HomeMy WebLinkAboutBLD2010-00015 SUILDING PERMIT APPLICAWN MLA Review Type:
15
I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00015 Received Date: 1/13/2010
SITE ADDRESS: 106 MADRONA VISTA PL
PORT LUDLOW, 98365
OWNER: DAVID A WILLIAMS PHONE: 360-437-2641
130 MADRONA VISTA PL
PORT LUDLOW WA 983658748
MADRONA VISTA 1ST ADD
SUBDIVISION: Block: Lot: 17
PARCEL NUMBER: 970300013 Section: 34 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: HENRY M SOUZA PHONE: (360) 379-8338
DESIGNS BY SOUZA INC (360) 379-9136
164 SWANSON
PROJECT DESCRIPTION NEW DETACHED 2 STORY SHOP/STUDIO
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 896
VALUATION 175,503.00 ADD'L: 825 HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
GARA
CONST TYPE: DECKLE 200 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 1
Total: 0 Total: 1
Routing Date:
�^ B—D
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,419.35 LYK 01/13/10 113644 APPROVED
Plan Check $922.58 LYK 01/13/10 113644
State Building Code $4.50 LYK 01/13/10 113644 MAR ib 201U
Potable Water Application $98.00 LYK 01/13/10 113644
Total: $2,444.43 Jefferson County Planning
& Building Department
Jefferson County Building Divan Permit Numb•3LD10-00015
Applicant: WILLIAMS
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks 1 I Z.� I ,o ;A- Setback from Madrona Vista Place right-of-way is no less than 20 ft.,
y side and rear setbacks are no less than 5 ft.A minimum 75 ft. stream
buffer and a minimum 5 ft. setback from the stream buffer is required.
Erosion Control Q /ill SEE CONDITION 2 FOR CONST. ENT.
Foundation Footing
Lfzz ►o
Footing Drains 2P (
Foundation Stem Wall 'kit D ��f
Underground Plumbing _13 !O h/e. 15
4),
Q�P.`
Under Floor Framing vjiA
Straps(hold downs) 9/3/1 f
Ext. Shear Wall Nailing Zo_I0
Rough-in Plumbing
Tr)Framing /a//,/ /
Blocking ! ` T
'I a/ixf tit
Airseal f/ti/+s
Insulation:Walls t�y4
11z.,'I, if 2 " 6• w dK 4/3/4 ¢ d' e 101
,�
Insulation: Floors
Insulation:Ceiling 1/14 ik �" S�YZAY O K q 3�� 6% 7 t Y ' 419Vit
Int. Shear Wall Nailing IVA
Wallboard Nailing
Gas Line: Interior 14/4
Gas Line: Exterior ),
Propane Tank NIA J
Heat/Chimney Clearance t
Drywell/Alt Drainage 9/3h y SEE CONDITION I FOR SPLASHBLOCKS
Address Posted
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00015
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
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 DRAINFILED AREAS.
2.) IF NEEDED, A SILT FENCE SHALL BE INSTALLED BETWEEN THE EAST SIDE OF
THE STRUCTURE AND THE STREAM BUFER (80 FEET TOTAL) PRIOR TO ANY
LAND DISTURBING ACTIVITY. APPLICANT/CONTRACTOR SHALL BE
RESPONSIBLE TO MAKE SURE THAT SILT DOES NOT ENTER THE STREAM.
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
3.) 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.
4.) The road appro 0 •
ach permit(RAP07-00200) must be inspected and finaled by the Jefferson
County Department of Public Works prior to the final inspection/certificate of occupancy of
this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the
final road approach inspection.
5.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 miie of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
6.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
7.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
8.) MANDATORY MEASURES FOR AN AT RISK SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirements:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
b. Installation of a flow meter.
c. On-going well monitoring for chloride concentration.
d. Submittal of flow and chloride data to the County per monitoring program.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
9.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
10.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
11.) The identified Fish and Wildlife Habitat Area (Type 3 Stream), shall maintain a vegetative
buffer setback of 75-feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to any structure.
12.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed buildable area.
13.) A permanent physical separation along the boundary of the stream buffer area sha 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.
14.) 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."
15.) 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.
16.) 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.
17.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
18.) 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.
19.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
20.) Pre-existing legal lots of record less than one acre in size in rural residential districts are
subject to the stormwater requirements in Chapter 18.30 JCC and must meet the "Area of
Impervious Surface Coverage"to the maximum extent practicable as determined by the
administrator. Lot coverage is defined as amount of impervious surface, which includes
rooftops, driveways, concrete, etc.
21.) The building height is not to exceed 35 feet.
22.) Setback from Madrona Vista Place right-of-way is no less than 20 ft., side and rear
setbacks are no less than 5 ft. A Type 3 stream exists near the rear property boundary. A
minimum 75 ft. stream buffer and a minimum 5 ft. setback from the stream buffer is
required.
23.) 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.
24.) 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.
►5.) The applicant shall fully comply with tFe Habitat Management Plan prepared by
BioResources LLC dated January 5, 2009.
III 1111
(-
al °L� JEFFERSON COUNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT
"' ' ` '4 1 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�sp www.co.jefferson.wa.us/commdevelopment
BINp
Master Permit Application MLA: t — 9
Project Description(include separate sheets as necessary
c.
