HomeMy WebLinkAboutBLD2011-00026 �0 •
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#: BLD11-00026
SITE ADDRESS: 22 ARGYLE LN Issue Date: 04/7/2011
PORT LUDLOW, 98365 Final Date: 9/12/2012
APPLICANT: STEVEN CROSS PHONE:
46 VILLAGE WAY PMB 124
PORT LUDLOW WA 98365-9762
SUBDIVISION: SOUTH BAY#2 Block: Lot: 14
PARCEL NUMBER: 995600014 Section: 21 Township: 28 N Range: 01 E
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 9/12/2012
\\tidemark\data\forms\F_BLD_Occu pancy.rpt 9/13/2012
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Jefferson County Building Diftion Permit Number: BLD11-00026
Applicant: ARGYLE INC
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 Noted 0.1 I y. A ,,c1
Setbacks {70 /Minimum setback from Argyle Lane right-of-way shall be 20 feet.
7,/ , c 1'" Minimum side and rear yard setbacks shall be 5 feet.
Erosion Control t L� Imo', SEE CONDITIONS 2&3
Foundation Footing C—���1 /�c„ 1 ' -
Footing Drains /a, 0 09 k I f 46_
Foundation Stem Wall n l`J ` `T�� 'i-'1 ( j� - _ 4- f e iG ` oC L
Under Floor Framing _ . a(f f l �y
Straps(hold downs) -7 12 I) 9✓
Ext. Shear Wall Nailing -I IL I , ?t,,,
N M( Di- 2 ?IWO— A-t, 14-0l p DAV>
Rough-in Plumbing ,t k *
Framing 6`9"-i. Pem
Airseal 6-r1 -- (( P,D
Insulation:Walls 42- C ( F-6
Insulation: Floors `) _/)
Insulation: Ceiling / �
SIP
Int. Shear Wall Nailing
Wallboard Nailing J_ f)_Af
Gas Line: Interior o_;-
— t ( -Pri-rer73
Gas Line: Exterior 9-11 ( 7
Propane Tank 191-1I Heat/Chimney Clearance 1A�!Z+:C/t--- 3
6l
Drywell/Alt Drainage '. lel. ll A1-22 SEE CONDITION 1 -/LA f
Address Posted 9//L 1 r(113
FINAL INSPECTION 9_/2 / 11 /77/3
1 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
MLA11-00023
SILDING PERMIT APPLICATOI Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00026 Received Date: 2/3/2011
SITE ADDRESS: ARGYLE LN
PORT LUDLOW, 98365
OWNER: ARGYLE INC PHONE: 206-201-2685
PO BOX 65135
PORT LUDLOW WA 98365-0135
SOUTH BAY#2
SUBDIVISION: Block: Lot: 14
PARCEL NUMBER: 995600014 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: GARRETT LARSEN PHONE: (206) 842-9984
16221 REITAN RD (206) 842-7913
BAINBRIDGE ISLAND WA 98110
PROJECT DESCRIPTION NSFR W/ATT GARAGE & A/G 120 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,144
VALUATION 237,522.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 624 SETBACK:
DECK: 350 BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: 68700
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 3
Total: 3 Total
Routing Date:
Type Amo aid Bv: Date: Receipt: Approved/Date
Permit $1,766.55 LYK 02/03/11 120427 /\IDIDRcJE[,
Plan Check $1,148.26 LYK 02/03/11 120427
State Building Code $4.50 LYK 02/03/11 120427 APR '7 ZJ:1
Potable Water Application $62.00 LYK 02/03/11 120427 Jefferson County Planning
Total: $2,981.31 & Building Department
• I
CONDITIONS for Building Permit# :BLD11-00026
1.) DESIGN CRITERIA FOR DISPERSION TRENCHES:
A VEGETATED FLOWPATH OF AT LEAST 25 FEET IN LENGTH MUST BE
MAINTAINED BETWEEN THE OUTLET OF THE TRENCH AND ANY PROPERTY LINE,
STRUCTURE, STREAM, WETLAND, OR IMPERVIOUS SURFACE. A VEGETATED
FLOWPATH OF AT LEAST 50 FEET IN LENGTH MUST BE MAINTAINED BETWEEN
THE OUTLET OF THE TRENCH AND ANY STEEP SLOPE. SENSITIVE AREA
BUFFERS MAY COUNT TOWARDS FLOWPATH LENGTHS.
