HomeMy WebLinkAboutBLD2011-00279 • S
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#: BLD11-00279
SITE ADDRESS: 249 KENNEDY RD Issue Date: 04/18/2012
PORT HADLOCK, 98339 Final Date: 7/31/2013
APPLICANT: BETHANY AXTMAN PHONE: 360-643-1941
249 KENNEDY RD
PORT HADLOCK WA 98339-9719
SUBDIVISION: Block: Lot: TX 31
PARCEL NUMBER: 901034010 Section: 3 Township: 29 N Range: 01 W
PROJECT DESCRIPTION: NSFR W A/G 250 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
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/31/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 7/31/2013
Jefferson County Building Di'ision Permit Num BLD11-00279
Applicant: AXTMAN
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 I.tr(Z a/ Minimum setback from private ingress/egress easements shall be 20
D feet. The parcel is accessed by a private easement via Kennedy Road.
(Kennedy Road is a county local access(C536609).
Erosion Control 7/24/, / SEE CONDITIONS 3 &4
Foundation Footing , S_I 0
Footing Drains -)--6 aj
Foundation Stem Wall ?`),(2....( L
Underground Plumbing9f—q*-1.L
Under Floor Framing AM,
Straps(hold downs)
Ext. Shear Wall Nailing .3 �) /..,
Rough-in Plumbing
4 `I3
Framing `7 Y)3 fiO),) /C/i�Yltt j-
tar
Airseal /��)
Insulation:Walls
Insulation: Floors I �G
q /•i iZ l D �iu�. 5�,q S
Insulation: Ceiling y 1/3
Int. Shear Wall Nailing /j,
Wallboard Nailing I 3
�/ZI�3 tfi
Gas Line: Interior
3/V13
Gas Line: Exterior
3/// 7c
Propane Tank Q/
7/26/ �/
Heat/Chimney Clearance NVA
Duct Test Cert
Blower Airtight Test
Smoke&CO2
Drywell/Alt Drainage 7/2 4./3 SEE CONDITION I FOR SPLASH BLOCKS& DRYWELLS
Address Posted
04/ 55/
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
9
RILDING PERMIT APPLICATal Review 0 pe1I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00279 Received Date: 10/12/2011
SITE ADDRESS: 249 KENNEDY RD
PORT HADLOCK, 98339
OWNER: BETHANY AXTMAN PHONE: 360-643-1941
249 KENNEDY RD
PORT HADLOCK WA 98339-9719
SUBDIVISION: Block: Lot: TX 31
PARCEL NUMBER: 901034010 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: WEBER CONSTRUCTION PHONE: (360)385-5204
RAY WEBER
4554 LOPEZ AVE
PORT TOWNSEND WA 98368
Contractor's License WEBERC*0330D Expires 11/29/201Z
REPRESENTATIVE: ANDREW REECE PHONE: (360) 385-4305 ,
2310 THOMAS ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP NSFR W A/G 250 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 966
VALUATION 133,000.00 ADD'L: 448 HEAT TYPE: RAD
CODE EDITION: 2009 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: 208
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: 05783
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 1
Total: 2 I: 1
Routing Date:
I� (f-)- I I J�
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,178.55 LYK 10/12/11 128232 APPROVED
Plan Check $766.06 LYK 10/12/11 128232
State Building Code $4.50 LYK 10/12/11 128232
Potable Water Application $62.00 LYK 10/12/11 128232 APR J 2012
Total: $2,011.11 Jefferson County Planning
& Building Department
• •
CONDITIONS for Building Permit# :BLD11-00279
1.) DESIGN CRITERIA FOR SPLASHBLOCKS:
A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED
BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE,
STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE.
SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS.
A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH
SPLASHBLOCK.
A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG
BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE
POINT.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE
DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS.
2.) 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.) CONSTRUCTION ENTRANCES 4IPALL BE STABILIZED WHEREVER TRAFIWILL
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.
4.) IF A SILT FENCE IS NEEDED, IT SHALL BE INSTALLED TO THE SPECIFICATIONS
LISTED BELOW. THE APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO
MAKE SURE THE SILT FENCE IS PROPERLY INSTALLED AND MAINTAINED AT ALL
TIMES DURING CONSTRUCTION.
