HomeMy WebLinkAboutBLD2010-00131 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 #: BLD10-00131
SITE ADDRESS: 251 MCMINN RD Issue Date: 06/2/2010
PORT TOWNSEND, 98368 Final Date: 6/2/2011
APPLICANT: GEORGE L HAYES TRUSTEE PHONE: 360-379-9713
LINDA D B HAYES TRUSTEE
PO BOX 1804
PORT TOWNSEND WA 98368-0210
SUBDIVISION: Block: Lot: T 11
PARCEL NUMBER: 001072002 Section: 7 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NEW HTD OFFICE/STUDIO - NO PLMB
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no:1
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 6/2/2011
I:\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building Dfikion Permit Nur : BLD10-00131
Applicant: HAYES TRUSTEE
BUILDING PERMIT INSPECTION APPROVALS Npplicable 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 LT,f <
Setbacks � , / ( Tl�(� Minimum setback from McMinn Road right-of-way shall be 20 feet.
It c + Minimum side and rear yard setbacks shall be 5 feet.
Erosion Control SEE CONDITION 2
Foundation Footing 'C ZA' T
Footing Drains
Foundation Stem Wall prri_Underground Plumbing
Straps(hold downs)
Ext. Shear Wall Nailing j)
e/ 1� P
Framing - 11( \l / zl
.
Insulation: Walls )� 1i
Insulation: Floors
Insulation: Ceiling ,f(
Wallboard Nailing Litt
Drywell/Alt Drainage SEE CONDITION I
Address Posted
ti-6+/CC"6°
FINAL INSPECTION � ' . 1 ( 03.
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
libUILDING PERMIT APPLICAION ML Review Ty 159
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00131 Received Date: 4/27/2010
SITE ADDRESS: 251 MCMINN RD
PORT TOWNSEND, 98368
OWNER: GEORGE L HAYES TRUSTEE PHONE: 360-379-9713
LINDA D B HAYES TRUSTEE
PO BOX 1804
PORT TOWNSEND WA 98368-0210
SUBDIVISION: Block: Lot: T 11
PARCEL NUMBER: 001072002 Section: 7 Township: 30 N Range: 01 W
CONTRACTOR: STAPF CONSTRUCTION PHONE: (360)385-3199
2727 HASTINGS AVE
PORT TOWNSEND WA 98368
Contractor's License STAPFC*249J8 Expires 2/12/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW HTD OFFICE/STUDIO - NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 416
VALUATION 33,353.00 ADD'L: HEAT TYPE: RAD
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
GARAGE:
CONST TYPE: DECK: 128 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0_
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $482.15 LYK 04/27/10 117599
Plan Check $313.40 LYK 04/27/10 117599 \IDIDRO\/EIState Building Code $4.50 LYK 04/27/10 117599
Total: $800.05 JUN ,9) ZUIU
Jefferson County Planning
& Building Departmen¢
• •
CONDITIONS for Building Permit# :BLD10-00131
1.) DESIGN CRITERIA FOR SPLASH BLOCKS:
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.) 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.
4.) 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.
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 shall9 . . .mantaned n 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.) Maximum lot coverage is not to exceed 10%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
9.) The building height is not to exceed 35 feet.
10.) Minimum setback from McMinn Road right-of-way shall be 20 feet. Minimum side and
rear yard setbacks shall be 5 feet.
11.) 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.
12.) 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.
• 111/
?ON c off,, JEFFERSON COUNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT
'' ` ' 621 Sheridan Street • Port Townsend • Washington 98368
\& l' Zt:y 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commd o nt;.
Master Permit Application MLA: 10 " (,JC)
Project Description(include separat sheets as necessary):
W l—AT cP' ro - t' o H mP
Tax Parcel Number: 00 07 aLocil Property Size: //, /576 Akre-5 (acres/square feet)
•
Site Address and/or Directions to Property:; .
1 YA C,kW L V\ i\ c i -Pa P-7 TOW Ns6,\j b G O-Fc o-Cf Msi &s)
Property Owner(s)of Record: ( be_G 'I• ,(,i ND fi YES
Telephone: ___?(po_3 7 mot' Q 7 13 Fax: email:
Mailing Address: Po Ilex (8'O rL POAit'-rdiii.yvt4RAA4 lull- ?8,368
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
)Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit Cl Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ 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 ❑ Road Approach 0 Short Plat**
❑ Home Business ❑Cottage Industry 0 Binding Site Plan**
❑ Propane ❑Long Plat**
❑ Sign . 0 Planned Rural Residential Development(PRRD)/Amendments** '
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑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 Cl 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 Li ri pa 'D 014a)►:S to act as my agent in matters relating
to this application for permit(s).
OWNER SIGNATURE ' -- )2-L Date: ( 16
By signing this application fo ,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 application that he or she wants prior notice.
