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BLD2014-00151
• BUILDING PERMIT APPLIC1ON BLD14-00151 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00151 Received Date: 5/1/2014 SITE ADDRESS: OWNER: STATE OF WASHINGTON-DNR PHONE: 360-374-2800 PO BOX 47014 OLYMPIA WA 98504-7014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 712253000 Section: 25 Township: 27 N Range: 12 W CONTRACTOR: OWNER/BUILDER PHONE: c of �ti� 41ITilI;cw L e. REPRESENTATIVE: arm IC C.1 �7j) PHONE: '. �v 1 C-,'f i er1 PROJECT DESCRIPTIOI' INSTALL VAULT TOILET AT WILLOUGHBY CREEK CAMPGROUND TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 17,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 MEB 05/01/14 APPROVED Plan Check $0.00 MEB 05/01/14 State Building Code $0.00 MEB 05/01/14 JUN 11 20% Total: $0.00 Jefferson County DCD 11fieinmorLlAefelfnrme1F RI fl Ann Mel ml Ff1/9MA S°" r, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,W..98368 Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jeffersonwa.usicommunilydevelopment /�.f/!N`,1 E-mail:dcd@co.jeffexson.wa.us CERTIFICATE OF OCCUPANCY PERMIT #: BLD14-00151 APPLICANT: STATE OF WASHINGTON-DNR PHONE: 360-374-2800 PO BOX 47014 OLYMPIA WA 98504-7014 SITE ADDRESS: Issue Date: 06/11/2014 Final Date: 7/1/2015 SUBDIVISION: Block: Lot: PARCEL NUMBER: 712253000 Section: 25 Township: 27 N Range: 12 W PROJECT DESCRIPTION: INSTALL VAULT TOILET AT WILLOUGHBY CREEK CAMPGROUND THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes 57 THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/1/2015 \\tidemark\data\forms\F_BLD_Occupancy.rpt 7/15/2015 g444,_ .64- JEFFERSON COUNTY -< DEPARTMENT OF COMMUNITY DEVELOPMENT 'SNIt,Gt�= Date: f g Time Received: Q/3 am/ 0. Tue. Wed. Thur. Fri. y Date: 4-f BLD: 1—1 - I Sly Contact Name: Owner: Contact Number: 360 (pip 3Z4& Address: "'1 j M - 90 ( D.1.6 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts 1 Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling Sally Ellis From: David W. Johnson Sent: Tuesday, June 10, 2014 3:43 PM To: Sally Ellis; Mary Blain Subject: FW: Zoe case. BLD14-151 DNR Vault toilet READY Ready to issue From: Stacie Hoskins Sent: Tuesday, June 10, 2014 1:32 PM To: David W. Johnson; Colleen Zmolek; Joel Peterson Cc: Randy Marx Subject: FW: Zoe case. BLD14-151 DNR Vault toilet READY Hi, David,Colleen and Joel, Could you please pull this permit of Zoe's and issue it? Randy says it's ready to go! EY Thanks! Stacie 4. r'ear 4 4 Planning Manager,Jefferson County Department of Community Development 621 Sheridan Street * Port Townsend,WA 98368 Phone 360-379-4463 * Fax 360-379-4451 shoskins@co.iefferson.wa.us Jefferson County DCD Mission: To preserve and enhance the quality of life in Jefferson County by promoting a vibrant economy, sound communities and a healthy environment. All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public Records Act,a state law found at RCW 42.56.Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)of this e-mail unless it is also exempt from production to the requester according to state law,including RCW 42.56 and other state laws. From: Randy Marx Sent:Tuesday, June 10, 2014 1:00 PM To: Stacie Hoskins Subject: Zoe case. BLD14-151 DNR Vault toilet READY 1 I I e . , _ . .. ....:... , ,..... . .' .•:: . . ..-: .1 ... . .. . , . , .. ,:,.... .. ...._ , .....,.. ...,„.,..,!,0 0.0,0,11 _...■ 100 . 0 , . ..%. . . ' ,, ,.,.■ ■ , .-_ \ . .• . \ • \ -, L.., . \ .;-.... ... . ..„, ., . .4.441k.' ' ,. .', , •, .., _ . .. _.,._ ..,. .. . —:-. 114:. I .1, ..' • ..' ,.•.'2.1.'.,„,' - ... ......... ,.., . .„, v.. ' • .,, , ,..4.,. A.. ' 0.... 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Hoh '`...•ss,0,,AL''- 2Z --'ife Plan -i0' ScN1.7\ • '''' ''' ' Am._ Natural Resources . 0 . . . ■• camsouolurimm Parcel O. 712____.f.,.. ..-'_digio . 4/1/2014 -- I / 15.' A r I 1r '1 I l Ct' CD CAC Zug -08 a o n (D X. ❑ O 0 -I (7)4.. m (' `+ c < 0 0 0 co I- 0 0 C C C7 O CL ° n (1) (5 ❑ � rF1 Z O CD N I i LO ❑ 'V 3 O 3' ❑ 0 CD y CD ❑ O ■ s s�x7 � • • 1 I Vault Toilet at Willoughby Creek S-T-R County WRIA eP t�A iv Campground 25-27N-12W Jefferson 2D f11414;4)11/440,,,,,,.;,s, WA5MIN6hTY 5TRTE 0EPMTMEI(r OF CD Natural Resources o Site Plan-20' Scale Hoh duck- • Parcel No. 712253000 °""` • �IL71»xarf' 4/1/2014 .'..4+ Single Itrnrlt f«11l trccesible. itiosilk 'fir 'r Aril" a - x+i ..{,V. Li ti+:.:. kk '' . The Gunnison is a single in ext 'x ta a a aI= 3m s k R h t T y'4¢i.. vault toilet building buildi - x q.,+� � designed with a SO"turning the . , " .+f rq' f ` � radius within the toilet ' ' fi` � ��tenor is easily t*''''''''' ed with a brush room.The l.._� " � ; 'turning radius sq :" e soapy water.The •rningre d ' structure are � ,�, � � � ,'�+r d roof st x ' " '� ith"coloredthru . -. k+ r` . �Cu g b,r'1,...4‘,:::::,,,•;,:,..;,,":"1,",x ",which are spray , ` to maintain. . '',''? °.. an exterior �� _ steel Flo l ' = allowed by an anti r co _ ' � �-��oncrete Ctritu � �;, � = a=seater. single 1 D00 gallon '. + ,„ 1,e ins art - ' ' hold the waste. �� $'� 1 ��e�, �, ' `� < ,.