TRENCHES SERVING UP TO 700 SQUARE FEET OF ROOF AREA MAY BE SIMPLE
10-FOOT-LONG BY 2-FOOT WIDE GRAVEL FILLED TRENCHES AS SHOWN IN
FIGURE 3.5 VOLUME III OF THE DOE 2005 STORMWATER MANUAL FOR WESTERN
WASHINGTON. FOR ROOF AREAS LARGER THAN Y00 SQUARE FEET, A
DISPERSION TRENCH WITH NOTCHED GRADE BOARD AS SHOWN IN FIGURE 3.6
VOLUME III OF THE DOE 2005 STORMWATER MANUAL FOR WESTERN
WASHINGTON MAY BE USED AS APPROVED BY THE LOCAL JUIRSDICTION. THE
TOTAL LENGTH OF THIS DESIGN MUST NOT EXCEED 50 FEET AND MUST
PROVIDE AT LEAST 10 FEET OF TRENCH PER 700 SQUARE FEET OF ROOF AREA.
A SETBACK OF AT LEAST 5 FEET SHOULD BE MAINTAINED BETWEEN ANY EDGE
OF THE TRENCH AND ANY STRUCTURE OR PROPERTY LINE.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
RNOFF DISCHARGE TOWARDS LANDSLIDE HAZARD AREAS MUST BE
EVALUATED BY A GEOTECHNICAL ENGINEER OR A LICENSED GEOLOGIST,
HYDROGEOLOGIST, OR ENGINEERING GEOLOGIST. THE DISCHARGE POINT MAY
NOT BE PLACED ON OR ABOVE SLOPES GREATER THAN 20% OR AGOVE
EROSION HAZARD AREAS WITHOUT EVALUATION BY A GEOTECHNICAL
ENGINEER OR QUALIFIED GEOLOGIST AND JURISDICTION APPROVAL.
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.) A SILT FENCE SHALL BE INST�D LANDWARD OF THE LANDSLIDE HARD
AREA BUFFER PRIOR TO ANY L D 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.
4.) 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.
5.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
7.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened
from view of neighboring dwellings and rights-of-way. Such screening shall meet all
applicable performance and development standards specific to the district in which the
storage is kept, and shall be in keeping with the character of the area. Screening shall
meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
8.) This parcel is within the Port Ludlow no shooting area per JCC 8.50.
9.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
10.) The road approach permit(RAP11-00004) must be inspected and finaled by the Jefferson
County Department of Public Works prior to the final inspection/certificate of occupancy of
this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the
final road approach inspection.
11.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
• •
12.) The building height is not to exceed 35 feet.
13.) Minimum setback from Argyle Lane right-of-way shall be 20 feet. Minimum side and rear
yard setbacks shall be 5 feet.
14.) 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.
15.) 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.
0 .
•
�.1"go_ JEFFERSOi1 COUNTY
47 , \ 4, DEPARTMENT OF COMMUNITY DEVELOPMENT
`' 621 Sheridan Street• Port Townsend •Washington 98368
1 360/379-4450 • 360/379-4451 Fax
�ryS,�N�,�p$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 1 i a5
Project Description(include separate sheets as necessary):
--z>A/"7- 0 Cr -s�/e..... a. •A,r7r>rzo Zia c, 0Ad P'T'z� ' A-CT
Tax Parcel Number 99Cj (ebb O(4- Property Size: 52.179j ,3r,A(acres/square feet)
Site Address and/or Directions to Property:
PA02.40/5e- , SouA 04 Thu-Lt. , RI aic!i-itEt 0,1- 'T or-)C4 tX.b)t leFT ao A fZ.f? j 1.-£.
