HomeMy WebLinkAboutBLD2009-00220 • •
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 #: BLD09-00220
Issue Date: 08/26/2009
SITE ADDRESS: 20 A BLUE SKY DR al Date: 3/25/2010
PORT TOWNSEND, 98368
APPLICANT: DONALD GREGORY PHONE: (707) 642-6902
PATRICIA GREGORY
248 W CAROLYN DR
AMERICAN CANYON CA 945031066 Block: Lot: TX13-i
SUBDIVISION:
PARCEL NUMBER: 001194003 Section: 19 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NEW ADU M/H
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 3/25/2010
I:\F_BLD_OccuPancy.rpt 10/29/19
MANUFAWURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00220 Received Date: 7/14/2009
SITE ADDRESS: 20 A BLUE SKY DR Issue Date: 8/26/2009
PORT TOWNSEND, 98368
APPLICANT: DONALD GREGORY
PATRICIA GREGORY
248 W CAROLYN DR
AMERICAN CANYON CA 945031066
SUBDIVISION: Block: Lot: TX13l
PARCEL#: 001194003 Section: 19 Township: 30 N Range: 01 W
CONTRACTOR/ J H CONSTRUCTION PHONE: (360)681-0871
DEALER 670 PARRISH RD
SEQUIM WA 98382
Contractor's License JHCON**033BF Expires 1/27/2010
PROJECT DESCRIPTION: NEW ADU M/H
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APP •UR PROJECT. c'
Setbacks/Footing (CONTINUOUS FOOTING,� FADS USED): � � -cc(
Stormwater FINAL Approval.: _
Blocking/Plumbing:.�/ ) /O' _
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/SkirtingNents/Porches/Steps: `.,.
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR --
BUILDING INSPECTION HOT-LINE 379-4455.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY-SEE REVERSE
To Schedule inspections, call
(360)379-4455 by 3:00 PM prior
day.
NOTE: Monday inspections by
3:00 PM prior Thursday.
MLA09-00233
43UILDING PERMIT APPLICAN Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00220 Received Date: 7/14/2009
SITE ADDRESS: A 20 BLUE SKY DR
PORT TOWNSEND, 98368
OWNER: DONALD GREGORY PHONE: (707)642-6902
PATRICIA GREGORY
248 W CAROLYN DR
AMERICAN CANYON CA 945031066
SUBDIVISION: Block: Lot: TX13-1
PARCEL NUMBER: 001194003 Section: 19 Township: 30 N Range: 01 W
CONTRACTOR: J H CONSTRUCTION PHONE: (360)681-0871
670 PARRISH RD
SEQUIM WA 98382
Contractor's License JHCON**033BF Expires 1/27/2010
REPRESENTATIVE: VELLA TUDOR PHONE: 360-681-7559
PO BOX 246 (360) 681-3242
BRINNON WA 98320
PROJECT DESCRIPTIOI NEW ADU M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP ADU
VALUATION MAIN: 1,250
CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total — --2__
Routing Date:
r1- I LI-og
Type Amount Paid By: Date: Receipt: AIDPFJED
Manufactured Homes $213.00 LYK 07/14/09 108749
Potable Water Application $62.00 LYK 07/14/09 108749 AU6 9(o 2009
Total: $275.00 Jefferson County Planning
& Building Department
SPECIAL CONDITIONS CASE #IIPLD09-00220 •
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
SPLASHBLOCK.
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.) The application was reviewed by the Jefferson County Department of Community
Development for the presence of Environmentally Sensitive Areas (ESAs). The
Department conducted a review and has concluded that the property DOES NOT contain
Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA
review and conditions may be added if new ESAs are found on the property.
4.) The applicant is proposing to create or add 4042 square feet of impervious surface and
1942 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the
project applicant submit a stormwater plan meeting Minimum Requirements#1 through#5
of the Department of Ecology Stormwater Management Manual for Western Washington.
The stormwater plan shall address measures to control stormwater, erosion and sediment
during construction and shall address permanent measures to stabilize soil exposed
during construction, and in the design and operation of stormwater and drainage control
systems.
5.) 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.
6.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
Alt
7.) The site plan as submitted wi�e building permit application on July 14, has been
reviewed for consistency under'the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to
the stamped, approved site plan dated August 26, 2009 shall be resubmitted for review
and approval by Jefferson County Department of Community Development.
8.) This approval is for an ADU manufactured home. Any future permits on this site are
subject to review for consistency with applicable codes and ordinances and does not
preclude review and conditions which may be placed on future permits.
9.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
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.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
13.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
14.) The building height is not to exceed 35 feet.
15.) Minimum setback from Blue Sky Drive and Cape George Road rights-of-ways shall be 20
feet. Minimum south and east property line setbacks shall be 5 feet.
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.) An address of 20A Blue Sky Drive, Port Townsend has been assigned to the parcel. Blue
Sky Drive is private (P278).
19.) The parcel is served by the LUD#3 public water system.