� �, :fig` s +y"s °� rz D�rBbi/ity" �� "� `' � � � `�, �� to are approved e r � - omisaiona. rAII The Gunnison is en 'a ;. ` ` In Contormsn '. and designed for long .k; � ' " ' 'codes and regul , „S• $ A a tot\ JEFFERSON C • # + l �;' BUILDING PLAN L/ k Dy ,1 j., �o yat3e c t 3 },��� S" a tgFw .F ro 4.W �j � )� d 3 3t . d u. x.e a;.`. k t Wall Textures: , `Va ' ' r s .3 m Standrd:' r,2 t 3u e i + ' s` is installed � belowgr d ` . level a -,- made of, ' thick reinforced concrete.The Ar ailuble Options: dimension of t t,* n.= the vault unit matches the '' '"" 11 Sweet Smelling { ��=� �: . �, perimeter of the building, Technology , t 5 x' providing a stable footing The building is designed .'''''''4,1..-'7„,,..;,..i...! structure which supports with sweet smelling * J the full weight of the technology in mind A � ro ,, building.The vault can black plastic i `sips 7� ;,,A" f �" hold up to 1,000 gallons zx= � "4; �, P g located on th ,, M r r ,, + of waste,or 15,000 uses, the building � ,r ; r { and is sloped;so that waste south. When t w'` fi.., -. , ' _;144' u with ' will drain to the clean the sun,: ; *+ ',� tomer out end of the vault.The continue _° s�- why we vault is lined with a black louvered, '' y a_C}CT ASS plash liner the build F "s, ,, , l.tiding you will ROOF Textures: ` Standard: which is cast a The a"" - e" 4c '' _ -e anything into the s� " ` � riser a' r walls. ,r4 . ,_'' Available Options: yI ft's 4 , 4 ', a h Ra A 4�4 ::i'- " } , , e y*Shown 674 standard cedar t „ ' 711.5() available in 25 R differentearthlone ,,r 3T$ $ Colors• 1 � Is 'iz tv aYr. a Qn ezt "1 5. . a a� + $ 4 A t £:a�''t ' " f k §'z, Ar "`"", ice' ; b } ' ,14,..1. r P9 � � � �� � °�� � FM�7026 ''`kg' qtr'',, + "`s nit . 's '' . ,,, y t � ." ISO 9001 Certifier] aus • O �o aO to ■ P 1 K "till ° e O itil§iys Y L i m "ea a s o W o y e- a VI h SF m i" w �' . 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N °® N U K l�W Yv-" I Z >^ Q£N O\m a N W Q ti J q LA-Adb ¢mpJ , 1 ( U XG 0 ><OQ OJQK d• dW�0 UD\ UQWW �Q �V) K CO M o d J. o- tt a o\ >I a_I a OZ Cr ¢U W 1- 3Z 00 d' Z W ¢ W £O -"m zC7 W 0 W U Z d ° d V)Z xr 0 p K.Z. W J Zm Z LJ U U 4111/ON was `O JEFFERSON COUNTY Wkrx.' G DEPARTMENT OF COMMUNITY DEVELOPMENT 9s ■ w. 2 621 Sheridan Street I Port Townsend,WA 983681 Web:www.co.iefferson.wa.us/communitydevelopment et NG� Tel:360.379.4450 I Fax:360.379.4451 I Email:dcdaco.iefferson.wa.us Building Permits&inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: - Project Description(include separate sheets as necessary): Vault toilet replacement at Willoughby Creek Campground Tax Parcel Number. 712253000 Property Size: 5.57 Acres (acres/square feet) Site Address and/or Directions to Property: Turn East on Upper Hoh Road from US 101 at milepost 179, then travel 3.5 miles to site on right. Property Owner(s)of Record: Washington Dept.of Natural Resources Telephone:360-374-2800 Fax: 36o-374-5446 email: eric.steffen@dnr.wa.gov Mailing Address: 411 Tillicum Lane,Forks,WA 98331 Applicant/Agent(if different from owner): • Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation Building ❑Critical Areas Stewardship Plan — I ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Econgrnir..-U LI Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]" i, \/ ❑ Manufactured Home ❑ Modular CI Discretionary"D"or Unnam d U C�(asficat idn ( B Commercial* ypgro .d ❑Special Use(Essential Publi Fabli('i3 - 0 ; ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** t 1, ❑Home Business I=1 Cottage Industry ❑Binding Site Plan'" i 1 t h J ❑Propane ❑Long Plat* ! '�,II 3 3' i ❑Sign ❑Planned Rural Residential De Ipp nt(PR( /Ame(r qts** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** )FI 4 LR`°1 ; t Etop9F14 ❑Stormwater Management ❑Shoreline Master Program Exe ption •grrpjt . "+:' -• ❑Site Plan Approval Advance Determination (SPAAD)* ❑Shoreline Management Substa i- !l; ..ment** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). 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 owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required la er i spections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applic on tha 9r she wants prior notice. Signature: / Date: (11-19-/171 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively Impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo are in rom.liance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe le resp•a. ity for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 1' "�, Date: iL/'14/ 07/24/2013 • • BUILDER STATEMENT The signer of this s teme/'do-s hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu theme s., ibility of the General Contractor for the proposed project. Signature: Date: 4-/-iLiq GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: er-New Ti Wood Existing: o ❑ Sewer ❑ Addition ❑ Steel Proposed: / Bank ❑ Community System ❑ Alteration/Remodel t'Concrete Total: / Height: ❑ Individual System ❑i Repair ❑ Masonry SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: 0 Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 203' ❑ Public N/A Precast concrete building Total: r7 Name of System: If this Is a Commercial Prolect you must answer the following: Number of Parking Spaces: Current: 3 Proposed: 4 Number of ADA Parking Spaces:1 Number of occupants(includes owners,tenants,employees,etc) Current 0 Proposed 0 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: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP I knaT retaWtoH i 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. 