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HomeMy WebLinkAboutBLD2009-00287 • 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 #: BLD09-00287 SITE ADDRESS: 292033 HWY 101 Issue Date: 01/28/2010 QUILCENE, 98376 Final Date: 1/19/2011 APPLICANT: SCOTT HOLLINGSWORTH PHONE: (360) 765-2457 KATHY HOLLINGSWORTH PO BOX 664 QUILCENE WA 98376-0664 SUBDIVISION: Block: Lot: T 9+ PARCEL NUMBER: 702012006 Section: 1 Township: 27 N Range: 02 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE TO REPLACE FIRE DAMAGED HOME 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 no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1/19/2011 I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building DiE on Permit Num• BLD09-00287 Applicant: HOLLINGSWORTH BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 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 / a- 1 fvl C Erosion Control Foundation Footing ,i)-W 10 , 1 r-0 Lc- Footing Drains Foundation Stem Wall 1 161/6 Underground Plumbing Under Floor Framing 3(r' 1x .53 Straps(hold downs) Vh Ext. Shear Wall Nailing z2 l� lto Rough-in Plumbing 6-23—c" Framing 6-2_3-1 Blocking Airseal Z to Insulation: Walls •71,,/0 Insulation: Floors 7I/p 0 Insulation: Ceiling VI io Int. Shear Wall Nailing ! / Wallboard NailingI `. A.e-,Ay--) Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage Address Posted _`I Q, t PkOIC) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 411RUILDING PERMIT APPLICA•N MLA09-00285 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00287 Received Date: 8/25/2009 SITE ADDRESS: 292033 HWY 101 QUILCENE, 98376 OWNER: SCOTT HOLLINGSWORTH PHONE: (360) 765-2457 KATHY HOLLINGSWORTH PO BOX 664 QUILCENE WA 98376 SUBDIVISION: Block: Lot: T 9+ PARCEL NUMBER: 702012006 Section: 1 Township: 27 N Range: 02 W CONTRACTOR: TNT HOME BUILDERS LLC PHONE: 360-621-0186 PO BOX 1126 PORT ORCHARD WA 98366 Contractor's License TNTHOHB925BJ Expires 1/11/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NSFR W/ATT GARAGE TO REPLACE FIRE DAMAGED HOME TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,570 VALUATION 215,705.00 ADD'L: 440 HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 546 SHORELINE: CONST TYPE: DECK: 402 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 3 Total: 2 Total: 3 'Routing Date: -' Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,643.35 LYK 08/25/09 110826 APPROVE) Plan Check $1,068.18 LYK 08/25/09 110826 State Building Code $4.50 LYK 08/25/09 110826 JAN SS nit; Potable Water Application $62.00 LYK 08/25/09 110826 Jefferson County Planning Total: $2,778.03 & Building Department • • CONDITIONS for Building Permit# :BLD09-00287 1.) Prior to Final Occupancy the water catchment system must be inspected by a certified 4 ira)� American Rainfall Catchment Association (ARCSA) accredited professional and documentation sent to the Health Department that the system was installed as designed and will function as proposed. 04 tfrOtyS 2.) Prior to final occupancy a satisfactory bacterialogical water sample must be submitted to the Health Department taken from a faucet within the household, that confirms the water catchment system and treatment is providing potable water. 3.) Notice to title was recorded for potable water under afn#549312 4.) All construction activities shall not encroach upon the stream buffer. This includes the storage or preparation of materials. 5.) The identified Fish and Wildlife Habitat Area (Type F Stream), shall maintain a vegetative buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed single-family residence and stormwater facilities. 6.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed single-family residence and stormwater facilities. 7.) A permanent physical separation along the boundary of the 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. 8.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 9.) The project shall adhere to the Best Management Practices (BMPs) 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. 10.) A Stormwater Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 11.