Loading...
HomeMy WebLinkAboutBLD2010-00069 4114 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 #: BLD10-00069 SITE ADDRESS: 1305 S DISCOVERY RD Issue Date: 04/6/2010 PORT TOWNSEND, 98368 Final Date: 8/10/2010 APPLICANT: MILTON M FUKUDA PHONE: 925-698-0517 RENEE T FUKUDA 152 HORIZON VIEW DR SEQUIM WA 98382-9312 SUBDIVISION: MOE'S DISCOVERY ROAD TRACTS Block: Lot: A PARCEL NUMBER: 001205001 Section: 20 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW M/H THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 8/10/2010 I:\F_BLD_Occupancy.rpt 10/29/19 MANUFACTOED/MOBILE HOME INSTALIION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00069 Received Date: 3/11/2010 SITE ADDRESS: 1305 S DISCOVERY RD Issue Date: 4/6/2010 PORT TOWNSEND, 98368 APPLICANT: MILTON M FUKUDA RENEE T FUKUDA 152 HORIZON VIEW DR SEQUIM WA 98382-9312 SUBDIVISION: MOE'S DISCOVERY ROAD TRACTS Block: Lot: A PARCEL#: 001205001 Section: 20 Township: 30 N Range: 01 W CONTRACTOR/ PARAMOUNT BUILDERS INC PHONE: 253-606-7313 DEALER P.O. BOX 112452 TACOMA WA 98411 Contractor's License PARAMBI001JE Expires 3/25/2012 PROJECT DESCRIPTION: NEW M/H MAKE: PALM HARBO YEAR: 2010 SIZE: 68X41 Directions To Site: 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/ i LZI i'0 Minimum setback from South Discover Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. Erosion Control SEE CONDITION 2 Drywell/Alt Drainage SEE CONDITION 1 FOR SPLASHBLOCKS L ._r,� FINAL INSPECTION al 101 0 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR CA') i-iN(c 6.fr j ki vo 5-101 to SPECIAL CONDITIONS APPLY- SEE REVERSE OILDING PERMIT APPLICATI• int44 ia- 8'7 Review y Nc. Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00069 Received Date: 3/11/2010 SITE ADDRESS: 1305 S DISCOVERY RD PORT TOWNSEND, 98368 OWNER: MILTON M FUKUDA PHONE: 925-698-0517 RENEE T FUKUDA 152 HORIZON VIEW DR SEQUIM WA 98382-9312 MOE'S DISCOVERY ROAD TRACTS SUBDIVISION: Block: Lot: A PARCEL NUMBER: 001205001 Section: 20 Township: 30 N Range: 01 W CONTRACTOR: PARAMOUNT BUILDERS INC PHONE: 253-606-7313 P.O. BOX 112452 TACOMA WA 98411 Contractor's License PARAMBI001JE Expires 3/25/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,788 VALUATION CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Tom: 2 —� Routing Date: L— Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 03/11/10 114001 APR Add. Manufactured Home $37.00 LYK 03/11/10 114001 OVEr Propane Tanks/Stoves $142.00 LYK 03/11/10 114001 APR f lU�U Total: $392.00 Jefferson County Plannin: & Buildino Deaartmpn, • SPECIAL CONDITIONS CASE # BL 10-00069 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 staff on March 29, 2010 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: SARPA aquifer recharge area. 4.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4) All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 7.) Critical Aquifer Recharge Areas require special protection measures to rile water quality degradation. The submitte proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) The applicant is proposing to create or add 3656 square feet of impervious surface and 3656 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. 9.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 10.) 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). 11.) The revised site dated March 25, 2010 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 April 6, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 12.) This approval is for a manufacture home installion and attached garage only. 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. 13.) The parcel has been designated as RR 1.5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) 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. 16.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) The building height is not to exceed 35 feet. 19.) Minimum setback from South Discover Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 20.) 