HomeMy WebLinkAboutBLD2008-00035 •
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
Carl Smith, Director/Building Official
PERMIT #: BLD08-00035
SITE ADDRESS: 322 PIPER RD Issue Date: 05/12/2008
QUILCENE, 98376 Final Date: 11/27/2012
APPLICANT: JOHN H BUGAJ PHONE: (415) 297-8313
LORI E BUGAJ
210 21STAVE E
SEATTLE WA 98112-5317
SUBDIVISION: TURNER SHORT PLAT Block: Lot 2+
PARCEL NUMBER: 701201012 Section: 20 Township: 27 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/A/G 500 GAL PROPANE TANK - REVISION 1/28/10 (CHANGE
ATTIC
& BASEMENT TO HTD SPACE
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
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 11/27/2012
\\tidemark\data\forms\F_BLD_Occupancy.rpt 12/18/2012
•
•UILDING PERMIT APPLICAON MLA08-00033
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00035 Received Date: 1/30/2008
SITE ADDRESS: ;:�,:j,PIPER RD
QUILCENE, 98376
OWNER: JOHN H BUGAJ PHONE: (415)297-8313
LORI E BUGAJ
210 21ST AVE E
SEATTLE WA 98112-5317 TURNER SHORT PLAT
SUBDIVISION: Block: Lot: 2+
PARCEL NUMBER: 701201012 Section: 20 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: HENRY M SOUZA PHONE: (360) 379-8338
DESIGNS BY SOUZA INC (360) 379-1327
164 SWANSON
PROJECT DESCRIPTIOI NEW SFR (1229 UNHTD ATTIC/STORAGE)
ALSO A/G 250 GAL PROPANE TANK I l R h+ri \bncY1 i 0 4-
TYPE OF WORK RES SQUARE FOOTAGE: I--'-I-P v Dior)- C',i"Y e_ unr CL
TYPE OF IMP NEW ( jtJ }r R-}-ki. r+ 7tt A4-}C
VALUATION 37-1,878.00-- ,`_i MAIN: 1,616
CODE EDITION: 2006 ADD'L: 1,616 HEAT TYPE: PRO
OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: EEE
OCCUPANCY: UNHEATED: 823 #OF STORIES:
CONST TYPE: 5N OTHER: 1,229 SHORELINE:
CONST TYPE: GARAGE: SETBACK: 40
DECK: 875 BANK HEIGHT: 104
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
I
130 C)
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,516.95 KAS 01/30/08 95820 APPROVED
Plan Check $1,636.02 KAS 01/30/08 95820
State Building Code $4.50 KAS 01/30/08 95820 fa 200�3
Potable Water Application $59.00 KAS 01/30/08 95820
Total: $4,216.47
Jeffe MAYrson County Planning
& Building Department
r �
Jefferson County Building Di✓ision Permit Number: BLD08-00035
Applicant: BUGAJ
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 0`2-fl`r94- 5'rl��n►?3-•
Erosion Control SEE CONDITION 1 FOR SILT FENCE BMP REQUIREMENTS.
Foundation Footing p
Footing Drains
Foundation Stem Wall st6-41,-, 94—.7tek y
Underground Plumbing
Under Floor Framing /r t
Straps(hold downs) —t ( ✓g
Ext. Shear Wall Nailing �11
Rough-in Plumbing
il - 1�
Framing
-
Blocking v
Airseal
Insulation:Walls z a `i C J t,Insulation:Floors ( IC 1- U / `/ ( �l L i 1
Insulation:Ceiling n ��, +, ( i
Int.Shear Wall Nailing
Wallboard Nailing 11-_ --tO ( ^--
Gas Line: Interior - + f-1
Gas Line:Exterior
Propane Tank ! ,
t'
Heat/Chimney Clearance
Drywell/Alt Drainage ,;:.;L�U SEE CONDITION 2 FOR FRECH DRAIN-GEOTECH
CERTIFICATION REQUIRED.
