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HomeMy WebLinkAboutBLD2008-00392 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#: BLD08-00392 SITE ADDRESS: 184 GARDEN CLUB RD Issue Date: 10/31/2008 NORDLAND, 98358 Final Date: 8/27/2013 APPLICANT: DEBORAH BACHELDER PHONE: 360-379-4973 %GERALD DACKIN 184 GARDEN CLUB ROAD NORDLAND WA 98358-9684 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921092004 Section: 9 Township: 29 N Range: 01 E PROJECT DESCRIPTION: NEW UNHEATED DETACHED GARAGE THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no ) THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 8/27/2013 \\tidemark\data\forms\F_BLD_Occu pancy.rpt 9/12/2013 RILDING PERMIT APPLICAT N MLA08-00407 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00392 Received Date: 8/29/2008 SITE ADDRESS: 184 GARDEN CLUB RD NORDLAND, 98358 OWNER: PETER KOPETZKY PHONE: 360-379-4973 DEBORAH (BACHELDER) KOPETZKY 184 GARDEN CLUB ROAD NORDLAND WA 98358 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921092004 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NEW UNHEATED DETACHED GARAGE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 60,552.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 2,400 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: a7 LA-) Or) Type Amount Paid By: Date: Receipt: Approved/Date Permit $720.75 AMS 08/29/08 100794 APPROVED Plan Check $468.49 AMS 08/29/08 100794 State Building Code $4.50 AMS 08/29/08 100794 OCT 3, I 2008 Total: $1,193.74 Jefferson County Planning & Building Department Jefferson County Building Dion Permit Nur BLD08-00392 Applicant: KOPETZKY BUILDING PERMIT INSPECTION APPROVALS %pplicable 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 ,-� Minimum setback from Garden Club Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. Erosion Control � SEE CONDITION 2 FOR STABILIZE CONST. ENT. Foundation Footing E - c Q S ( a� sltuA. k-b-vet R-lb o Footing Drains /4/A Foundation Stem Wall A L ok f/�03 Straps(hold downs) Ext. Shear Wall Nailing g3/27//3 y, Framing Q,/ /6. �"', Drywell/Alt Drainage s�3/Z7//3 SEE CONDITION I FOR SPLASHBLOCK CRITERIA 7 Address Posted pft7/r 3 #1 FINAL INSPECTION q/z7/3 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD08-00392 1.) DESIGN CRITERIA FOR SPLASHBLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASH BLOCK. A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS. 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.) 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. 4.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 5.) 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. 6.) A Stowmater 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. • 7.) Outdoor residential storage shall �e maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) 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. 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) The building height is not to exceed 35 feet. 11.) Minimum setback from Garden Club Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 12.) 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. 13.) 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. • • U A ai � o Q --0 ID I b ICD CD _ \ I A I II co II II 0 II o co II Q II c) II � i t CD - ;MI 0 < L o \ o - o 0 0 0 4 i : (-!1 0 i> co co 0 0 ACD ---:.2-r . s , -(i'D 1( q R.) ui o O o I r--, o VCI I - o o o W o td 0 oar RF CE1V D ,�� O JEFFERSONOUNTY W DEPARTMENT OF COMMUNITY DEVELOPMENT AUG 2 2Q08 ~' ` `� 621 Sheridan Street • Port Townsend •Washington 98368 top360/379-4450 • 360/379-4451 Fax sN��s Jf Fff RSUN COUNTY In p www.co.jefferson.wa.us/commdevelopment Master Permit Application - '-.- MLA: ( R )---�‘. Project Description(include separate sheets as necessary): (OD ( (fa elB-ka tlize) gprr J e-/ 62 rL( Tax Parcel 9210q2. 004 Property 4• 7 acres Number: Size: (acres/square feet) Site Address and/or Directions to Property: 184 £ xdet.4. Ci(f,b`i,d. IJB red( (-kJ / U 'A q'g 3 ..8 Property Owner(s)of Record: ;A&He,Q&-74 ( jM/f,�-i 1�e ) PE'j Z Telephone: 3a0 7 4�7 3 Fax: ��_ ,,_/email:'Ar/WI7 5�f707, Mailing Address: / l C' i1.�J• DE,O�T7v4, vV 1. �� 5g- Applicant/Agent(if different from owner): P7 l Telephone: c.•7'i'O • 7- '.u . ' Fax: email: /?QZZ G /6��/)G7T7)c iL Mailing Address: /s-/ � X'f��A, �j,C6/jam, ,q..f%/.. K,7k7% II/i2- (�'"�i < aC What kind of Permit?