HomeMy WebLinkAboutBLD2009-00321 ILDING PERMIT APPLICATIONMRA09 00p3e: I
17
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00321 Received Date: 9/28/2009
SITE ADDRESS: NIGHTHAWK RIDGE RD
PORT TOWNSEND, 98368
OWNER: DOUGLAS M GIRON PHONE: 360-643-0722
GEORGE M LUCAS JR TSTEE
4854 EMERALD ST
PORT TOWNSEND WA 983681047 SKY VIEW HEIGHTS
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 902225004 Section: 22 Township: 29 N Range: 02 W
CONTRACTOR: STAPF CONSTRUCTION PHONE: (360)385-3199
2727 HASTINGS AVE
PORT TOWNSEND WA 98368
Contractor's License STAPFC*249J8 Expires 8/12/2009
REPRESENTATIVE: RICH STAPF JR PHONE: (360) 301-6184
211 SOUTH JACOB MILLER RD (360) 385-6722
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP NEW DETACHED GARAGE - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 16,527.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 616 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Tot at:
Ro ting Date:
-zeroq
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $279.25 LYK 09/28/09 111011 APPROVED
Plan Check $181.51 LYK 09/28/09 111011
State Building Code $4.50 LYK 09/28/09 111011 DEC \( 2009
Total: $465.26 Jefferson County Planning
& Building Department
Jefferson County Building Dion Permit Nur.: BLD09-00321
Applicant: GIRON
BUILDING PERMIT INSPECTION APPROVALS applicable 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 -_IO--Vo Minimum setback from Nighthawk Ridge Road right-of-way shall be 20
feet. Minimum setback from the south property line adjacent to the
commercial forest lands shall be 250 feet. Minimum setback from the
Type F stream shall be 155 feet. Minimum setback from the west
property line shall be 40 feet.
Erosion Control SEE CONDITION 2
Post Holes
Foundation Footing
Footing Drains
Foundation Stem Wall t.,`,O 1.41 vr:1,
1
7
Underground Plumbing
Straps(hold downs)
Ext. Shear Wall Nailing cj b III
*---"
Rough-in Plumbing
Framing
Blocking
Wallboard Nailing I-69 I�r )..
Drywell/Alt Drainage 11 SEE CONDITION I
Address Posted
FINAL INSPECTION ..
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• s
CONDITIONS for Building Permit# :BLD09-00321
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 FLOVVPATH LENGTHS.
A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH
SPLASH BLOCK.
A SPLASHBLOCK OR A PAD OF CRUSHED ROCK(2 FEET WIDE BY 3 FEET LONG
BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE
POINT.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE
DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFLED 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.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
4.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC) Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
5.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
6.) All construction activities shall not encroach upon the landslide hazared area buffer. This
includes the storage or preparation of materials.
7.) The applicant shall permanently Orate the boundary of the Landslide Haz rea
Buffer from the remainder of the subject property through installing logs, trees, edge
row, or any other prominent physical marking approved by the UDC Administrator.
8.) 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 detached garage.
9.) An additional setback of five (5)feet is required from the edge of the stream buffer area to
the proposed single family residence and detached garage.
10.) A permanent physical separation along the boundary of the stream 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.
11.) Stream 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."
12.) 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.
13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
14.) 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.
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.) Minimum setback from Nighthawk Ridge Road right-of-way shall be 20 feet. Minimum
setback from the south property line adjacent to the commercial forest lands shall be 250
feet. Minimum setback from the Type F stream shall be 155 feet. Minimum setback from
the west property line shall be 40 feet.
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.
19.) 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.
ONc_
wow 6,� JEFFERSON COUNTY
` A DEPARTMENT OF COMMUNITY DEVELOPMENT
1.•) 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
t"s www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: J 1 ------3 t,__,
._ 7
Project Descri ton(include separate sheets as necessary,}:.
