HomeMy WebLinkAboutBLD2009-00035 • •
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
Al Scalf, Building Official
PERMIT #: BLD09-00035
SITE ADDRESS: 250 JANSEN RD Issue Dat : 04/22/2009
NORDLAND, 98358 Final Date: 3/9/2010
APPLICANT: CHRISTIAAN P MEYER TRSTEE PH NE: 602-920-9375
STEPHENIE M MEYER TRSTEE
32531 N SCOTTSDALE#105
SCOTTSDALE AZ 85266-1519
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot: 3
PARCEL NUMBER: 977700090 Section: 4 Township: N Range:, 01 E
PROJECT DESCRIPTION: NEW DETACHED HTD GARAGE W/ 2ND FLOOR HTD REC ROOM and
Shoreline Exemption Permit: (SDP09-00009)
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes Lam-
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/9/2010
I:\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building ►• -ision
BUILDING PERMIT INSPECTION APPROVALS Permit Number BLD09-00035
ROVALS Applicant: MEYER TRSTEE
To schedule inspections, call (360)379-4455 no later than 7:00 AM the
applicable Code: 2006 International Building Codes
Requests received after 7:00 AM will not be scheduled for that day's
day of the inspection.
ELECTRICAL PERMITS are issued byy inspections.
The electrical permit must be signed off by the State tInspector on State ior to
DepartmentotheCounty's Labo & Industries.
Inspection Item the Framing Inspection
Date Approval Signature Notes
Setbacks
:2;o L� 5`
'n _ Minimum setback from Jansen Road right-of-way shall be 20
dge of wetland shall be 90 feet feet.
Erosion Control •epicted on the approvedMinimum setback from top of bank as
,��k 6SEE CONDITION 2 FORsCONSTRUCT ON ENTRANCE
te plan dated March 3, 2009 is 35 feet.
Foundation Footing
1,0) ,Kt --�
Footing Drains 6�' ���
Foundation Stem Wall �'
Underground Plumbing °`
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing y �����
Rough-in Plumbing ��'O jj�,
i���i_
Framing
11111111111111111111111
Airseal
Insulation: Walls
Insulation: Floors M
Insulation:Ceiling 'iti
MEI111111111
Int. Shear Wall Nailing M
Wallboard Nailing
11111111111111111
Gas Line: Interior ��
IIIIIIIIIIIIIIIIIIIII
Gas Line:Exterior
IIIIIIIMIMIIIIIII
Propane Tank
11111111111111111111111
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted 5j"111 SEE CONDITION I FOR DRY WELL
IIIIIIIIIII
1111111
FINAL INSPECTION $
OF
FINAL INSPECTIOMUST BE APPROVED PRIOR TO B
THIS PERMIT IS VALID FOR ONE YEAR DING BEING OCCUPIED
CONDITIONS for Building Permit# :BLD09-00035
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 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.) A minimum setback of 90-feet, measured perpendicularly from the wetland edge, shall be
permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the
wetland or its buffer is allowed. However, the proposed garage is greater than 500 feet
east of the wetland.
6.) A permanent physical separation along the upland boundary of the wetland buffer area
shall be installed and permanently maintained. Such separation can include installing
logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
7.) Critical Aquifer I q fer 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.
8.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through #12 of the Department of Ecology's Stormwater Management
Manual for Western Washington to control stormwater, erosion and sediment during
construction. BMPs shall address permanent measures to stabilize soil exposed during
construction, and in the design and operation of stormwater and drainage control systems.
9.) 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.
10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
11.) 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.
12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
13.) The building height is not to exceed 35 feet.
14.) Minimum setback from Jansen Road right-of-way shall be 20 feet. Minimum side yard
setbacks shall be 5 feet. Minimum setback from edge of wetland shall be 90 feet.
Minimum setback from top of bank as depicted on the approved site plan dated March 3,
2009 is 135 feet.
15.) 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.
16.) 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.
17.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
18.) Final approval/completion of SEP09-31 required prior to final approval of this building
permit.
