HomeMy WebLinkAboutBLD2007-00568 • •
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
Al Scalf, Building Official
PERMIT #: BLD07-00568
SITE ADDRESS: 31 CASCADE AVE Issue Date: 11/15/2007
PORT TOWNSEND, 98368 Final Date: 10/7/2011
APPLICANT: DONALD L OLSEN PHONE: 509-366-9468
JUDY K OLSEN
31 E CASCADE AVE
PORT TOWNSEND WA 98368-2587
SUBDIVISION: IRONDALE Block: 130 Lot: 1+
PARCEL NUMBER: 962113013 Section: 34 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GAR -A/G 250 GAL PROPANE TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006
EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/7/2011
I:\F_BLD_Occupa ncy.rpt 10/29/19
Jefferson County Building Division Permit NumbiBLD07-00568
Applicant: OLSEN
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 /OHnf- /✓
Erosion Control
Foundation Footing J-70 -as, ?../- 7 77 ;Ai 70//3,423 s- /AL%rrr"- 55T6 Ids. +-
Footing Drains te-1•Cie T_mtip 10-1-artgAtic
Foundation Stem Wall
Underground Plumbing 5-2- Oe-' to i'jl?J Ttcl
Under Floor Framing "1
Straps(hold downs)
Ext. Shear Wall Nailing
Rough in Plumbing 9//o/ng e,„4 °2/j+�Fl�ey- 1 L-01
Framing r°1 ,.-� 'Airseal �" /31Y D Insulation:Walls n
Insulation:Floors
Insulation: Ceiling 0 -2-7_��q,_ OP per, ,(tx,A- c� a '-'61
L
Int. Shear Wall Nailing 1a_--7. /�Gait f`��2 1
Wa.lboard Nailing ( v-�c %-t LA I gt.A- ItCet-r- j - 1-7- 1 j rkt
Gas Line: Interior
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted / � /45
/
FINAL INSPECTION " ' (( I( 1)/
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
ItUILDING PERMIT APPLICA'IN MRA07-00605
ype: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD07-00568 Received Date: 11/2/2007
SITE ADDRESS: CASCADE AVE
PORT TOWNSEND, 98368
OWNER: DONALD L OLSEN PHONE: 509-366-9468
JUDY K OLSEN
2301 S LEDBETTER PL
KENNEWICK WA 993372430 IRONDALE
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 962113013 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: TOM SHUTE PHONE: 360-379-4032
4533 S DISCOVERY RE
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GAR - A/G 250 GAL PROPANE TANK
}:vt. ko) . 6 EI-C(i u_Ittt t •t( 10 / ,cacz ,') l i `�
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 188,24gg0-2tr,a MAIN: 65
CODE EDITION: 2006 ADD'L: 1,152 HEAT TYPE: PRO
OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: EEE
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER: t}rD 960
SHORELINE:
CONST TYPE: GARAGE: 2,112
DECK: 320 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS.
Exist: Exist:
Prop: 7 ; Prop: ,2 I
,'V Total:Total: Z �Routing Date: '/ 51 0 1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,492.15 CJZ 11/02/07 93481 APPROVED
Plan Check $969.90 CJZ 11/02/07 93481
Jefferson
State Building Code $4.50 CJZ 11/02/07 93481 NOV 15 2()D7
Potable Water Application $58.00 CJZ 11/02/07 93481
County Planning
Total: $2,524.55 & Building Deaartmr„*
• •
CONDITIONS for Building Permit# :BLD07-00568
1.) PRIOR TO OCCUPANCY& BUILDING FINAL- FINAL APPROVAL OF SEPTIC
SEP07-290 IS REQUIRED.
2.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
PROTECTIVE BARRIERS ARE REQUIRED AROUND DRAINFIELD-MUST BE
INSPECTED BY HEALTH DEPARTMENT.
3.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC
TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS,
STATE AND LOCAL CODE.
4.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND
EDGE OF SEPTIC TANK.
5.) The application was reviewed by the Jefferson County Department of Community
Development staff on November 5, 2007 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
coastal SIPZ.
6.) Marine shorelines and islands are susceptible to a condition that is known as seawater
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.
7.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according
to the County GIS map. There are voluntary and 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 Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources
within 1000 feet.
8.) 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.
9.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
10.) The applicant is proposing to create or add 4027 square feet of impervious surface and
4068 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.
11.) 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.
