HomeMy WebLinkAboutBLD2008-00134 MANUFACTURED/MOBILE HOME INSTALLATION LA TION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD08-00134 Received Date: 4/7/2008
SITE ADDRESS: 73 N PITTSBURG AVE Issue Date: 5/29/2008
PORT TOWNSEND, 98368
APPLICANT: JASCHA KOZELISKY
912 S JACOB MILLER RD
PORT TOWNSEND WA 983689253
SUBDIVISION: IRONDALE Block: 117 Lot: 10-11
PARCEL#: 962111704 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER
PROJECT DESCRIPTION: M/H (1983) &A/G 500 GAL PROP TANK
MAKE: FLEETWOOD YEAR: 1983 SIZE: 56X24
Directions SEE MAP IN FILE
To Site:
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 5/29/2009.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPL OUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTIN SLAB r PADS USED . S'_ 3c/d c
i
Stormwater FINAL Approval: a
Blocking/Plumbing:r4-- ?j7]t'
Propane Tank/Lines V— $''4`0,1. amtr-
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval: tt
Final/Skirting/Vents/Porches/Steps: S E E CohO\k-1 vr1 as (Pr f o r -cl r.0.�1 l- I
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY- SEE REVERSE
ILDING PERMIT APPLICA•N MR vi w00169
Type: l
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00134 Received Date: 4/7/2008
SITE ADDRESS: -13 N PITTSBURG AVE
OWNER: JASCHA KOZELISKY PHONE: 360-344-3269
912 S JACOB MILLER RD
PORT TOWNSEND WA 983689253
IRONDALE
SUBDIVISION: Block: 117 Lot: 10-11
PARCEL NUMBER: 962111704 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: JAIME KOZELISKY PHONE: (360) 385-3215
1112 S JACOB MILLER RD (360) 385-3215
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr M/H (1983) & A/G 500 GAL PROP TANK
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN: 1,344
CODE EDITION: 2006 ADD'L: HEAT TYPE: PRO
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3 Total 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Manufactured Homes $168.00 LYK 04/07/08 �,7135 APPROVED
Potable Water Application $59.00 LYK 04/07/08 9
7135
Total: $227.00
MAY 6q 2008
Jefferson County Plannin f
& Building Department
• •
SPECIAL CONDITIONS CASE # BLD08-00134
1.) DRYWELL DESIGN CRITERIA PER DOE 2005 STORMWATER MANUAL
ALL INFILTRATIONS SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY
STRUCTURE, PROPERTY LINE OR SENSITIVE AREA.
FOR SITES WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE
DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY
PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD.
DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH
GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS.
EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS
SURFACE FOR EITHER MEDIUM SANDS OR COARSE SANDS.
TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM)AND HAVE A
DEPTH OF 5 FEET ( 5 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER
MATERIAL).
FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK
AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING.
SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET.
2.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
3.) The application was reviewed by the Jefferson County Department of Community
Development staff on May 29, 2008 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:
SAPRA aquifer recharge area; coastal SIPZ.
4.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into tie 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.
5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
6.) Critical Aquifer Recharge Are•re defined as Seawater Intrusion Areas, *Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
7.) 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.
8.) 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.
9.) 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.
10.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
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.) The applicant is proposing to create or add 3262 square feet of impervious surface and
3644 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.
13.) 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.
14.) 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).
15.) The site plan as submitted with the manufactured home and building permit application on
April 7, 2008 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 May 29, 2008 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
16.) This approval is for installatiooa manufactured home, sunroom additional 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.
17.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
19.) 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.
20.) This parcel is within the Kala Point no shooting area per JCC 8.50.
21.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
22.) The road approach permit(RAP08-0033) 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.
23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
24.) Minimum setback from North Pittsburg Avenue right-of-way shall be 20 feet. Minimum
side and rear yard setbacks shall be 5 feet.
25.) 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.
26.) 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.
27.) The building height is not to exceed 35 feet.
28.) An address of 73 North Pittsburg Avenue, Port Townsend has been assigned to the
parcel. North Pittsburg Avenue is private (P490).
29.) The parcel is served by the Quimper public water system.
30.) A septic permit(SEP08-0041)was issued on May 16, 2008. A building permit
(BLD08-0136) for an attached garage and a sunroom addition (BLD08-0135)will be
issued with the manufactured home permit(BLD08-0134).
31.) The lot was created through the Irondale#5 Subdivision on April 2, 1910 under AFN
29795.