20.) A building permit (BLD03-0700) for an above-ground propane tank was finaled on
December 22, 2003. A road approach permit (RAP03-0227)was withdrawn. A building
permit (BLD03-0617) for a manufactured home was finaled on February 20, 2004. A
septic permit(SEP03-0227) was finaled on February 19, 2004 and an EES done on April
11, 2007. A septic permit(SEP09-0074)was approved on August 21, 2009. A building
permit(BLD09-0221) for a garage and breezeway will be issued with the ADU
manufactured home permit(BLD09-0220).
21.) NOTICE: This permit does nScuse the proponent from complying with lit local,
state, and federal ordinances, regulations, or statutes applicable to the proposed
development, but consistent with RCW 90.58.
Development pursuant to this permit shall be undertaken subject to the applicable policies
and performance standards of the Jefferson County Shoreline Management Master
Program and the Jefferson County Unified Development Code.
If during excavation or development of the site an area of potential archaeological
significance is uncovered, all activity in the immediate area shall be halted, and the
Administrator shall be notified at once.
The Federal Endangered Species Act rules to protect threatened Chinook and
Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been
listed as threatened since early 2000. Under the ESA, any person may bring lawsuit
against any individual or agency that"takes" listed species (defined as causing harm,
harassing, or damaging habitat for the listed species). In addition, the National Marine
Fisheries Service can levy penalties. All areas in Jefferson County are included as
"critical habitat"for a listed species. Development of property along any marine shoreline,
freshwater shoreline, or floodplains could harm habitat if protective measures are not
taken. To minimize the potential to damage habitat, all property owners developing
adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the
following:
-All development activities should avoid unstable slopes, wetlands, and forested areas
near surface waters
- Remove minimal vegetation for site development, especially large trees
-Allow trees that have fallen into surface waters to remain there
- Infiltrate stormwater from buildings and driveways onsite through drywells rather than
discharging directly into surface waters or roadside ditches
Any individual, group, or agency can bring suit for a listed species"taking", even if you are
in compliance with Jefferson County development codes. The risk of a lawsuit against
you can be reduced by consulting with a professional fisheries habitat biologist, and
following the recommendations for site development provided by the biologist. For more
information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and
Wildlife Service.
22.) WATER LINE MUST MAINTAIN 10' MIN. SETBACK FROM ANY PORTION OF THE
SEPTIC SYSTEM UNLESS OTHERWISE APPROVED THROUGH JCPH.
JACK WESTERMAN II� •
Jefferson Count. Courthouse
ASSESSOR Po Box 1220, fort Ton-nsend, W:11 98361)
(360) :l85-9I05
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME:-DOV `4-701/4k GW O(cal
ADDRESS: € S r► /� `1th('1 1OL L1SLtn u3A- 9E..)(c&',
PHONE NO.3(pO - 14-1?1
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
J U L 1 4 2009
1►MORILE HOME DATA:
(A) MAKE S 1c4.6Li itve 'l,1o,ll.
(B) MODEL -46 (C) YEAR .
1
(D) LENGTH 4 Lo (E)WIDTH 7» (F) SERIAL #
(G) YOUR PURCHASE PRICE (Do not include sales tax) 0 61 DOD PURCHASE DATE 62/p94/09.
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE 1i k
ADDRESS
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes N�
(B)IF LOCATED IN MOBILE HOME PARK:
NAME & ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME P iK; O
NAME OF LAND OWNER: DnV\ �d' �Jo� /ll�p1
LOCATION ADDRESS ZO 1616 �+J Q rU6Rt-
REAL PROPERTY PARCEL #/DESCRIPTION Doi- a 4- OL7's,
Signature applicant
THANK YOU FOR YOUR HELP!
JO COSSELL, Property Technician
Jul 14 09 03:17p Vella Tudor 3607964959 p.3
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) o6� JEFFERSON COUNTY
W , ,� DEPARTMENT OF COMMUNITY DEVELOPMENT
~' A P ' 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
1,3, rc0. www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 69-23-3
Project Description (include separate sheets as necessary): r
z
Tax Parcel Number: DO - 1 o]I�- O�� Property Size:
s/square feet)
Site Addressre and/or Directions to Property: I
JO
Property Owner(s)of RecbidEpon .,}-`yy&}- (le ejoe
Telephone(?14.J )3,- ][-I 33 . Fax: 3(Lr)- (Q ay- =1 E t email:Vea $370
Mailing Address: llq 1�a�lOt)•cow,•
Applicant/Agent(if different from owner): V't,J Lek_ 1>4 cc.,
Telephone: .c0- (agl.—1C)661 Fax�ltA) VS] -1-GJ3.
4 email:�pldRv►hOr►LaStCa?1f41100.Co►+t.
