HomeMy WebLinkAboutBLD2008-00419 •
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 #: BLD08-00419
SITE ADDRESS: 123 SANDSTONE LN Issue Date: 10/8/2008
PORT TOWNSEND, 98368 Final Date: 8/13/2009
APPLICANT: STEPHEN L KELLER III PHONE: (360)643-3199
LISA YOBBAGY KELLER
PO BOX 1023
PORT HADLOCK WA 98339
SUBDIVISION: EISENBEIS BAY VIEW Block: 28 Lot: AA
PARCEL NUMBER: 948602805 Section: 16 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE ALSO 2 A/G 120 GAL PROPANE TANKS
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 8/13/2009
I:\F_BLD_Occupancy rpt 10/29/19
BUILDING PERMIT APPLICA�0 Review J M T0420
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00419 Received Date: 9/19/2008
SITE ADDRESS: 123 SANDSTONE LN
PORT TOWNSEND, 98368
OWNER: STEPHEN L KELLER III PHONE: (360) 643-3199
LISA YOBBAGY KELLER
PO BOX 1023
PORT HADLOCK WA 98339 EISENBEIS BAY VIEW
SUBDIVISION: Block: 28 Lot: AA
PARCEL NUMBER: 948602805 Section: 16 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NEW SFR W/ATTACHED GARAGE
ALSO 2 A/G 120 GAL PROPANE TANKS
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,989
VALUATION 208,571.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 524 SHORELINE:
CONST TYPE: DECK: 103 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: CITY
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
Q-Z2--CR
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $1,604.15 RAC 09/19/08 102671 APPROVED
PPRO E
Plan Check $1,042.70 RAC 09/19/08 102671 �1
State Building Code $4.50 RAC 09/19/08 102671 OCT 2Qaa
Potable Water Application $59.00 RAC 09/19/08 102671
Total: $2,710.35 Jefferson County Planning
& Building Departmen+
Jefferson County Building Oision Permit N •r: BLD08-00419
Applicant: KELLER III
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 (®_31_.� Y Minimum setback from Sandstone Lane right-of-way shall be 20 feet.
l� Minimum side and rear yard setbacks shall be 5 feet.
Erosion Control SEE CONDITON 2.
V
�,\ Foundation Footing (p-3 t-D Cz.— -, U
Footing Drains `y, id
/l
e Foundation Stem Wall � I
Underground Plumbing 1 �1A
g N Under Floor Framin `_,
0) Straps(hold downs) ;/20 f69
a Ext. Shear Wall Nailing 0,_ii_L, ,
Rough in PlumbingLI 1/1116 n '•i �-C seekowev- e.4-. Lc-2:1-os IMhoc
Framing V25/69 ' S L
Blocking 14 ik
Airseal 2/2p/69 ligii .�G
Insulation:Walls
Insulation: Floors LfltTll1c/)It. ��% PI iv t�"3- :(24./6
o�
fi Insulation: Ceiling i oc
fCI ww40c.VS 6.1 ?cc 4 ,niT.
A. Int. Shear Wall Nailing ] \O9
kJ
Wallboard Nailing .3( t1 loet
F Gas Line: Interior 0(140,
f Gas Line: Exterior 7 I LS y�1-- /.�'"
F Propane Tank i 1^`01 9
a Heat/Chimney Clearance ! `( Fl%/0(.+r)LE, 6) F(1IW I A-)C'
1:-. Drywell/Alt Drainage [Z 0494,7SEE CONDITION 1.
F Address Posted C Ia. 0ci (i..
1=. FINAL INSPECTION Ii1`, 9
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD08-00419
1.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA
ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY
STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA.
FOR SITE 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 COURSE SANDS.
TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM) AND HAVE A
DEPTH OF 5 FEET (4 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 FC)R MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
3.) 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.
4.) 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.
5.) Outdoor residential storage shai maintained in an orderly manner and shipeate no
fire, safety, health or sanitary hazard.
6.) 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.
7.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
8.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
9.) The building height is not to exceed 35 feet.