Address Posted ' ! ;.'.;•
r '
FINAL INSPECTION ,��- J
l 1 ,
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VAI in FIR nmv YPAR
0 i
CONDITIONS for Building Permit# :BLD08-00035
1.) CONTRACTOR SHALL INSTALL A SILT FENCE AT THE 40 FOOT SETBACK FROM
TOP OF STEEP SLOPE. SILT FENCE SHALL BE INSTALLED ACCORDING TO THE
2005 DOE STORMWATER MANUAL BMP C233 (SEE ATTACHED).
2. PER Di_ M , 2008 FROM STRATUM GROUP, STORMWATER
DISPOSAL WILL
ATB E Dv MI A FRENCH5 DRAIN. GEOTECH CERTIFICATION OF FRENCH
DRAIN INSTALLATION IS REQUIRED PRIOR TO FINAL BUILDING SIGN OFF. AN
ORIGINAL WET-STAMP LETTER FROM THE GEOLOGIST SHALL BE PROVIDED TO
THE DEPARTMENT.
3.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND
EDGE OF SEPTIC TANK.
4.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
5.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC
TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS,
STATE AND LOCAL CODE.
6.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
7.) 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.
8.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow to lets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
9.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
10.) MANDATORY MEASURES FOR4OASTAL SIPZ: i
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
11.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
12.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
13.) A Geotechnical Report dated January 24, 2007 prepared by Stratum Groip was submitted
in conjunction with this application. The report addressed the stability of the geologic
hazard area. A setback of 40-feet shall be measured perpendicularly from the top or toe
of the geologic hazard to the proposed development.
14.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT A WRITTEN
LETTER FROM THE GEOLOGIST WHO PREPARED THE GEOTECHNICAL REPORT
DATED JANUARY 24, 2007 STATING THAT THE STRUCTURE AND/OR FACILITIES
HAVE BEEN CONSTRUCTED IN CONFORMANCE WITH THE REQUIREMENTS OF
THE "GEOTECHNICAL REPORT." THE LETTER SHALL BE STAMPED BY THE
LICENSED GEOLOGIST/ENGINEER.
15.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC) Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
16.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
17.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
18.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
19.) 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.
20.) 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.
• 40
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.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
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.) Minimum setback from Piper Road right-of-way and private ingress/egress easement
rights-of-ways shall be 20 feet. Minimum north and south property line setbacks shall be 5
feet. Minimum setback from stop of steep slope as identified on the geotechnical report
site plan shall be 40 feet. If an ESA is present, then the more stricter setbacks shall apply.
27.) 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.
28.) 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.
29.) The building height is not to exceed 35 feet.
30.) RESIDENCE SHALL MAINTAIN A 40 FOOT SETBACK FROM THE TOP OF THE
STEEP SHORELINE BLUFF SLOPE.
31.) NO DEBRIS SHALL BE PALCED ON THE TOP OF THE BLUFF OR ON THE STEEP
BLUFF SLOPE. THINNING AND TRIMMING OF TREES ON THE BLUFF SLOPE OR
WITHIN THE 40-FOOT SETBACK SHALL REQUIRE REVIEW AND APPROVEL BY THE
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT.
32.) STORMWATER RUNOFF SHALL BE ROUTED INTO DISPERSION TRENCHES TO
THE SOUTH AND NORTH OF THE BUILDING AREA. WATER SHOULD BE ABLE TO
REDILY INFILTRATE INTO THE GROUND AS THESE STIES.
33.) THE SEPTIC DRAINFIELD SHALL MAINTAIN AT LEAST A 40 FOOT SETBACK FROM
THE TOP OF THE STEEP SHORELINE BLUFF SLOPE.