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) Not more than 2 unlicensed vehicl,hall be stored on any lot unless totally sc ed from view of neighboring dwellings and rights-of-way. Such screening shall mee II 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. 14.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 16.) The building height is not to exceed 35 feet. 17.) Setback from SR 101 right-of-way is no less than 25 ft., side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. Due to constraints on the subject parcel (Type N stream requiring a 150 ft buffer and the location of the existing septic system) the administrator issued an administrative road setback variance to reduce the Minimum Front/Road Setback from 50 ft. to 25 ft. 18.) 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. • llakz4 JEFFERSOti)UNTYg ki 4 ri • DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 � �., 36t)/379f15Q• 360/3.wa.0 /tom Fax wow.co.Jefferson.wa.us/commdevetopme nt a Master Permit Application MLA: nq - � Project Description(include separate sheets as necessary): ,--e /4,-,.-rto.i.fi a f si=rL -- Si J<_ (3,„ ( 4- Tax Parcel Number: J OL / Z. --) (> Property Size: e.o �Crs�square feet) Site Address and/or Directions to Property: Z 'tZc> 3 /4i 1 1 io Qt., 1rihe 1,44 9YI.7I Property Owner(s)of Record: Kc.'71 1(..� c,�„P S,a(f- � 1f.--,5 r ci°:-lA Telephone: f/v) -7(. — '2) 7 Fax: email: Mailing Address: to 6 6 4 Y Q,,,`( c«re 92 77t Applicant/Agent(if different from owner): %Nr f*, nz /_?‘..-;/a .- Telephone: 36 )- So 5 — ,C 7c z Fatc Zr' - Z?,1-- 2 Wy email: "ti-vr f"Gt f fr U,rt zi r.-,c. w-.._, Mailing Address: ea) /3Jx I i i-c /',.-r U,-dam,„.0 evvr- 7 i'f 6 4 What kind of Permit?(Check each box that apples IBuiding 0 Critical Areas Stewardship Plan ❑ Demofition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ifSingle Family ,f5 Garage ..r.a/Detached Elo Conditional Use[C(a),C(d), r C]"Manufactured Home ❑ Modular ❑Discretionary'Er or Unnamed Use Classification ❑ Commercial" ❑Special Use(Essential Public Facilities)" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach 0 Short Plat" ❑Home Business 0 Cottage Industry ❑Binding Site Plan" ❑Propane 0 Long Plat" 0 Sign ❑Planned Rural Residential Development(PRRD)/Amendments" ❑Mowed`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 Mna, Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Majrgir n�Id dram *Nay 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: J / DESIGNATION OF AGENT I hereby designate WWI Cl'15561�111 1 yr /-lu.,r�.to act as my agent in matters relating to this app lication for permit(s). OWNER SIGNATURE �Yl 7"r 2�7L'�' Date: l IC) By signing this application form,the owner/agent attests that the information provided herein,and i,any attachments,is true and correct to the best of l 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 resut 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 uired later in pections. Staffs arms and right of entry will be assumed unless the applicant Wane,the County in writing at the time of the a o j�that r wants prior I Signature: i Date: a79/C) The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential`take of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act'or'ESA.'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued wil 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 rice wit the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non trio adhering to and with the ESA. The Applicantis has read this c nsand dates it below. Signature: Date: l J j G:\PemritCenter\###FORMS###\t)RD FORMS\Msstcr Permit Application 5-29-013.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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX 7 v /u /su:/�c<• (36 ba-1 - v/F� /(as7) zss- -1 y,y MAILING ADDRESS: pa 3.„ %/z( f?� (�r,x,-/ ` EMAL t/t+y e .1r+T f?..,,,,,/%,c , c..)•-.