10.) Minimum setback from Sandstone Lane right-of-way shall be 20 feet. Minimum side and
rear yard setbacks shall be 5 feet.
11.) 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.
12.) 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.
#SON cod,. JEFFERSON OUNTY •
az
f` c2.
A DEPARTMENT OF COMMUNITY DEVELOPMENT
," '4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
1s p'' www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: b 6- LI in
Project Description (include separate sheets as necessary):
NSR. uY Arr A I CZ) AA 12o qat:Pccp larks
Tax Parcel Number: 1:11e4poZ Property Size: .43 (acres/square feet)
Site Address and/or Directions to Property:
123 SancisirrE, Lki , -Rae,- ate,- tom. g834c3 r
Property Owner(s)of Record:
Telephone: 1043-3 iqc . tlet: (0,43-3'71 Li- email: 800Z 6 1 d3S "
Mailing Address: PM_ ►.C)73 r Finclicelc. Lad- y
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
Single Family ! Garage attache Detached 0 Conditional Use[C(a),C(d),or C]**
O Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
$Propane ❑ Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 its 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 a • ctions. St a ' t of entry will be assumed unless the applicant-informs the County in writing at the
ti of the application that he or sh wa nor notice.
Signature: Date: q"LB 08
The action or actions Applicant will u ertake as a ult of the issuance of this permit may negatively impact upon one or more threatened or
Lendangered species and could lead to ential"tak 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)eve nce with th velopment code.The Applicant acknowledges that he;she or it holds individual
and non- ansferable responsibility
Signature: ring to d complying wi the ESA. The Applicant has read this dij jlaimer and signs and dates it below.
— Date: `1—(E3'{
-;:\PemutCenter\###FORMS###\D S emit Application 5-29-08.doc
7
110 BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced hereinithat they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Sigrpture: -;."'. Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: •
( ) SEE,' 1 2008
MAILING ADDRESS: EMAIL: I
CONTRACTOR'S LICENSE WAINS
NUMBER: • NUMBER L '
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
1)1( New X.Wood Existing: 0 ❑ Sewer
Li Addition ❑ Steel Proposed: 3 Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 3 Height: )tit Individual System
❑ Repair ❑ Masonry op SEP Permit#
❑ Demolition Cl Other: Bedrooms: Water Supply:
Existing: [) Setback: ❑ Private well ❑ Two Party
Type of Heat;' Proposed: _ jx Public
Plertric ��'� "'`" Total: 3 Name ojystem:
�r icon6Enb
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 XAbove ground Tank Size of Propane Tank:(Z) I2o CHI.
i Heat Stove i Cook Stove i Woodstove X 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 BId App Review:
19�9 15°14,�� '7C �D
2nd Floor Heated Consistency Review: 151.
51 CO
Other Heated Base fee: 04..
Mezzanine Additional Section: F
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: .4. b
Other Unheated Pot Water Review fee:
a 5. DO
Garage/Carport SUBTOTAL
524 15 351.5a aq13.35
Decks i- Catieret,b flteen a {Dori•`1`t 911/Rd Approach fee: `n
103
Other TOTAL: $ a GI"'l
Receipt Number: tG2(Q"` \
Cash/Check Number: L U S
ESTIMATED COST(REQUIRED) Date: A
.Fair m u
�epo all a o terials foundation ttofinish rC
�J 5'71 . t 570.B Initials: Q_1 lq I OP)
•
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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RECEIVED
CO
0 � 6 JEFFERSON COUNTY {3EP 1 8 2008
k40.41
Ki DEPARTMENT OF COMMUNITY DEVELOPMENT
• 621 Sheridan Street • Port Townsend • Washington 98368 JEFFERSON COUNTY DCD
OHO 360/379-4450 • 360/379-4451 Fax
.�
`s81N http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Q - L Q PROJECT/APPLICANT NAME: E LI so..