Mailing Address:•0•�jp,� �� ����t� �� 9$�Z�
•
What kind of Permit?(Check each box that applies
wilding 0 Critical Areas Stewardship Plan i❑ Demolition Permit ❑Variance(Minor, Major or-Reasonable Economic Use)
0 Single Family C!Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use C s tion
0 Commercial* ❑Special Use(Essential Publi aciatids) it I' :._./ ;
0 Change of Use 0 Boundary Line Adjustment j
CI Address 0 Road Approach 0 Short Plat** j
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
❑Propane
0 Long Hat** ..LOPM NT I
0 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**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
J .- ' DESIGNATION OF AGENT
I hereby designate ,t Q 1 ''0 IL_ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE /`t ���;.,� L._ A 3
-� � Date: 7
By signing this applica'en form,the o,'agent attests that he information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any mater'- alsehood 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 t provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any quired later inspie ' s; Staffs access and right of entry will be ass timed unless the applicant informs the County in writing at the
time of the appli .lion that s e a s prior notice.
Signature:
/ Date:4 � . , 7
The action or 9ctions Appli t ill unde ake a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and 96u lead to a pote al"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Sp ies Act r"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has bee lasued 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• )/ou are in complia ith the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans ble respgilit for�,adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: !!
Date: , J` -e-1,>�
' ' c _n_, n r _ c ^n nn ,
7 • I
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 General Contractor for the proposed project.
Date:
Signature:
PHONE: FAX.
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( ) (�) ' ^G�^ r CO
A- ,� CAnS-�v .o� - EMAIL: �.�10 �-V.fO
•
MAILING ADDRESS: Vt tl
CONTRACTOR'S LICENSE WAINSNUMBER O4745ti ,
NUMBER: PHONE ( ) FAX.( )
ARCHITECT/ENGINEER:
EMAIL
MAILING ADDRESS:
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Project Type: & Wood p Existing: ❑ Sewer
0 New ❑ Steel Proposed: Bank ❑ Community System
n
❑ Alterati
❑ Alteration/Remodel ❑ Concrete Total: Height: KIndividual System
SEP Permit#
❑ Repair ❑ Masonry Water Supply:
❑ Other:
❑ Demolition Bedrooms:Existing: _ Setback: ❑ Private well ❑ Two Party
Proposed: _ ❑ Public
Typ of Heat: Total: _a- Name of System:(Ai IN-it 3
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed:
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 i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured I 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.
ICurrent Proposed For Office Use Only, Amount Revision
Square Footage p Main Floor Heated J�6O ., EH Bld App Review:
q5
2"°Floor Heated Consistency Review: ,1 7j
Other Heated Base fee:
' Mezzanine Additional Section: —
-Heated Basement Plan Check fee:
Unheated Basement
State Surcharge fee:
--
Other Unheated Pot Water Review fee: I SUBTOTAL V
/���-1 ��
Garage/Carport (ir CI
Decks C11/7pu1
oach
fe>e: -
Other TOTAL $ (P —
Receipt Number: l ov ` 1
Cash/Check Number: ' C7CG,
ESTIMATED COST(REQUIRED) Date: j. I�p
.Fair market value of all labor and materials foundation to finish Initials: `i• �-i
I 1 - ........0.----
r:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• —
.g,Sozv C� STORMWATER PLAN
q, JEFFERSON COUNTY AUG 2 6 9
g 441 ill DEPARTMENT OF COMMUNITY DEVELOPME T
., 621 Sheridan Street • Port Townsend • Washington 9:368 JEFFERSO,Qc NO�O 360/379-4450 • 360/379-4451 Fax DEPi OF�p MM CO
`'' http://www.co.Jefferson.wa.us/commdevelopment/ S!GNATU wit .V . • iiit
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
IMLA# i —233 LI PROJECT/APPLICANT NAME: rlor -
(6
Please answer all of the
applicant may choose to either incorporate ate the elements into the generquestions to the best of your raal plot plan. Where t for the Mastehe question r Land Use alls for pApplication oriction on a tto submit the
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicateposition and relative siz r e rovements on the
p p � p
site map.
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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 areas on the site map. (�
p O SA S LA-A .“S CJ "�
4. Describe the existing soils. Indicate soil type on the site map.
06)vrt So ( S.
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 activity:
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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 theisite. Indicate location Aon�the site map.
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.).'✓3 " � v p— (.1_c rcu
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00 Si- o r WS.
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.
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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.
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12. Describe the flow control system.
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stormwater site plan template—rev.10/1/2003
•
13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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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.
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18. Describe methods for restorationi of the site.
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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.
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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 perrrtittpr approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
stormwater site plan template-rev.10/1/2003
7
•
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.
2. Establish Construction
onstruction Access.
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3. Control Flow Rates.
4. Install Sediment Controls. 0�—
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LI 5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets.
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8
stormwater site plan template—rev.10/1/2003
•
• S
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
1,6,
9. Coromi pmilitants.
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
•
12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003
9
III •
b. Description of special requirements for working in or near environmentally sensitive areas.
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
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5. Construction Phasing.
a. Construction sequence_ i 1 _ 1� D r
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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).
I. Provide a proposed construction schedule.
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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
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g. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
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c. Waterways.
d. Runoff/Stormwater Detention Calculations
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stormwater site plan template—rev.10/12003
! !
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 sormwater 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.
1 /6 eV
(LANDOWNER OR AUTH RIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
12
storrnwater site plan template-rev.10/12003
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