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HomeMy WebLinkAboutBLD2010-00157I 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 #: BLD10-00157 SITE ADDRESS: 142 OLD LINDSAY HILL RD Issue Date: 07/29/2010 QUILCENE, 98376 Final Date: 7/12/2011 APPLICANT: DAVID NEUENSCHWANDER PHONE: 925-779-9949 LAURIE NEUENSCHWANDER 2919 LARKSPUR DR ANTIOCH CA 94531-6727 SUBDIVISION: QUILCENE BAY VISTA Block: Lot: 1 PARCEL NUMBER: 701205001 Section: 20 Township: 27 N Range: 01 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE & U/G 250 GAL PROP TANK 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 no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/12/2011 I.\F_BLD_Occupancy.rpt 10/29/19 i, Jefferson County Building Otsion Permit Nulll r: BLD10-00157 Applicant: NEUENSCHWANDER BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item 1 0 Date Approval Signature Notes Setbacks Erosion Control Foundation FootingQ VIO f8 / ! (///` r �. Footing Drains �I� � Foundation Stem Wall Underground Plumbing n Under Floor Framing �- ,4 ?1 ifc i Straps(hold downs) Ext. Shear Wall Nailing Rough in Plumbing 11\2`4.\W C4I✓ — Framing I �4� Blocking Z`Z��I t l F i►f-t_ (-1'0 _ .Or'i=+i S Airseal Insulation: Walls 2 1-1( IZ-V Insulation: Floors '3 q 1l Po) Insulation: Ceiling -3 /c '1' // (: Int. Shear Wall Nailing Wallboard Nailing 42-4/ iL Gas Line: Interior Gas Line: Exterior b-44:7—C( "r6 4 p....L. A_ ce").„....„4„._ cx.?-,/,./ Propane Tank 11--w,_11(7 Heat/Chimney Clearance Drywell/Alt Drainage see condition #2 (drywell) Address Posted Ji -1/1 )-c--- (A) 1 f , l.J' ri ' ,- 'S(A-t om^. FINAL INSPECTION -7)j' l f 111 1 f FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR •UILDING PERMIT APPLICN MLLA1Revie0 00p185 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00157 Received Date: 5/17/2010 SITE ADDRESS: 142 OLD LINDSAY HILL RD QUILCENE, 98376 OWNER: DAVID NEUENSCHWANDER PHONE: 925-779-9949 LAURIE NEUENSCHWANDER 2919 LARKSPUR DR ANTIOCH CA 94531-6727 QUILCENE BAY VISTA SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 701205001 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: TBD PHONE: 205-807-2541 REPRESENTATIVE: LINDBERG & SMITH ARCHITECTS PHONE: (360)452-6116 319 S PEABODY ST STE B PORT ANGELES WA 98362 PROJECT DESCRIPTIOP NSFR W/ ATT GARAGE & U/G 250 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,668 VALUATION 350,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: 0 #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N SHORELINE: GARAGE: 1,061 CONST TYPE: SETBACK: DECK: 513 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 P Total: 3 Total: 3 Routing Date: Type Amyu aitd� d Bv: Date: Receipt: A w Permit $2,393.75 LYK 05/17/10 117700 ^ PrItY VE r Plan Check $1,555.94 LYK 05/17/10 117700 JULc2 2010 State Building Code $4.50 LYK 05/17/10 117700 Potable Water Application $98.00 LYK 05/17/10 117700 Jefferson County Planning Total: $4,052.19 &Building Department • CONDITIONS for Building Permit# :BLD10-00157 1.) THE PROJECT IS SUBJECT TO COMPLIANCE WITH THE DEPARTMENT OF ECOLOGY IN STREAM FLOW RULE OF WRIA 17. THE PARCEL IS LOCATED WITHIN THE -BOLTON PENINSULA SUBBASIN IN A DESIGNATED COASTAL MANAGEMENT AREA; AS SUCH, THE FOLLOW IS REQUIRED: INSTALLATION OF A WATER METER, MEETING DEPARTMENT OF ECOLOGY SPECIFICATIONS, IS REQUIRED FOR ALL NEW USES THROUGHOUT THE WATERSHED. (WAC 173-517-180). BROCHURES WITH SPECIFICATIONS ARE ENCLOSED WITH THE PERMIT. REFER TO ENCLOSED DOCUMENTS FOR MORE INFORMATION OR CONTACT ECOLOGY AT 360-407-6300. 2.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD. DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS. EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS SURFACE FOR EITHER MEDIUM SANDS OR COURSE SANDS. TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM) AND HAVE A DEPTH OF 5 FEET(4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER MATERIAL). FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING. SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET. 3.) The project shall adhere to the Best Management Practices (BMPs) 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. 4.) A Stormwater 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. 5.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 6.) Not more than 2 unlicensed veils shall be stored on any lot unless totally Iliened 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. 7.