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HomeMy WebLinkAboutBLD2010-00096 • • 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 #: BLD10-00096 SITE ADDRESS: 1621 CAMP DISCOVERY RD QUILCENE, 98376 Issue Date: 06/2/2010 Final Date: 8/10/2011 APPLICANT: TODD & KAAREN L DAUGHERTY JAMIN BORG PHONE: 425-836-0873 22102 NE 10TH PL SAMMAMISH WA 98074-6863 SUBDIVISION: Block: Lot: TX 7 PARCEL NUMBER: 701224007 Section: 22 Township: 27 N Range: 01 W PROJECT DESCRIPTION: New SFR and shoreline exemption permit (SDP10-00041) THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON8/10/2011 I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building "on Permit Null: BLD10-00096 Applicant: RTY BUILDING PERMIT INSPECTION APPROVALS kpplicable Code: 2D 06GHE Intena International Building Co( 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 tv ) Minimum setback from Camp DiscoveryRoad right-of-way shall be feet. Minimum side yard setbacks shall be 5 feet. Minimum setbacl from the existing seawall shall be 30 feet. Erosion Control SEE CONDITION 2 FOR SILT FENCE AND CONDITION 3 Foundation Footing - i0 Footing Drains Per eN� 1-1 n O er Foundation Stem Wall Underground Plumbing Under Floor Framing Straps(hold downs) Ext. Shear Wall Nailing Rough-in Plumbing 2Y— Framing Airseal / 1 Insulation: Walls 12 , 9,_ Insulation: Floors Insulation: Ceiling \„Zq Int. Shear Wall Nailing Wallboard Nailing Heat/Chimney Clearance Drywell/Alt Drainage SEE CONDITION I FOR SPLASHBLOCKS Address Posted q—icy-�� FINAL INSPECTION �-1C -tl FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 1311/LDING PERMIT APPLICATIS MLA10-00124 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00096 Received Date: 4/1/2010 SITE ADDRESS: 1621 CAMP DISCOVERY RD QUILCENE, 98376 OWNER: TODD R DAUGHERTY PHONE: 425-836-0873 KAAREN L DAUGHERTY 22102 NE 10TH PL SAMMAMISH WA 98074-6863 SUBDIVISION: Block: Lot: TX 7 PARCEL NUMBER: 701224007 Section: 22 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NSFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 202,593.00 MAIN: 1,176 CODE EDITION: 2006 ADD'L: 724 HEAT TYPE: EEE OCCUPANCY: R_3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 560 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 _ Total: - 2 -__ _ Routing Date; Type Amount Paid By: Date: Receipt: Permit $1,570.55 LYK 04/01/10 117501 APF5114°VED Plan Check $1,020.86 LYK 04/01/10 117501 nn ZU1l! State Building Code $4.50 LYK 04/01/10 117501 JU� O' Potable Water Application $98.00 LYK 04/01/10 117501 Jefferson County Planning Total: $2,693.91 R!Building Department • • CONDITIONS for Building Permit# :BLD10-00096 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.) A SILT FENCE SHALL BE INSTALLED LANDWARD OF THE EXISTING SEAWALL AND AS CLOSE AS PRACTICABLE TO THE PROPOSED RESIDENCE PRIOR TO ANY LAND DISTURBING ACTIVITY. APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT DOES NOT ENTER THE DABOB BAY. 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 applicant shall fully adhere Oct conditions and requirements of the ea le management plan as signed by WDFW on June 1 2009. 9 Tiabitat 5.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 7.) 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. 8.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) The building height is not to exceed 35 feet. 11.) Minimum setback from Camp DiscoveryRoad right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from the existing seawall shall be 30 feet. 12.) 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. 13.) 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. 