HomeMy WebLinkAboutBLD2010-00299 •
411
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 #: BLD10-00299
SITE ADDRESS: 251 ANN KIVLEY DR Issue Date: 11/1/2010
PORT HADLOCK, 98339 Final Date: 5/25/2011
APPLICANT: RAYMOND T NICKEL PHONE: 207-479-1616
JUDITH A NICKEL
370 SKYWATER DR
PORT HADLOCK WA 983399705
SUBDIVISION: MELWOOD TERRACE Block: Lot: 22
PARCEL NUMBER: 972000022 Section: 1 Township: 29 N Range: 01 W
PROJECT DESCRIPTION: NSFR W/ATT GARAGE &A/G 120 GAL PROP TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2009 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 5/25/2011
I:\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building vision Permit Nu•Lr: BLD10-00299
Applicant: NICKEL
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks /) 1710 ? Minimum setbacks from Ann Kively Drive and Lylus Lane
�/e,Y' rights of ways shall be 20 feet. Minimum stback from the north
property line shall be 5 feet.
Erosion Control SEE CONDITION 2
Foundation Footing I i 1-) (0 w l�
Footing Drains
-Z —tl
Foundation Stem Wall ?` _fig-- 01 C
Underground Plumbing
Under Floor Framing 1^Lt_ I I Re2
Straps(hold downs)
Ext. Shear Wall Nailing I_Z%-t_`l
Rough-in Plumbing 3- J. `/
Framing j
Blocking )_ / / -,
Airseal % / fc-p
Insulation:Walls _I, , - (/ / 5
15
Insulation: Floors /"
Insulation: Ceiling 3- /,
Int. Shear Wall Nailing ll �+ 69)0
Wallboard Nailing
Gas Line: Interior
( 1 I
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage l III, SEE CONDITION I FOR DRYWELLS
Address Posted
FINAL INSPECTION Vols---tt
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•UILDING PERMIT APPLICAWN MLA
Review Type:
14
I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00299 Received Date: 8/18/2010
SITE ADDRESS: 251 ANN KIVLEY DR
PORT HADLOCK, 98339
OWNER: RAYMOND T NICKEL PHONE: =t37_
JUDITH A NICKEL
370 SKYWATER DR
PORT HADLOCK WA 983399705 MELWOOD TERRACE
SUBDIVISION: Block: Lot: 22
PARCEL NUMBER: 972000022 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: TRUE BUILT HOME INC PHONE: 253-272-5300
2522 N PROCTOR PMB 32
TACOMA WA 98406
Contractor's License TRUEBBH925CD Expires 2/4/2012
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NSFR W/ATT GARAGE &A/G 120 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,270 15 b(9
VALUATION 196,485.00 ADD'L: 543 Wel2HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 514 429, SHORELINE:
CONST TYPE: DECK: 142 �(1 SETBACK:
• BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 3
Total: 2 otal: 3
Routing Date:
g 161—(O
Type Amount Paid Bv: Date: Receipt: API'JFi1Ep
approved/Date
Permit $1,536.90 LYK 08/18/10 119961Plan Check $999.02 LYK 08/18/10 119961
State Building Code $4.50 LYK 08/18/10 119961 NOV I 2010
Potable Water Application $98.00 LYK 08/18/10 119961 Jefferson County Plannint
Total: $2,638.42 &Building Department
•
CONDITIONS for Building Permit# :BLD10-00299
1.) 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.
2.) A SILT FENCE SHALL BE INSTALLED LANDWARD OF THE LANDSLIDE HAZARD
AREA BUFFER PRIOR TO ANY LAND DISTURBING ACTIVITY.
APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT
DOES NOT ENTER THE STREAM. IF NECESSARY A SILT FENCE SHALL ALSO BE
INSTALLED SOUTH OF THE 55 FOOT STREAM BUFFER.
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.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
4.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
5.) 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.
6.) A Stormwater Site Plan has beeebmitted and approved by the Department.
