HomeMy WebLinkAboutBLD2008-00328 • •
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD08-00328
SITE ADDRESS: 543 SILENT LAKE RD Issue Date: 08/28/2008
QUILCENE, 98376 Final Date: 5/21/2009
APPLICANT: MARK A ANDERSON PHONE: (425) 277-8915
KAREN A ANDERSON
PO BOX 65019
PORT LUDLOW WA 98365-0019
SUBDIVISION: SILENT LAKE LARGE LOT Block: Lot: 3
PARCEL NUMBER: 701355003 Section: 35 Township: 27 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE/WORKSHOP W/BATHROOM
ALSO A/G 120 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 now
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/21/2009
I:\F_BLD_Occupancy.rpt 10/29/19
WILDING PERMIT APPLICAT N MLA08-00355
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00328 Received Date: 7/23/2008
SITE ADDRESS: 543 SILENT LAKE RD
QUILCENE, 98376
OWNER: MARK A ANDERSON PHONE: (425)277-8915
KAREN A ANDERSON
12716 SE 189TH PL
RENTON WA 98058-7961 SILENT LAKE LARGE LOT
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 701355003 Section: 35 Township: 27 N Range: 01 W
CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156
260 KALA POINT DR
PORT TOWNSEND WA 98368
Contractor's License KELLES1150LF Expires 6/6/2009
REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156
DENNIS KELLEY (360) 385-3115
260 KALA POINT DR
PROJECT DESCRIPTIOr NEW SFR W/ATTACHED GARAGE/WORKSHOP W/BATHROOM
ALSO A/G 120 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,295
VALUATION 258,902.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 1,322 SETBACK:
DECK: 204 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 1 Prop: 3
Total: 1 Total: 3
Routing Date:
�Iaa log®_
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $1,884.15 KAS 07/23/08 100580 APPROVED
Plan Check $1,224.70 KAS 07/23/08 100580
State Building Code $4.50 KAS 07/23/08 100580 AUG 2 2008
Total: $3,113.35
Jefferson County Planning
&Building Department
Jefferson County Building Dion Permit Num.: BLD08-00328
Applicant: ANDERSON
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks /
Erosion Control
Foundation Footing 06/663
ks-neuz_40 1/6A3OV
Footing Drains ..; i' "
� f I
v‘lr•-.ON PIPS
Foundation Stem Wall f ff, /i)A Q�
Under Floor Framing (jiigJ
Straps(hold downs) / C
Ext. Shear Wall Nailing itt3/0a fkl
Rough-in Plumbing WI)?
a,tn.. 1ot- 114--A‘
Framing /4'49
r Blocking
/6/9
Airseal 1t O 9 9
Insulation: Walls _ 1 L 09
Insulation: Floors
Insulation: Ceiling i I1 'O1 F 1 i C. ;1 , ✓
Int. Shear Wall Nailing 1/2_,,/ i / '
Wallboard Nailing t�zu/U 9
Gas Line: Interior ///'9
(4/
Gas Line: Exterior
t Propane Tank
Heat/Chimney Clearance /////9
Drywell/Alt Drainage
Address Posted Sr l
FINAL INSPECTION SID qr
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD08-00328
1.) PRIOR TO OCCUPANCY& BUILDING FINAL - FINAL APPROVAL OF SEPTIC
SEP03-132 IS REQUIRED. THIS STRUCTURE ACCOUNTS FOR 240 GPD (2
BEDROOMS) OF SEPTIC CAPACTIY. MUST MEET ALL CONDITIONS OF SEPTIC
PERMIT.
2.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND
EDGE OF SEPTIC TANK AND PUMP CHAMBER.
3.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC
TANK, RESERVE & DRAINFIELD.
4.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
5.) Minimum setback from Silent Lake Road right-of-way shall be 20 feet. Minimum setback
from the commercial forest lands shall be 250 feet. Minimum setback from Silent Lake
Shoreline shall be 100 feet. Minimum south property line setback shall be 5 feet.
Minimum north property line setback shall be 30 feet due to the 15 foot wildlife corridor
and 15 foot drainage easement as depicted on the recorded plat.
The site plan as submitted meets the minimum setbacks.
6.) A Stormwater 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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
9.) A septic permit (SEP03-0132)was issued on July 17, 2003. A well review(USR04-0047)
was finaled on August 30, 2007. A building permit(BLD07-00469)was withdrawn June
17, 2008.
