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HomeMy WebLinkAboutBLD2010-00307 • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD10-00307 SITE ADDRESS: 796 LORDS LAKE LOOP RD Issue Date: 12/22/2010 QUILCENE, 98376 Final Date: 12/12/2012 APPLICANT: BRIAN D HALL PHONE: 360-333-1711 JEANNETTE M HALL PO BOX 567 QUILCENE WA 98376-0567 SUBDIVISION: LORDS LAKE LOOP#1 SHORT PLAT Block: Lot: 4 PARCEL NUMBER: 702024027 Section: 2 Township: 27 N Range: 02 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE 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 12/12/2012 \\tidemark\data\forms\F_BLD_Occupancy.rpt 12/18/2012 • Jefferson County Building Division Permit NA : BLD10-00307 Applicant: HALL 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 Signatureg Notes , 0 f ,vele ,� /e cl Setbacks �^-1 /( k m setback from Lords Lake Loop Road right-of-way and private easement rights of ways shall be 20 feet. Minium north and south property line setbacks shall be 5 feet. Erosion Control SEE CONDITION 2 Foundation Footing S—I,- it I t /1 Footing Drains 6- --, (/ ril) Foundation Stem Wall 712..44 1 u )._____ Underground Plumbing Under Floor Framing , ,vZ), / t . Straps(hold downs) ?_ /j Ext. Shear Wall Nailing sit �'�3"i/ S-D2 t}L`h'P( 4/A, / o i%' iz4/5 c- /het Rough-in Plumbing Framing g-`_Y r t Blocking y.,3G,, I / ? �/ Airseal ' Insulation:Walls — I ' �� I tc 1 11 c Insulation: Floors `311 k2 i A -- Insulation:Ceiling41,1 ‘1.j l k rk...._ Int. Shear Wall Nailing ' —5—t Wallboard Nailing 11�I 1,Z "GaTe: lntenor 1 1 --8'Gne: Exterior e Tank Drywell/Alt Drainage SEE CONDITION 1 Address Posted r--Z C 2 - -- Miscellaneous ` 2-!O _tC1 ` I rock retaining wall Miscellaneous _26 i Ll u� PRIOR TO FINAL OCCUPANCY,AS BUILT VERIFICATION MUST 13E SUBMITTED FROM CATCHMENT SYSTEM DESIGNER AND A SATISFACTORY BACTERIALOGICAL WATER SAMPLES FOLLOWING THE TREATMENT UNIT MUST BE SUBMITTED TO JEFFERSON COUNTY PUBLIC HEALTH. 0 I G.02..._ r- -e a `� !Or -TO ;-a (1,,c FINAL INSPECTION i 411 1 i FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR !UILDING PERMIT APPLICA GN MLA Review Type: 23 I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00307 Received Date: 8/26/2010 SITE ADDRESS: 796 LORDS LAKE LOOP RD QUILCENE, 98376 OWNER: BRIAN D HALL PHONE: 360-333-1711 JEANNETTE M HALL PO BOX 567 QUILCENE WA 98376-0567 LORDS LAKE LOOP#1 SHORT PLAT SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 702024027 Section: 2 Township: 27 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NSFR W/ATT GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 932 VALUATION 92,365.00 CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 932 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 1 Prop: 1 _ Total: 1 Total: 1 Roouu►ting Date: --- �9_ID Type Amount Paid_ _Bv: Date: Receipt: Approved/Date Permit ------ .— $944.75 LYK 08/26/10 119997 APPRDVEE7Plan Check $614.09 LYK 08/26/10 119997 State Building Code $4.50 LYK 08/26/10 119997 DECZ2-2O O Potable Water Application $98.00 LYK 08/26/10 119997 Total: $1,661.34 Jefferson County Plannint & Building Department • • CONDITIONS for Building Permit# :BLD10-00307 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.) 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.) ONLY ONE RESIDENCE CAN BE CONNECTED TO THIS SEPTIC SYSTEM. STATE CODE AND COUNTY CODE REQUIRES 240gpd MINIMUM PER RESIDENCE. THIS SEPTIC SYSTEM IS RATED FOR 360gpd 4.) PRIOR TO FINAL OCCUPANCY, AS BUILT VERIFICATION MUST BE SUBMITTED FROM CATCHMENT SYSTEM DESIGNER AND A SATISFACTORY BACTERIALOGICAL WATER SAMPLES FOLLOWING THE TREATMENT UNIT MUST BE SUBMITTED TO JEFFERSON COUNTY PUBLIC HEALTH. 5.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Erosion Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 6.) A Storwmater Site Plan has beell/bmitted and approved by the Departments 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 setback from Lords Lake Loop Road right-of-way and private easement rights-of-ways shall be 20 feet. Minium north and south property line setbacks 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. 