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. 21.) 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. 22.) An address of 1305 South Discovery Road, Port Townsend has been assigned to the parcel. South Discover Road is a county minor collector. 23.) The parcel is served by an on-site individual well. 24.) A septic permit (SEP94-0045) foOrainfield is filed with SEP07-0147 for a tank and pump chamber that was approved on May 10, 2007. A well review (OTH9 -0199) was approved on August 22, 1995. A buidling permit(BLD95-0440) for a single family residence was cancelled on August 22, 1995. A building permit (BLD07-0157) for a single family residence with attached garage was cancelled on March 29, 2010. 25.) NOTICE: This permit does not excuse the proponent from complying with other 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. JACK WESTERMAN III • Jefferson Count,CoSouse ASSESSOR 1'O Box 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS:NAME: fihtto µJ FO ka a( ADDRESS: S f IO /Z pR) ITS �ll� PHONE NO. LcAS- 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. I)MOIIILE HOME DATA: (A) MAKE / Ql/rn (B) MODEL/ -5-VY4 y (C►YEARO,O/O (D) LENGTH e (E) WIDTH ! / (F) SERIAL # + C/(�e Or ei2 (G) YOUR PURCHASE PRICE (Do not include sales taxic6JJ7: PURCHASE DATE 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE nTOQUESTION 3)(A) FROM WHOM DID YOU PURCHASE MOBILE P°I /yr l �l � I -Fc, Cl f\ ADDRESS J606 ( � A rIf 1A�� q(II) WAS MOBILEME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes o If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. A)J1 30WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No (B)IF LOCATED IN MOBILE HOME PARK: NAME di OF PARK I I Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: fil 1•/±.0 1 rU tad, NAME OF LAND OWNER: n /V LOCATION ADDRESS ) OS /.J LC Ve P©rzT k cuo REAL PROPERTY PARCEL #/DESCRIPTION 00/aC).-S Sig ature of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician it. Q K o K A m W a. '. W 1 0 �� I SkR .) . Cuku-is/eni .1 6 0 u• , 4,3 axis .. CO Si u, , XI N. co., I. G _ I � -) ° R 4StR f+f b W O Z O C .Z CI? I O N l ° . I -1 x S&R I II r 1 IQ Is \_. . 1.2.it g I L J '',/ .0e4s. I 1-- IIMMI_.j i , CAD L...._ f�d . I INO i CD cji al {I d ts,T U a •■ mu ■ I `! Qo �`_ i P. • • �4�ON% goN JONTY ti DEPARTMENTEFFERSN OF COU COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �q s 0 www.co.jefferson.wa.us/commdevelopment Nd Master Permit Application MLA: 10 -S.( Project Description(include separate sheets as necessary): ma's/CI R J ..uti 'jR'ipI LA)1cy(-e�� i iv06 ci-oe�- Ho i€ �.JLJ Tax Parcel Number: 00 I a 5 1 Property Size: (acres/square feet) Site Address and/or Directions to Property: s. b , ._ Property Owner(s)of Record:q // 0 Uk Cl Telephone:*025 - 678 8- OS( 7 Fax: ,,mail: Mailing Address: d e,. a r, - Q, -- ,,t) ,J,.i C " - •1 ' j 'r • f' Applicant/Agent(if different fro owner): �PE (?I N � �II A C - ('e A Telephoner-y 2S ' 6t�6 73/3F x:�l�O .s'£3YY8 email:,'ni/c t C2i7 pL/'l� cq /,E Mailing Address: P O c a J(-43 /-Q_,I h'] P A What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** 'J.Manufactured Home .0 Modular • 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan** 0 Propane 0 Long Plat** 0 Sign . 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑ Stormwater Management 0 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 ❑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: D SIGNATION OF AGENT herebyI designate j' , �� 91�1©�Pv U s' to act asd my agent in matters relating to this application for permit(s). �fJWNER SIGNATURE�� 1�`- J� Date: -3 - 6 • /o 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 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 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 applicaation that he or she wants prior notice. Signature:_f -'_` � Date: ^‘ f0 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 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 uaarre�in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual ,xand non-transferabl esponsibility for adhering to and complying wit a ESA. The Applicant has read this disclaimer and signs and dates it below. ��Signature: -► l�/lu— _‘ / Date: • 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: �GEN RAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: /4/z"7-4ndd /34-)1 Je-R-1 .2I_ (eV) 464 ? ?,.3 (34-4 Yid' KveYCY MAILING ADDRESS: A /)0( 0e4 �/13 /YG� Ce. -- �3� IL:/Y9,/GG-,--/7 /J.C3/ e Goi.41 y-iT.