41 1 fi. h r . M1{l,.:.,- z `(V*-- -f,:4,;1.1 .,,1 till i iii °ia r■4 gi) pl' fi i.b 1,4 ar h,.1.�} (� .e. s �Fi a i 4 4 11 41 ,4=44 1;14 I-i. , r S•uare FOOta•e Current Pro•osed , a " • ,. �t ,i,.--:,-,,;',.111•11,iN:, i ;�II0.1. ., L, }`.�'` "(' Main Floor Heated i I, 1 :v4 a. , ": EH Bid App Review: ' • 2"°Floor Heated 'i'i'i �V,71 ,, Consistency Review: l \'''' � �, ,i i iI } i�I`�' ���; 11 ■ ,44 `' Other Heated .:'',11,:•;';'1;':• ,.i;' ; 1 ' illy �' Base fee: ! � 1A.�, � , p r Mezzanine I, rjI1i 1": ° Additional Section:• Heated Basement ' + x,141 i1 Plan Check fee: •2 c t` 1; 1411iiilr \ - t V et Unheated Basement ; I1.:1� 'r� .:, State Surcharge fee: v \y,,,,‘,.:„.: �t (It� t 5''m: ti , ✓ �,��, . Other Unheated "° Iii i f,t;P` . Pot Water Review fee: . t co Garage/Carport ,11 i in SUBTOTAL ,,,;o III�,iili Decks �,�t;q,I- i 'I 911/Rd Approach fee i , Other airtlgtl :„•r•,° + TOTAL: $ i4 � - Receipt Number: ,j ,, r` Cash/Check Number: ESTIMATED COST(REQUIRED) Date: -Fair market value of all labor and materials foundation to finish $17000 Initials: 07/24/2013 • I Vault Toilet In tallatio DNR Wll oughby Creek Campground Existing structures: Two small wooden outhouses with 250 gallon vaults were removed in 2009. The vaults were pumped,the building materials removed to an off-site location and the vaults were collapsed and then filled with native soil. The area has since returned to natural vegetation. Proposed structure: The new toilet is the Gunnison model manufactured by CXT precast products. CXT manufactures both the vault and the building. The footprint of the new vault toilet is 8.5 feet by 14.5 feet measured at the eaves. The vault has a 1000 gallon capacity,or approximately 15,000 uses. No onsite sewage treatment is planned for this site. Structure Siting: Willoughby Creek Campground is located on state trust lands managed by the DNR. The Jefferson County parcel number is 712253000. The structure will be located 203'from the ordinary high water mark on the Hoh River, as shown on the enclosed site plan. Maintenance/Operation Plan: The new CXT vault toilet will be pumped at least once per year,or as needed upon inspection, by a licensed septic pumper. The vault will be inspected at least once per month during the winter and spring months and at least twice per month during the summer and fall months. These inspections will be performed and pumping coordinated by the designated DNR staff person, currently Eric Steffen. , Z . • 0 r w ti- �rt9ND sc FEMA NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND INSTRUCTIONS 2012 EDITION • IP . III • U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY Expiration Date:July 31, 2015 Notional Flood Insurance Program IMPORTANT:Follow the instructions on pages 1-9. _. ._ SECTION A-PROPERTY INFORMATION -F �j$' L a a r ,r-_) , Al. Building Owner's Name Washington Dept of Natural Resources i lE - , A2. Building treet Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P0.Route and Box No. ft* A"`e - 5692 Upper Hoh Road ` " City Forks(Unincorporated Jefferson County) State WA ZIP Code 98504 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Jefferson County,WA tax parcel no.712253000 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Toilet A5. Latitude/Longitude:Lat. 47 8992 Long. -124.1967 Horizontal Datum: El NAD 1927 ❑x NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 9 A8. For a building with a crawlspace or enclosure(s): A9.For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 95 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace 2 b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b >95 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ®No d) Engineered flood openings? ❑Yes ❑No SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3.State Jefferson County,WA(Unincorporated Areas) Jefferson Washington B4. Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel Effective/ B8.Flood Zone(s) B9. Base Flood Elevation(s)(Zone Revised Date AO,use base flood depth) 530069 0600 B 07/19/1982 07/19/1982 A (not provided) B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: ❑FIS Profile ❑FIRM ❑Community Determined ❑Other/Source: (not provided) i B11.Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 ❑NAVD 1988 ❑Other/Source: (not provided) B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes in No Designation Date: / / ❑CBRS O OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction* ❑Finished Construction *A new Elevation Certificate will be required when construction of the building Is complete. C2. Elevations-Zones A1-A30,AE,AH.A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/A0.Complete Items C2.a-h below according to the building diagram specified In Item A7.In Puerto Rico only,enter meters. Benchmark Utilized: -- - - Vertical Datum: Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 ❑NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) ❑feet ❑meters Note: Section C not b) Top of the next higher floor ❑feet 111 meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet ❑meters completed because d) Attached garage(top of slab) ❑feet ❑meters flood map does not e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters (Describe type of equipment and location in Comments) provide base flood f) Lowest adjacent(finished)grade next to building(LAG) ❑feet ❑meters elevation. Section E g) Highest adjacent(finished)grade next to building(HAG) ID feet ❑meters completed instead. h) Lowest adjacent grade at lowest elevation of deck or stairs,including El feet ❑meters structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S.Code,Section 1001. .r$RIQ�A, I]Check here If comments are provided on back of form. Were latitude and longitude in Section A provided by a '"ov WAS6.1 ❑Check here if attachments, licensed land surveyor? ❑Yes (83 No ,.S tf Certifier's Name License Number &�`- '!r James Patrick Patton,PE 38370 -� b.f. Civil Engineer Washington Dept.of Natural Resources A�O.o� •ecrsTtw tis'�w Name Address City State ZIP Code SIGNAL 1111 Washin. on St Olympia WA 98504 Sign.*-e Date Telephone ::i'''ii 05/27/2015 (360)902-1769 IEXPIRES 04/03/2017 1 FEMA Form 086-0-33(Revised 7/12) See reverse side for continuation. Replaces all previous editions. V • ELEVATION CERTIFICATE,page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding information from Section A. w a s X r - 1'SE;„ Building Street Address(including Apt.,Unit,Suite,an Bldg.No.)or P.O. Route and Box No. °�-� N. �91'� 5692 Upper Hoh Road 4 Y �o x - City State ZIP Code e.,r. t d -� )"� G Forks(Unincorporated Jefferson County) WA 98504 �� h� � �{ � � �� jl�tT If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View” and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8.If submitting more photographs than will fit on this page,use the Continuation Page. 1 '€ `..y ,.:h ° +sue z a t w g tr ' 'Y x• ' -..., -1,,,,i•` f a 4A a P h r a'"4 e " ; cc Iv� g k 1*j � � y « lir ? g y� A �, P 7 �' ) 1 r "pp,a [ by —S-'- N`h.JUkca xi WI t.n FEMA Form 086-0-33(Revised 7/12) Replaces all previous editions. P. • rogressi ve (Engineering inc. May 26,2015 Mr. Robert Walker CXT Incorporated, Precast Products Division 3808 North Sullivan Road, Building 7 Spokane,WA 99216 SUBJECT: CXT Model Gunnison G-5739 (built from G-5599) Dear Mr. Walker, At your request,we have reviewed the ability of the above referenced building to resist the buoyancy loads imposed by floodwaters. Our review indicates the building will not become buoyant at any water level. The referenced building is constructed of flood damage resistant, reinforced,5000 psi concrete. Flood ventilation is provided 7.5"above finished floor,in excess of 1" per square foot in order to limit the buoyant depth of flood waters to less than 1 foot. Our conclusions were based upon the following parameters: 1. Building weight=44,1541bs. 2. Buoyant force 30,423 ths., Evaluations conducted for this review were based upon CXT drawings and assume that the floodwater is flowing slow enough it does no impart a significantlateral load on the building or surrounding terrain. The weightoflthe displaced water'.is less than the weight of the unit therefore no anti-buoyancy devices will bill required forthis unit if located in a flood zone. This building will not sustain major damage from air over pressurization during a flood. The below floor area for this particular building is a sewage vault containment space. The automatic exit of fluids from this space is undesirable. If flood waters were to enter the vault, the building should be serviced and the fluids inside the vault pumped out as normal. The vault walls are designed to withstand the hydrostatic forces applied to them. If there are any comments or questions,please do not hesitate to call or email. 05/27/2015 '(0 *of CS) • 01Z•"--- ro • 1.E ' Evor F Johns E President Y� f Progres a Engineering, Inc. 0 u �FOts P�� '`�` ejohns @p-e-i.com ` JONAL.0" 58640 State Road 15 - Goshen,IN 46528 Phone:574-533-0337 - Fax.574-533-9736 www.p-a-i.com z U.S.DEPARTMENT OF HOMELAND SECURITY Instructions for Completing OMB No. 1660.0008 FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program the Elevation Certificate Expiration Date:July 31, 2015 The Elevation Certificate is to be completed by a land surveyor,engineer,or architect who is authorized by law to certify elevation information when elevation information is required for Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/Al—A30, AR/AH, or AR/AO. Community officials who are authorized by law or ordinance to provide floodplain management information may also complete this form. For Zones AO and A (without BFE), a community official, a