14.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. ! I NTI ENGINEERING & SURVEYING 717 SOUTH PEABODY STREET,PORT ANGELES,WA 98362 Engineers-Land Surveyors-Geologists NTI Construction Inspection-Materials Testing (360)452-8491 FAX(360)452-8498 July 29, 2010 Shold Excavating PO Box 179 Port Hadlock, WA 98339 Attention: Tim Subject: Cabin at 1621 Camp Discovery Rd, Quilcene, Recommendations for Foundation Excavation Greetings: Thanks for contacting us to assist in resolving the problem resulting from the unsuitable foundation soils and excess groundwater on this project. Background This project involves the construction of a small cabin at the foot of the slope at 1621 Camp Discovery Road. The cabin will rest on spread footings. Your firm is performing the excavation for the foundation. You excavated to grade and encountered large amounts of groundwater flowing into the trench. In addition, soils in the area of the groundwater are soft and not capable of supporting heavy bearing pressures. The photo below shows this area. W f • h v wry �' 1 • Shold Excavating, Inc. July 29, 2010 Page 2 An area of pea gravel was encountered in this area, apparently an old attempt to collect the groundwater. The pea gravel is visible on the left of the photo on the previous page. _ The photo at right shows - �` the same area from the .�,;' � „ other, direction. the pea <F ,' ..‘,. TIOL:r;‘ � gravel is at the right in the ,7 background of this photo. s ; \� ,, ,,,,:::::, < d : I understand the footing � � i `\ $ will be placed 4 , \ ,. '`\ approximatelyin the A F : ` >� center of the trench. iir ce You requested advice on \` ¢ .,may ,,, ",`e . x \�' \\y t managing the Y*,- . �'\ . �`�� -_ groundwater and poor soils. X` " ,.\ \k'.' a' 0. ff rxIV `cm`" -,444F.; .T.Z.-f***N, rogY.l1 Site Visit � ; ' u >! � �ct : yr ' I visited the site on Friday, ° ; 3 ,, ,� July 23, met with you, and .; � � � . R inspected the excavation. „, T �, \ my observation is that the "` `�_~' water is year round and � � 4 j, P 0. _k at? w , the flow may slow but it , • ;` ` will not stop during the dry ram' " � t \�` season. It can be ate expected that flows will increase during periods of extreme rainfall and provision should be made to handle increased flows. �� . The soft soils are primarily a cohesive silty clay with very low permeability. Their location coincides with that of the groundwater and the softness of the soils is probably the direct result of saturation. The impervious nature of the soils means it will not be practicable to restore strength by draining them. • • Shold Excavating, Inc. July 29, 2010 Page 3 Recommendations The soft soils should be removed until hard, competent soils are encountered. The excavation should then be backfilled with clean crushed rock as shown on the attached overexcavation details. If competent soils are not encountered, the excavation should continue to the depth and width shown on the enclosed distributed bearing capacity details. In either case, drains should be provided as shown on the attached details. A recommended option is to extend the drains out both ends of the excavation (on both the north and south sides of the cabin). Our firm is available to inspect the soils after overexcavation if additional consultation is desired. I trust I have adequately addressed your concerns. Please call if you have any questions. Sincerely, NTI ENGINEERING & SURVEYING David Hanna, PE Civil Engineer , / Enclosures �A, J> 237479ty¢ ?�,�GISTO �"`'IONAL��� 7-2 -/O • .„.