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.
5.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
6.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC) Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
7.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
8.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
9.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
• 411/
10.) 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.
11.) 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.
12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
13.) 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.
14.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
16.) The building height is not to exceed 35 feet.
17.) 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.
18.) 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.
19.) Minimum setback from private ingress/egress easements shall be 20 feet. The parcel is
accessed by a private easement via Kennedy Road. (Kennedy Road is a county local
access (C536609).
�,�goN C06, JEFFERSOSDUNTY
w4 . •• I , A DEPARTMENT OF COMMUNITY DEVELOPMENT
") 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
' cj www.co.jefferson.wa.us/commdevelopment
�`S`HIN9
Master Permit Application MLA: I i `:;-9 1 y •..
Project Description(include separate sheets as necessary):
14 4 1.F MEIJ 'Jf3- OK Ui t/ Loj_
Tax Parcel Number: gini M4 3o Property Size: `i-S7 (acres/square feet)
Site Address and/or Directions to Property: 2444i t5ziS:C-:4A{ ^ TuP,K Le-i lt_x x
Property Owner(s)of Record: I AX7 /'j1
: ? - 0 �(Telephone r `-,., l
ax: email:
Mailing Address: .1t1 1/7 tal 4 giV
V ' e , WA., 1�
Applicant/Agent(if different from owner): dr.1 t'ZY*y•
Telephone: &(orn. 774 c1 Fax: email: _ t.ltE
Mailing Address: ZSto -T - ' 1'. lace I(^ s- j t 'WA_ lc
Whit kind of Permit?(Check each box that applies 0 Lot or Road Segregation
L�Iiuilding ;. 0 Critical Areas Stewardship Plan
❑ Demolition Permit - • 1 0 Variance(Minor, Major or Reasonable Economic Use)
2-tingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .0 Modular 0 Discretionary"D"for-Unnamed t Ise C assifirati n
❑ Commercial* 0 Special Use(Essent•al
_ li�fa '
t I❑ Change of Use . .. ;11 0 Boundary Line Adjus*
❑ Address 0 Road Approach 0 Short Plat** i .
❑ H e Business 0 Cottage Industry 0 Binding Site Plan'1*' 1
l Propane ❑ Long Plat** I n I OCT 1 2
❑Sign -• 0 Planned Rural Residential Development(PRRD)/ a ents**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Altgratio **
❑ Stormwater Management 0 Shoreline Master!Program *_imptymj g evisions *
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manademer?trSupsj O?,i,t yp h*
❑Temporary Use 0 Shoreline ManagemenfVarrance
❑Wireless Telecommunication* 0 Comprehensive Plaq/U49/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Slot" tine Master Program Amendment
*May require a Pre-Application Conference 0 Tree Vegetation Requp§t
**Requires a Fcc.'Akplication Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate , � � to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE y/t F1l Aj (Az-hvi Q-Q'\ Date: 14- 20II
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,represerVtives or agents for the sole purpose of application
review and any r:.a ed, . er i pec'•ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the app catio.h the of.heh ants prior notice.
Signature: _ _ Date: 011 j
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 issue 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 ar in corn I' c ith the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable r ponsib- ty or adhering to and complying with the ESA. The Applicant has read this disclaimer and4sigus,anel ttates'it below.
Signature: - (-{. -C.+ L g Date: r 1j 0. (J-'." . ..
• 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:
MAILING AD ESS: 446 tipp.2.