32.) A Declaration of Restrictive Covenant has been recorded on March 11, 2008 under AFN
532014 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.
JACK WESTERMAN• Jefferson IL Courthouse
ASSESSOR 1.0 no% 1220. Port"1'ewuwcnd, W.% 90368 -'
(360) 305-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS: J FFL1!J r altiV y
NAME: �o..Sc.i.kc.. k-o2C 1 :SJ--,
ADDRESS: 4)2 S, "—ZG,..�.v5 Lua'I1-es- VI) Pcz ;~ "76wv-, Se IA. a w14 i g3b8
PHONE NO. 2 8'5 - O D
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
I►MOBILE HOME DATA:
(A) MAKE Y Let 1..,''00 CS (B) MODEL &rs J (C►YEAR C‘...
(D) LENGTH S CP (E) WIDTH 2 / (F)SERIAL #
r-.
(G) YOUR PURCHASE PRICE (Do not include sales tax) `r'•C' £- PURCHASE DATE
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 30
(A) FROM WHOM DID YOU PURCHASE MOBILE 0 ; 1 kvx,i> e I Lr
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes
If Yes, Previous address of mobile._
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B) IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Spare#
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER: -- (k3Ci- t o7,2.t:'S eci LOCATION ADDRESS `E‘. ' 5._ uA-- J /--ot_ p �-�-
V /6,0 S.
REAL PROPERTY PARCEL #/DESCRIPTION g"Z /11 ?4,`l/ 9`72- /11 7 ) I&2 ///705-
a
Signature o applican
THANK YOU FOR YOUR HELP!
-.bAf3 01)S1-e -Q 1
JOD4 COSSELL, Properly Technician
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JEFFERSON�NTY4111
ft
4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
l'S, NO,�O www.co.jefferson.wa.us/comt#idaVbtOpment -=f
Master Permit Application MLA: , I
Project Description (inc id- separate sheets as necessary): �P
IA
Tax Parcel C'i /. ... I. Tir .. t�0 .s.. Ail�•r -"
Number: )�? �I� �C �j (4.P t r ` Property / C�
t J Size: l Vd`[`O0
Site Address and/or Directions to Property: (acres/square feet)
N 04-kLus • Aug
Property Owner(s)of Record: .�._ CL� -
Telephone: 0 ' r
Fax: email: $Cj-•c�GCcz r
Mailing Address: F • tencL.t
•t wvt vk ' •
1�°Lc.
Applicant different from owner): -S ;,,.` ' k ° ,
Telephone:__R�_ "�2 �— Fax: S., ---�
Mailing Address: 1 G. ` J emai
What kind of Permit?(Check each box that applies D.
L�
Building
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Sin le Family0 Conditional Use[C(a), C(d),or CI**
g ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial*
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Binding Site Plan**
❑ Home Business ❑Cottagelndustry--
Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Allowed
Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication*
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*Ma r•.uire a Pre-A..lication Conference ❑ Tree Vegetaion Request
Please identify any other local, state or federal permits required for this aproposal, if known:
I hereby designate,. �.,�, • kite_ j DESIGNATION OF AGENT
/ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE i
AAINi _-_y Date: li By signing this application form,th owner/.T t 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' spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that for•iil- wa?prior notice.
Signature: 40
r Date:
The action or actions Applicant will t.ertake 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 no violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding
action(s)even if you are in c• pli.. -with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable respi'ibili f. ad II g to and complying with the ESA. The Applicant has read this disclaimer and signs dates it below.
Signature: " .A
Date: 2—S'-�
4
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 tt a,spRn ibility of the General Contractor for the proposed project.