(A. OVEREXCAVATION DETAIL CLEAN CRUSHED ROCK PLACED IN SIX INCH LIFTS AND COMPACTED WITH A MINIMUM OF TWO PASSES WITH A WACKER PER LIFE. MAY SUBSTITUTE QUARRY SPALLS COMPACTED OUTSIDE OF WITH EXCAVTOR BUCKET FOR CRUSHED ° ° ° BUILDING ROCK. PLACE FILTER FABRIC ON SIDES AND BOTTOM AS SHOWN. ° FILTER ° I.<1.00 FT FABRIC °a a \- , 0� ° a 1. 0.50 FT �� • �� gyp, ° a ►Yk , t Yei �i i • • • • S •-a` ••-•-•-•-•-•-• • • C.91.9111 . ^i Olit ^i 0 V S 1; t 'i • VARIES - EXCAVATE of 0000 TO COMPETENT FS �5 0\ FOUNDATION SOILS v c 3.00FT >1 O°P 01x�� DRAIN ROCK AS INDICATED SURROUNDED AND ENCASED BY 6" X "IN F OF 0�� FILTER BABRIC. ROUTE TO DAYLIGHT. PLACE 50\�5 CRUSHED ROCK OR SELECT NATIVE SOIL ABOVE DRAIN lei . NTI ENGINEERING & SURVEYING ♦`!r .1.,' Engineers — Land Surveyors — Geologists V .o I '�' .' 23747 �Q ,w %T Construction Inspection — Materials Testing �0 REGISTER -�' 2 (�Q N/ I 717 SOUTH PEABODY,PORT ANGELES,WASHINGTON 98362,(360)452-8491 ANAL E�� 'J'' $ • • DISTRIBUTED BEARING CAPACITY DETAIL FOUNDATION PER BUILDING DESIGN FILTER < 1.50 FT FABRIC OUTSIDE OF ilinBUILDING ' A M00 � 1 2 71 L....)----. *PO OS 0 / Al.." 4 bilk" / (-- 'OW.*CIAO%ji& _-_'i *0 0 ii.1400 W4I‘ Wati\ ..00600.11110*b.okboo:. V OS*IW.01 Ob- .. 41b#A 101; O DEPTH OF OVEREXCAVATION VARIES. O 6" PERF PIPE SURROUNDED BY EXCAVATE TO COMPETENT SOILS OR DRAIN ROCK AS INDICATED AND TO A DEPTH OF FOUR FEET BELOW ENCASED IN FILTER FABRIC. MAY THE BOTTOM OF FOOTING, WHICHEVER SUBSTITUTE TWO 4" PERF PIPES IS LESS. FOR THE SINGLE 6" PIPE. ROUTE TO DAYLIGHT AT POSITIVE SLOPE. 0 BACK FILL WITH QUARRY SPALLS, CRUSHED ROCK, PIT RUN, OR SELECT VATIVE SOILS ® QUARRY SPALLS COMPACTED IN PLACE AS SHOWN. PLACE FILTER FABRIC ON BOTTOM AND SIDES AS SHOWN. eillk4' NTI ENGINEERING & SURVEYING ♦.,r �� 1 Engineers — Land Surveyors — Geologists •p �, /�23747 p w'�' I 'PO ''GISTE1 T Construction Inspection — Materials Testing ' 2$ �{ NTI I 717 SOUTH PEABODY,PORT ANGELES,WASHINGTON 98362,(360)452-8491 I�NAL E��� �� O lib Pr I ' 1 01 ! --- y ii (p+ , a zWQ za � zn as3 aa ¢ r z 0 o ! _Qua Q 1 di , 4 iEg llllllllllfl ; E IL ui Q pK iZ ail ,, �� ° A � s8 Co ant iDO '` rir.4 ra 1 p n R L{x Rami 9,, a >I73Q i O .o-., - J-L >-1 . 0-1. 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R N i. �I � *L ® �10"Q! rN 160ML TOT y-F .WI L-S .r/c c-N ,/l 1-4 'll i/G FL .i-.Q O-., } a a n- o R - t_ [RV aauao Qac WI F-A 1t$ j.s(1 r-L, -u1.-LFi .*s ..':e-A - `�'- Kft Nc+t 8 i aa try o s1 ��a1 ig _ R , rA t AIc.Al if-) I _..._ _ _ . _ ._...I 0R)11 MJV R \ 3& F r 411 a-.n 1 b-N 4 S rr r .s-x =e. ,i,a I ....................... b / VJ .a a 11 !/I t-S Ana .r/c 1-a ' ® o-.w *c. • 0 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ',Zs- www.co.jefferson.wa.us/commdevelopment 13IN Master Permit Application MLA: 10-12--`I Project Description(include separate sheets as necessary): Tax Parcel Number: 7O I -ZZ`A - 00—1 Property Size: 1. I e AC- P Y S (acres/square feet) Site Address and/or Directions to Property: I h Z \ CArn rb1 SCrOVE2-y IP-:- CAvIi_c_-trrE, I aS37.i, Property Owner(s)of Record: ----riv;-- ►rr4o(--. cr2 i-y / i smite ' )Zf� Telephone:`i�-C $�� C) 13 Fax: / email:'telr,,,o, ►-,e..r ryv I r, d, Mailing Address: •��•'L1 OZ N.)6 1Ot�` tL. A✓0\ISb,/r^/�A cAto"1 - J J Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation `wilding 0 Critical Areas Stewardship Plan 0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) r Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** APR 1 0 LT0 �i Manufactured Home .❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment 0 Address 0 Road Approach ❑Short Plat** 0 Home Business 0 Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑Sign 0 Planned Mural Residential Development(PRRD)/Amenciments** ` ❑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 0 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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 a and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati tha or she wants pr. r n ti . Signature: Date: /1/r D The action or actions Applicant will undertake s a result of the issuance of s permit may negatively impact upon one or more threatened or endangered species and could lead to a pot ntial"take"of an endangered species as those terms are detined in the tederal 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 Jefferso• •unty development code.The Applicant acknowledges that he,she or it holds individual and non-transferabponsibilit or adhering to d co ••lying with the E The Applicant as read this discla-mer and signs and dates it below. Signature: i4i1 Date: I/i(7 ... •..- \1a1a1 /n 1rll'01,144A TTT r`-Nnx M\l`__ _ .Tn rs. ,1 r , • ♦ ♦• , „„ • S • 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 oft ,General Contractor for the proposed project. _Signature: Date: 1/4-4/1/i 0 �-GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: Ph1 : FAX: ( ( ) MAILING ADDRESS: EM CONTRACTOR'S LICENSE WS NUMBER: NER ARCHITECT/ENGINEER: PE ( ) FAx:( ) MAILING ADDRESS: E Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: flew TZLNWood Existing: 0 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank H Community System ❑ Alteration/Remodel 0 Concrete Total: -37--- Height: u Individual System ❑ Repair ❑ Masonry SEP Permit# f ;C> 1r3 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: a Private well ❑ Two Party Proposed: Li Public Type of Heat: Total: • UGC-TZi( Name of System: 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 owner;,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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank i 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 I Current Proposed For Office Use Only Amount Revision Main Floor Heated 11-74 EH BId App Review: 2n°Floor Heated Consistency Review: ��� ln � 21 3 Other Heated Base fee: Mezzanine _ ciMr7(1—np -107— Heated Basement Plan Check fee: ' Ib� �� Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: i 3to Garage/Carport SUBTOTAL 3`5)k-E.CI) 911/Rd Approach fee: � Decks l) r,..� 1 CCJ� 1 Other TOTAL: $ .' C: Receipt Number: ) 11 ,) i Cash/Check Number: !�� 2-5.1 o ESTIMATED COST(REQUIRED) Date: (� •Fair market value of all labor and materials foundation to finish _ L ±�` O 12S'� 0 CAN • c• O Initials: 1 i ,-.\u,,....,:•C,...,..\}4f1-1FCIR MCitiki\1-114 T1 Rr1R MC\C1,1,-Pnr T1R Tl Fn«nc\A,f,1 cry.P,.+n:r Annl:r-n r:.,.,S_'XLne An,- • . se) , �, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT APR i 0 2010 621 Sheridan Street • Port Townsend • Washington 98368 --tit NG http://www.co.jefferson.wa.us/commdevelopment/ 60/379-4450 . 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 10 /a , PROJECT/APPLICANT NAME: ' �-LI/�O 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.t_ �+ / CAL r vcl- A- ZsiT Sf. C4. lt�ro b 1( /cLArei 1&I CL C4 i h 1 AK_ o.ek t�ICkA Cab i h 5!ft. ►�q Co ah4 cir`i v{/�t)cc A used (SY are,4'S. Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site ma . Sloped ped e,, ll_s i e- //o,-. oas1 J5 idt- 1 P it./ Si cups o a.cce,�s road cI u iv l , S • d r [ALI,.. Wis'Y/l2- a 19 ZS/-/o 30' W 1S._ - e- OttAmx ex is i i c�tzir. s ic a>,d add i{l ll /al,�!►� A r ��' fled- �o teen Berl�� s�o 3. D cribe the existing vegetation. Indicate native vegetation areas on the site map. AMA. �s I o f c.