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4'' JEFFERSON COUNTY
'. �; DEPARTMENT OF COMMUNITY DEVELOPMENT Jam' , U , i f''
`"' ' ''4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p www.co.jefferson.wa.us/commdevelopment
�`FIZNe�'
Master Permit Application MLA: OE ,
Project Descripn(include separate sheets as necessary):
Tax Parcel Property i 12 3 Number: a \ �� l G �Z Size: , (acre /square feel)
Site Address and/or Directionsir � to Property:
BIAS 1 4U►\ '�(.),, \l'' OV\-c 14Ot4 1 /C\q. '•C . it tcA t\e{totATc7Pt (5(
Property Owner(s)df Record: '3C c u.1-k r ; U.. r?,.
Telephone: i--k16 - 2,61'7- 313 Fax: ic(e--4Ort--4L email: l4--.3h b61?Car4r,lt.&..0-ric-
Mailing Address: 2.1 b 2`SA-- Pkv€. / Set-AM ke 1iP1 61 a 1(-2-
Applicant/Agent(if different from owner): bri.A.lCoS tau SOU-z ,--s-me.
Telephone: )1 1 - c 2S Fax: 3-1-i1 -1 2- - email:.g‘�tntrq e]ttl'U►viv�Siu�+ta�cv".
Mailing Address: 1 toi-1 `J;;Ci,..;`,e�1 ti-Cif.) pcirk -c t�n`�('.Mc-� , l,3« cl >l=
What kind of Permit?(Check each box that applies
❑Building ❑Variance(Minor, Major or Reasonable Economic Use)
O Demolition Permit 0 Conditional Use[C(a), C(d), or C]*"
0-Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
O Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)*"
O Commercial* 0 Boundary Line Adjustment
O Change of Use 0 Short Plat"
O Address ,-;.Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
l Propane 0 Planned Rural Residential Development(PRRD)/Amendments*"
0 Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ 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:
'f ems/ DESLGNATION OF AGENT
R"I hereby designate CNr✓, Jc Z-6\1 `1 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE L et Date: /(3/(, g,
By signing this application form,the er/agent attests that the information pr ided 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 access an ,right of entry will be assumed unless the applicant informs the County in writing at the
time of the aatio `• at he or she wants prior notice. -2Signature: `` ( `J�u,t Date: t 1 �O i3
The action or actions Applica - II undertake as a result of the issuance of th �ermj 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-tran bl sponsibility for adhering to and plyin 'th the ESA. The Applicant has read this disc) imer nd signs and dates it below.
Signature: '�.. Date: 1 ? 3O L
f:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
• •
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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 umi the responsibility of the a era/ ntractor for the proposed project.
Signature: ., Date: I(3/0 8
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: AN
3 + '
8
( ) ( 111V
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: .6 Shoreline: Type of Sewage Disposal:
New Wood Existing: ❑ Sewer
❑ Addition E Steel Proposed: Bank ❑ Community System
I Alteration/Remodel I Concrete Total: Height:_ ,/ Individual System
❑ Repair ❑ Masonry T SEP Permit# O6-0C Z(�
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: I Private well ❑ Two Party
Type f Heat: Proposed: —3— '` 1 Public
7� �'�aS Total: �1Qt '2 Name of System:
-RU(Ci'tt1)&( .(csAlu"^Clcc,
If this is a Commercial Project you must answer the following: nines-
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:
❑Underground Tank @g.Above ground Tank Size of Propane Tank: 250
❑Heat Stove 1 .Cook Stove 0 Woodstove ® Fireplace Insert lig Hot Water Tank 0 Pellet Stove 0 Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /61)
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. , ,h4a
1 loin.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: I-Zi-ir I EviS
2 Floor Heated ci LAY 1'z°X
I Consistency Review: 1-51, CC rTtc TD orbb
na I`� 15541,
��
r c,
Other Heated ' Base fee:
a51(0. 65 '78. `f� ("I (4)s
MezzanineSo ''
aa
Heated Basement (��(� 1 L'C OINAII Q x-Wr 361, /_
y�' j t .---_ Plan Check fee: 1 5lO_Qa ! . (�V Avis'C12
/`` "7"
0 2.,45
Unheated Basement p x State Surcharge fee: L .
