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HomeMy WebLinkAboutBLD2008-00118 • BUILDING PERMIT APPLIC ION ML vy 156 Review T Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00118 Received Date: 3/28/2008 SITE ADDRESS: 3291 PARADISE BAY RD PORT LUDLOW, 98365 OWNER: GARY L OSTERHOUT PHONE: BARBARA K OSTERHOUT 1930 8TH AVE W APT 1 SEATTLE WA 981195804 PARADISE VIEW ESTATES SUBDIVISION: Block: A Lot: 15 PARCEL NUMBER: 984000114 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: JEREMY VANCE INC PHONE: 360-385-2560 46 VILLAGE WAY PMB 162 PORT LUDLOW WA 98365 Contractor's License JEREMVI001C4 Expires 10/28/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NEW GARAGE - NO HEAT - NO PLUMBING i llf ;x t TYPE OF WORK GAR SQUARE FOOTAGE. eauLalL TYPE OF IMP NEW MAIN: VALUATION 30,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: r SHORELINE: CONST TYPE: +�'� SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: 313/O3 5. Type Amount Paid By: Date: Receipt: Approved/Date Permit $441.75 CJZ 03/28/08 97204 APPROVED Plan Check $287.14 CJZ 03/28/08 97204 State Building Code $4.50 CJZ 03/28/08 97204 MAYS( 200 Total: $733.39 Jefferson County Planning &Building Department Jefferson County Building Di sion Permit Nu•: BLD08-00118 Applicant: OSTERHOUT . \ i BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Ruiidi, ;,',odes 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 b/s/og w,TN GauIv/trois DA11n 6/5/08 Erosion Control „ #4 Refer to Conditions I &2 . //1A,I Post Holes N/A Foundation Footing 19/ 4I5/0 Q/ GIFFEI-fusT,Stt&b 4/s/OB 8 14 dX. 14,KN AONcUIONS LASOgY Footing Drains Foundation Stem Wall G/9kg Q/ Dk Underground Plumbing N/b Straps(hold downs) iiir . lo13D1 efs Ext. Shear Wall Nailing ib/zlta& Rough-in Plumbing ,./..),/Za Framing bigelcig Blocking !a/3%8 tbli/ Wallboard Nailing Drywell/Alt Drainage /i4/i # Refer to condition 3 OK 2 Address Posted / 1 }� 141 nr lam- k G FINAL INSPECTION f j . .) / K 4', -?‘„,.. 1 /IV FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR CONDITIONS for Building Permit# :BLD08-00118 • 1.) A CONSTRUCTION ENTRANCE PER BMP C105 OF THE STORMWATER MANAGEMENT MANUAL FOR WESTERN WASHINGTON SHALL BE ESTABLISHED AND MAINTAINED TO REDUCE SEDIMENT TRANSPORT ONTO PAVED ROADS. 2.) A SILT FENCE PER BMP C233 OR STRAW BALE BARRIER PER BMP C230 SHALL BE INSTALLED PER THE STORMWATER MANAGEMENT MANUAL FOR WESTERN WASHINGON TO REDUCE THE TRANSPORT OF COARSE SEDIMENT FROM THE CONSTRUCTION SITE. 3.) A 10 FT X 2 FT WIDE, MINIMUM 18 INCHES DEEP DISPERSION TRENCH, DESIGNED PER THE DESIGN CRITERIA OF VOLUME III OF THE STORMWATER MANAGEMENT MANUAL FOR WESTERN WASHINGTON, WHALL BE INSTALLED. A 5 FOOT SETBACK SHOULD BE MAINTAINED BETWEEN ANY EDGE OF THE TRENCH AND ANY STRUCTURE OR PROPERTY LINE. 4.) BARRIERS ARE REQUIRED PRIOR TO FINAL OF THE BUILDING PERMIT ALONG EDGE OF RESERVE DRAINFIELD AREA NO MORE THAN 8' FROM THE EDGE OF THE GARAGE EXTENDING FROM THE GARAGE TO THE WEST PROPERTY LINE NEAR PARADISE BAY RD. 5.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND EDGE OF RESERVE AREA. 6.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE. 7.) NO PLUMBING HAS BEEN REVIEWED OR APPROVED =OR THIS PROJECT BY JEFFERSON COUNTY PUBLIC HEALTH. ADDITIONAL REQUIREMENTS MAY APPLY IF PLUMBING IS PROPOSED. 8.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. 9.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 10.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through #12 of the Department of Ecology's Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 11.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) 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 or 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. 14.) A minimum of two (2) on-site parking spaces shall be provided for the single amily residence. 