HomeMy WebLinkAboutBLD2007-00537 CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD07-00537
SITE ADDRESS: 6514 BEAVER VALLEY RD Issue Date: 11/14/2007
CHIMACUM, 98325 Final Date: 10/10/2008
APPLICANT: JACOB L LISKE PHONE: (360) 732-7595
MARILEE HUNTINGFORD
PO BOX 501
CHIMACUM WA 98325-0501
SUBDIVISION: Block: Lot: T 18+
PARCEL NUMBER: 901251012 Section: 25 Township: 29 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yesE no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON
10/10/2008
I:\F_BLD_Occupa ncy.rpt 10/29/19
Jefferson County Building Divigion Permit Numb. BLD07-00537
Applicant: LISKE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 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 ��LL,,, - f I)�1
(I 'o I/Ff iNsTAILLiz ////q/o, iri
Footing Drains /
Foundation Stem Wall 4/ /� a/ b4_ �7m-e_h 516M�A� 124,610s 3/,D/q$^y
Underground Plumbing / �` / v�p
Under Floor Framing f0s/v4/
4e kite',Z.6 o'il
Straps(hold downs)
Ext. Shear Wall Nailing . /
i
Rough in Plumbing 2 3- of Peg. eela-teCrIGIJS
Framing
2/3�/Dr JAI Fee_ 16R1z-6CTic 's
Blocking a LZ/UC ,V
Airseal /-,/y/'/de 7� ,Ql/ GAB
Insulation: Walls si2_Jof a/eGiZerelv t4)
Insulation: Floors
l'7,g e. $
Insulation: Ceiling
Int. Shear Wall Nailing 1 3h/ie /t 6K
Wallboard Nailing 3/j6frO gl OK
Gas Line: Interior !.7 /
,
Gas Line: Exterior /,"
Propane Tank f
Heat/Chimney Clearance, `f ..-
. 5
Drywell/Alt Drainage f�� .,,� C ((
-71
Address Posted l "' y ' f,--p
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
RILDING PERMIT APPLICATIl MLA07-00576
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00537 Received Date: 10/11/2007
SITE ADDRESS: 6514 BEAVER VALLEY RD
CHIMACUM, 98325
OWNER: JACOB L LISKE PHONE: (360) 732-7595
MARILEE HUNTINGFORD
PO BOX 501
CHIMACUM WA 98325-0501
SUBDIVISION: Block: Lot: TX18-i
PARCEL NUMBER: 901251012 Section: 25 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,697
VALUATION 194,030.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: WOD
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 1,067 SHORELINE:
CONST TYPE: DECK: 248 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
Oh/4 2
Type Amount Paid By: Date: Receipt: I Ap roved/Date
Permit $1,525.75 KAS 10/11/07 93366 APPROVE
OVEE
Plan Check $991.74 KAS 10/11/07 93366
State Building Code $4.50 KAS 10/11/07 93366 NOV 1+ 2007
Potable Water Application $58.00 KAS 10/11/07 93366 Jefferson County Planning
Total: $2,579.99 &Building Department
• •
CONDITIONS for Building Permit# :BLD07-00537
1.) PRIOR TO OCCUPANCY & BUILDING FINAL - FINAL APPROVAL OF SEPTIC
SEP07-108 IS REQUIRED.
2.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND
EDGE OF DISPOSAL COMPONENT.
3.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
4.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC
TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS,
STATE AND LOCAL CODE.
5.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS
6.) A 30' SETBACK SHALL BE MAINTAINED FROM THE DISPOSAL COMPONENT AND
RESERVE AREA TO ANY DOWNSLOPE FOOTING, CURTAIN OR INTERCEPTOR
DRAIN OR DRAINAGE DITCH.
7.) The application was reviewed by the Jefferson County Department of Community
Development staff on October 12, 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:
landslide hazard area 1; erosion; SUSC aquifer recharge area.
8.) 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.
9.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
10.) 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.
11.) 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.
12.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
13.) 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.
14.) 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.
15.) The applicant is proposing to create or add 3012 square feet of impervious surface and
14,844 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.
16.) A Stormwater Site Plan has been "knitted and approved by the Department o!
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.
17.) 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).
18.) The revised site plan dated November 8, 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 13, 2007 shall be resubmitted for review and approval by
Jefferson County Department of Community Development.
19.) This approval is for a single family residence with attached garage only. Any future
permits on this site are subject to review for consistency with applicable codes and
ordinances and does not preclude review and conditions which may be placed on future
permits.
20.) The parcel has been designated as RR 1:10 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
21.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
22.) 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.
23.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
24.) The building height is not to exceed 35 feet.
25.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
26.) 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.
27.) 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.