property owner, or an owner's representative may provide information on this certificate, unless the elevations are intended for use in supporting a request for a LOMA or LOMR-F. Certified elevations must be included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F. The property owner, the owner's representative, or local official who is authorized by law to administer the community floodplain ordinance can complete Section A and Section B.The partially completed form can then be given to the land surveyor, engineer, or architect to complete Section C.The land surveyor, engineer, or architect should verify the information provided by the property owner or owner's representative to ensure that this certificate is complete. In Puerto Rico only, elevations for building information and flood hazard information may be entered in meters. SECTION A—PROPERTY INFORMATION Items Al—A4. This section identifies the building, its location, and its owner. Enter the name(s) of the building owner(s), the building's complete street address, and the lot and block numbers. If the building's address is different from the owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location description based on distance and direction from a fixed point of reference. For the purposes of this certificate, "building" means both a building and a manufactured (mobile) home. A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or detailed community map is appropriate.If no map is available,provide a sketch of the property location,and the location of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water. For building use, indicate whether the building is residential, non-residential, an addition to an existing residential or non-residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of the appropriate section if needed, or attach additional comments. Item AS.Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees (e.g., 39.5043°, -110.7585°) or degrees, minutes, seconds (e.g., 39° 30' 15.5", -110° 45' 30.7") format. If decimal degrees are used, provide coordinates to at least 4 decimal places or better. When using degrees, minutes, seconds, provide seconds to at least 1 decimal place or better.The latitude and longitude coordinates must be accurate within 66 feet. When the latitude and longitude are provided by a surveyor,check the"Yes"box in Section D and indicate the method used to determine the latitude and longitude in the Comments area of Section D. If the Elevation Certificate is being certified by other than a licensed surveyor, engineer, or architect,this information is not required.Provide the type of datum used to obtain the latitude and longitude.FEMA prefers the use of NAD 1983. Item A6.If the Elevation Certificate is being used to obtain flood insurance through the NFIP, the certifier must provide at least 2 photographs showing the front and rear of the building taken within 90 days from the date of certification.The photographs must be taken with views confirming the building description and diagram number provided in Section A.To the extent possible,these photographs should show the entire building including foundation. If the building has split-level or multi-level areas, provide at least 2 additional photographs showing side views of the building. In addition, when applicable, provide a photograph of the foundation showing a representative example of the flood openings or vents. All photographs must be in color and measure at least 3" x 3". Digital photographs are acceptable. Item A7.Select the diagram on pages 7-9 that best represents the building.Then enter the diagram number and use the diagram to identify and determine the appropriate elevations requested in Items C2.a—h. If you are unsure of the correct diagram, select the diagram that most closely resembles the building being certified. Item A8.a Provide the square footage of the crawlspace or enclosure(s) below the lowest elevated floor of an elevated building with or without permanent flood openings.Take the measurement from the outside of the crawlspace or enclosure(s).Examples of elevated buildings constructed with crawlspace and enclosure(s) are shown in Diagrams 6-9 on pages 8-9.Diagram 2, 4, or 9 should be used for a building constructed with a crawlspace floor that is below the exterior grade on all sides. NFIP Elevation Certificate Instructions—Page 1 •111 • • Item B6.FIRM Index Date. Enter the effective date or the map revised date shown on the FIRM Index. Item B7.FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be determined by calling 1-800-358-9616. Item B8. Flood Zone(s). Enter the flood zone, or flood zones, in which the building is located. All flood zones containing the letter "A' or "V" are considered Special Flood Hazard Areas. The flood zones are A, AE, Al—A30, V, VE, VI—V30, AH, AO, AR, AR/A,AR/AE,AR/Al—A30,AR/AH, and AR/AO. Each flood zone is defined in the legend of the FIRM panel on which it appears. Item B9.Base Flood Elevation(s).Using the appropriate Flood Insurance Study (FIS) Profile,Floodway