15.) Setback from Paradise Bay Rd right-of-way is no less than 20 ft, side adjacent property setbacks are no less than 5 ft, rear shoreline setback is 56 feet or one foot back for each foot in bluff height as measured from the top of the bluff. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 16.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 17.) 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. 18.) The building height is not to exceed 35 feet. 19.) 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. 20.) Pre-existing legal lots of record less than one acre in size in rural residential districts are subject to the stormwater requirements in Chapter 18.30 JCC and must meet the "Area of Impervious Surface Coverage"to the maximum extent practicable as determined by the administrator. Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 21.) The development will be serviced by public water and a well will not be utilized. If a well is required for potable water the applicant shall meet all of the Aquifer Recharge and SIPZ conditions. 09/23/2007 05:09 206-242-0824 PATTEN AIA PAGE 01 Mar 10 OB 11 : 11a 41Jeremy 34 79 1121 P. 1 '� Or• � JEFFERSON COUNTY t 3 r3` DEPARTMENT OF COMMUNITY DEVELOPMENT '' ` `` "41 821 Sheridan Street . Port Townsend •Washington 98368 360/379-4450. 360/379-4451,Fax %r. Nasc5 www.co.jefferson.wa,us/commdevelopme�nt t Master Permit Application MLA: Project Description(include separate ylets as necessa ry) (_ *) , Tax Parcel c-r r�`� �1 Number: O 00 0 1 ( Li • Properly _ Size:ize: 1't (acre square fsety Site Address and/or Directions to Prope "3 r -Z 91 P��� cc__ R- ��,• /CSC-C2,.S. J�o. (��.� & sS Y i,) s� , Property Owner(s)of Record: u.c{ (� (.1�(-�e •..rc� (.)s_ 1� / G'>� � 4 Telephone: Fax, Mailing Address: l5 ,C) -- !n/f. W -4 t 4 � email: Applicant/Agent(If different from owner): j c �,c .. , Se �� .�c` 9 fC l 11, - 5S 0'`I Telephone: :_6 C 3 E'S ��Go � ��t'—' Fax 3 3 79 t 1-1-f email: Mailing Address: & V. IIc- ((JP ort' Z.t,etrow (.a)r~ e3 ,S What kind of Permit?(Check each box that applies (litSutlding ❑Variance(Minor,Major or Reasonable Economic Use) O Demolition Permit DI Conditional Use[C(a),C(d),or C]" O Single Family liCLGarag Attache( i• 0 Discretionary"D"or Unnamed Use Classification D Manufactured Home 0 Modu r CI Special Use(Essential Public Facilities)'• D Commercial* 0 Boundary Line Adjustment 0 Change of Use ❑Short Plat" 0 Address 0 Road Approach O Binding Site Plan"• ❑Home Business 0 Cottagelndustry ❑Long Plat" ❑Propane ❑Planned Rural Residential Development(PRRD)lgmendmente ❑Sign 0 Plat Vacation/Alteration"O Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions O Stormwater Management CJ Shoreline Management Substantial Development"' O Slte Plan Approval Advance Determination(SPAAD)• ❑Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium •Ma ulry a Pre_ lrcatinn Conference � Tree Vegetalon Request _Ra ulres a Pr+e-A lication Conference Please identify any other local,state or federal pe its required for this proposal, If known: I hereb to r`'m DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ' tO . D _ Date; (! By signing this application form.I owner/agent attests that the Information provided herein,and in any attachments,ie 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 Ilanikties.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 en to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required r inspections tr ac ss and right of entry will be assumed unless the applicant informs the County in writing at the plrcatio h he or she wan Signature: ' / f O Dale: -omen or actions ncent will undertake as a result of the Issuance of this perm may negatively Impact upon one or more threatened pr endangered Species and could lead to a potential"take'of an endangered species as hose terms are defined in the federal law known as the "Endangered Species Act"or'ESA.'Jefferson County makes no assurances to the a permit has been issued wilt not violate the ESA. Any individual,group or agency can filar a lawsuit on behalf of an andan cant that the actions that%vitt be u red species because this actlen(s)even If you are in co . :rice with the Jeff tot County development code.The Applicant acknowledges that he,she oholds repair/Ina individual W arable respo1• .I for adhering t. : o, ii Signature i ' �i, h the ESA. The Applicant has read this dlscf rend signs an d h below, .