*L h- p /'+ ( t s cove ra w ai, ry t 9 rn o►-d Cei erptid osI _ a� 6.•,►1 rkly t'i t ke.S. IV i Jldkls vcc'& y So iI a.rr p ro�fir l i._ . Bull i s%'i`c i 5 g Y�eSS area. �7 4. Describe the existing soils. Indicate soil type�n+ on the site map. / oil S e a�r^S 4 La- .4 l-y p;Csl 1Iy i r. o c p !`� IA A 0150 69fte- ,si rs k s/©r�l h ruck as �D i Q+'��►�l krotAD- t r. Co& - 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 I applicable,and indicate acreage of each. 5 Neach. 1 h NO 5 le.n.,wcak L4,' e- 40r rrak4 l h ) reS�r c2-j , J ✓ APPROVED STORMWATER PLAN 6. Describe any excess levels of noisegenerated by the proposed use or activity: aty__ C�Tr l ,Ll C07S 1+ftcTtn �Y1S-Z - �h JUN - 2 2010 StOrrnWa -r �l • ` IEFFERS CpU TY Require a 1IOs1►rat +► 446 DEPT.OF CO v ` i SIGNATUR.• �arm,.mi. ., `� III stormwater site plan template—rev.10/21/2008 . 5 • • . 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes, etc.)SOAP— the site. Indicate location on the site map. 1 _ 0 1 UV ly S� S OAP Oh. ed-- S, 0 si k• cathl woc•Itn( arow�"af� ri �mr, OT 4's dA,J . ) d- 6iale_ 0� Si le eS Ai /xaf cbead tocak Oit b{ T. tch-ESN 1��5�n2P .NC,L.Jt�ct� 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.). a �--5/ as s►►- 0h kW Luck --. , A-- G�yIe gel. div,-. 67 lOts u- kd. Q.R r~;I-ts , All deer'ri i-y , Was art.-- e to `va Zs?, yQ,as. Sleep sb> t:,I I h S - a. o f p��s� r Rd. Pry va4 road is rr os� ri4 W i 4- a -' V, clow tis. 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. ,*1 5/0frf• user- 14L1 g IIy di's 1ersa. A l c_xis lir, CAL,►• hAs ao ra1, gs,fiers or (kw" s 1 OlAr tNRW tahik _will CAW— 4r0( cm,{Iro I riki hw tkcr lav"( it- 41.,ffer i _dew,-y tAis_, iJ. Z i ll clrCcc ft.;s wookr dew/. 5aoµds i�I-0 Awl eli 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.] jv/n 11. Describe the performance goals and standards applicable to the project. 'f/ )e ► e " le) i nyietd" O,.v- LA i Id i y s i 1e as li l!-e a s /nassi J�, e x i s h r, robs „)cj `.;II ir 4SPi• 12 Describe the flow control system. i I�-�""-� i __.fM7 el-is ry i 1,4a a " <dew,- I- �Ii siide t,.,i Et r€ L irc.cJed a.ow o/ iKiwta a Lk ti « th dam,. dilly 1,spsed ►t4,, yars( � ,.�►M.al. (LA,ti•AI/ .. ra�.ti• w,,I,(�e.. .a.11y dis rSe0( a ISO / As 5*� I ice. K(44ei#c. stormwater site plan template—rev.10/21/2008 6 • • 13. Describe the water quality system. �(z.A,..J /0 7-,15 SS,ExLw-w 1rc' ZAA-J - 0+4 c ,nn V i -Kt5 ��t�Ift2� CLA v 111Nb VCi-v fAY►r).�l 14. Describe the conveyance system analysis and design. 2.6p)S-r 1 1,sI Aow Se°tiVS ,ram S-1'bi241....4n-05& To Z ��^ 'f�— 11h'i= FLL 1 rt j 1A .3 t'v.ln btt vveLara ri Ap/10 S1"1 i 1_. 15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. AIji1 1 O 2010 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Li utryvp V N( 17AR IN A its-4 A eLF Am,„ ./�/It ireNdoir1 -rtLASS y Ce[zd., aLJ •� 'gb c,ek "S - l� 17. Describe the proposed surfacing material. LP w Ps) S) etArr'. - L Est);y A Z ITOD ( -btl V'I L� �'t- fi��1� L{'r Art-thm r 017 ��!lk:lu^' `Nov awrffacreg 18. Describe methods for restoration of the site. 1)64- a c045 read el. a( cLr-iV c s- ,.rt_ exls j w II /^ei►11:t i h• 5,.k a rraaty /� he T' ors s i�s C� � am(r_ft D,�[ '�'w�( 4�� � a.r,,l r.ew rv1.�i� w 1't i OC[µ�y h"o57- aft�l�p /are/a a� tier sled Qrert I S 4.1 t OraSs/4'4''h ; AL I4, tl / f�l�6h,sie Ls?I n ate' 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. iti/+ 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. / ce h e sy s�- c , de( if(read- exi sA' 41.4 ��rrr.t+ . ( stormwater site plan template-rev.10/21/2008 7 0 0 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. No C.