Floor Heated ` EH Bld App Review: 2na Floor Heated !,,1„1 Consistency Review: Other Heated ' ' 1- Base fee: Mezzanine - Additional Section 3� Heated Basement Plan Check fee Unheated Basement State Surcharge fee 0,—. — — Other Unheated Pot Water Review'ee (I 3 Garage/Carport SUBTOTAL ---- -- LI Decks 911/Rd Approach fee �kth� 3 - 3X3 4, �r� z - Other TOTAL: $ - Receipt Number: ; C`3 aatyp Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 7 , d� �j *Fair market value of all labor and materials foundation to finish SEP 1 8 �f L - -- 1 - Initials: C-').(). , I G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Applicatisn T219-200(doc Ill1. C360/. JEFFERSON COUNTY K1 DEPARTMENT OF COMMUNITY DEVELOPMENT � 621 Sheridan Street • Port Townsend •Washington 98368 SEP 8 ��� O 379-4450 • 360/379-4451 Fax Na` http://www.co.Jefferson.wa.us/comrrdevelopment/ 1CGl STORMWATER SITE PLAN SUBMITTAL TEMPLATE IMLA# 01 ` Si 1 PROJECT/APPLICANT NAME: 4-el.,ly, i j 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. (/Ai.iu-clo. 01‘2.2 ,l- ) Existing Conditions Summary / 2. Describe the existing topography. Indicate contours on the site map. —r i-ee- / -xd _ mom -.. da /2A-0_7Qe _ / iez �c_ 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. APPROVED STORMWATER PLAN 4. Describe the existing soils. Indicate soil type on the site map. NOV - 8 2001 yfri,6,1, JY JEFFERSC•i1 NT 5. Describe the existingsite hydrology drainage; behavior of water on the sAab ve, ee ow, i I.round . Indicate Y 9Y(i.e., 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. /r 6. Describe any excess levels of noise generated by the proposed use or ac ity: iti/4 — StormWa .1. Aore,; N. �,,. Require ,, 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. 3 1 }: 'A/A 8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands,lakes,steep slopes,etc.). /i}e died- ,t -.44gte--iLikt ,,,,,ALL tvA-w- A8-7-72.,Lt Lit, 044 ,i)y,(_artd- hail 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. ,A01-OP)-r02,44-7-4.--- tiY2---V OP dta_pii . , f__, 17 /1-71--g-/-(A4-0 DI—) ilSe—,< A.(___Zet3 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.] i i Aj/ff .. 11. Descn e the performance goals and standards applicable to the project. Yl - 4 ,,6 (.? ,ice'- /e,,-�` 12. Describe the flow control system. A.)/A' ' . ., 6 stormwater site plan template—rev.10/1/2003 • • i a t 13. Describe the water quality system. tt I 'i ' ; I SEP 18 2007 �JJ ,, ;OUNTY _JEVEEOPMENT 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 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. 18. Describe methods for restoration of the site. 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. /V/A2/ 20. List here and include any special reports or studies conducted 10 prepare the Stormwater Site Plan. //1// 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. N /n 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. A/1/1 /41 2. Establish Construction Access. /^^v/I /4 3. Control Flow Rates. N/g 4. Install Sediment Controls. AVA 5. Stabilize Soils. A)//t9 6. Protect Slopes. /OP 7. Protect Drain Inlets. Al/f stormwater site plan template—rev.10/1/2003 • • t✓ ,) 12 Required Elements—Construction SWPPP(continued) T i; I I 8. Stabilize Channels and Outlets. ! ?' SEP $ 2007 i. . Itr OUNTY otA r - N 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwater site plan template—rev.10/1/2003 9 i • b. Description of special requirements for working in or near environmentally sensitive areas. AO 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). N/ 5. Construction Phasing. a. Const tion sequence /a_e / d.2-72--Zc r b. Construction phasing proposed) 4.)/41 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. el 4 1 .lJ /d 0 II. Wet Season Construction Activities. a. Proposed wet season construction activities. b 6=- - -6 /a /3-O b. Proposed wet season construction activities for environmentally sensitive areas. , AYR 7. Financial/Ownership Responsibilities. a. Identify the property owner responsibl or the i '' ton of onds and/or ther financial securities. and/or 4 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. —/e 4/3 iZ� g. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. AS()b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template-rev.10/12003 • S • 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 co ect to th est of my kngwl ge. I also certify that this application is being made with the full knowledge and consent of all rs of affected property. 9/p5Va (LA1N60 ER OR AUTHORI PRESENTATIVE SIGKIT RE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: SEP 18 moT COUNTY <i TY .7)\/ .LCPMENT 12 stormwater site plan template—rev.10/12003