�, Lam,_, ----, Date: �r I 6. t� c;;VermitanrcAMV#FORmStt##\DAD FORD fs\N,,ocer 1'cmnt rlpplirytion 12-19-2pp6.doe ��` BUILDER STATEMENT The signer of this statement does hereby ceitiythat they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility-ofthe General Contractor for the proposed project. Signature: `- Date: _ 5 C GENERAL CONTRACTOR OR M�NUFACTURED HOME INSTALLER: PHONE: FAX: ec-e.ti. VOn�� Sic (36O) 3 S �sCd (� a wl G�) ( t� MAILING ADDRESS! 116 V,• 1 1(.l (.,-)C-:,, EMAIL: v✓y,``_e_ "rt 0 01 y`yl,„,.:,.. .1 e }-" CONTRACTOR'S LICENSE ( "11I3 i.C-1- Y ,-{ L..c/0v� L1 ct y3(:7 - WAINS dr NUMBER: NUMBER ARCHITECT/ENGINEER: tj t(f-`� - vi PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New [Wood Existing: ❑ Sewer Ca Addition ❑ Steel Proposed: f\ Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: o Hei ht:, GI-Individual System ❑ Repair ❑ Masonry b O SEP Permit# VI- I b-) ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: .-GI-Public (� c)n'C Total: 0_ ( Se Name of System: rii�v'c \-e(0-7 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 U• nderground Tank I Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: S -1 Other Heated Base tee: �.I rl S Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: i Other Unheated Pot Water Review fee: Jul Garage/Carport 1 ?I—O / i ` SUBTOTAL /r ;} Decks / 911/Rd Approach fee: N - -. Other TOTAL: $ _ Receipt Number: " a.o"1- d Cash/Check Number: 1 zkc,k^y ESTIMATED COST(REQUIRED) Date: �/ l� U� •Fair market value of all labor an materials foundation to finish ' ;t A D'a� o 2o�Q J ( ICJ d o a o ll�rli{ O 8 i / l G:\PermitCenter\###FORMS###DRD-FORMS\Master Permit Application 12-19-2000.doc ��7 - . 1.._,1 r, il - ,245 1.... .0 11 3,-0 SP 10 ./1 ' - te)1 A rL. 1 tk; c I -i PP . - si If PC .\ ° \ ! f\ \) i/V\L 1 isa • .P.! • 4 1 0 it , Lir i. 1 _e , - act I or , r ,_ ,, t 4 . OkIVI 19F P . j. I 414 : k)MAR 2 8 2008 - , k, II 13 I kit ( . 1 ' 1 i %.) 1 i - , ( ! '7/ =-13 , k 1 , ! 1__ ___ ___ ____ _. __ __ ___1__ I { • — ___._... __._. L Vi rgr, 14 1 1 !i III • (-_-4.--o/vco %, JEFFERSON COUNTY - 4404,3 DEPARTMENT OF COMMUNITY DEVELOPMENT r` i' b ,2 g 2OQu \\,....„_ 621 Sheridan Street • Port Townsend •Washington 98368 O<O7 360/379-4450 • 360/379-4451 Fax m%itiN http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# L/% - VVJ V3 PROJECT/APPLICANT NAME: C5 itCT 0 1/4.,l V C.)r';..c e- �J i 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 th te. ndi a osition a relativ si a of roposed improvements on the site map. 22t(2,Z, Cam` i-�.r+ Cons c -rc--i ore e)c1 's VI'1 Existing Conditions Summary 2. Describe the existingtopography. Indicate contours n the si a map. ttC1 'l ct: hI- - lop -- Li;, �- - 1-1,„. •� s �; 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe th(�J existing soils. Indicate soil type on the site map. ,,.ISO,-,^ti' 1UCLA\, Grc;_iiRI Scr•c,�C7 ( GC"✓n 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. �- 1t '�.L-a c7 ( r ,kf-.r;�! pc.s4 ti (vPc APPRO,VED 6. Describe any excess levels of noise generated by the proposed use or activitl: STORMVATER PLAN MAY 2 , ate • JEFFERSON CO DEPT.OF D stormwater site plan template—rev.10/1/2003 SIGNATURE:C017722, �� 5 • 0 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes e p.)on the site. Indicate I cation on the site.map. 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (streams,wetland lakes,sleep slopes,etc.). IVE c-1_ U-� pfup L A J t , . r s(cpe 4..A. ji 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. 9. 