-1 CONTRACTOR'S LICENSE WAINS rr NUMBER: TN>- / id /7 y u%77 NUMBER ARCHITECT/ENGINEER: P,�f� f=— .,a cr.i:�s PHONE (LS I ) j�S- _ 7-u.'r FAX:( ) MAIUNG ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New VI, Wood Existing: I l Sewer Addition 0 Steel Proposed: 2 •1-- Bank ❑Community System ❑ Alteration/Remodel f I Concrete Total: 2.,' Height: $(Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: _ _ Setback: kl Private well ❑ Two Party Tye of Heat Proposed: _2._ ElPublic i�/ec.tn:c. !o� Total: _1-_ Name of System: If this is a Commercial Protect 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 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank I Pellet Stove 1 Other Is this appliance being Installed In a Manufactured I Mobile Home? Yes /6 9 g n When applying for a permit to instaH a propane tank you must also submit a site plan showing al ,ail property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. f- S•uare Foo Current ..._. _, -,«. fi t▪ .- , - - . 1, aTx a J , _._ „.. f54A..,a.,.... f ... a..., k`anJt!'�:Y{6 ,..,Ls.—: .1..at, _ Main Floor Heated e i- rt-4 EH Bid App Review:/ eview: y /)7 ,, v+. - I 2"0 Floor Heated Consistency Review: I Other Heated Base fee: I(G 2 Mezzanine Additional Section: Plan Check fee: IX Heated Basement 2 S} ,. �: 1 ram/ Q , -gieex (fib Unheated Basement a State Surcharge fee:**:',*4-f-,.._1`:,- / (1--- Other Other Unheated a ' Pot Water Review fee: 1e Garage/CarportA SUBTOTAL 5-./t & - 2 Q.3 Decks - ,, 911/Rd Approach fee: 1 Other i s€a TOTAL $_ i�i2'(? • ' .- Receipt Number. ( 1 0 2(L' Cash/Check Number ESTIMATED COST(REQUIRED) Date: , .Fair market value of all labor and materials foundation to finish /I- 4' ,00 Initials: c._ , G:\PcmntCcnrer\#t##FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc r * • I APPROVED STOP. ,'•,'A T R PLAN csON w� 7k6 JEFFERSON COUNTY ,I ; Logo ►, ra ► i DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 JEFFERSONOU TY � � 9 NIT �QS �IINO�O 360/379-4450 . 360/379-4451 Fax SIGNATURE: http://www.co.jefferson.wa.us/commdevelopment/ DEPT.Of C' J, PMlEAiT • STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# Q9''ags- PROJECT/APPLICANT NAME: Cco77 y le4iA y A/7-.jlAi•r14 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. vf ..,,,r- J . AN ZuO C4 F: s, 0.4 4ctIY,.-!' (A r 6-, ht)-+-ram! .1j r • xu-c, 2 5 c^'N Existing Conditions Summary l-. i 1 f � 1 2. Describe the existing topography. Indicate contours on the site map. Slrf� 11 /2ac p /v-Ly t1j, i /)/7# A .fL/ - C71fT 1Cor,� �-�%U T/r`.E NJ,2 r� G�-r 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. V!S(f .f/'- u,ti /S Ii- M/x ill, , ,c. IV/ /,,,A A. ivr s / �/2i►s SZ c J/sjeujf Arno ji2.f.Cr, /fa. LJi.<c. ye 4,4;e_ A- t2Z-,c/vic y dc/.r/+.c D I,'1) /M?.r 4)4s lZc:c�.vTcY OAt..:4.`,0 . _ C�.-)/+// S'h&. r.ea,v s 62.4 t SAE J v sW"-..4✓ a 4. Describe the existing soils. Indicate soil type on the site map. SJ/Ly T /2 7) /7C SLiNO' 1,L.)/fr.-.x hi/TA, Co.»t G44 /1 r sI .a/447c.d y Ca r ea7v,1/4- - 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. c(Y6 /7/0/'. =I /7/ _/.401.4t 6 v,r:., .�.c iJ.:,✓flCt. _ /vv JT,n/D.—,), c✓/4-i wit f//,.f ea"---.fiV •2,S'S,6-a /C`,. aft. J,Z -^-1,4+1✓L Tii� /ic-/4o/-cic• i T2 , %/I4/1e• "P,scjJ,:i is _7f A O.y si-,4J0.,.,rlc P ''..,AGrz`. =.E,„1- /9i7.✓9- 20-)' /=r /Z, j'NE N,,:'Tft J,- i- d'c•,co.,n/i,- 6. Describe any excess levels of noise generated by the proposed use or activity: 0j✓i-Y ryf'/L,1-1_ AV?,S... /ere6-•-, /fU--.0 47i„G-4.),nJCr A C74,,re --1 stormwater site plan template-rev.10/21/2008 5 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. 42, , ScvP,i5 vtcy re-/c,ffLy C=1-«-•7 SnNTis 7b ..' eer4/ /h+/O 'f'—' S;r,, G/�1✓.Jt.�fi .: 1D Goal i -51/4s/J y t.lt Ay'P4 s- ee fd Ok'-i 44-�"v l VOL r i�.: . D/4474.4$ 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.). �05 nr� itRf=rYr 42 /nocr-z-y S M I. 4)2 i) Tinxi'.�s2 ,A .6./lT y // A-0: /l c oC.1r 72' / `� /o l 7 P Tn .- i€-' /r i r,E Ot y r_ .dYvxo i,t,t..-' cA,%, /fcc G/livrai O„ 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. �90 F j7J,p [la-Po,/v6 T i & 7;4:9 /^'T o AA' /Ni=/�/),>'-,4%.u Pit (. c 6 /177 uti&, (Jfi!/r/V) _ Pt r S/Za,2 ., .r _s rT 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.] i/L 1/2-gT,o,ti ;'/r As -5/ G'LTh 11. Describe the performance goals and standards applicable to the project. /� �rr✓(� fh/.