Signature: la AO, t• I
1permitDate:1 & II 0
The action or act�plicant will undertake as a result of the issuance of thismaynegatively I g e y impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tran erable responsibility for adhering to and complying with the ESA. The pplicant has read this disclaimer and signs and dates it below.
Signature: �Q,.� L ,Q/1 �9�At,/)(A, /J A. A Date:/ V-41 `L 0
. •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
I PF C'onis772vL jiOM fir; (3 ) 385 --31 t9( )
MAILING ADDRESS: �' `�' - } �� Lt` (� EMAIL: 5 t� , l ,•
.
CONTRACTOR oS LICENSE d +� WAINS s // eerril
NUMBER: S rig Pic i o' AL C le NUMBER
K
ARCHITECT/ENGINEER: ;IQ« t K6 PHONE (340)386.040 0FAX:( )
MAILING ADDRESS: q e o, IAQ„p j1-yl > P IL @ , IVA
-
Project Type: Frame Type: Bathrooms: Shoreline: Type of Se ge Disposa,,
`( New Wood Existing: 0 Sewer
O Addition 0 Steel Proposed: Bank 0 Community System
Total: Height: 0 Individual System 0 Alteration/Remodel 0 Concrete y
❑ Repair 0 Masonry SEP Permit# ar�
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Pajty
Type of Heat: Proposed: 0 Public
,12•0-4 in k Total. 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 owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No '
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated A I/ - ,5 EH Bld App Review:30 '1 -
2�Floor Heated . Consistency Review: 13
C
Other Heated Base fee: z_V 15
Ll l I`taopco-SEAT-
Mezzanine Additional Section:
Heated Basement / Plan Check fee: /
Unheated Basement State Surcharge fee: ,4 —
Other Unheated Pot Water Review fee: 00 � a
Garage/Carport / SUBTOTAL (� p f
Decks ' Q 3,55 911/Rd Approach fee:00 ex 1�
Other C, TOTAL: $ I a
r,940
Receipt Number: I I, "ICI
- 53 Cash/Check Number: c,,r5,7
ESTIMATED COST(REQUIRED) Date: _ _
*Fair market value of all labor and materials foundation to finishGR _
,./ Ooo Initials:
.__ . .. ....u.-r...•rraiula r..r�rr.n��c i- i�n.�r . n i r �n i.n -_
• •
JEFFERSON COUNTY
w effiV >t;P;=� 2 7 2010,., q DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368
0 360/379-4450 • 360/379-4451 Fax
�`3.4 ING� http://www.co.jefferson.v0a.us/commdevelopment/ •
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# ____ 4'FDIA PROJECT/APPLICANT NAME: ,491. C tAA,6 &. r
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. �/ •
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Existing Conditions Summary •
2. • Describe the existing topography. Indicate contours on the site map.
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
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5. Describe the existing site hydro ogy (i.e., drainage; beh for of water on a 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. /I , yr l
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APPROVED
6. Describe any excess levelsp of noise AC�C generated by the proposed use or activity: STORMWATER PLAN
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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.
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8. De ribe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, al5d sensitive/critic I rea�
(streams,wetlands, lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
10. If e 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 "large"projects or projects that involve the potential for dispersion of contaminants.]
A
•
11. Describe the performance goals and standards applicable to the project. •
amps w-032..,642-.,W12LL•
12. Describe the flow control system.
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stormwater Sit,plan terrpplate-rev.10/21/2006 *, 4 x ,
6
• •
13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. D scribe a source of fill material, physical characteristics of fill material,and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Cod •
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here. fi
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 h re.
stormwater site plan template—rev.10/21/2008
• •
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 thb 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. � Qi
6.A.AAJAVNAt.
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2. Establish Construction Access.
3. Control Flow Rates.yys.A
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4. Install Sediment Controls.
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5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets.
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stormwater site plan template—rev.10/21/2008 8
i
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants. T )
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10. Control Dee Watering(the act
off pumping groundwater or stormwater away from a;actidA444OQ
onstruction site).
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11. Maintain Best Management Practices(BMPs). ,
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12. Manage the Proj ct. •
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2. Adjacent Areas. P i; 2010
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template—rev.10/21/2008 9
• •
i
b. Description of special requirements for working in or near environmentally sensitive areas.
i\VA
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,ero I , settleability, permeability,depth,texture, soil structure).
5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed) (J
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.�e�
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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. Identi he property owner responsible forth i itiation of bonds and/or other financial securities.
AI
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide esign Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations .41AdaulA.,j ✓tO
Ictlit41
stormwater site plan template—rev.10/21/2008 10
•
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. 'r,f
i. Provide rock specifications and detail for rock check dam(s),if applicable. Ap;j 2 7 LU IU
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
•11,
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes, and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the 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.
0(ija&./..0 /1
(lANDO R OR AUTHOR! REPRES TATIVE SIGNATURE JJJ (DAT
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
•
stormwater site plan template—rev.10/21/2008 12
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