12.) Jefferson County determined that*proposal is categorically exempt from reijunder
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
13.) The site plan as submitted with the building permit application on November 2, 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 14, 2007 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
14.) This approval is for a single family residence with attached garage and 250 gallon
above-ground propane tank 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.
15.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
16.) A Declaration of Restrictive Covenant has been recorded on September 12, 2007 under
AFN 527283 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.
17.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
18.) 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.
19.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
20.) The road approach permit(RAP07-00177) 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.
21.) The building height is not to exceed 35 feet.
22.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
23.) 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.
24.) 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.
25.) Minimum setbacks from Cascade Avenue, Law Avenue and South Gary Avenue
rights-of-ways shall be 20 feet. Minimum rear(south) setback shall be 5 feet.
26.) An address of 31 Cascade Avenue, Port Townsend has been assigned to the lots.
Cascade Avenue is a county local access (C678409).
27.) The lots were created through the Irondale#5 Subdivision on April 2, 1910 under AFN
29795.
28.) The parcel is served by PUD#1 public water.
29.) A septic permit (SEP)7-0290)was approved on September 21, 2007. A road approach
permit (RAP 07-0177)will be issued with the building permit.
(,(,;,esON 0O6� JEFFERSOOUNTY
•
rzi ,\ DEPARTMENT OF COMMUNITY DEVELOPMENT
'N ` '4 621 Sheridan Street • Port Townsend •Washington 98368
° 360/379-4450 • 360/379-4451 Fax
�s&7Np�p www.co.jefferson.wa.us/commdevelbpment NOV - 2 2007
Master Permit Application MLA: 0rl -Lo 05
Project Description (include separate sheets as necessary): - ---
�-rim (7, i.,- (
Tax Parcel Property
Number: 1( '- ::. -> Size: ,`�2/ I 3 U. It (acres/square feet)
Site Address and/or Directions to Property:p� i i n 'J
6 b j-N F'V e. 14 -7 -11 4 P,,,Tc.�F C- ay1 Pifc�si?tc't / S c�fl & r/ 14�e./l of r y 1 ltvel(kS(4de
Property Owner(s)of Record: Inc,A ?-1 3,), 7 ()key\
Telephone: S01- 3t -"PI6 0 Fax: email:L&& k; noojsen ecic2),<eri1
Mailing Address: Q301 5 Led be.tiec pi_ • Kerwww; c k 1 ,, 4f`13?7 - Qif3v
Applicant/Agent(if different from owner): : Ili jn,o-{C.._.
Telephone: 37i-40 3L Fax: email: -shook sh,;lee rrtsn.Ci.44-1
Mailing Address: N533 S ?�i [nVPri I . -4. CvwnS4vc1. 1 . rZia3(E;
What kind of Permit?(Check each box that applies
0/Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
l 'Single Family *Garage •ttached Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
('Address E'/�Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
lik ropane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis 0 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
0 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
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE y , Q_. 1 Date: (c t%;:.t" it
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 requirgd\later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica' n th t he or s antsj.j6r notic �/
Signature: Date: A 6 ' e,0 A. ,�+A°
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-transfe*,1. - -sponsi•�ty1or dh ng to an lying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1 Date: a.6"' Sele 2" 7
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 f the proposed project.
Signature: PC,i/\ G`(S P 1� �7 LI,,,tA._<c( Date: //12- I0 7
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
W A ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: l NUMBER
ARCHITECT/ENGINEER: eit �a`rick ! SGS()Yn$ tVl`MCc'✓�41j T/l,'r1- PHONE (? ,() ),-ts2_ 3v23 FAX: (?i 0 )9S>,Xj7
MAILING ADDRESS: 6119 c C has F o"} ►An5eirS u.el. if,it:2 EMAIL Par- b'I-- "1c;VI-50#:).;dL7pPi1.even
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0• New U Wood Existing: ileewer
❑ Addition ❑ Steel Proposed: Bank 0 CommunityS stem
❑ Alteration/Remodel ❑ Concrete Total: - Height: Individual System)
❑ Repair ❑ Masonry SEP Permit# on-aqa
0 Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: [3 Public
Pro 1 Clrle/tlt'[r'('ric.- Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank . bove ro nu d aT nk`--• Size of Propane Tank: R Sc)
" Heat Stove i Cook Stove i Woodstove X Fireplace Insert I lot 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 , Atotint.: , , , .revision -
Main Floor Heated 4 S �Q EH Bld App Review: O `�
cc
2"°Floor Heated f �. Consistency Review: 1
it SZ153
Other Heated Base fee: 1 ,E- �—"'
q(00 116`7 t I ;�1� .I q .15
Mezzanine /� Additional Section:
Heated Basement Plan Check i 1-0 (n� cio , 0
1 s
Unheated Basement State Surcharge fee: Q 0
Other Unheated \\c Pot Water Review fee: 1
Garage/Carport SUBTOTAL ..7) ,0 •c
Zii Z, 5241 .