-I€A j eye,41 7re #L 2. Establish Construction Access. //r-may eXi sIs. Al cons cfitp- vet-ides will across s,k by axi!slim (AA- rtatel 44,4 drivewAys. 3. Control Flow Rates. d1 rr, has L oc s 4. Install Sediment Controls. L L / LAW r. en 1K�S h0 r l Dw%-et 1AK S'f- n 71 p re;J eel' 5. Stabilize Soils. �.{ .A1 l (Ili s t►s,e., /it W�h t ett-2-r5 -o r l^ 0+��` 1 cf . ( proj e . 6. Protect Slopes. S-r L.;�i, roc 6reit ►r;ly, Neil I) o� .aas-- 9; roJ t41 A y >� - d e s lnp-e- CM. la ,._ •�— Al s� ! r 7 Protect Drain Inlets./ [ ' -rG are_ ckAIv` %-.le "Ph" aif!)kc0 Y 8 stormwater site plan template-rev.10/21/2008 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. kind - (5Xn5214.iiv, 9. Control Polluta ts. jr poiti As-4-� /);// o ee,�r-s ,o-e- ,�.1 C I �_t , L/� 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Al D T' rL E-, ,acty 11. Maintain Best Management Practices(BMPs). eltAA., c�u�- G orJ-f'fc,-;rill < vv1tA, --cs- i c,iSvv,vc--)-t-;n v.-r S iTg 12. Manage the Project. 0 v,-.A.l_ Q' esR-py. [Llr-r it.."L-T L vr 1 2. Adjacent Areas. C;F;i i0 �i� a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). A -S�� Zbyan ,s S H A(7.45b Aivh v-4;, EA bt._l5 4 L O i H,ir-S ? ter-) xycz,2,Qva 0 (NA) -fjX,g Pis rat vv p i ) —;►{i 5 -it S�V iCr+ _ C Sfi Ai4c) A pp nca%-�) N► ta, ;.,t t t,L. N.o% 0 MruR 90 b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). ^J' fl A A't_ Vs- -CA V t tar, � Nit\ 'Sat L t+vl� �SA Nj ;RP-, /J'v`o 7 "e.14&) c t-A -gA)r, 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. "�,c1. c»A,.. �A y / ",isva o-1, i 06 f- vnAd-rt,fn n 1",1 i — htA a.glO i t Cv ,Ati stormwater site plan template-rev.10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. tVA 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). -fncrir .r.N. IN r2r .%NS rA> 't?. o7:i".v-s 2A t ::4_t kid qLn.✓- t.l►--r11 NA 70,41 . St i -co ,..jsufriv. ; ay Si TV , 5. Construction Phasing. a. Construction sequence "bsrrp 6x.1s0,4 , cf_ c---?u-.`3 i fi,or.»0-r,c,--+ i i�P,3cY t+.J-U 1 (L.o ,,.1 1,./r 2.l ". 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. J unA? - ►'J..)6 t-7 ?0‘b Lin'-o f -Fvu el-nc , Mk-- 1 "Rzity II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev.10/21/2008 • , SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation (e.g.,tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales, interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades,dimensions, and direction of flow in all ditches, swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth, length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. APR 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 i •' 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. L-Il/I v (LANDOWNER OR AUTHORIZ RE SENTATIVE SIGNAYGRE) (DA ) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template—rev.10/21/2008 _. - • :73 CD ' — C.= a_ , • _, , ' ' . • . . . . . . ic,41 z Ir.....mon•momm•••••••rilD In .411 Ah cc, .... -1)c) -cac-gcL9 , -IL-gab --K-ri --24...caorrtu -1?-3 I' •-ragdo elk% 1 *.t 0 ' -....AL• t....111 --- K-1-cio.in ,,.,, , C•4 g W I T.3-41- co 6 %--- Loo(-)ee )QL Is"3c2/ 11--ia.--- c3L1„-c 0 CC 0 t..< ,os--=‘,I H'IVDS w z rz RLITON A 0\ VC'Ci 11,1 am( i II ROTH A c *. ^" _ • 1•4'.. ,„,,,,", ,..ga kl'-' .,„ ....---'":'-',-----r.rr-t' .--•."--r-•""*.' "Vz.,,,--..., ., . ..,.„„.......,...„, .,,........-. .. u" . ., '' '''''''' . ‘°6 vs, ,,,, , *:i:..<•:3, 0 4. , ,ott . . .. • ,...... P4 ItPX •• ') , ... . •• - ‘N 'N'C.111:1140 • - 1 4-41 r4 \e\O 9 kett , , '.! 4:1' • Iv 44411,00/ c,e '' i r- - - .t I • i " III,k , . 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