.50
Other`Unhea d -d 41- f j2-zq of Water Review fee:
a q,5•aa
Garage/Carport 12,�j 1(,,1_i 1<-;, SUBTOTAL 4 b��' 47 I 51
Decks c- at 551. 11/Rd Approach fee: ` '
OD
Other 0 TOTAL: $ 5Lma�j`"� 1`'"7 3(F,.
Y� Receipt Number: 9 5 D 30
,)z iL- I I 1 (312o
tc I .1ccc Cash/Check Number:
33 ( I7 ttg3_
ESTIMATED COST(REQUIRED) �� Date: /�,�xi �� -ply
.Fair market value of all labor and material oundation to finishssh ��V L �'�Ci I G i
3Z �r✓� 0 e . .311
v `��ab Ini 'als: _.. �� _�
C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master permit Application 12-19-2006.doc
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RECEIVED
00
49 6 JEFFERSON COUNTY
otl 4 �, ;•4 DEPARTMENT OF COMMUNITY DEVELOPMENT JAN 3 0 008
:/ 621 Sheridan Street • Port Townsend •Washington 98368 FFE p� COUNTY nr'n
Q 360/379-4450 • 360/379-4451 Fax 4 �: °�,.
`��tINO� http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# DC6 '' 3� PROJECT/APPLICANT NAME: N /1o�� e>ld C►4C t/
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.
S'i32. R L , 4e1 S d
4. Describe the existing soils. Indicate soil type on the site map.
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5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable, and indicate acreage of each.
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6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
NA A ''4 f d See. STORMWgTFR PLAN
MAY - 9 2008
Stormw.-
stonnwater site plan template doc—rev.10/12/2003 Requir a M '1't���• ��,' JEFFERSONkUN g
f\�iy , . DEPT.OF
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JAN 3 0 200E
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlan ('t
steep slopes,etc.)on the site. Indicate location on the site map. 1r E► / � 11 U�
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.).
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.]
N /4
11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system.
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stormwater site plan template.doc—rev.10/12/2003 6
•
13. Describe the water quality system. RECEIVE
A JAN 3 0 2008
14. Describe the conveyance system analysis and design. JLRHSON COUNTY D CU
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
N 4
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
P
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site. ' Fla A, n, h ) 6 /N�/f�i�Gc� 604 't
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.
Nl14
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
N//
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.
11`IS
storrnwater site plan template.doc—rev.10/12/2003
•
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. /
See fririKri 8r1 5R,N CEIV -N D
3
2. Establish Construction Access. JAN O 2008
1.E::EA ON �OUNTYDCD
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
7. Protect Drain Inlets.
stormwater site plan template doc—rev.10/12/2003 8
• •
12 Required Elements-Construction SWPPP(continued) R [�'',jam CEivE1j
8. Stabilize Channels and Outlets. �l
JAN 3 0 2008
9. Control Pollutants. JEFFERSON COUNTY DCD
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).
f
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
4-0' Gam% lr ip/(ve7
Crn se-f4''e'ti`) 2itW oW ry ,. 1-
stormwater site plan template.doc—rev.10/12/2003 9
• •
RECEIVED
b. Description of special requirements for working in or near environmentally sensitive areas. J A N 3 O 2009
1-'A JEffffISON COUNTY DCD
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).
14/P
5. Construction Phasing.
a. Construction sequence
�� /� �✓�
?/ 6I, cloven")
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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.
r114-
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. ngineering 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.doc—rev.10/12/2003 10
111 •
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.
OWNER 0 ORIZED REPRESENTATIVE SIGNA EE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECEIVED
J AN 3 0 2008
RE % COUNTY DO
stormwater site plan template.doc—rev.10/12/2003 12
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fTt XXXX PIPER ROAD TAX PARCEL 701201012
p Z in QUILCENE, WASHINGTON 98368
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