-/t'" CONTRACTORS LICENSE /�,� WAINS SX/ST1GG2o NUMBER: ( �//emu/"r�-7. /Ti NUMBER s/-"/Dp 0/71.5 O 3 Z. c ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL •-�Project Type: Shoreline: Typeof Sewage Disposal: Frame Type: Bathrooms: g p YJ 'New ❑ Wood Existing: 0 ❑ Sewer tion 0 Steel Proposed: Bank 0 Community System D Alteration/Remodel • AlteraAlteration/RemodeloRemodel 0 Concrete Total: Height: ❑ Individual System SEP Permit# ❑ Repair 0 Masonry Bedrooms: Water Supply: ❑ Demolition 0 Other: Existing: 0 Setback: rivate well ❑ Two Party Proposed: 0 Public Type of Heat: Total: Name of System: If this is a Commercial Project you must answer the following: Number of ADA ParkingSpaces: Number of Parking Spaces: Current: Proposed: p 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: derground Tank i Above ground Tank Size of Propane Tank: 1 Heat Stove i Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank 1 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. i Current Proposed office UseOnly , Square Footage � � EH Bid A Review: r—� Main Floor Heated pp I, 21'tl Floor Heated Consistency Review: 2_1 . Other Heated Base fee: 2 Mezzanine Additional Section: 3 -- Heated Basement eC�t�2 I I--_( Unheated Basement State Surcharge fee: ___. Other Unheated Pot Water Review fee: E -t tDOI 6 Garage/Carport SUBTOTAL /^�� �' Decks 911/Rd Approach fee: w Other TOTAL: $ (o`Th Receipt Number: 1 1403 J Cash/Check Number: L 1 of ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: auunflfl'Wxuu'rinr nflnX rc\C.. rin t,r.__._ a♦ n..�:« A.,..t:.....:..�.c�n no a,..- , r • • ;ONCO(c. , ,, JEFFERSON COUNTY DDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 `.qs �Or 360/379-4450 . 360/379-4451 Fax LNG` http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# (b PROJECT/APPLICANT NAME: Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. 7:MS--a 1t a ag410 fbAV-1aC-tU2P-di MOM f Willi) of A.) A&)1p ci q 3 , qg.a ,� cJ S 4 G2S (AJifj €x/ >1) 6Al r-Pcx 22- r1 ai Existing Conditions Summary 2. Describe the existin to rah . Indicate contours on the site ma . 5 , l S -ac-rive, y ct 3. Describe the existingvegetation. Indicate native vegetation areas on the site map. E X./Ti cue /'40efi 1,!t'j 1 1 2010 4. Describe the existing soils. Indicate soil type on the site map. 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. -l'I?e e /5 0. !1/a(-^BIZ en;T-P.P,iC /'�/ ,!L A t i V ill fl✓err-P,Z (DJ !u S / 1 e_ APPROVED 6. Describe any excess levels of noise generated by the proposed use or activi : STQRMW ATF.R PLAN TV. CO(N), C b ,‘) o>v t v At A ' ' --1- , StormWet r 0 Required - JEFF C U DEPT.OF C , ITY E . PMF.NT stormwater site plan template—rev.10/21/2008 SIGNATURE: C. • • 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. A)0 ( 11 e,ei ) 1fzeetk mA) s 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.). ff Ke id cLF 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. PStt•-.- 4 • 15 ti 5 Act.. Exisfi N /�p . 105-ec STORAYY1 W ta. To �� 9 P4cil /oc +- \ � •+VA Path, ��� eitsp j Jor) 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.] Iv �. 11. Describe the performance goals and standards applicable to the project. , / /A 12. Describe the flow co trot system. 11 i/ �q f .. js 5 AC Q.t NocJGS w i I l_1 Il ' '�c�^l E'lavJ stormwater site plan template—rev.10/21/2008 6 • • 13. Describe the water quality system. > t5--ri,$)j p[u\ e, 14. Describe the conveyance system analysis and design. NIA 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. I 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. t, ciB.T 5'l�. Ski tv •9 N GN6{�tACi6 18. Describe methods for restoration of the site. _ J c- 5et\C,V..., Cb N`.' ZCTI1,p) {1 R 1© 1?De El'A Qe,k .Ct..4051C)a.