Property Owner(s)of Record: ,Q C[✓'7'>'. (NC.
Telephone:.Z.d4 -2 c,!• _e.,,g,.„ Fax: .— email:"--
Mailing Address: 71'V'..ALiS4 W '( -'h1P /Zle - ,p - AY 9 8 3(19
Applicant/Agent(if different from owner): 7 k E/7 ��43, 6// /7 - r'
Telephone:ZdC o/29 q 8 s- Fax:ZeZ. 2 7,I email: -D{.CfELACS6 C4-11"Te4.Go rill
Mailing Address: 1G22/ 2 V _ ct/n/ /tj{Ec op, /lb
What kind of Permit?(Check each box that applies
X,IBuilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
.Single Family 'IRT Garage ID/Detached 0 Conditional Use[C(a),C(d),or Cl*"
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
0 Address 8[Road Approach Xf 7?H 0 Short Plat**
❑Home Business 0 Cottage industry 0 Binding Site Plan**
11C1 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)* ❑Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 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
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal,if known:
D SIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ,.1 -1 Date: A3�•/1
By signing this applicatio 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 e,by¢teowvr(> > ?@riagp:tit Wtttt,respect to this application packet
may result in this permit being null and void. i�'� �(( I -t
I further agree to save,indemnify and hold harmless Jefferson County against all lia Nities,judgments,court costs,reasonable attomey'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 .=ss and right of entry to Jefferson County and its employ pis-,tatiJel or agents for the sole purpose of application
�:�a
review and any requi ter inspectio s. Staffs access and right of entry will be ass uiless the applicant informs the Count
y in writing at the
time of the applica�ti•/, -•at he or s nts prior notice.
Signature: ..a "3i.'•�/
i.
The action or actions Applicant will undertake as a result of the issuance of this i 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 ' compliance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual
and non-transferab nsibilitydhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: iL.Adi Date: // d'/J
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
II •
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:
No r r� - GTE ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: F Acc/4(7; G7 PHONE (ZAtr) 84219 G 4. FAX:(21,L)gl.Z 7,13
MAILING ADDRESS: EMAIL6MIQTN1=1.h125E4) •RcPOECPS• c
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
g New *. Wood Existing: t-44. . Sewer
❑ Addition ❑ Steel Proposed: 2 t(2 Bank 0 Community System
i i Alteration/Remodel ❑ Concrete Total: 2 (x. Height: 0 Individual System
1.1 Repair ❑ Masonry SEP Permit#
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: II Private well 0 Two Party
Type of Heat: Proposed: 3 Public
Total: j Name of System:
If this is a Commercial Project you must 2nswer 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:
4Jnderground Tank I Above ground Tank Size of Propane Tank: f c7LU G
I Heat Stove Kook Stove i Woodstove 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.
w4 ` Y rt .
4r M; : "+: x , �t,. yt, t `44:1Square Footage Current Proposed l , w ,, r h -Main Floor Heated `" ,.; EH BId App Review:
21 if 5* ` Q n SP,Uler
2"0 Floor Heated " Consistency Review:
Other Heated �, r , Base fee: /J ' '-
Mezzanine k4 i (7�r-��
Ott - Additional Section:
Heated Basement Plan Check fee: 'CIQ� Z�j
Unheated Basement U
, State Surcharge fee: jC-)
Other Unheated Pot Water Review fee:
Garage/Carport F.41: °1 SUBTOTAL
Decks -f ` r rr 911/RdApproachfee: 67 l
ter ry , t, �
r,r,:; TOTAL: $ S.
r
} Receipt Number: I43-1
'{• :`` Cash/Check Number: I Zia
ESTIMATED COST(REQUIRED) Date:
.Fair nyiket value of all labor and materials foundation to finish 3'1_ 1
Tr/go coo Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
I • •
re:sON
°°�� JEFFERSON COUNTY
o ,'a� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend • Washington 98368
�qs �O\\,........