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 8.) Maximum lot coverage is not to exceed 25%. 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.) Setback from Old Lindsay Hill Rd. right-of-way is no less than 20 ft., side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. gk°NC • •o> JEFFERSON COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT kiii `� 621 Sheridan Street• Port Townsend •Washington 98368 t,�,,,,,__ 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: (D-I E3 Project Description(include separate sheets as necessary): Cc>i<1,%rej7oW afA1 NEM/ 3- n .S/ .ST'.S/ne44y4s4/ ...:.yam Tax Parcel Property A Number: 7a e( Zs5' / Size: 5."- ,lr z (acres/square feet)_ Site Address and/or Directions to Property: /42 L /1D.S,4y ,4"tLi reL> Property Owner(s)of Record: DAvi' 4 Lad iAe'E JAPE/-i -141.-Se.44j#1llL11IL e__ Telephone: 472,5.7 1- cf14/ Fax: �I email: Mailing Address:2.7/9 L,G.SrU jt_ cj2/✓F 14ntz1,•Y_Al r Cs41- `:'g;X/ Applican(Age0(if different from owner): L/Nr,.4 •e&.4,,_ „/-// ,4 *'.," Telephone: 3/a/5-4 2'4,/1 Fax: p-4 7 7,)4- email: Mailing Address: 3Je S. fk4Aftevy Sr. �=47--4 # L sS, of gia,� What kind of Permit?(Check each box that applies j$Building 0 Variance(Minor, Major or Reasonable Elconoitac Use) ❑ Demolition Permit ❑Conditional Use[C(a), C(d), or C]** rgSingle Family )3[Garage(Attached)Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business El Cottagelndustry 0 Long Plat** JEC1 Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** $1 Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land U stri�t7VlapAthendment El Wireless Telecommunication* El Jefferson County Shoreline MasterProgram Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: FM'r ( ,1 DESIGNATIO DES F AGENT I hereby designatedesignateLiNtWA -ShIMAAeJl. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE VO�f1UQ Date: `(12<;/10 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 it's 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 applikatiorttthe wa is prior not' e. Signature: UV-) Date: 470 I D 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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tra fefer 'ble re ponsibility for -tiering to ancrcomplying with the ESA. The Applicant has read this disci 'mer nd signs and dates it below. Signature: 13 A 'I�k '1-- Date: kk2.c- 1b C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • 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: iqz,r ycr c_e ce' j (tiny siov,. ) ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New yt Wood Existing: ❑ Sewer 1-1 Addition ❑ Steel Proposed: # Bank ❑ Community System _i Alteration/Remodel ❑ Concrete Total: 3 Height: yt Individual Syste ❑ Repair ❑ Masonry SEP Permit# I U-- D Bedrooms: Supply: ❑ Demolition ❑ Other: Existing: !S Setback: X Private well ❑ Two Party Type of Heat: Proposed: _ ❑ Public 0E puMp Total: 3 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 th ttaappl ►� nderground Tank 0Above ground Tank Size of Propane Tank: lJ •Heat Stove ❑Cook Stove 0 Woodstove 0 Fireplace Insert ❑Hot Water Tank 0 Pellet Sto 0 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 '` kiPYRe1iisior(- I� Main Floor Heated EH Bld App Review: 2 °Floor Heated Consistency Review: Other Heated - Base fee: D5(15 r-i3�✓Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL lc? Decks 911/Rd Approach fee: 5,3 I33Q, 45 F -IS:f Other ' -. TOTAL: $'4371A Receipt Number: \ \J CO Cash/Check Number: `� 3t s`ooi 3© ESTIMATED COST(REQUIRED) Date: �,� .Fair market value of all labor and materials foundation to finish t e r\v 7 du 3 SO cz:In Initials: n — C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • APPROVED STORMWATER PLAN JEFFERSON COUNTY JUL 2 9XiV ti DEPARTMENT OF COMMUNITY DEVELOPMENT JEFF . 0 C 621 Sheridan Street • Port Townsend • Washington 98368 DEPT.OF *7 UN 140'ELOO4 ENT �q O 360/379-4450 . 360/379-4451 Fax SIGNATURE: LINO http://www.co.jefferson.wa.us/commdevelopment/ ' STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA # +o` PROJECT/APPLICANT NAME:DAV/D 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 ma . • F.4V-Ogist i !4-/N alp ic[e.,c. .moo A e .4. N y/SE1"T/ Lae&#[Flf i£C©. iV A teaaY£Lr vE-G//7,iedsysed Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. ', -S[of f Wtit /Y4e.721E4rber Azott614/2- Geyesitou,.4 L. Sl.e,fJEs wira s $4 L E ' c fl . 