15.) THE PROJECT IS PROPOSING RAIN WATER CATCHEMENT SYSTEM ilk POTABLE WATER AND IS THEREFORE EXEMPT FROM THE REQUIRMEMENT OF WRIA 17. The following is for inforamtion only: The project is located within WRIA 17 and thus is subject to compliance with the WA State Department of Ecology In Stream Flow Rule for that region. The parcel is located within the_Leland/Little Quilcene sub-basin in a designated Reserve Management Area; as such, conservation standards per state regulations require the following: 1. A permit-exempt well serving an individual user shall not exceed a maximum of 500 gallons per day (gpd) or an annual average more than 350 gpd, for all permit-exempt uses authorized under RCW 90.44.050. (WAC 173-517-120(1)(b)) 2. A well serving a group domestic system shall not exceed a maximum use of 500 gallons per day (gpd) or an annual average more than 350 gpd, for each residence, and shall not exceed a total use of 5,000 gpd for the group. The design and construction of group domestic systems must be consistent with applicable state department of health requirements and applicable Jefferson County or Clallam County requirements. (WAC 173-517-120(1)(c)) 3. 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; see Ecology web site at http://www.ecy.wa.gov/programs/wr/instream-flows/quilsnowbasin.html or contact Ecology at 360-407-6300. • ,r�40N % JEFFERSON COUNTY • `IA DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 ,y 360/379-4450 360/379-4451 Fax !w OHO www_co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1 0 323 Project Description(include separate sheets as ne�csary): 1 BVlt (1 S incA_.E. i-(,‘tYl1 1 aoYY)�. Tax Parcel Number 7C?0 G 4 U 2Y7 Property t z 2 r party Size: Ecre 'square feet) Site Address and/or Directions to Property: r7 c , Locck V-.(k\c LAT 'Rock( CQ(. .i IQ.enE' 98 326, Property Owner(s)of Record: r ion c TP ca Ylr�p } a I-}a Telephone: (.o U .3 3 3 (`7 I Fax: l Mailing Address: P. U. �c x �(o 7email: jh1� 42�i3 V a i�t W��t C- i_t,+ l N.Q n ,. 9 6;3 r7 to Applicant/Agent(if different from owner): Telephone: — Fax email: — Mailing Address: What kind of Permit?(Check each box that applies j�6uilding ❑Critical Areas Stewardship Plan 0 Demolition Permit ❑Variance(Minor, laSingle Family Garage (� )ched 0 Conditional Use Major Reasonable Economic Use) El Manufactured HomeModular (�.or Cj" ❑ Commercial• ❑ �rY`D"or Unnamed Use Classification ❑ Change of Use ElSpecial Use(Essential Public Facilities)" ❑ ❑ Address ❑Road ApproachBoundary Line Adjustment ❑Short Plat"" ❑Home Business ❑Cottage Industry ❑Binding Site Plan" ❑Propane 0 Long Plat'* ❑Sign 0 Planned Rural Residential Devel ❑Allowed'Yes"Use Consistency Analysis 0 Plat Vacation/Alteration'* opment(PRRDyAmendments" ❑Stormwater Management ❑Shoreline Master Program .,t ❑Site Plan Approval Advance Determination SPAADSSubstantial ial Development ❑Temporary Use ( ) 0Shoreline Management Substantial Development*` ❑Wireless Telecommunication* 0 Shoreline Management Variance 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference ❑Tree Vegetation Request Please identify any other local,state or federalpermits 'Requires a Pre-Application Conference required for this proposal,if known: I hereby designate DESIGNATION OF AGENT to act as my agent in matters relating to this application for permits) 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 ownerlagent 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 Countyand its review and any uired later ins em pb tees,representatives or agents for the sole purpose of application pections. Staffs access an right of entry will be assumed unless the applicant informs the County in writing at the tine of the a - n that he or she wanprprinotice. Signature: l..xi?",u-eZ` 1 ,:.,e./ & I L _/6 Date: The action or s Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered s 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 unty development code.The and non-tr responsibility for adh�aapg to andApplicant acknowledges that he,she it holds individual it belol `�'/ n9 with the ESA. The Applicanrt has read this disclaimer and signs and dates below. Signature -L$-224Z.Lf f 2 - /G ` O Date: �. (>:\PennitCcnt ###FORMS###\DRD FORMS\Master Permit Application 5-29-08.