28.) Minimum setback from Beaver Valley Road right-of-way shall be 35 feet. Minimum
setback from private ingress/egress easements shall be 20 feet. Minimum north, south
and east yard setbacks shall be 5 feet. If an ESA, is present then the more stricter
setback(s) shall apply.
29.) An address of 6514 Beaver Valley Road, Chimacum has been assigned to the parcel.
Beaver Valley Road is a state minor arterial.
30.) A boundary line adjustement(SUB05-0023)was finaled on July 27, 2006 under AFN
513756. The recorded survey identifies a 30 foot wide easement on parcel 901251022 for
ingress/egress and utilities for parcel 901251012.
31.) The parcel is served by an individual on-site well. Potable water(USR07-0027)was
finaled on October 24, 2007.
32.) A septic permit (SEP01-0204) for Altinfield on this parcel (901-251-012) serv1cel
901-251-005 and has a recorded easement under AFN 449994 &461344. The septic
was finaled on December 31, 2002. A well review(USR07-0027)was finaled on October
24, 2007.
33.) THe parcels is identified as being located with a slight landslide hazard area. The
proposed residence is located approximately 133 feet north from the southern boundary
and approximately 440 feet west of the eastern boundary. The area of construction for the
single family residence is approximately at the 370 foot elevation. According to Jefferson
County GIS mapping, this location appears to be the more level area of the parcel and not
within a landslide hazard area. Therefore, a geotechnical report was not required and no
mitigation proposed.
gON O
,i C 6 JEFFERSO UNTY •
al \-.k DEPARTMENT OF COMMUNITY DEVELOPMENT
''' ' 4 ` 621 Sheridan Street • Port Townsend • Washington 98368
�400
�ti 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
�`YI3INa
Master Permit Application MLA: ({ A4t -576,,E
Project Description(include separate sheets as necessary):
r) CC`-lls;t:--c.c-nc--‘ - I\ .) `fir-(- =✓ I ktrpi—t t6-c. C::i'r-r_A c E:
Tax Parcel Property -a
C1 2 5 Number: 1 G`2- Size: 10' -) r S (acres/square feet)
Site Address and/or Directions to Property: ( )S I LI e-)CA-v p2. U A LLey IL��
Property Owner(s)of Record: J A k<=c t-V-✓,:G I in��'t Li✓ 1 t r r r r r`7c:t-.c,--v
Telephone: t C.) 73 2---7 3 1 S Fax: email:
Mailing Address: '' t-�>• ;--)c x '.A.,t i C.Fti‘ (nit co,(y1 i t c:Fv r{ 2-s
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
1 Building 1 Variance(Minor, Major or Reasonable Economic Use)
I Demolition Permit I Conditional Use[C(a), C(d), or C]**
1 Single Family 1 Discretionary"D"or Unnamed Use Classification
1 Garage Attached/Detached 0 CI I 1 qn7 1 Special Use(Essential Public Facilities)**
1 Manufactured Home 2("' I Boundary Line Adjustment
I Modular 1 Short Plat**
I Commercial* r� �/ �y(+ I BindingSite Plan**
1 Change of Use ,=-- ' U..: j�, j diLl�li 1 OCLI! **
9 � � ,u�l ; ,Long Plat
I Address 1 Road Approach I Planned Rural Residential Development(PRRD)/Amendments**
1 Propane 1 Plat Vacation/Alteration**
I Allowed"Yes"Use Consistency Analysis I Shoreline Master Program Exemption/Permit Revisions**
1 Stormwater Management 1 Shoreline Management Substantial Development**
1 Site Plan Approval Advance Determination (SPAAD)* 1 Shoreline Management Variance
I Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment
1 Wireless Telecommunication* 1 Jefferson County Shoreline Master Program Amendment
I Forest Practices Act/Release of Six-Year Moratorium
*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 against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs accepsce nd ri t of entry will be assumed unl s the applicant informs the County in writing at the
time of the application that he or she wants prior notrcr �� / (� (�?�
Signature: '1/Lau . j,� z,t� J; y� L -,° Date: t l 3/0 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."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trannsferable responsib�'lity for adhering to a c plyin it h ESA. The Applicant as read this disclaimer and signs and dates it below.