10.) On Lots 1-12, in the area extending 35 feet back form the Silent Lake shoreline and the
upland boundary of its contiguous wetlands, native vegetation (including submerged logs)
shall be maintained, except that a trail to the lake shore no more than 6 feet wide and a
landing area no more than 10 feet wide formed or constructed from natural materials and
extending no more than 5 feet into the lake shall be allowed; understory vegetation may
be trimmed down to a height of 6 feet: a minimum of 75% of the trees representative of
the size and species composition of the stand and all snags and all trees larger than 21"
diameter at breast height (DBH) shall be maintained, except that all retained trees ay be
limbed up to provide views.
11.) On Lots 1-6 the minimum building setback shall be 100 feet from the shoreline or the
upland boundary of its contiguous wetland.
12.) On each lot outside of the area cleared for a homesite, a minimum of 50% of the trees
representative of the size and species composition of the stand, including all snags and all
trees 21" DBH shall be retained, except that all retained trees may be limbed up to provide
views.
13.) An area 30 feet wide (15 feet on side of lot lines) between Lots 1 and 2 mots 2
and 3 shall be maintained in natural vegetation and existing trees to serve as a wildlife
corridor between Silent Lake and adjacent state forest lands.
14.) The building height is not to exceed 35 feet.
15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
16.) 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.
17.) 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.
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 automobile 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 requirements 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.
-
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oN cow JEFFERSON UNrti
TY
0,i, 1l ��Jt_� �. ii. 11 'I
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 FaxJ�lL 2 3 2008
1 G,tO/ www.co.jefferson.wa.us/commdevelopment
Master Permit Application JEf fEg �;
MLA:
Project Description(include separate sheets as necessary):
'Nt `3i1ielLe: vt it".; (Ze3-t ptr�GC w /r'f/Achec/
Tax Parcel �'P'9/ne
Number: 10 1 345 P D.. Property S.}
Size: �Q S fa :"J quare feet)
Site Address and/or Directions to Property:
S4 S1i.tl -r-- (..k.e.e• a.)ic,ce,-.)...0 e i ,A 98374,
Property Owner(s)of Record: )„R pi2t )60. ) y-a
Telephone: 42S - 277 — $ij t S Fax: email:
Mailing Address: al i to SC'. 1 EAR -Li, pL. 2EJmM i.,l oer c 0 s 6
Applicant/Agent(if different from owner): ie-ea"c.e.AT 's,ii/e 5 r l i-L.
Telephone: 'I'i b v - •,*S 5. 1/ $Lr Fax: VA, - 16 5--Poi i S email:
Mailing Address: ZLLC? 14 i .0 isi r, bit • Pr filar
What kind of Permit?(Check each box that applies
[wilding 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
Sf Single Family JIB Garage Attache' 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 0 Road Approach ❑ Binding Site Plan**
❑Home Business 0 Cottagelndustry 0 Long Plat**
Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ 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
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑ 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 Ve.-1--41 Ste,(-t 'S lNr• to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE "....)1\.4.0.4.____L%—.9.....4..A..—___— Date: 7"L -- 'Zs r C'
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he r she w prior otice.
Signature. Date: —2—Z-. -- e-ejo r , -
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-transferable respons. ility for a hering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature:
Date: 7- 2. S - 24" �'
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
h . • •
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 Genera or or the proposed project.
Signature:
Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:
PHONE: FAX:
c`( S+iez-P5 )NL. (36c+ ) 385R-t1 SC. (3(.4) 3S5-3)1
MAILING ADDRESS: )4.44 (4 - Pit
'PrEMAIL: ' -
Z(�0
CONTRACTOR'S LICENSE WAINS
NUMBER: 41.4ES I 1 5zz,L.c NUMBER
ARCHITECT/ENGINEER: sST/0 Ayr)Vtat,64.�" " PHONE
wt 11'YI 'r (17 60 ) 3 "67 3cS ( )
MAILING ADDRESS:
EMAIL
Project Type: Frame Type: Bathrooms:
Wood Existing: Shoreline: Type of Sewage Disposal
KNew '$
0 Addition 0 Steel Proposed: 2'f Z Bank 0 Sewer
0 Community
0 Alteration/Remodel 0 Concrete Total: Zt z.- Height: System
❑ Repair 0 Mason g Individual System
❑ Demolition Masonry Bedrooms: SEP Permit# 63-Qpl 3 Z.Other:
Existing: Water Supply:
Type of Heat: Proposed: Setback: .Private well 0 Two Party
p �— 0 Public
yF�'r 4.M� Total: if
Q./cc/R/
Name of System:
If th re/cc/R/0
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
IBC Occupancy: Propose , . ,
P cy: IBC Type of construction: (, ;( g
If this is a Propane Tank a . .r A.•liance Installation .ermit mark all items elow that ayou have Food Servi �1e�r ><Alt1�:_
t.rp
i Under.round Tank . •bove ground Tank
Size of Propane Tank: t 20
i -eat Stov- - Cook ove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other JUL 2 3 2008
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 I .
lines, tank location and size, distances from the propane tank to all property lines, buildings and se4�� ,.'�,'
including the reserve area.