19.) This structure has not been approved as a residence, accessory dwelling unit or bedroom
due to the capacity of the onsite sewage system.
*BUILDING PERMIT APPLIC•ON MRAOw TOp 29
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00035 Received Date: 2/10/2009
SITE ADDRESS: 250 JANSEN RD
NORDLAND, 98358
OWNER: CHRISTIAAN P MEYER TRSTEE PHONE: 602-920-9375
STEPHENIE M MEYER TRSTEE
32531 N SCOTTSDALE#105
SCOTTSDALE AZ 85266-1519 OLSON & HAMBLETON'S
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 977700090 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080
TODD HULBERT
PO BOX 100
CHIMACUM WA 98325
Contractor's License TOLLEBI977N9 Expires 3/15/2009
REPRESENTATIVE: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080
TODD HUBERT
PO BOX 100
,LI)
PROJECT DESCRIPTION NEW DETACHED GARAGE W/ 2ND FLOOR HTD REC ROOM
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW ` MAIN:
VALUATION 170,000.00 i !'
CODE EDITION: 2006 ADD'L: C160 HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE:}}ih; q(� SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 1
Total: 0 Total: 1
Routing Date:
1)-((, r--=
Type Amount Paid Bv: Date: Receipt: AIrOVED
edte
Permit $1,385.75 LYK 02/10/09 105365
Plan Check $900.74 LYK 02/10/09 105365
State Building Code $4.50 LYK 02/10/09 105365 APR mom
Potable Water Application $62.00 LYK 02/10/09 105365 Jefferson County Planninc
Total: $2,352.99 &Building Department
WOMEN
FEB-2-2009 02:12P FROM:SPECS LLC (480) 575-1785 iik : 13607324081 P. 1
ON •
4)1�4i6 JEFFERSON COUNTY
•
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• PortTownsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
q� OsO� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: -t-Qq-i
Project Description(include separate sheets as necessary):
f ('e r- c1-�a.P G ��•,� ii.) 2 16 Lou( 1'11 c„ IELA. t`(
Tax Parcel Number. `) 77.}, °yap v Property Size: 67 5e-/j (acres/square feet)
Site Address and/or Directions to Property:
2 s v a..,sue. �2 t� vt,�,.�:1(4v�e P t.✓4
Property Owners)of Record: Lnr,ST',SSr. wt _y '
Telephone: (e,v7. •d7 ZV 3 3- 5 Fax: email:
Mailing Address: Co 2 14, - „Ye( ears, or �S 7R f
Applicant/Agent(if different from owner): rvc/e_I 1a4..1b..-y `-
Telephone: 3(e0 —b 3 l Z3' ( Fax: email:Tvc a-i f j •f t e4c t tq cr'VI-
Mailing Address: , r C.ow%
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑Single Family %Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]
❑ Manufactured Home 0 Modular 0 Discretionary"D'or Unnamed Use Classification
❑ Commercial• 0 Special Use(Essential Public Facilities)••
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat'•
❑Home Business 0 Cottage Industry 0 Binding Site Plan'"
O Propane 0 Long Plat••
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments••
❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration••
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions•"
❑Site Plan Approval Advance Determination(SPAAD)• 0 Shoreline Management Substantial Development'•
O Temporary Use ❑Shoreline Management Variance
0 Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pro—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:
Td d •re (it o/A DESIGNATION OF AGENT
I hereby designate act a iy agent In matters relating to th s application for permft(s).
OWNER SIGNATURE Date: v 2 L Coet
By signing this application form,the owner/agent attests that the Information p vl ded 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 attorneys 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 insoedions. Staffs access and right of entry will be assumed unless the applicant Informs the County in writing at the
time of the applica he or s e ants slice,
Signature: . Date: 7/(VC?
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 specie:,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 c:an file a lawsuit on behalf of en 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-transf r a d complying with the ESA. The Applicant has read this disclaimer and signs end dates it below.