(Check each box that applies) i'Building i Variance(Minor, Major or Reasonable Economic Use) I Demolition Permit i Conditional Use[C(a), C(d),or C]** i Single Family I Discretionary"D"or Unnamed Use Classification >CI.Garage Attache tached i Special Use(Essential Public Facilities)** I Manufactured HorT1e 1 Boundary Line Adjustment I Modular I Short Plat** I Commercial* i Binding Site Plan** i Change of Use I Long Plat** I Address i Road Approach i Planned Rural Residential Development(PRRD)/Amendments** 1 Propane i Plat Vacation/Alteration** I Allowed"Yes"Use Consistency Analysis i Shoreline Master Program Exemption/Permit Revisions** I Stormwater Management 1 Shoreline Management Substantial Development** I Site Plan Approval Advance Determination(SPAAD)* i Shoreline Management Variance I Temporary Use 1 Comprehensive Plan/UDC/Land Use District Map Amendment 1 Wireless Telecommunication* i Jefferson County Shoreline Master Program Amendment 1 Forest Practices Act/Release of Six-Year Moratorium *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 / - -T�-✓✓ ' /- TZ e/ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE -L),,Ly,47 _ Date: �/.. f/ By signing this application fo ,the owner/agent attests th t the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Aryyi material falsehood or any mission 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 N'n 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 tiSme of the ap i • n that heshe wants • r' notice. P—� 1 --�� / �d —Signature: • % Date: /%/ The acti or a ions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered cies 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-trans ratSfe responsibility for adheri and c mplying with the ESA. The Applicant has read this disclai der a " si and dates it below. .Signature: Date: 'les/e er G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.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 as uming the responsibility of t GGeneral Contractor for the proposed project.project.Signature: / Date: 7 47 e GENERA(CONTRCTOR OR MANUFACTU D HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New ,.Wood Existing: J [1 Sewer ❑ Addition ❑ Steel Proposed: (3 Bank Li Community System ❑ Alteration/Remodel 0 Concrete Total: { Height: `4 Individual System ❑ Repair ❑ Masonry SEP Permit# 4r aj ❑ Demolition 0 Other: Bedrooms: r Water Supply: Existing: J Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: -- o Public i)tZk�C & Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove i Woodstove 1 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: , -7 cD0 2"0 Floor Heated Consistency Review: i o Other Heated Base fee: _ —1 ao .- am l Mezzanine Additional Section: Heated Basement Plan Check fee: rL G e ' I 1_l9 Unheated Basement State Surcharge fee: `l —I-. /� I � Other Unheated Pot Water Review fee: • Garage/Carport 1/0 co,65;) 1q SUBTOTAL - I Decks ./; 911/Rd Approach fee: Other TOTAL: $ I4 y Receipt Number: t OC)fl i L4 Cash/Check Number: ea(C)c ESTIMATED COST(REQUIRED Date: 0 i ).Fair Market vahfu of. -•t•r and materials foundation to finish iaci /,S Oo C Initials: [} G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc 0 pgma # HIP 1? iiffeliv .�,so�v � � � � 3 9 2 r. � ,.JEFFERSON COU T R 1. �1 k44r. 'ECG � Q DEPARTMENT OF COM I DEVELONT `��' 2 ,,_ 4.. ,„,,. ,. ,�� 621 Sheridan Street • Port Townsend •Washington 98368 , .,,,7/70 diii C 360/379-4450 • 360/379-4451 Fax �'lul ilk'j' / http://www.co.Jefferson.wa.us/commdevelopment/ ''�L�ypi STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# N"' Cf ) PROJECT/APPLICANT NAME: V O -42_ r_L J 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. VG tr o 4-010u,1✓1 A iiak o b atrk,/yar Cu a 4• - 4 . . t i v e ,ur a i t /„L'. /t r — L�r.1-4 -'M1 Dpe rL j2e 6- 4-- Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. .1/,'ram it44 /y ro U 11-1LA; (44 0/apei.-s tfi-ar — S"/o 3. Describe the existing vegetation. Indicate nat've vegetation areas on the site map. k o qrGO Le,-4-11 -h' 4er-- +_ qr) .g 9. arecV S 4. Describe the existing soils. Indicate soil type on the site map. -5�f•IS e/aoc•` ,Is G ' (Wile) - tfrreo- 9 7 Ir.1-47 r -ie_aZo le S er r* (a ✓eC per1ea le I' a2P / et-ill 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,an indicate acreage of each. Ord , 1,4.acr i Is9 'u rr-) f !h -/ Al V/ ./t)-r°z2` ` 6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED STORM*W 4p' _ r' l-j- - o1 /ho r1 74t-re (O�'� CT 3 2008 Stormwate JEFF 'SON Q• N DV ;y . OP stormwater site plan template-rev.10/1/2003 ReaUired DEPT.OF C!M ' ' \ I 1 SIGNATURE: a ��� ► 5 r • • 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. [ �� N 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.). r-&.S(de(4.7k. a 1ura f ✓i-i " <iil€- - 04tL! 1 G '/ec, c/�I -/. ) a cres '✓./e dP � rcp ?it'd Ou 13-f-ti,q r 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 di eree�tiate pro osed facilities from�xisting facilities. 