►emu) I t Oki) , _- unn+d, Nc aH13
Tax Parcel Number: C(OZ22 cog / t Property Size: 0.0 (acres/square feet)
Site Address and/or Directions to Property:
CX NI(2k{ -Ma- eIME Po, -- Orr GASs A- r e0 - - ofr v , umeiks QD•
Property Owner(s)of Record: LOM:AS t(261,1 O6C LtaCRS
Telephone( 0) Gq;—(072.2— Fax: email:
Mailing Address: yc35r4 rmrd.{(} ST, FbeT —fN/IJ tt OA • 41E3
Applicant/Agent(if different from owner): S"@-PF Co s.STQcfcocK) i JC• — ? QF
Telephone:( 30Ha( q Fax: email: STicfrc. 40S-y .4(Z Oree.Ls cJ.Corr
Mailing Address: Zit S. 11,45g fNIU 4-- el). Pow 'fbWNSfaiD r WA. q 8yt>g
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
►A:uilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
CI-Single Family Ij .Garage AttachecCetached ❑Conditional Use[C(a),C(d),or C]**
U Manufactured Home .0 Modular • ❑Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment :;: r `,1'
❑ Address ❑ Road Approach 0 Short Plat** `
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
f]Propane 0 Long Plat"
'U iyn - 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 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:
DESIGNATION OF AGENT
I hereby designate ga STAPF to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE jk_yM / • ti, ,a f Q
1•
vx Date: `t - 9- - 200 c
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the cation that he hew nts , r •oboe._
Signature:, -�&1h'f, * '(4N % Date: 0?'Z o sn
The action or actions Applicant will undertake as a result of a 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 will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tran rable responsibi' f adhering and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1 • Date: C T — 2� (A)` 2 0 7
• •
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: FAGX-!-1•.,l{
sT F $Teu n o,0 102,- GGo) 585—31 c °f (760) 3101-6 l fay
MAILING ADDRESS: ZI( 5, rA 4' tvl ILVL L e . P.T. 61 8366 EMAIL. STAP�-(p:03S `I0C CAtikru.SertED•Co M
CONTRACTORS LICENSE WAINS
NUMBER: STAPFC 19 1 )GV- NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
X.New A.Wood Existing: __ _ ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank l l Community System
❑ Alteration/Remodel ❑ Concrete Total: _ _________ Height: Individual System
❑ Repair ❑ Masonry SEP Permit# 09 -opo67
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: i7 Private well XTwo Party
Type of Heat: Proposed: _ , I i Public
1i n 1, )V- Total: — — Name of System: •
If this is a Commercial Projectyou 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 Pro•ane Tank an• • :r'Hance Installation ••unit,mark all items below that apply:
i Underground Tank - Above •rou . ... Size of Propane Tank: 2SU &k t.-
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/Mobile Home? Yes / No , _
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Foota e Current Proposed fq-O ice ' ., . _ Amount `. Revision
Main Floor Heated EH Bld App Review:
22 Floor Heated Consistency Review:
Other Heated Base fee:
rq . a
Mezzanine Additional Section: __ _____.
Heated Basement Plan Check fee: I I
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport 6% I gicZi SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $Ikea ,a(10
Receipt Number: ( I I n ( 1
- Cash/Check Number: c q I
ESTIMATED COST(REQUIRED) Date: (�,2
•Fair market value of all labor and mat 'als foundation to finish 1
Initials: ►„_.)
_..........,____ ... ___ - ,.. .. . . . .
•
0 •
wowIS N C% JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
4464
621 Sheridan Street • Port Townsend • Washington 98368
•qs, GA,0 360/379-4450 • 360/379-4451 Fax
SIN http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# ID . 17
PROJECT/APPLICANT NAME: LUCAS/G-1R)yJ WEv-) _- ,SFg-
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map. S i•P 2 8 2009
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements-'on the
site map. PosFA D4v61_4P6,44E,..rT Cat I.<, r5 Or 0) /t1E44) 5FR 4'io (/J Ngtil
DE-Ae#E40 gtfle-A&E• ACLF55 W/C-i- 8F 'Rom Er/p2ilor Pe/if/f af9 C//ffT//ifl✓,e-,/,
770 - /��/yh c/ , ' 3-fie W/GL J,E e��D �j On/ S/Tr SE/9/74. P,01..cQ,_
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. A/7,PC4-C cz., Es ,iPo4.1 Gvics7-
jDu rQR$i 7P A.�r it//7fr ,4W ,e2.crilr/a•l D,ev/' GF 40/Ao,I AD - o4/ / 127 s`
_J W29�09,1 O ZOO' DA.1 .�u77( treee,vast,e7
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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C,a s, s14.D S 'io,✓G /I//77" 5ife-lz 44145,
4. Describe the existing soils. Indicate soil type on the site map.
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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. 7�/f�. 'A ,,e,C ,f/p ,fir/Sn,,G 572;, , ,exif,`,e -S
Bn/ /ie/vice 7 / 77 h' /5 ,1 S7x9f i 7),5t-r /QN,d/l /fu,144. 7XC ,c p "
gaDFie
_ APPROVED
6. Describe any excess levels of noise generated by the proposed use or activity STO WATER PLAN
att
DEC 1 5 2009
Requite
JEFFER O TY
DEPT.OF C . ITY E LOP ENT
SIGNATUR :
stormwater site plan template—rev.10/21/2008
• • 1
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.
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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.). T'is a /1 4,2rS 74'Q t5/7A Zr WAS
"44 J -D A/PiOoX 10 Yes /¢6fl /4✓720 8 'wens /T /5 /J07D/a/CD M
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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.
6711,eAfK/1-77j2 A)iLL B 0i1Ar 6tUy /1 K ,.c i7o,/ 4 •5
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 performance goals and standards applicable to the project.
*fit
12. Describe the flow control system.
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stormwater site plan template—rev.10/21/2008 6
. •
13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
SEP 2 8 2009
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements, describe those conditions or
restrictions here.
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.
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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.
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stormwater site plan template—rev.10/21/2008 8
• •
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Chann Is and Outlets.
girt
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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11. Maintain Best Management Practices(BMPs).
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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).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site. __? 2 8 IOC
stormwater site plan template-rev.10/21/2008 9
• 0 ,
b. Description of special requirements for working in or near environmentally sensitive areas.
/t//ff .
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, settle bility, permeability,depth,texture, soil structure).
N/fi
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).
I. Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction�y activities.
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b. Proposed wet season construction activities for environmentally sensitive areas. •
11 40
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
GfoRGF LaGd5 1' DotuGM$ G/Ron/
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
stormwater site plan template—rev.10/21/2008 10
• • .
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.
-ft. - 0y_ 2vr zoa5
LIxS' 71AR-
NDOOR AUTHORIZED E ESENTATI y,IGNA U E) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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