Signature: (7(t! �'n �A �s2 2. 04 ki-u1(rl) Date: 4(1 h�C-7
G:\PeimitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc
•
I
BUILDER STATEMENT • r
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. _/
Signature0474Le-cam -of- Date: q'/3/6—7
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type:' Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Thi New 4(Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 3 Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 3 Height ,: Individual System
❑ Repair ❑ Masonry Ei1 t\ SEP Permit# 569f;1--001 r g
Bedrooms: Supply;
❑ Demolition ❑ Other: Water Su
Existing: Setback: `K Private well ❑ Two Party
Type of Heat: Proposed: 3 ❑ Public
feet" e:km p 1,,.,, Total: 3 Gl IA Name of System:
Sfo'
If this is a Commercial Protect 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 f•Cook Stove f4//oodstove i Fireplace Insert i`4ot Water Tank i Pellet Stove i Other t{ex-.\ .uMP
Is this appliance being installed in a Manufactured/Mobile Home? Yes /6
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.Offce Use Only Amount' 1 Revision
Main Floor Heated � ��1 �r_� ��� � �H Bld App Review: 1
2"°Floor Heated tU Consistency Review: }pG 3
Other Heated q 7 ' y; ,. Base fee: l J
t 15a5 .`75
Mezzanine Additional Section:
Heated Basement O C T 1 1 �1 Plan Check fee: 4
Unheated Basement - State Surcharge fee:
Other Unheated , '' �N + ',.. I ..t_1a Pot Water Review fee:
'5. DO
Garage/Carport SUBTOTAL
Decks .-j r �gG 911/RS+Approach fee: __ __r,
Other TOTAL: $ o�?, j .
Receipt Number: 9 33(o(0
, -Cash/Check Number:► i I )
a ,
ESTIMATED COST(REQUIRED) 0Jr,Oto — --trite: E o
t'Fair market value of all labor and matedi s oundation to finish 7
Initials: � l
`' vi
G:\PemtitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc
• •
RECEIVED
sow d ° , JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT OCT 1 1 2007
45. s , • 621 Sheridan Street • Port Townsend • Washington 98368 JCFmEu N" COON
0 379-4451 Fax
http:/3/www.co.jeffe s/on wa.s/ommdevelopment/ f '+ DCD
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 0 1 -5-1 W PROJECT Jr%ar, 'O." /O 4- .(t 1 1�K 4
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map. T O
Pt'hv w 4 - t {Pc 3 APPROVED
S"I.ORMWATER PLAN
5. Describe the existing site hydrology(i.e., drainage;behavior of water on the sit-a—above belm anel o�t6tqound). Indica e
existing stormwater drainage to and from the site on the site map. Depict separate drat e bbsins99fithe ;ite map, if
applicable,and indicate acreage of each.
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SIGNATUR.. ` 41/I
6. Describe any excess levels of noise generated by the proposed use or activity:
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stormwater site plan template—rev.10/1/2003 ,
• • '
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.
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8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation.of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g• Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30
in the Manual)or,if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site: Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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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.]
•
•
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11. Describe the performance goals and'standards applicable to the project.
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,12. . Descnlie4the flow&Intro)system.' 1 1 `U�7
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stormwater site plan template—rev.10/1/2003
` • •
13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
n IA RECEIVFD
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan
O C T 1 1 200?
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21. List other necessar
y permits and approvals as required by other regulatory agencies. If those permits or approva s niiQb
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I-CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements-Construction SWPPP
1. Mark Clearing Limits.
?R o T Is Ov\
2. Establish Construction Access.
itp e L t t_t USE i fir✓ x(S I-, C e- •o v-t.O Ew A ,
3. Control Flow Rates.
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4. Install Sediment Controls.
n I CC_Pc1 QF Tit"t=7-7 duiLI 0(7.
5. Stabilize Soils.
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6. Protect Slopes.
f k - CAUL MitA2--C. 00 It t`S-T At L& S(-e-P
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7. Protect Drain Inlets.
OCT 11 200?
�JE Rve vnLevS .
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pia, .MRY _c[l
stormwater site plan template—rev.10/1/2003 '8 ' 1
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
L >e c H c-tae .�_eTS
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
11 IA - (A) Lkitit>_ 1 e-c p TK t 5 (-re f 1 In i n'1 u
n. n crr A-Fi f r g-e-k)t, o'c:) (\(•)-- j P-&-AS .
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
OCT 1 1 2007
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site. AfFERa,0� COUNTY B
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s (I ( Lcnd6ilde Harc/ ,
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C.
stomiwater site plan template—rev.10/12003
r
b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence
e) L VA`f — ejkIA (Th - ' \Y1 •
b. Construction phasing(if proposed)
n IA
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
. Provide a proposed construction sched e.
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in/ 5Prn,l, iJl GPIPL-u-hn3\AG/ Nt#42_04,Aftgr.,vr, ►7 f H / 1=i ►'1/12-
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated itnits a i
impacts. K IL :-10- II
O C T 1 1 2007
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. n (A J[IFERSON COUNTY BCO
b. Diversions. IA
c. Waterways. f1 A
d. Runoff/Stormwater Detention Calculations ;(1 I R
stormwater site plan template—re..10Y12003 #. ,,r
•
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
Ngfit OR AUTHORIZE711
E?•{TATIVE?IGNATJ.IRE)t
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECEIVED
OCT 1 1 2007
JEFFRSON COUNTY DCD
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storrnwater site plan template—rev.10/1/2003 12
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