� 360/379-4450 • 360/379-4451 Fax
WING http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# ` .C9,5 PROJECT/APPLICANT NAME: A,,24 4l 4/#i f(
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.
4164' /2f-s' ,A) Al '" AP. '°f1-67 —40141494 2Vi # IIC.1i
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L.Existing Conditions Summary '[UEERSUN CUUPi f? fpCr
2. Describe the existing topography. Indicate contours on the site map. �f[ �+•
Z'/ /5 ,vPLi Ii//pci 4..e3Dar 211,AT z ui ) Td,G7/TG�,i440 ST
LEfL...
3. Describe the existing vegetation. Indicate native vegetation areas on the site map. rm. --<,ink
Ge.9�s�✓, 4!/.-2 - ,�//.t 2,4eL. a'Ta47. � A ,11-�nk )I i` g
4. Describe the existing soils. Indicate soil type on the site map. "- 3 `
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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.
/41 a, .-°T-- A449NS 7-D -s'7Z T 4'7W/ 14)2 a 4in)6d otfAvo if cryl
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6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
A9r111� ,dj�47 e.04,5�v,p�,, J S COKM W A I �K PLAN
APR - 7! c)O E 1
s
011‘14 1 N Y
stormwater site plan template.doc—rev.10/12/2003 u�C DEPT.O C 1TY EL PMEN 5
Re4 SIGNATU E:
.
• .
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.
,br a/Aidar o 74W 1,0 Aj /3 yo soU)
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.).
•
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ST 72 7 7� r
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 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.]
(STD
11. Describe the performance goals and standards applicable to the project.
r ;' eliCEj72 ,5 Ac/(N/A. TE. O/Wpl5✓2"bCI
76I4/1 Zf '"-'lTAS \WOCS7 p j7iStL1V ,e
12. Describe the flow control system.
' Ve .,2cJ, /t!s 7 t V //-7',e477 I4-4
stormwater site plan template.doc—rev.10/12/2003
6
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13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
<9N s/7Z-3 /A/ 7 4 k /a 1 - "� � 7/(5 �i S.1N ;moo c�c
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.
CW/s2 , f��5c4:Sei A 'VA-)
18. Describe methods for restoration of the site.
X( fAJ •'f77'S 7754.-L4 414/47
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.
N. 4 .
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
pe:=N" FEB Q32,''
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21. List other necessary permits and approvals as required by other regulatory agencie if-tio e',petrmits or ati151-t.vals include
conditions that affect the drainage plan or contain more restrictive drainage-related. qulrements, describe those conditions or
restrictions here.
storrnwater site plan template.doc—rev.10/12/2003
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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 section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
2. Establish Construction Access.
4
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
6Y oI \V k ? , 1-1l
6. Protect Slopes.
�451/V!—
7. Protect Drain Inlets.
stormwater site plan template.doc—rev.10/12/2003
8
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12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
Iel-FAFP .e7/7Cht
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs). ,o
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12. Manage the Project. v
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards). S t/S ►'Y\
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to th to
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stormwater site plan template.doc—rev.10/12/2003 9
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b. Description of special requirements for working in or near environmentally sensitive areas.
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).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing (if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule. �^
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II. Wet Season Construction Activities. //YP;l ' - /H-
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
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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. (V../4.--
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template.doc—rev.10/12/2003
10
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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 4-4dio`i irgi`igd,WAt ,gaiity on
the construction site. Sampling stations should be located upstream and downstream of the-proj 's'te `-" �JJ
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11
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Stormwater Site Plan Changes
If the rigcinr r wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
�.for 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 est y knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of th affe property.
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(LANDOVyWER OR HORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template.doc—rev.10/12/2003 12
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