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.
t'i . is n Osfl9 CI friN b Cc:- -rvci- q tclAci nF N3F2
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
�t NAL NOCE Of.1 bac-k h -hcan nl^ prbFEelij
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
l✓rE$ c UPS
4. Describe the existing soils. Indicate soil type on the site map.
brcx.�nN rrki loam
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.
StnrilQ Lf aLra.t.na9 e_ onto iPr r-4t i - S ►5 dry cl ra n5 wed
APPROVED
6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN
SFP ? 62008
Required JEFFERS•NAs UN
DEPT.OF CO r • 031 E T
SIGNATURE. Rik affil• -fril.'L.
stormwater site plan template—rev.10/1/2003
' • 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.
Iry nn
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.).
_ SLUrlinikfICLintO1S Of6 Zof1E.6 (FE,tcd£-itbal. - tip ES0C5
Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual)or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
6-orrnt er ko ,br. d tspi b 'Mitt do ILLEti s
•
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.]
IJO
11. Describe the performance goals and standards applicable to the project.
. to .be t rnroCi nS LA.f-H-IQ s ucLE
12. Describe the flow control system.
- C1.�i�h f •Rx�t QUraiy & Is#g - StFYn1t L r fityrn
Con on W ciu(Etloft In &lux-11s
stormwater site plan ternplate rev.10/1/2003 6
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design. it�C F I V I pm, D
Gf-u € s, C)bwn3�1 cfs to C n tura 1 s [' �'
SE P :i. Z008
C.15. Describe the source of fill material,physical characteristics of fill material,and deposition IIEF t.,..01INTY DCU
kbgd idate laL (d
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
i vfi`in l ID be 3r0.Vc L /Cunt a' t-t h j p I , ecrpic f
17. Describe the proposed surfacing material.
Aprpt. 2cco Dr I au E t tf, ,i
18. Describe methods for restoration of the site.
nnt1sr+ape- lawn
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.
A
•
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.
--r AVEYA
stormwater site plan template—rev.10/1/2003 7
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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 Consttuction 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 se n, of the Manual(beginning on page
2-15). C
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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0.011 COU \/t/
2. Establish Construction Access.
Road Gx_tart t
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3. Control Flow Rates.
DroaraaE In Extsn� — 1,t appasaN d rciLoeis For •
SFe
4. Install Sediment Controls.
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5. Stabilize Soils.
_ U3Sr-k. dry p lr s -1-r) ,L' cryver.isw� rQ u r-d-i
gretztAn3
6. Protect Slopes.
WtLL t.rncLL (on -back. sue-h porgy-en pf~ +y p1*( Fd
Fx lh t.xj - v c -cihrn
7. Protect Drain Inlets.
010
stormwater site plan template—rev.10/1/2003 8
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RE CE1 v I[D
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. ritlUB
tJ�r�
ANSO4J CUUV1 UUN
9. Control Pollutants.
tA-rl_ ceps 5 hail aka bE. ri_vru 1a.blE on SLIC
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.
OupP.aL..
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
f'jot.fa
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template-rev.10/1/2003 9
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b. Description of special requirements for workiitiebien environmentally sensitive areas.
TADl1g_.-
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).
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5. Construction Phasing.
a. Constru on sequence
gradkn9 , CiattrIl , PY-a.mulp rt�fv9, t n fe iirr- Ey .tor
b. Construction phasing(if proposed) J
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
�, p rF f) 4- �, in n ton (Crr) , R �~Rooknq 6.)0y)(�f rtcr 4�e Tan t ( E$�
II. We Season Cons ruction Activities.
a. Proposed wet season construction activities.
Sarre. as__ ctbnvE
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. O J R
c. Waterways.
d. Runoff/Stormwater Detention Calculations _
stormwater site plan template—rev.10/1/2003 10
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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 knowledge. I also certify that this application is being made with the full knowledge and consent of all
ers of the affected prope .
q-6-08
(LANDO IZED REPRESENTATI SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECEIVED
CEP 1 9 200
JEFFERSON COUNTY DCD
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stormwater site plan template—rev.10/1/2003 12
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