f �`' +:0't/— n—r—0$ Date:
Signature: I f'
GENERAL CONTRAC" PHONE: Fes'tOR OR MANUFACTURED HOME INSTALLER: ���) 4; (34.0) Ju�¢S Z j
11..cI7 O 3&— '
-� EMAIL: J c c L-c Z e- /4
.4._v_N •'cc'
MAILINGG ADDRESS: WAINS
CONTRACTOR'S LICENSE NUMBER
NUMBER: PHONE ( ) Fes' ( )
ARCHITECT/ENGINEER: EMAIL
MAILING ADDRESS: Shoreline: Type of Sewage Disposal:
Project Type: Frame Type: Bathrooms:
Wood Existing: ❑ Sewer
o New 0 Steel Proposed: 2 Bank ❑ Community System
❑ Addition Total: 2 Height: Individual System
❑ Alteration/Remodel ❑ Concrete SEP Permit#
0 Repair ❑ Masonry❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
'3 'Public
Type of Heat: Proposed:Total: 3 Name of System: C20 D -1
1.5:
If this is a Commercial Project you must answer the following:
Proposed: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: p Proposed
Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Service? Yes / No
IBC Occupancy: IBC Type of construction:
If this is a Pro•ane Tank • I ., A'pliance Installation permit,mark all items below that apply:
i Underground Tank I Above ground Tan; Size of Propane Tank: SDK •—
i Heat Stove i Cook . - i c C
eve i Fireplace Insert i Hot Water Tank i Pellet Stove -dap i r
5 ,
Is this appliance bein installed in a Manufactured/Mobile Home? Yes /QD A A, � �
t
k you must also submit a site
an showing all of the
,all property
When applying for and install a frompropane
tpro propane tank to all property lines,l buildings and septic system csomponents,
lines, tank location and size, distances from the p p
including the reserve area.
Amount Revision;
Square Footage I Current Proposed For,Office Use Only
EH Bld App Review: u,)
Main Floor Heated I-,c4 t,/ 110,
2nd Floor Heated Consistency Review: 5. OD
•
Other Heated _ Base fee: I , 8 •
03
O
•
Additional Section:
Mezzanine
Heated Basement
Plan Check fee: ----------
Unheated Basement
State Surcharge fee:
Other Unheated Pot Water Review fee: CO• CD
4 �
Garage/Carport SUBTOTAL q
Decks 911/', Approach fee:
Other
TOTAL: $ L ,'
Receipt Number: q1135
Cash/Check Number: IO2
ESTIMATED COST(REQUIRED) Date: �t
.Fair market value of all labor and materials foundation to finish Initials: t
GAPermitcenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-20O6.doc
•
•
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5 4 . ON c°� JEFFERSON COUNTYj_ ,
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368 4e fi fi,��l� � 1 ��I)
�y��,_ O 360/379-4450 • 360/379-4451 Fax
"ENO http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# U v .- I 0 PROJECT/APPLICANT NAME: ScL,c, ho2-e ('s5, 41
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 the site. Indicate position and relative size of proposed improvements on the
site map.
(o S(Jt Z $ 1CST, MA4 v.--A-'N 2-`1)( 2C ITT e ?on H 3t ,caow...
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
3. Describe the existing vegetation. Indicate Rtive vegeta on areas on the site map. ,
we-e. 'S A tow z-vim S Qk^A A a Co(ve L, ,-rets
4. Describe the existing soils. Indicate soil type on the site map.
SrAn-1. Li 0av-1
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
9 p ep ct separate drainage basins on the site map, if
applicable,and indicate acreage of each.Ceekt a-r 140 16 S no 1.„_e_I-Cc C_,--, 1 a i S%, 1
��
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
�� , ;STORMWATER PLAN
MAY 2 9 200R
Stormwater BM'lD
Required ''I W.��I� JEEP 'S•it
� SUN
DEPT.OFC�, �Jl� � EVE.► EN stormwater site plan template-rev.10/1/2003 III
SIGNATURE: .
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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 map.
Cam, 2 S 094 Sow 4A- ✓10 S S fr=' �-t..4Leme,g3
8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas
(streams,we ands,lakes,st ep slopes,etc.).
cn - - o E — A 1 ouSE 4-0 6--C- as.
1 - k \ t tin v-€,.
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 andc�differentiate propos d facilities from existing facilities.
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.]
11. Describe the performance goals and standards applicable to the project.
12. Describe the flow control system:
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13. Describe the water quality system. � si�(— '11
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14. Describe the conveyance system analysis and design.
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here. /^
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.
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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.
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2. Establish Construction Access.
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3. Control Flow Rates.
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4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
7. Protect Drain Inlets.
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stormwater site plan template-rev.10/1/2003 8
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12 Required Elements—Construction SWPPP(continues) Ti ` �_.1,q
8. Stabilize Channels and Outlets.
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9. Control Pollutants. i►"•L�� t' 1 ! j;�l., ,{ i; 1
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.
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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).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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b. Description of 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, erm ability,depth,texture,soil structure). �^�,
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5. Construction Phasing.
a. Construction sequetice (1
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed constructse n 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.
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.10/1/2003 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 pr erty.
(LANDOWN OR AUTHOR D REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/1/2003 12
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