Tax Parcel Number: Gi 0 3 C
t,. Property j ;`3 Size: (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: Q,�ti (D t l\trc.lAA.S
Telephone: ! Fax: email:
Mailing Address: I� rAILLryv ,v�ti, `ACk_ x`rk,,@a, i Q4 (AJ.tr\ tv,, 0 (I ‘-Y5
A=',
Applicant/Agent(if different from owner): f k pQ�1 O 11I Lc.� -l s 4_6 �J 3 ,'-'
Telephone: ?L0 3I1'J Fax:" email:
ail:
Mailing Address: p6¢ r'wrliA-),.) a4ji p i y b
IN t kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑ uilding 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family P Garage Attached/Detached ❑ 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 ❑ Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry 1 A 1_I 1 0�
' (� Binding Site Plan**
0 Propane �' c � � Long Plat**
❑Sign - • ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions'`*
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development'"`
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
�
DESIGNATION OF AGENT
I hereby designate _ �J act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE I' r Date: y`Y / Z 'L1 f/
By signing this applica ion form,the owner/agent attests that the information provided herein,and in any attachrfients,is tfue and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any requirejlater inspections. St:;ffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application hat he r sh/e ants prior otic�e.
Signature: ii, /'� l�,,A/ X • Date: Q i/ 3 .26 !0
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one 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 y u are in complian 'with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer e respons' ility f t adhering to and complying with the ESA. The Applicant has read this disclaimer/nd sign nd dates it below.
Signature: 4% {--�_._—_._--..._„ _ Date: e,,/ ,, / 3 / LO /e
1 d
• . .
BUILDER STATEMENT
The signer of this tatement does hereby certifyhh t they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuring the re��nsi 1ty of the I Contractor for the proposed project. ,, /
/I : Dater- ,./ // ,� ,/2-0/O
Signature: �f .�--.•�/� t
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
2L New =Wood Existing: r' 0 Sewer
❑ Addition ❑ Steel Proposed: i Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: ) Height: ( Individual System
❑ Repair ❑ Masonry SEP Permit#
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: LI Private well U Two Party
T of c Heat:t Proposed: d tll_Public
Lei Total: d Name of System: RAS t•I'"
/Prat
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
if this is a Propane Tank and/or Appliance Installation permit,mark all items below that!Rely:
Underground Tank 4.Above ground Tank Size of Propane Tank: ). B /
• Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank 1 Pellet Stove 1 Other _
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed fg,r Office Uses?-AIL, � ,,_`E t` .q't. OLision
Main Floor Heated EH Bid App Review: ar�3--
2nd Floor Heated wt, c•sx 1;,,,. :: Consistency Review: (
Other Heated "� t _ Base fee: I ''—�.
Mezzanine Additional Section:
Heated Basement Plan Check fee: Jo
Unheated Basement State Surcharge fee: .4 57
Other Unheated Pot Water Review fee: =
y
Garage/Carport SUBTOTAL a, , ,, .2_,
, ,,,,,,, •,__, ___...,
_f _ ,
Decks ,. 911/Rd Approach fee: 1
Other TOTAL $ arrtoZ,Il
7- Receipt Number: t t 4
Cash/Check Number: , _, i
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish t—(3--td
qInitials:
r �
•
°e` JEFFERSON COU
NTY UNTY JAN 1 3 2010
, DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
,t0 360/379-4450 • 360/379-4451 Fax
ItINO http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# I0r15 PROJECT/APPLICANT NAME: Williams Studio Shop Building
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.
See Site Plan
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
See Site Plan
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
See Habitant Management Plan
4. Describe the existing soils. Indicate soil type on the site map.
Sandy Clayey Loamy Rocky
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.
Storm water will drain towards south east
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
Standard SFR construction noise STORMWATER PLAN
•
MAR 152010
stormwater site plan template.doc—rev.10/12/2003 Requi 'd ` O' • JEEP •S t �U
�i`1 DEPT.OFCO',Y' 1I �C: .�e ENT
SIGNATUR.• aI ‘..450. .i/. •
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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.
Wetland area around stream with 75 ' buffer
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.).
Adjacent land use is single family residence, no structures
on prnparty
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.
Storm water will be dispersed by sheet flow
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.]
NA
11. Describe the performance goals and standards applicable to the project.
NA
12. Describe thp flow control system.— 1 sly, ►olocac 460' VcX-161-tvpt1
6
stormwater site plan template.doc—rev.10/12/2003
• •
13. Describe the water quality system.
NA
JlA N 1 'd 2010
14. Describe the conveyance system analysis and design.
NA
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
NA
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
NA
17. Describe the proposed surfacing material.
Gravel
18. Describe methods for restoration of the site.
Normal replanting of native vegetation, also see Habit
Management P1an
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.
NA
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
NA
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.
NA
stormwater site plan template.doc—rev.10/12/2003 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). N 010
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
See Site Plan
2. Establish Construction Access.
See Site Plan
3. Control Flow Rates.
4. Install Sediment Controls.
c&t) P'11°9%-. 6 611T
5. Stabilize Soils.
6. Protect Slopes.
7. Protect Drain Inlets.
8
stormwater site plan template doc—rev.10/12/2003
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
NA
9. Control Pollutants.
NA
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
NA
11. Maintain Best Management Practices(BMPs).
p e ezi/D1--( fiff ei44(\a-d-evr
12. Manage the Project.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
Westerly stream C.1..k,ork tei ( / b ccsei y /
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.
There is a stream running at the west side of the property line
stormwater site plan template.doc—rev.10/12/2003 9
• •
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).
Some erosion make take place from sediment runoff from
PxpogPd fnvncipti nn Thi . will IMP mi ti cgaterl with silt fenrP
5. Construction Phasing.
a. Construction sequence
Foundation June, Wall construction July , Finish September
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual):i i ' L "U
I. Provide a proposed construction schedule.
June to October
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.
NA
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. NA
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template.doc-rev.10/12/2003 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 signin. the Construction SWPPP.worksheet, I as the applicant/owner attest that the information provided herein is true and
correct • he best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owner- • the affect prop rty.
•
/ - 4/ / #Z D
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
12
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