Data Table,or FIRM panel, locate the property and enter the BFE (or base flood depth)of the building site.If the building is located in more than I flood zone in Item B8, list all appropriate BFEs in Item B9.BFEs are shown on a FIRM or FIS Profile for Zones Al—A30,AE,AH,Vl—V30,VE, AR,AR/A,AR/AE,AR/Al—A3 0,AR/AH,and AR/AO:flood depth numbers are shown for Zone AO.Use the AR BFE if the building is located in any of Zones AR/A, AR/AE, AR/A1 A30, AR/AH, or AR/AO. In A or V zones where BFEs are not provided on the FIRM, BFEs may be available from another source. For example, the community may have established BFEs or obtained BFE data from other sources for the building site.For subdivisions and other developments of more than 50 lots or 5 acres, establishment of BFEs is required by the community's floodplain management ordinance. If a BFE is obtained from another source, enter the BFE in Item B9.In an A Zone where BFEs are not available, complete Section E and enter N/A for Section B,Item B9.Enter the BFE to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico). Item B10.Indicate the source of the BFE that you entered in Item B9.If the BFE is from a source other than FIS Profile,FIRM, or community, describe the source of the BFE. Item Bll. Indicate the elevation datum to which the elevations on the applicable FIRM are referenced as shown on the map legend.The vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM. Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CARS) area or Otherwise Protected Area (OPA). (OPAs are portions of coastal harriers that are owned by Federal, State, or local governments or by certain non- profit organizations and used primarily for natural resources protection.) Federal flood insurance is prohibited in designated CBRS areas or OPAs for buildings or manufactured (mobile) homes built or substantially improved after the date of the CBRS or OPA designation. For the first CBRS designations, that date is October 1, 1983. Information about CBRS areas and OPAs may be obtained on the FEMA web site at http://www.fema.gov/business/nfrp/cbrs/cbrs.shnn. SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Complete Section C if the building is located in any of Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A,AR/AE,AR/A1—A30, AR/AH, or AR/AO, or if this certificate is being used to support a request for a LOMA or LOMR-F.If the building is located in Zone AO or Zone A (without BFE), complete Section E instead.To ensure that all required elevations are obtained, it maybe necessary to enter the building (for instance,if the building has a basement or sunken living room,split-level construction, or machinery and equipment). Surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If access to the crawlspace is limited or cannot be gained, follow one of these procedures. • Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the "next higher floor," and then subtract the crawlspace height from the elevation of the "next higher floor." If there is no access to the crawlspace, use the exterior grade next to the structure to measure the height of the crawlspace to the "next higher floor." • Contact the local floodplain administrator of the community in which the building is located. The community may have documentation of the elevation of the crawlspace floor as part of the permit issued for the building. • If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor, try to verify this by looking inside the crawlspace through any openings or vents. In all 3 cases, provide the elevation in the Comments area of Section D on the back of the form and a brief description of how the elevation was obtained. NFIP Elevation Certificate Instructions—Page 3 IIP • or equipment. Indicate machinery/equipment type and its general location, e.g., on floor inside garage or on platform affixed to exterior wall, in the Comments area of Section D or Section G, as appropriate. If this item does not apply to the building, enter "N/A"for not applicable. Items C2.f—g Enter the elevation of the ground, sidewalk, or patio slab immediately next to the building. For Zone AO,use the natural grade elevation, if available.This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F. Item C2.h Enter the lowest grade elevation at the deck support or stairs.For Zone AO,use the natural grade elevation,if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F. SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or architect who is authorized by law to certify elevation information.Place your license number, your seal (as allowed by the State licensing board),your signature, and the date in the box in Section D.You are certifying that the information on this certificate represents your best efforts to interpret the data available and that you understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of Section D, on the back of the certificate, to provide datum, elevation, openings, or other relevant information not specified on the front. SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) Complete