Square FootageI Aa7`: ` .r r, z rt k �q Current Proposed f ri fide i „e `fl i � % i ; �' rt x: .
Main Floor Heated 4a4 EH B Review: ;. �.n '" la... A.
I ?��
Z,ZQ Id App
r ,o1 `70•t
2"°Floor Heated ���.
f , ,4 Consistency Review:
Other Heated . '4`' I` i!57. CD
k r: Base fee:
Mezzanine irz; ,
T
_ k� st Additional Section:
Heated Basement iY — I—'' -'
,; ` Plan Check fee: la a.�F, 7
Unheated Basement 5
',`,"!,, ,:it',,,',.,, State Surcharge fee:
Other Unheated * v ' Pot Water Review fee: Prt)V$-.v.u..4 Dv
,�
Garage/Carport `' " i, `' 43LD0-7- 6C(
( 3 22 SUBTOTAL
Decks �.t
' �--r0 33/40.n5
911/Rd Approach fee:
Other Co✓2R LC /� . p ��
/� Z * TOTAL: $53 0:55 4-i r
s Receipt Number: 1 DC55O
1:44;4: ' , Cash/Check Number:
• } l
ESTIMATED COST(REQUIRED) ICI Date:
'ae.Fair market value of all labor and material u ation to finish is%
ra I ba• t f In ials: -
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application I2-19-2006.doc
♦ •
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N co, JEFFERSON COUNTYRECErviED
al �� ,'. DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
�xq�, O 360/379-4450 • 360/379-4451 Fax g L 2 3 200
http://winrw.co.jefferson.wa.us/commdevelopment/ 4iiikkiiiSTORMWATER SITE PLAN SUBMITTAL DCD
MLA# O- 355 PROJECT/APPLICANT NAME: Apt I)e'R-
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 chotlse 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.
. . 'fit .. W►-% (e1f kia, PO i2 140 S1. S tJt f Rk.a '1,'tr..-04. Act
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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- 01-4- 011 2. Pr's Fv 4-CP-•=g eA AJ A-T'e at, St+14.+4 4S'.
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 activit . i , PLAN
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stormwater site plan templaUe.doc—rev.10/12/2003 V..�. 1,3 t 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 map.
S r LC r✓T ticq4L, /00 7 /1-t"✓A I
8. Describe the general vicinity of the site,including adjacent land uses and structures, utilitiefoa ,i�nlljkerl']; O'/ ripcaf�keas
(streams,wetlands, lakes,steep slopes,etc.). .1� L� �1t ll 4+,1
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Permanent Stormwater Control Plan JEffE SO COUNTY DCD
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.]
11. Describe the performance goals and standards applicable to(the project.
12. Describe the flow control system.
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stormwater site plan template.doc—rev.10/12/2003 6
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•
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design. JUL 2 3 2COR
,� JEffERSON CQUN`Y nCD
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.
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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stormwater site plan template.doc—rev.10/12/2003 ® 8 -- f) 3 2 S,
zt 7
JEFFERSON COUNTY UCU
• •
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 'C �-i it\7 �'
1. Mark Clearing Limits.
JUL 2 3 200E
2. Establish Construction Access. JEFFERSON COUNTY DCO
3. Control Flow Rates.
W l NX 'VLX,.70tc-T Ft c..i J-441 A-r c 1w*t
4. Install Sediment Controls.
5. Stabilize Soils.
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6. Protect Slopes.
7. Protect Drain Inlets.
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8
stop iwater site plan template.doc—rev.10/12/2003
• I
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
'R
9. Control Pollutants.
Nowt- A rrr ► .c /
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
Li tie
11. Maintain Best Management Practices(BMPs). T ' T
J U L 2 3 200P
12. Manage the Project.
t.'S . J[[FEIS8J COUNTY DCU
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
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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).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template.doc—rev.10/12/2003 0 8 0 3 L F 9
JEFFERSON COUNTY OCC
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
Cev'd—rf ti s. RV 14 " f P „6 1d;a. ' f. >Jr-
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).
(JO)J C tryj00 t fei
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5. Construction Phasing. JUL 2 3 20U1
a. Construction sequence
JEFFEDSON COUNTY DCD
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.
—ram`p ( 200 a:6AI , L''y f‘ D"0 •
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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. r,
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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
10
stormwater site plan template.doc—rev.10/12/2003
• •
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.
)7110e-%%_. '3 • Av. 2-
(LANDOWNER OR AUTHO ED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECE 77,11)
JUL 2 3 2008
JEFFERSON COUNTY DCD
12
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