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 rru the res General Contractor for the proposed project. Signature: Date: 1/ G7 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE / WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: 4ctu,, 12 cdl�� PHONE (3t$O)��}j-/,i'/ FAX:( ) MALING ADDRESS: /Cv0./ ( i<V ((U /�>r �3(nif ENIAII Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Existing: i Sewer I New �d Wood ❑ Addition t I Steel Proposed: I Bank ❑ Community System Total: I Height: Individual System ❑ Alteration/Remodel Li Concrete �Ep Permit# (0-v UO 2.9 ❑ Repair Li Masonry ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: X Private well 0 Two Party Type of Heat Proposed: I ❑ Public c -+ r ► e: Total: � Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current-- Proposed: Number of ADA Panting Spaces: Number of occupants r owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Prot ne Tank andlofAppliance Installation permit,mark all items below that apply: AUG 2 6 2010 I Underground T - Above ground Tank Size of Propane Tank: 1 Heat Stov Cook Stove L Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove Other Is this pliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a peimft to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank locationand size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. •uare Foota•e Current . .•: Main Floor Heated 3 2 EH Bid App Review: (`� 2n0 Floor Heated Consistency Review: / Other Heated Base fee: `[ q, I L1. 15 Mezzanine Additional Section: Heated Basement = Plan Check fee: // w 4•cf1 Unheated Basement/ � x State Surcharge fee: .�Unheated � ,� Other Unheated z) j" Pot Water Review fee: rs•_ SUBTOTAL Garage/Carport r a no Decks. f 911/Rd Approach fee: s' Otherr .. TOTAL• 85 ` Receipt Number. I i 7 CashlCheck Number. I ESTIMATED COST(REQUIRED) Date: / .Fair market value Sall labor and materials foundation to finish 5o6p Of 040. 00 Initials: G:\PemutGrnter\###FORMS###WRU FORMS\Master Permit Application 5-29-08.doc ; rnwa e aril APPROVED Require- il[pm STORMWATER PLAN . ON co w,�,9 , . �1 JEFFERSON COUNTY DEC 2 1 2010 ti . �4 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 1EFFER,• �•qS, N0�0� h60/379-4450 . 360/379 4451 Fax DEPT.O c,i ;PM ttp://www.co.jefferson.wa.us/commdevelopment/ srGNATt; Al l���i STORMWATER SITE PLAN SUBMITTAL TEMPLATE iMLA# f v 3z3 PROJECT/APPLICANT NAME: Car I.ck n E a a n i'1P iTE 1'lCt tl I 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. AUG262010 Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. Pro pos e ct de_ve�rm_e_,iL (�inil e ccar n 1 I y h orvtz) Will uh_Lie e e$i s}in c l ea rec Urea on pr rEple(4>/ n�rc �ta�-Iterec Pecu by c` `ire Ii as (op/ownercieue i is psi_ pool, -Iro all na4tie e+a4-io.n, Existing Conditions Summary `� 2. Describe the existing topography. Indicate contours on the site map. Arperoktrnate_ly (kJ% The .. roiikarty is y_nfly_ sle)p_od anc i/or Vick+. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. PreUou5ly Cleared areas are cuss, 4he o� r 4-4-acre-6 includerno, le, ciIclet` . evergreens , Soli-non berr, .erns_ 1-o —1`hese ve a- 4ed crrkas will NAbe iis4-ucbeci. �' 4. Describe the existing soils. Indicate soil type on the site map. Per our owr:c1rer4 5e(Ai' ., permif, 1/44-he Sl?ii is "clay loam ". 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. lL � i d i rort cur\dS a1- c+-ctb(� [�\t rL cikeln i4 rc�.une& 1' w() Gr car Ail drairAacJ i a\o,orbeci irk 1-he round. 6. Describe any excess levels of noise generated by the proposed use or activity: None. oker 4I-)ah normal e_ons4rue loK., ctcts' Ji {-l' S• 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.)on the site. Indicate location on the site map. i 1 • c;.r .s1; n oc e r r 5 e e c�L.Q 1-,?rmi nec -1-o be c n Bros ow h 22 Se-+bac cs and bu ers derm;neck and will be cier,ero ply ab5c:c�enl . 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.). 'i_ S eneral 1/i Ci1- l-y includes _!-her camI )y homes, vacant' °perVies , , --11 y S -ate rncas tv:41,1 ewer and phnn e. akin i laln[e. 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; rer h\/Arolocc./ will be di;sruT -ed tulle as possible.. Any 565rm 1. 1.-er run of- ' c'rorr‘ e house, w:11 be- cli verEe.d. Uway crony, �F' P_rosto�� 1n6,2.2arc rar.)d uny o*Ier se-nsi rive, areas. StArTc' er Loileeked b-y (try well . Se e, s►l>o Cor loccl . 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.] None ryeede ct of- required, 11. Describe the performance goals and standards applicable to the project. This Prb; (2 - shokklcl ka_v 1 no ►rope et an tur re Kt hyi2s.rolAy 12. Describe the flow control system. Drell (s) will b y w e used as tt& e`ssc:kr stormwater site plan template—rev.10/21/2008 6 • • 13. Describe the water quality system. ,VA 14. Describe the conveyance system analysis and design. 