�J:.a�,k /MPrhr. ,c - "c-/Z.e.;tr., A S f /14-r A te,i v, ram. 12. Describe the flow control system. 1 V..'r 1.),1r3 CC /N!%,[.7ZAi,I; A r. r.✓ S/%,% Gt7,VD.i7 O,, /,• /A7AC.4'e /r`+r✓y' Jf i'—' ri!!9r�ic 2u.✓Jrr: �' '�//1sZCA 7-4 //T.el GJ Kam'/%/U.✓s stormwater site plan template—rev.10/21/2008 6 • • 13. Describe the water quality system. hoar 17, 0�'-9,NJ T-a rzvc;/4 JLATi o..,j /a% 14. Describe the conveyance system analysis and design. 57A1 E t y .57-nhi. m t S 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. /w r7 .2g? - v/c _r L E-' 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the psed 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. /Lu,re 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. .S44./'i ✓ F} AUIG__ 2 5 2C stormwater site plan template—rev.10/21/2008 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 Volume II Section 3.2.3 of the Manual (beginning on page 3-7). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. /1/O; _ silo /14-/2 •9 e4"Lt—O. 2. Establish Construction Access. ILA,L. AC ctif f 3. //Control Flow Rates. KXis ✓4 . t./,r pro 00%It.ifl',n % iN-r7 AZ LED Tor. Dseel/n.$ 4. Install Sediment Controls. Si iZ�t�.I j U ye- "AcC;) C12 _-) ©/.ir4li2/e;0 AR r4S q 7d .L /17�c.c/`zc 5. Stabilize Soils. 6. Protect Slopes. (i/r L/Zsi L 7. Protect Drain Inlets. :-.rYr 8 stormwater site plan template-rev.10/21/2008 • • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. ice r- 9. Control Pollutants. /fQ Pot��-irw7 s r' :W,= 6. 014../f.or6o 10. Control 7De-Watering(the act of pumping groundwater or stormwater away from an active construction site). I' / Jut,N 6- 1V w9'rA,2 W iL. .. i.741 19:!:.61 fed/ %its.d44 6 if .Si'7-414/ Il�1C,i1 �F�ic�ffAacl 11. Maintain Best Management Practices(BMPs). J. Go,vr2. J,cr -7`0 ie..,sr/Lut r 4) j ,v7/,.v TY}/iu i,u6 iN,� f irz 12. Manage the Project. PF--/L"ocjc ✓ZIP Ts rTQ 'Ow.a.,ti4 C. uf�'�+v�T,d.� 71) �/vsi.ve ,MN, ^/,gA/7: .,ul= Jam%,a e ,T-J el'S 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). A,&-4 r 1 A=r vi iU �/v,�,d r1 T,e. 76 g?,e b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). Rsc 7 0'-7; 1`�'L/1 />L / -'— i i� 7b L-'<../1.T-,c,tit T nii i I-rn4/7 o.v �r os/zo 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. Tir6 ,I ft '..E4g I %b r'>� f) irriY S >v.t r2 ,;i be 1 2l1? ! 4 ,,., Tits, 1' AUG 2 5 2999 stormwater site plan template-rev.10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. /1414 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). 711 .I%' U.tJ ;/ r .51 7 is / GAS/4,e�Gy LEVee 5. Construction Phasing. a. Construction sequence /� 5 1' ( , S ri. /""-' -ivGL©r�4at1 /`� Niiu Ui/�/fY ,,".cr)l C . , .i �i'/l I" 7/)tt, /2.4../a F'i' . S/4,v0 U/ divi. Arira f corl/Jiiv G- 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. II. Wet Season Construction Activities. 5 r/� 560 J a. Proposed wet season construction activiitt4es,. /f%�'�'S T f LGP S//� �/le/> �f=v.•.✓O)PT./s:0/ /%L/11t--�/.vlT/4/l `(7c-(T- .vD v o/4) lr/iLi/7 C Nud Oz ) Gi74.-;.✓ �.n /ri �Or`- (J5/ �Lr-�.-tT��J C' / Lrr/7//'•./i..., r C .J.R.0 iC ) 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. Sc or, /O/v, /�-//%//r A Lc/NG 4./ti;.?7 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. SGL-,�Ze d t 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template-rev 10/21/2008 • • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation (e.g.,tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales, interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes,ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions, and direction of flow in all ditches, swales, culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s), pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth, length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s), if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. - stormwater site plan template—rev.10/21/2008 11 • • 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 be of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners .f - - = ted property. 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