l �..ta7 EMAIL: /A f,j tj 46. �"�.t
CONTRACTORS LICENSE �l► WAINS ��I �! "•
NUMBER: NUMBER
V• A •-
ARCHITECT/ENGINEER: Atat' / 1, ti PHONE ('! 774 6514.FAX:( )
MAILING ADDRESS: 2�jt0 '� i} ^V ex- Arco AIL if;I 14=1
Prolpet Type: Frame Type: Bathrooms: ! Shoreline: Tye of Sewage Disposal:
to'New 12-Vood Existing: ❑ Sewer
O Addition 0 Steel Proposed: ( Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: dividual Syste
O Repair 0 Masonry —LPL SEP Permit# I I- ( _
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: v Setback: ❑ Private well ❑ Two Party
• Ty a of Heat: Proposed: D_ 'ublic
Total: 2- WS' Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: 2.,. 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's a Pro•a - ank and/or ••liance Installation •ermit mark all items below that apply
. 1 •bove ground Tan. Size of Propane Tank:3
• ea o e ook Stove Woodstove i Fireplace Insert 1 Hot Water Tank i Pellet Stove i Other
5:341EilaV
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 [ urrent Proposed For Office Use Only Amount Revision
Main Floor Heated 9 LL EH BId App Review: 173
2nd Floor Heated Consistency Review: —
Other Heated Base fee: ' l V 55
Mezzanine Additional Section:
Heated Basement Plan Check fee: 1 ! / •b°
•
Unheated Basement State Surcharge fee: i_f_. Gc
lop
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
c_)335.i
Decks 205
911/Rd Approach fee:
Other • _ . • TOTAL: $ 3 3331 t
Receipt Number: I M.35
Cash/Check Number: +9 .
ESTIMATED COST(REQUIRED) Date: _
•Fair rm
rket value of all laborr and materials foundation to finish
# ,)55t1 --_A Initials: ,
.._..: • . "_.___
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• •
,���ggoN CO6`�
JEFFERSON COUNTY
`a� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�`SH7N0� http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# I , c9 1 / PROJECT/APPLICANT NAME:
Please answer all of the following questions to the best of your ability. Where the questio II ft�re;.I nl. , he
applicant may choose to either incorporate the elements into the general plot plan for the Ma t •._.� fir :tl�i u t a
separate stormwater site plan map. u
OCT 1 2 20111
Project Overview
_
1. Describe the proposed developed conditions of the site. Indicate position and relative size on the
EFFERSON OUNTY
site map. OUTIY �_ t 1--j—
x` E'er �� �- vert u FL u�g C At.� P y��l
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
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5. Describe the existing site 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
a.•licable, and indicate acreage of each.
APPROVED
6. Describe any excess levels of noise generated by the proposed use or acWity: sToR A[VATER PLAN
APR 1 7 2012
Requir
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stormwater site plan template—rev.10/21/2008 SIGNATURE' (� 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.
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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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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.
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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" protects or projects that involve the potential for dispersion of contaminants.]
11. Describe the performance goals and standards applicable to the project.
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12. Describe the flow cg ,
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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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.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements, describe those conditions or
restrictions here.
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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. _
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2. Establish Construction Access.
3. Control Flow Rates.
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4. Install Sediment Controls.
Jjt1-4. /VIM/ I _ S
5. Stabilize Soils.
6. Protect Slopes.
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7. Protect Drain Inlets.
ADD PP /ZW5—PlibArd, <� s�-
stormwater site plan template-rev.10/21/2008 8
•
• •
12 Required Elements— Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
DUE, Pi 7.41f r ?ls 1'
9. Control Pollutants. e
tI>Tf?, ty 604 hLr
10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices (BMPs).
Ab, _ t .t W "LetaP. `-ir►' i' y ji►,__ AIL J
ter? n� ,,_• _TitiEr5
12. Manage the Project.
UMPA i C ,'S851Ll0 a AS l /61/41
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
zs /L 37x —4F't. r c(12= ji7E Prr,
, 4
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
iyA,
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
WAr
stormwater site plan template—rev.10/21/2008 9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
WA,
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).
c'x Pg b
5. Construction Phasing.
a. Construction sequence
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b. Construction phasing (if proposed)
6 M 4 7 rijol IrivE
6. Construction Schedule. Wet season is October 1 through April 30 (page 2-21 of the Manual).
Provide a proposed construction schedule.
1145
II. Wet Season Construction Activities.
a. Proposed wet season constru on activities.
p c
O i % ram
b. Proposed wet season construction activities for environmentally sensitive areas.
Ls ((
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
LAtik
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
airl.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. f4
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/21/2008
10
• •
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,-5ffecte rty.
•
(LANDOWNER OR AUTHORIZED EPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/21/2008
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