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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) 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.
9.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimum setbacks from Ann Kively Drive and Lylus Lane rights-of-ways shall be 20 feet.
Minimum stback from the north property line shall be 5 feet.
13.) 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.
14.) 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.
ON C
�� O& JEFFERSON c.OUNTY • R JUDYNA.NICKEL ---^
try ' DEPARTMENT OF COMMUNITY DEVELOPMENT PORT HADLOC370 AK WTERA 98339
al
I "1 iy
621 Sheridan Street• Port Townsend •Washington 98368
'' ;s7 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: 10��14
Project Description(include separate sheets as necessary):
Arr C- Ael4()E, 0
A/ki 180 cl_Q. RD.f) laid_
GI
Tax Parcel NJmber:(.7,;j-o CO(Y 2 (voCC 33 Property Size: % C. L= (acres/square Pe y !�}-- �i (ac eslsquare feet)
Site Address and/or Directions to Property:
2S( A-NH KIr/LE/ UQ., ,
Property Owner(s)of Record:�7 n cu(y'�✓►t </l
1G ) ew
Telephone: '3 60 /4 3 / (/� I Fax: ' email: All d t—2_0?cAJ71-S(J1_---&-D,cox!
Mailing Address: 3 70 57_y lv/¢-7L(! b(Z,
Applicant/Agent(if different from owner): 'TIP yr f WlL r l+'ti(L c
Telephone: 2-6-3 `17? 6'47 Fax: 3 -- P3.y ,57. 4 email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
76uilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
LSingle Family Garage she etached ❑Conditional Use[C(a), C(d),or CI**
❑ Manufactured Home. • .0 Modular.
-d/'. . . 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities),'"_ j r
❑ Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan'"`
,ropane 0 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)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate T 1P1/1 " (3(f(L / ,q0 &S to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE i q Date: IC.
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or she wants eno noise.
Signature: ( 1ir. i' Date: I c
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-transferable responsibility for adhering Wand complying with the ESA. The Applicant has read this disclaimer 'id signs and dates it below.
-
/ Signature: �� '�'�'��' �l� "�/Z � 7LG Date: 6->
\G:\PermitCenter ###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
_.__„_._._s,...._____.______o______._
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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
the y will be assuming the responsibility of the General Contractor for the proposed project.
Sig nature: Date:
--GE NERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
/
1 � ( ) ( )
MAILING ADDRESS: EMAIL:
CO NTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
NAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
i. New ❑ Wood Existing: __0_ — ❑ Sewer
0 Addition ❑ Steel Proposed: 3 Bank ❑ Community System
C Alteration/Remodel 0 Concrete Total: 3 Height: ,ttiIndividual Syst
0 Repair ❑ Masonry S Permit# - i
0 Dernolition ❑ Other: Bedrooms: Water Supply:
Existing: b— Setback: ❑ Private well ❑ Two Party
Type of Heat: — Proposed: Public
`4 .-(' p�MP I 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 FoodSenrice? Yes / No '
Ifth is is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank )(Above ground Tank Size of Propane Tank: Age
,A-/eat Stove )(Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /.-fly
When applying fora 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 , :f ice Us, 1k-. ._. i ,.. clt nt? ..°Revision ,
.....--Main Floor Heated "' EH Bid App Review:
2"'Floor Heated i Consistency Review: ,
Other Heated Base fee:
j Mezzanine Additional Section:
Fleeted Basement Plan Check fee: CH,
Unheated Basement - State Surcharge fee: ,I. :_0
Other Unheated _-_.. Pot Water Review fee: ,,
Garage/Carport SUBTOTAL act, � I(f2
_ Decks ` 911/Rd Approach fee:
-Ct ai& Qdt�� 2 = Sc 15T1
Other TOTAL: $ 2.14 L
Receipt Number: `
1q
Cash/Check Number:
I 2
-'IMATED?COST_(REQUIR.ED)-- Date: Ip�(�
,Fair market value of all labor and materials foundation to finish O
la)) l Initials: < i\
� --_ -
J
G:\Penn Center\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
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76sON
, 6 JEFFERSON COUNTYitiv DEPARTMENT OF COMMUNITY DEVELOPMENT
j, ,, 621 Sheridan Street• Port Townsend •Washington 98368
‘%( o ° 360/379-4450 . 360/379-4451 Fax
http://www•co.jefferson.wa.usicommdevelopmenU
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
I MLA# l 0 3 + q
PROJECT/APPLICANT NAME: J7/� Ni C.4 f.) o f e��
y 4 y
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.