15. Describe the source if fill material, physical characteristics of fill material, and deposition of excess mat rial. ► • b• - lS I be needed • ' • ' & - ■, - ' 1 e es�� erla�s co� I 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the proposed surfacing material. or►-,r,et— • ems a - as _ be rekr eci •. 4- ' • * 5sS 18. Describe methods or restoration of the site. A e - tor- hon 2 -Ct6 A 171 e a • 1r , 4e � 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 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 conditions that affect the drainage plan or contain more restrictive drainage-related requirements, describe those conditions or restrictions here. .n stormwater site plan template—rev.10/21/2008 7 • • 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. e )ro?os_eci, e_leocknc� but�din5 si e �� mar <ea wi - /, , h P. OS+5 , oranc � -��e orc�r�� c��S and w � 2. Establish Construction Access. 1 11 raFOI�S r,�[` �f"h e driveway -1-0 4 e t_oin SIT e.,- 0 5i -e' u)a S 1 -2n 'ye a.rs ctc o. 3. Control Flow Rates. Non tl,;l\ be needed , 4. Install Sediment Controls. None Will be. neecteo( 5. Stabilize Soils. EIT•O ea o►1 S LoAl seeded a.s soon fpos .' i 61 e . 6. Protect Slopes. ti%e.r� s1o2c1 sods will be eyposed , s raw t,�: I1 b 1�se c-.( late.a nit l� a re az. Lv.l 1 b e c_e cp e d a_� �')oo it. C*. S 7. Protect Drain Inlets. `fihere a_re nc) drain inlets on or hear Si eo 8 stormwater site plan template—rev.10/21/2008 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. -There a t?k.re n� r\r s or ocA-neL on site. 9. Control Po uta ts. 1\10 ��olYct -u1.I-5 Lodi be Generated, 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). NA 11. Maintain Best Management Practices(BMPs). We are del;bero-Fe�y Se+gin OLlr 932 square ?oc,-i home 06 ?roper- yy 1p'D mi nt nnca � ► ti(. 4- � OiArren-L ti. h ioj-r - en `�' ' 12. Manage the Project. RPi-Mi -in �urr�r, •c6u.) Arid Conk-rot and. c �uert c h r—r� r f 0.i[�LUo fer 5, t1� ne�(zsc�r y 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). UJ.g a I_I_ d.t`s -L rD 100 aCt;aee n (ire.cxs b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). ( 1. e - 1.)1 �'- - +,ro►� .ua I ;mmimi.. e 4-0 4- • e r c•. I'n c . na AL��11�1 ',�"1� ' { a , ec 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. i stormwater site plan template-rev.10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. 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, sett eability, permeability,depth,texture, soil str cture). A , ,-n IS• - ' o 1` . ,♦ .3V_ r has t3ee'f1 de ermined .,. s . - rD . 0.0•1111E101MIRM, o e e r 5. Construction Phasing. a. Construction sequenc St= ?red rou.nr r an , rGm1 n�j. .OU nct, roo inP_rtor 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. I ra We c ok.ose, .tobtxnet2+e siie u 'RCPe, Yor tia ram-knc roar 4, scLi n ' o `�- t 1.t2�� CP_ - ,0 anCI V->iru'sk +4,e. interior CC.ucirtoj 4he lvin�er �x Y rr , II. Wet Season Construction Activities. a. Proposed wet season constr ction activities. isn +n ere are o ev io it r.mye.,en4-0.lii Se nsa'i-i'v ax-e,o, Co( c...oll c.c 'ory cke4;v files. Plus by 06. 1 we u.)A1 have seeded and 1anrerJ b. Proposed wet season cons ruction activities for environmentally sensitive areas.O�-U OtiS fb' GI "fir WZA- Sea.f oR ton3-1-ru l.. f ovL (A.A. - ' i nick 1rNi—ex 0 r. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or othegr financial securities. Prtar. D,. and Sea.nngii•e H . Hall b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation Im acts. we dale r;na►,,,eiJ re-- or, ;be<i y . 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. A/4 c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev.10/21/2008 • ! SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation (e.g.,tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales, interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions, and direction of flow in all ditches, swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth, length, and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s), if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g., concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/21/2008 11 L. ! • 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. i -10 [iv' '` " d 62, (LAN, LAN NER OR AUTHORIZED REP S N E SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template-rev.10/21/2008 o d w 4'0. 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