Decks 3 - 911/Rd Approach fee: •
i-:•
Other TOTAL: $ `tli •� E 5 `� ..f.)
o�-t a�
,4444410aReceipt Number: '134$ 1 4
c zx4 ,7,¢r .,� Cash/Check Number: 1005 1 1
ESTIMATED COST Date:
•Fair ma value p of u all labor and mate Is foundation to finishlz NCMilitias: 7 ��a\a'� ]� "CI
%1
_ ___, °e (-----)--
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc `Nr J
• IP
.. , JEFFERSON COUNTY '
kiii,
n ` t; M DEPARTMENT OF COMMUNITY DEVELOPMENT NOV — 2 2007
I ;
.� ., 621 Sheridan Street • Port Townsend • Washington 98368 _I
360/379-4450 • 360/379-4451 Fax I ����
O' http://www.co.Jefferson.wa.us/commdevelopment/ = Tv r 1' OPF;'F"�,
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICANT NAME: Do In of S e ri
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. (��
UV'a eu.,'ort& Lo - —
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.
Sandy Loa i/ Cra.*de. I
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
applicab e,and indicate acreage of each.
Sa y'A a , L,e�( clr&th-zc9 5()t 1 S(6--� I t54-
APPROVED
STORMWATFR PLAN
6. Describe any excess levels of noise generated by the proposes'use or activity
le' - NOV 1 4 2007 1
Require• iit/M
Is s JEFFE O TY
4 . DEPT.OF C , D VF. OPME T
SIGNATURE:
stormwater site plan template-rev.10/1/2003 �i r i l II v ii t »— y a • ` __ 5
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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 m (l
f 1cl,� Lo 1- k 0 se5m � Vl lretriA (4 me ?ect, -uv'eS,
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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,� wetla1nds,lakes,steep slopes,etc.). q
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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 1erf rma d ce goals a standards applicable to the project.
,
12. Describe the flow control system. j
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stormwater site plan template—rev.10/1/2003 6
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13. Describe the water quality system.
Nov - 2 2007
1
14. Describe the conveyance sy tem analysis and design.
C�- �� fz i as h 1r)( -
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 restor?tion 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
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
0IA
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 ' )A
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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 Clear(ing Limits. ( 1�
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2. Estaht.`'
'P coln3kr w ,Tags l ►";t,e
see` S,i� p [etyl
3. Control Flow Rates.
4. Install Sediment Controls., ()
(I (— r tar fen cihs co id) .
5. Stabilize Soils.
SPdca� S sc� rti 01/1 QicpC-See9 Cefe4S
6. Protect Slopes.
laA— Jo ores
7. Protect Drain Inlets.
stormwater site plan template—rev.10/1/2003 8
• •
12 Required Elements—Construction SWPPP(continued) �'
8. Stabilize Channels and Outlets. NOV ` '
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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 Bet Management Practices(BMPs).
12. Manage the Project. /Rt
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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). r
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
1q
3. Environmentally Sensitive Areas.
a. Description of environmente I sensitive areas that are on or adjacent to the site.
W
stormwater site plan template—rev.10/12003 9
I
• •
b. Description pf special requirements for working in or near environmentally sensitive areas.
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).
Il) ecoc 1 rir-, . crc'agl 54(G( ui Ct.vl 0 tack_ clOS4
e?,S ✓'e ¢�v,lref�' !J
5. Construction Phasing.
a. Construction sequence 1�1I
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b. Construction
�phasing(if proposed)
-‘441
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule
�cl,fJw") i � � 7. S -Qi\ ��i���� r �v{ S )QA
Fe1Q . - 'r(Gti AA `V'3 {o (off
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
1) ►‘,cu.)el `c VnCVO- Pr)v f
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 with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations •
stormwater site plan template—rev.10/12003 10
!► i
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.
La„,i(2_ 6 Oaf- A et g
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
r t; (;Th fl
it Ill
! NOV - 2 2007 `''GOUNTY
y ,c• n ,l a_N7
07 - 0568
stormwater site plan template—rev.10/1/2003 12
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