Signature: Date: Z.l c/Cal
G:\PemutCcnter\###FQItMS###\DRD FORMS\Master Permit Application 5-29-0B.doc F L R 1 0 2.609
09
'ice
FEB-2-2009 02:12P FROM:SPEGS LLC (480) 575-1785 TO:13607324081 P.2
0 •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they ere not licensed contractors end that
they will be a the r s onslbility�f, reoerat.Contractor for the proposed project.
Signature: ^ Date: Z/ 5 /O 1
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
i v ltc-C-Sc-V• a„, L-r-f S Tvtc. (340 7U- 4/0150 (3Gc) 73a. -leAfs I
MAILING ADDRESS: Po OtoIC /Vv Lam, gs_vwN /AAA MAIL. -.1- -VIP•Tjll�Sa.. u,K•.(-4., co..,
CONTRACTOR'S LICENSE WAINS
NUMBER: T .,LLr--RIet- K 47 NUMBER
ARCHITECT/ENGINEER: iya.,t /4akilaSn PHONE (?¢)3iS$z(„„zir FAX:( )
MAILING ADDRESS: • EMAIL
Pro ect Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
ew Wood Existing: 0 Sewer
❑ Addition 0 Steel Proposed: I Bank 0 Community System
U Alteration/Remodel U Concrete Total: I Height: H'Individual System
❑ Repair 0 Masonry 3 6- SEP Permit#
o Demolition 0 Other. Bedrooms: Water Supply:
Existing: 0 Setback: ❑ Private well o Two Party
Type of Heat: Proposed: o E.Public
}- V(,_+"1 V Total: n i(.0g3 Name of System: Qujau
I/this is a Commercial Protect you must answer the foliowinst:
Number of Parking Spaces: Current: Proposed: Sj 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,mRditillItems below that apply;
1 Underground Tank 1 Above ground Tank Size of Propane Tank: Z by
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Ge-"c44^4.'1r_✓'
Is this appliance being Installed In a Magufactured/Moblljbcme? Yes / No
When applying fora 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 end septic system components,
Including the reserve area. a "
..,�� ;,1;1 7 yl,„ ;•*,�_N;1 Hit 1i, "�n+ , ,1 1'p,, +s i , ";'1}. r ,, '
� 'r✓� vi�{' r} { � S t b
S.uare Foots e Current Pro•osed ,f4°lt4 '. 1: i�.Nf t.,u•IA Si-.01_ ,y 1ELL1,.•,:-iw
Main Floor Heated .4.,, .f�;`l..,io., EH Bld App Review:
73 , .
2 •
"°Floor Heated Consistency Review.
(It -t ) I'Is't 'r"Cr..'"'II `(CC'—
Other Heated I fit eo r„!:„i Base fee: ,i` I') pp �/
,-. 1,Ihd.PIL 1 I' 1,_ • I ii-
Mezzanine ;;,,f ri,'^1c `' . -Additional-Section: c C
-
Heated Basement y.f ;+i Plan Check fast
t{t, .I
4
Unheated Basement 47. Cat,�' `*; State Surcharge fee:
Other Unheated F111E ‘r,':!,c z I. Pot Water Review fee: 1 f CO
Garage/Carport -,_;, SUBTOTAL �;
1l Jc13 •' i
Decks ` ;+: y' ll-1,1 I. 911/Rd Approach fee:
P:..".t e I IL I.,
' L3� ' 'I
Other " .IrtIfi,,E?'sit TOTAL: $ _-, 0L3
gI� ,f .1 at, Receipt Number, 1 0534)5
e-1,1 2; Cash/Check Number. 2
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish -10-0 1
170,uve-, Initials:
• r E 0 1 0 2009
GAPemritCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
I
•
�ONc
rr ?„ JEFFERSON COUNTY
ti
,�q DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
OY 360/379-4450 • 360/379-4451 Fax
'atly http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Doi--a l PROJECT/APPLICANT NAME:
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.