1 ;)ll cciet vi6 k,g ee- �, 11 low (1 /! Is Ord_ced -1/efie ©ram"�"G' r s /Lo0� Gl 1' 10% 0 1 //t (peI-v'/ do . C c 10. If the project requires the use of stormwater treatmen 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 projectsrr /, that involve the potential for dispersion of contaminants.] JA 11. Describe the performance goals and standards applicable to the project. T-i_Lf fe c&, < </ � ( -/ /i t- p ge V- 0-6( l �el-F'. — 477/ L7if''� q� CC._ l�-c- l b� rP - p/mac{ ' S�� r c_,p G ram','!/ L2.' *rote el l�.. f ()4 c'ee- `- !2 r f a/A-I ..0 , 1,2._...Describe the flow control system.""- / / t tiZ e Leii it h ife i// ,[i- ,.)e'8 z -t �• � l�, f'� ,ti ° �G 1 ' -/ � I c-E• / I r i 4 I stormwater sate plan template—rev.10/1/2003 J E F F�R O N COUNTY "� 6 • . 13. Describe the water quality system. 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. • 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. RECEIVED T # AUG 2 9 2008 JEF� t N r JE1 it tja COUNTY Oct stormwatersite plan template—rev.10/1/2003 U 7 ` 1 • • 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. , ►tc.a(L cleap; 11�, t s ( t. L9Gl r u tut pt 2. Establish Construction Access. a�lre /y (ram e -• s �I-i wg �rt 3. Control Flow Rates. , + re baIe.<' -- �c 1-I-- ,f/o- L 4. Install Sediment Controls. , �t Hi e/alt 5. Stabilize Soils. 6. Protect Slopes. sera ba Ie� 7. Protect Drain Inlets. MINTY 14; stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. rra-Le- to a 1/0 S 9. Control Pollutants. i le eIo-Lti 4- f-i-rd.i ifgIe 10. Control De-Watering(the act of pumping gr9ondwater or stormwater away from an active construction site). Y1V( 11. Maintain Best Management Practices(BMPs). I t ik f vL cl AIe'/ �- ,s---/r.,- bd le < a.s L-Le-e_% 12. Manage the Project. 1,14. cLc e O G L.. O—tv < H- e obit -!- ct(rd <<— Up le f 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). ?( 2 7 €1 rd 1 s 2 Ge447, (11)a e) Pi-)4 cit. b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 'e test e �A, �"�-te, )l oCt �0 3-t �o 1 S Mc -te t e c>x- L tope 3. Environmentally Sensitive Areas. a. ,:Qe cription of environmentally sensitive areas that are on or adjacent to the site. JO f t i;. lr„ JEFif DSeGi COUNTY Dc D stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. J,4 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). P o pit o id l etc s l,(2-1-eal 5. Construction Phasing. a. Construction sequence wL".“:4 OdS 1 c le f i``'� 4o oec. Ga y�r u,�,J-i,vu t t ,i, . 704-'1.04 &AC s1 0 POur sla b riu.(, awl/ i" lo?c I � j -u44 i b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Pr vide aproposed construction schedule. �e' Ci 5/9b by z-401 PI 4kt, . II. Wet Season Construction Activities. a. Proposed wet season construction activities. , ire) u /-"/®Se-- /42 b9 _,.-4, /-e-4 b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownershlp Responsibilities. a. Identify t e pr pertyr owner fesponsillle for the initiation of bonds and/or other financial securities. ��1J11v_ P-i-i -- D (A)n P/(' 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 2 kill b LiiiiJ Min s t, tr C stormwater site plan template—rev.10/1/2003 10 IP • 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 o ers of the affected property. C7`A c `/ (LANLjOWNER OR AUTHORIZED R P SENTATIVE‘GNATURE) (DA ) f THIS OPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: QoiET # BE J 0 8 - 0392 JEIFERSON COUNTY OW stormwater site plan template—rev.10/12003 12 ID I 1 : m T �+ �J1 t 1 ! -r �-- a i 1 --I I. } % -0 , 1 , , 1 ; . 1 1 i ...._...4 , __t. 1 1 , . : , mN ) • . t 1..._ • .y___. ' t - - ha • . CI Ns) r — 1 # I _ — k -i 34 - ' . WO-4,--14,SDP—IY6 v — ' I (k) e-prpxrPIER rr Y , I ., -41 il ` o __r _1 coD Li0 ± 1 \V , . • , • C JiflifiSUN COVNN OCC co1 0 .t . _. _[..-1(0 ; . ,..--- Q rvo v, / , , a, i , . ' _ • o-1 , \ I I I - - -i / . __ ' a r • to i / 1.L 0 , . ' 0----- - i. , a Rc•' ki ypv 7- / �D \ s mC \ ‘44, . K m E co O _ SEPT!c H � -_ i ,oic;1 . _, m LJ — , . . z� I I . , _._ Ji O "41 i �' •1 1 ' --._ , - - C • I Z 7 ? t- I ft -- - �i �`� x W wl� • i I i iir S • i 1 ' — -- -- . --,p-ig 0-14----k):1-0-6-k----4------"------ ! ---, 4-1-0‘ ( _ �R14►tJ FIELD 1 eI eV IZS . .,-...._._ 32 b—I —