En iic2 _ir TS AQ> co e �� R/nl » Tka 3 Pc
ft WiaW P i�,1' itE0 Ox4 �iTg ' r
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. APPROVED
STORMWATER PLAN
3, Describe the existing vegetation. Indicate native vegetation areas on the site map. I
i 166&AS 1z. . NOV - 1 2010
4. Describe the existing soils. Indicate soil type on the site map. DEPT.OF ' IT D: t.t. MENT
Self,:DI LOy rt4 SI(;NATIIRE:
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
ap licable,and indicate acreage of each.
PAS eCUArnf irbfb J4/1,1ED P MlA noA a
6. Describe any excess levels of noise generated by the proposed use or activity:
/ OE
Stormy e
Required
stormwater site plan template—rev.10212008
5
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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.
Ai CAD N/A
8. Describe the general vidnity of the site,including adjacent land uses and structures,utilities,roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc)_
N/2l
Permanent Stormwater Control Plan
This portion of the Storrnwater 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 polution-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 pro facilities from existi facilities.
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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.}
N/A
11. D ' the performance goals and standards applicable to the project.
<�Describ
A
12. De cribe the flow control system.
ill
stortnweter site plan template—rev.1021/2008 6
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13. Descibe the water quality system.
N
14. Describe the conveyance system analysis and design.
/jd •
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
1pro- > 5 /h pp_cf-)Epri t f. -rc Lau_ ez � /oea
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
n/14
17. Desc'be the proposed surfacing material.
At It
18. Describe methods for restoration of the site.
Via
, 19. f n 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
her
20. List re and include any special reports or studies conducted to prepare the Stomwater Site Plan.
VA
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
restri ons here.
N/A •
stormwater sae plan template—rev.1021/2008 .
7
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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 lI Section 3.2.3 of the Manual(beginning
on page 3-7).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits. rr��
fpTl1 /5 CAVAD WAS 6012.11E46)
2. Establish Construction Access.
Acrpssi8L5
CcvNrt1•
3. Control Flow Rates.
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4. I tall Sediment Controls.
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5. Stabilize Soils.
SOILS Al STi118Lb
6. Protect Slopes.
o ,S.L.OpES
7. Protect Drain Inlets.
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•
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12 Required Elements—Construction SWPPP(continued)
8. tabilize Channels and Outlets.
NY A
•
9. Control Pollutants.
N/1
10. Control De-Watering(the act of pumping groundwater or stomiwater away from an active construction site).
NOT r N,ti£CE.SS
11. Maintain Best Management Practices(BMPs).
NAti
12 Manage the Project.
'v/A
•
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
• areas, roads).
N/A NO Su ndisiOL/U LoFrtA,vbs UI? STREnmS
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards). l
N A
3. Environmentally Sensitive Areas.
a. De ription of environmentally sensitive areas that are on or adjacent to the site.
Al A
stamwater site plan template—rev.1e21120oe
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b. pescription of special requirements for working in or near environmentally sensitive areas.
14/A tio__<Exisrrty , 02 ep►TiC.aI /3124c3I'S
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).
'19 t WI /ak 66os1Q WILL Now �� � t
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5. Construction Phasing.
a. Construction sequence
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
.11. 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
4
F✓stow @. k—pan template—rev.16.:130. 10
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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.
t (/ Gd-/7_/ b
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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