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 differ ntiate proposed facilities from existing facilities. 5.7h)r✓"� w c� r- cc•'"N U S-t r i " t i; Ld r i . It.,.. er 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 norm�allly for large"projects or projects that involve th pot tial for dispersion of contaminants.] V ✓ :6 'r—."T" / e_dc 11. Describe the performance goals any sta dards applicable to the gLect. US3 r� S wkl p, Urzr . Lc r L „ s; ib e (Vt r,,, Z--' Q)LCo-vC..&s 01 12. Describe the flow contr system. , t .:.}; stormwater site plan template-rev.10✓1/2003 -• 6 13. Describe the water qualitysystem. Co ) Q o.'\ S e. ' Lk,, [ 6_t; c r'-e U J(, 1 CS e.<-, c (1.'7 e_ro 54, 4 -- C e."- E.()1 k Of' in t- cAe---Ve\-t 4 A x. LDS Sc- 14. Describe the convey ancystem analysis and design. � ` �p„ .� t s � r. w��� -c AS �� � lt0 l80 15. Describe the source of fill mpterial,physical characteristics of fill material,-and deposition of excess material. A p C- c9 r c )--C-� s 1 c---1-. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. VA- 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the si e. i'vt j fN 1 rt.e .o,A Ai ( rt„,----(t - L. i cA.,7 , Fi-,r1,-5 5- CA/ .e' \ 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,l1 .--. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 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.S _ f/� �'f�c �'i /emu`. ekte ! . l)c 1�. ln..� r✓‘ c) F- r e_c c rv--t.. cep- 7`1- o f fi -Z stormwater site plan template—rev.10/1/200,3 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. fV cs:_\t��"•�'` V 2. Establish Construction Access. CA — 572.,3/0 s 3. Control Flow Rates. l . t � 4. Install Sediment Controls. 5. Stabilize Soils. Ark- 6. Protect Slopes. 7. Protect Drain Inlets. stormwater site plan template—rev.10/1/2003 8 0 • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 3 e „. CO r\ .-6-.\r---c,( air-i Lo-,..i . c,„( CX A,(.�i .6. \N.-JI 10. Control De-Vya ring(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices( MPs) I i- t.k..r. 1\ c `e�41 A{ 1 �(1 V S. 0 t'� Cyr S u 'e•- v."s. ;c^'- c -4 �4( L MA F t. 12. Mana a the Project. (i,1 ate s j Vc.4-•c.t. -Ze^c 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). At V .0 At S-'-tv rta k.-t. b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). \ % CJ i V'i-'T C9 k/'c 1 e o—L C 3. Environmentally Sensitive Areas. a. Rescriptipn of environmentally sensitive area that are o or adjacent to t site. ��k A t,- Q� U.. rv�-4./-- ;, , 2 stormwater site plan template—rev.10/1/2003 9 • • b. Description/0 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). 5. Construction Phasing. a. Construction sequence 1 cc fNs � C-`�zk 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 pr posed construction chedule. � - -6 _ i 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. 6 Cr b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. rf cC`� 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. ik%r c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/1/2003 10 • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 3 3,.(LANDOWNER AUTFjQLED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: MAR 2 8 2008 12 stormwater site plan template—rev.10/1/2003 \0. z AV- , . *FS ,e5:e-riVi .0Q. ko 0 Cowes � 4-e_+ \0" T'd1 S e A f_ro r S rM Lf. Q/hr i�D ti Cl/ .....) S�o,....\&. L't 0 r e...2.-1/4- 0 _ ?v?Ose.c . snow 6..r-ry c r-- S g4 $ ' ^ p ca po sect s a\w 0..,*- .1- cA� e.r. -cr-s 4�� 10 \ O 4r � APPROVED ' X- SITE PLAN ° �' _______ cv ded.% • MAY 2 1 2008 JEFFERSON COUNTYSY troc" "et ® DEPT.OF COM NITY D Op E ` © lI IGNATURE: �` `4 /.. i , n ::r .)7410$._ ' .y Y' y 1 `1 ' �`('�.. X ! MAY 20 2008 rY > 1 et-TAiY t rFP.. ,Ty�:£'vELopi ENT 1 9✓ 4P-*/ l''S J > , 41 4‘.. - 9 .,..iti s ' ° , 411 'Z , z yb \ 13 Cn� � N / � � 3ow '` ^• .. CT,�� - ,. a U c' mnil PH -< y Ax d6 p �et 1033v 33 � HO . 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