Section E if the building is located in Zone AO or Zone A (without BFE).Otherwise,complete Section C instead.Explain in the Section F Comments area if the measurement provided under Items El—E4 is based on the "natural grade." Items E1.a and b Enter in Item El.a the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). Enter in Item El.b the height to the nearest tenth of afoot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as indicated in the applicable diagram) above or below the lowest adjacent grade (LAG). For buildings in Zone AO, the community's floodplain management ordinance requires the lowest floor of the building be elevated above the highest adjacent grade at least as high as the depth number on the FIRM.Buildings in Zone A(without BFE)may qualify for a lower insurance rate if an engineered BFE is developed at the site. Item E2. For Building Diagrams 6-9 with permanent flood openings (see pages 8-9), enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the next higher floor or elevated floor (as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). Item E3.Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest adjacent grade next to the building, for the top of attached garage slab. (Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the diagrams.) If this item does not apply to the building,enter"N/A"for not applicable. Item E4.Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico),in relation to the highest adjacent grade next to the building, of the platform elevation that supports the machinery and/or equipment servicing the building. Indicate machinery/equipment type in the Comments area of Section F. If this item does not apply to the building,enter "N/A"for not applicable. Item ES.For those communities where this base flood depth is not available,the community will need to determine whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance. SECTION F—PROPERTY OWNER (OR OWNER'S REPRESENTATIVE)CERTIFICATION Complete as indicated.This section is provided for certification of measurements taken by a property owner or property owner's representative when responding to Sections A,B, and E.The address entered in this section must be the actual mailing address of the property owner or property owner's representative who provided the information on the certificate. NFIP Elevation Certificate Instructions—Page 5 • Building Diagrams The following diagrams illustrate various types of buildings. Compare the features of the building being certified with the features shown in the diagrams and select the diagram most applicable.Enter the diagram number in Item A7, the square footage of crawlspace or enclosure(s) and the area of flood openings in square inches in Items A8.a—c, the square footage of attached garage and the area of flood openings in square inches in Items A9.a—c, and the elevations in Items C2.a—h. In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor elevation is taken at the bottom of the lowest horizontal structural member (see drawing in instructions for Section C). DIAGRAM 1A DIAGRAM 1B All slab-on-grade single-and multiple-floor buildings All raised-slab-on-grade or slab-on-stem-wall-with-fill (other than spilt-level) and high-rise buildings,either single-and multiple-floor buildings(other than split- detached or row type(e.g.,townhouses);with or level), either detached or row type(e.g.,townhouses); without attached garage. with or without attached garage. Distinguishing Feature-The bottom floor is at or above ground Distinguishing Feature-The bottom floor is at or above ground level(grade)on at least 1 side.* level(grade)on at least 1 side.* C2.b C2.b 4/1) F _..NEXT HIGHER. .. .. . t r NEXT HIGHER FLOOR FLOOR 1 GRADE BOTTOM FLOOR BOTTOM FLOOR GRADE _ y w r e j v "�� x'-, � s. �n , ai a C �7+ :.n ° �' x�-S can'".°. °�' : a».. t�. y�e° WI mar., 'dt � Y�� g�h."`V'r�.+✓ '*> �, ra =4 3 y r ri x. '11 -hyg a Iar%74,C*A mt",WX∎ Xti5-A1 ,4` Y"C2.f h } t ti ffi t i s r g 3e 1 f i DIAGRAM 2 All single-and multiple-floor buildings with basement (other than split-level)and high-rise buildings with basement,either detached or row type(e.g., townhouses);with or without attached garage. Distinguishing Feature-The bottom floor(basement or underground garage)is below ground level(grade)on all sides.