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. A14Tr(/ f - sr L.4 Io x1 -ZS L" . ph. sP e. 4. Describe the existing soils. Indicate soil type on the site map. cam►✓�LLy - 4HOy L-ea4/-1 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. -sir. P.2.04gCf . _Sri is Cc -. 'Ly ,Sl f".le=7 AA.to.ALL 4t T w Ill, T,e477 s a,�r �s lr 6. Describe any excess levels of noise generated by the proposed use or activity: MAY 1 7 ."Uju • stormwater site plan template.doc—rev.10/12/2003 5 • 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. sires /S G- ,k1 r .S1.907A/4.. . ‘3774rAiviS a e sNrvs'T/t 41 4,5 //I /A4M 't4,TZ VicrA&7y 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.). $I7; !S /1 T7,vjib.41. ©p £A—, .. rateciEt. fie" T- Alen, �1a4-�� ta✓ .77-612-1‘47. p ..Spze514-ic4,5 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. ALL. Je.e dqudstesirL,lt/LL J'i pr, TL /S cy L LL . ter' ni IV�a' re's. s riE <SLl.-mac-Ate fL14/ CeIrvita444rEl> Ag.,d0 Ask( 2p[JJ U 4 S 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for"large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the performance goals and standards applicable to the project. 12. Describe the flow control system. _ .off L,.,t/ s rt T—Le o 1 L zytt€/ S ii t f Vim- fipr _ ,t' itt.4G-->F cSk4e1165 py2.44014441 r ' got1-t,+oe/.. L LIAA.f.c dir 42'a// . IN 1 l J,., stormwater site plan templale.doc—rev.10/12/2003 6 13. Describe the water quality system. /�54 • 14. Describe the conveyance system analysis and design. "(7-04 15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. flu, zpa/ D • 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. AVA- 17. Describe the proposed surfacing material. .Ur21YF ,/ W'1L .0e ! t1 ..c:, Rcz.,e-- SU/ &?r.,. ,ors cl�, ,4 y//LL ier.c c c -c 18. Describe methods for restoration of the site. 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. 20. List here �an�d include any special reports or studies conducted to prepare the Stormwater Site Plan. `4 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-1.9.Se=4 A04449 ;Y 1 7 UiU stormwater site plan template doc—rev.10/122003 - 7 • S CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing..Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. cg WAS ,� ii at��y ci— 2. Establish Construction Access. s77 AZ:7/e1V 44y WJLL_ 4 / naWilEsv WiT?/ tjf,Glr!! Gs3L�s— LZ � i�1J eit'h 7.--,. LS722.11cJ7GAZ rt SS . 3. Control Flow Rates. prA i/. 4. Install Sediment Controls. ,SW4 .E4 W ..q/ztvE 5. Stabilize Soils. p rh' - �� A Z E 4 C ib .� G'.o L/�,, �Z},♦�it��i+ l Gt//161U�.Cr4f 6. Protect Slopes. /WA 7. Protect Drain Inlets. Al/A MAY 1 7 stormwater site plan template.doc—rev.10/12/2003 8 • • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. / VA 9. Control Pollutants. 10. hCo��ntrool�lDe-Watering(the act of pumping groundwater or stormwater away from an active construction site). W A 11. Maintain Best Management Practices(BMPs)., 12. Manage the Project. O!G Si T V'Ji jS �o 14f//7/ 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). /s4 o4,e2jE{__ ar_ STCiSa.Mg WETh4,J'?(' 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 templale.doc—rev.10/12/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. N/A 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). my f-; L.E .t 4, S . 5. Construction Phasing. a. Construction sequence x-,x .s Wi4J7 /I fe'A.+ I/<1 E.44...Zaegth LALlictscAtip b. Construction phasing(if proposed) f/i 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. / /?Z,/-4//cl�- 1NT 4Q-- 1r+► 1 - re dli.Sr s b. Proposed wet season construction activities for environmentally sensitive areas. .'a/✓ 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. 4:t7 ¢s 4,b4/3/61%�/ram /ALSUKR � k� /../7 ter s �c>�.r '/,car/, ' " " 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 • t,. '�� 1 `JiU itirl) I 7 stormwater site plan template.doc—rev.10/12/2003 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. 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.doc—rev.10/12/2003 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. -DP‘13 300A.v.- tg-ts-(0) (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template.doc—rev.10/12/2003 12 rn of —Ii, I r 3•-r 4,, 3•41' , C IllZ 11 ii ' Maiiriiii o o W 1 1 o : I � � t w. rik lig al . ...,,_)1____ 4 7 it L4 z 4 §1 ... i 4'-cr-117 toli-i -__1 o. - t:,:,,, -.11 i 110 : 0 Rs _14 ..,:r "-----3— —1 —I d I s I p W jrn • L ^ t Zu. 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