PIN/ ax}sr 1Na, 25$4 ScC) Fr, 6A�A6,•e. (wool) PFAA4ED w IL c. BE.-
DEMousNW, A NEW 1224 SO Fr GAP14, wITri UFO LEVEL ��C-/Tt61V _
12-00M j0' F PLfiCE Ir 1L SAVE LaCATl0N ls.X1ST'ING {-r0M-+✓ $-
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Existing Conditions Summary 3UILP lNG S c J Slr�
2. Describe the existing topography. Indicate contours on the site map.
LJc PED �1- IN ITN' Pr LOW SLOPE -r ,) THE If7L12FF AT E_P6 OF
The 13trAc+-1
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
MDsr QP Cff6 5-.3 ALPES IS MATUI27AC rArar),
�VEgGP-E-ENS, E1&. GEPAaS , f•ERNS , ETC-- 13 cu71PS ENrtzr
OF P'DPE 1"r /
4. Describe the existing soils. Indicate soil type on the site map.
(OoP TYPE 3 t_J07/\M1/4( SAND
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.
ND \VEIJ AP?AVLN N1\Je OF W4raR
SHaET FLDwED 17) i<AS
APPROVED
6. Describe any excess levels of noise generated by the propse3 ����CR P-LAN
No HOR_L THAN NORMAL _ FEB 10 2009
WARm
Re uir 1EFFERSOUNT
`� DEPT.OFCs, / �j I •VF.LO'M NT
SIGNATUR.. '��
stormwater site plan template—rev.10/21/2008 4111 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.
TI-t E PE IS A S Ili f\ W“T E♦? A g-E pv (NOT STANDING WA TEr,
tts You , J T PP6 P E l2 T i. Fo'V EST G D Ek c EN- F-
LAvuiv A-QoUND E-YiSrLN& ST'UCTL?E.s 51-10gE LI 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.).
MpgPawsraN . 151 N D aST oN Wkr Woo
PP c E LS ALi. A Qa U N D s I tJ )( e FR I Ly ,DEN c-s
S(i\)CoL I11.1I<' WELLS
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.
Ivr41—rV WS i\S DescV 1tJ
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.
L—OW _IM PACT" 6F S/1 , '1 77-11 s Is Pe-PLA(111/4.1G AN
EX(sT7 Srieu6 MP oV; E-7,1TS twit, c ),E 1Y144D
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12. Describe the flow control*stem.
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stormwater site plan template—rev.10/21/2008 ?,,1
6
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13. Describe the water quality system.
U SITE is EXISritJC.a
14. Describe the conveyance system analysis and design.
ipoPos€p .PRYwet L o N ti E s-r 5/4) oi= ST'ucr ,i ILE
Po WN sPours t r&HrL1 kJ ry LT
15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
'NO lLL NEE- Del�
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
(kJA-
17. Describe the proposed surfacing material.
C�Nc, IN F?6 W 6e\VA
18. Describe methods for restoration of the site.
PlzlvENA'r5 APE £x(STING , REPLciNT EXISri�JG LAWN
WILE_u bISTU-ff5E12.)
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here.
N/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.
5ePTi6, 5YSrG14 I W
FEE 1 0 2009
stormwater site plan template—rev.10/21/2008
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 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 Volume II Section 3.2.3 of the Manual (beginning
on page 3-7).
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.
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5. Stabilize Soils.
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6. Protect Slopes.
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7. Protect Drain Inlets.
0/4----
stormwater site plan template—rev.10/21/2008 8
I
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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WEST TO MO E F612-Ec Tet A?
11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
S I I
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).
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—rev.10/21/2008
9
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b. Description of special requirements for working in or near environmentally sensitive areas.
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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).
Nor ft-PPPr -e-N r
5. Construction Phasing.
a. Construction sequence
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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 construction schedule.
paMcL,irlo ( Mkcf-f (01, ou/vD&r10N- we-I (04i)
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a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
G1-12(51I A L) ME\(-E i'z--
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
lstormwater site plan template—rev.10/21/2008 10
•
! S
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.
27S10`-1
(LANDOWNER OR A HORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/21/2008 12
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