� 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. N f� ��,r 20. List here and include any special reports or studiegs conducted to prepare the Stormwater Site Plan. 1 �J�J 1IN 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. C)C15---)/001 )tijA Qrfr) g-RptC 74y* P 3.S.S l ) • stormwater site plan template—rev.10/21/2008 7 11110 • 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. -ec y i s 5 AC ei- 9�`J J O 1 PP l / Gleacz i5 otz \arhP. r C AGE .�- 44-i0 .1s 3 ( Sc, 2. Establish Construction Access. } -,V u I 1 in 3. Control Flow Rates. 0 r\ 4. Install Sediment Controls. I e1as.\'‘ (�looks To V Ted Flaw Pot 5. Stabilize Soils. 6. Protect Slopes. ( ly 7. Protect Drain Inlets. r 8 stormwater site plan template—rev.10/21/2008 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 'p 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Al/A 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. G-eN'QVA CP►+ G ak �� - a ik.., zLR 0 ur- t 11 CO N s77ROo d r-> 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). fd b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 111jA 1 1 2010 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. `1/2 stormwater site plan template-rev.10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. or tl �. te_ i 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). /"' 1h 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a pro osed construction sch ule. Svc N / p e / A 1 1c�T� �R � �'e ic.rif II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season on action activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible foi the initiation of bonds and/or other financial securities. �►11+-ON) Ev a -A b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. /- g. 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 thedesigner Sitewishes Planto Changesmakech anges or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be he l shall de substitute es t proposed nges, revised ubm to priory u ural changes, and other supporting informa on thato xplainsaand include upports the reason for the change. drawings showing any structural any Final Corrected Plan Submittal (notIf Ps the project included construction of conveyance systems,treatment management BMPs), the applicant shall lsubm flow final tcorrected plan (as-bui ts)when the project is ple ed. on-site hstormwater m g 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 rope_rty (DATE) ( DOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • 12 stormwater site plan template—rev.10/21/2008 w i- !� 1:11 o 0,3 v o1-1 m CP a C-I 2 . R) -i �.... ors • u Cr, < - cot, p Z 2\ m cn v ,Z !� IIII G <X. u' m 3 cf) ' (ib D r-z O N v n • b a Oi " Z 0 m .r n _ -._. N m Yn ,� �? 0 "ram. R� ij C r z 77 --C r r 4 Cb • •• '8 \ 71 2i- c ---- -r g r*A ts -.-- \'\ .:7 . rn z. '' \ r ti u) oz 41, rr- T' T. l m rd Hi \ PI- .4 • " ''- -d -I (` Cr) fit, 0 { m 0 I 0 f s \ ' e • < r l q o mTR < (11 ' _ 7a —I I—I. I— (,� \ Fee '�' Z cr. D i 0 :m I. 0 ,m r �, 1 3 < Y m Z 0 C7 S-- Fv6H t; `'*� u+ m 1 ;Z' m -a - Z tm 'cN Irn IO \ '(� /, - h o Ko rn y 71 0 i , . „ C o �+ C.ri Z o (-" a 70 R li s N C, irlu:r r D N `•r N o :)\-.-.) 11 al 5 yy. ____ 0 it M -4 ):=- .. • .4 1' ch. 0.4 : ... 41 > , 0 . ZmZ70C) tv i 'mod vi:a.G g irrl c ` Oaol A ms E r c „ (� j �7 z z moi o � mcn o .� 18 Ezzz . 4'.t; 4 ,i, i P--t - — -0 z _ a., -0 L k Q Q^ I D.zrnrcn Si � � e " t'l zn• zmm ID -- f 0 $ d% �, . � zaDm c� O 0 .�p � a o > =z -I -, _ H _ _ Q. � / I. .�' • m -� v, m z � Oom 7. riip i ) t cu Z 7) 0.) 'k • t 1 I , m < -< m _ • 53 0mo m -� XII '0 '� m m O D 1111111° O 0 , C< • ,7-1 D C) D m r- < cn m - [f1 -i G 0 m It o m m m _ -a �� 6� Z p zmm7K W (/P W u, ccnn m z y _r z m Ccn 1 P n z p 0 m -n m