* ® N # # { C2.b NEXT HIGHER FLOOR GRADE -- BOTTOM FLOOR BASEMENT 'VAAV 5.. rtve • y v+S C2.f—h d *A floor that is below ground level (grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office, garage,workshop,etc. NFIP Elevation Certificate Instructions—Page 7 • 111 111, DIAGRAM 7 DIAGRAM 8 All buildings elevated on full-story foundation walls with All buildings elevated on a crawlspace with the floor of the a partially or fully enclosed area below the elevated floor. crawlspace at or above grade on at least 1 side,with or This includes walkout levels,where at least 1 side is at without an attached garage. or above grade.The principal use of this building is located In the elevated floors of the building. Distinguishing Feature—For all zones,the area below the Distinguishing Feature—For all zones,the area below the first elevated floor is enclosed,either partially or fully.In A Zones,the floor is enclosed by solid or partial perimeter walls.In all A zones, partially or fully enclosed area below the elevated floor is with or the crawlspace is with or without openings** present in the walls without openings**present in the walls of the enclosure.Indicate of the crawlspace. Indicate information about crawlspace size information about enclosure size and openings In Section A— and openings in Section A—Property Information. Property Information. • * I I.. 410 f t.. s f C2.b CB C2.b NEXT HIGHER FLOOR GRADE NEXT HIGHER A co FLOOR A GRADE C2 g 0 WALKOUT LEVEL C2.g (ENCLOSURE) � r m I + EL; •r• .,eb 1. ; ,i gqr a ' " i ..1 'i yR - ;iv,as "� *"t y„• :a 1-j"/-'77471'17.7g 3'amay— a? •+F r.''.`4"--1.-' AS.b-c °� -,> � � c �;fie cr�i`�. a*"�� A8.b—c A8.b—c= OPENINGS” OPENING" OPENINGS"" DIAGRAM 9 All buildings(other than split-level)elevated on a sub-grade crawlspace,with or without attached garage. Distinguishing Feature—The bottom(crawlspace)floor is below ground level(grade)on all sides.*(If the distance from the crawlspace floor to the top of the next higher floor is more than 5 feet,or the crawlspace floor is more than 2 feet below the grade [LAG]on all sides,use Diagram 2.) CD; I C2.b NEXT HIGHER GRADE FLOOR ® C2 g s ?. Y OPENINGS" *A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office, garage,workshop,etc. **An"opening" is a permanent opening that allows for the free passage of water automatically in both directions without human intervention. Under the NFIP, a minimum of 2 openings is required for enclosures or crawlspaces.The openings shall provide a total net area of not less than 1 square inch for every square foot of area enclosed,excluding any bars, louvers,or other covers of the opening.Alternatively,an Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service(ICC ES)must be submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls.A window,a door,or a garage door is not considered an opening;openings may be installed in doors.Openings shall be on at least 2 sides of the enclosed area.If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter.The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or Interior grade or floor immediately below the opening.For more guidance on openings,see NFIP Technical Bulletin 1. NFIP Elevation Certificate Instructions-Page 9 • • • Jim Coyne From: Steffen, Eric(DNR) <Eric.Steffen @dnr.wa.gov> Sent: Wednesday, May 27, 2015 4:17 PM To: Jim Coyne Subject: Willoughby Creek and Upper Clearwater CXT Installs Attachments: f_053_elevicertif_30nov12_fillable-signed.pdf; G-5599 Flood Certification 5-26-15 (WA).pdf Hi Jim, This took much longer than anticipated, but hopefully this information is what you need to close out the permit for the CXT Vault Toilet installation at Willoughby Creek Campground(BLD14-00151). I'm also hoping the Upper Clearwater Campground CXT Vault toilet(BLD14-00152)can be closed out now as well.These permits expire on June 11th and I'm really anxious to get them done and signed off well before then.Sorry again for how long it took to get this info and please let me know if you need anything else from me. Thanks, Eric Eric Steffen NRS1 Recreation and Maintenance Steward, Olympic Region Washington State Department of Natural Resources (DNR) 360-374-2865 (office) 360-640-3266 (cell) eric.steffen©dnr.wa.gov www.dnr.wa.gov 0\9( C9-5C 1 Op Front Parcel Review is 131-D ( l- 00/S/ Parcel 712253000 Printed: May 5, 2014 STATE OF WASHINGTON-DNR Site Address(es): PO BOX 47014 , WA OLYMPIA, WA 985047014 • Parcel Number: 712253000 S-T-R: 25-27N-12W Total Acreage Legal Description S25 T27 R12W BALANCE OF SECTION SUBJ/EASE Land Use: 9720 Flood District: Fire District: 0 Planning Area: 12 Flood Map(FIRM) Panel No: School District 402 Zoning: (lag- ( • 7+ COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ ] Plot plan states "property line" [ ] Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ ] Legal Access to Property YES NO [ ] Parcel Tags or Scanned Documents YES NO [ ] ESA's: Special Reports Nearby YES NO [ ] Designated Ag YES NO C�Y►� �?i1 r " [ ] Shoreline Designation: YES c cdt - 27C2--. s . 1 f 41 '1 IV/ [ ] Shoreline Slo•e Stability: YES NO Stream Type NO F S - rltev.` k- Zoo P r., 5t►K-a (2� `t- D- FWHCA: 40 NO S •• g1_, d i./ .;.� �J 0,-14- &Li_ Wetlands: YES tic el4fitw( IV la-N.A/ Rare Plants:YES IV Seismic: YES Landslide: YES Flood: dgill"g Erosion: YES Aquifer Rech. •e Area:YES g WV K SIPZ: no•• At Risk High Risk Coastal CMZ: on- High Risk Moderate RiskDisconnected CMZ Stormwa - site . : - submitted: YesNo [ ] Forest Lands: NO Adjoining Forest Lands: Commercial/ Rural/ Inholding [ ] Mineral Lands: YES idOIP [ ] Agricultural Lands: YES • [ ] Archaeology: YES ® c [ ] No Shooting Zone: YES �, [ ] Stormwater: N- I-- urface 1-7 w Land Disturbing Activity 36- I Z 3 ESA's Stormwater 'eq'•:Min Res # Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ ] Notice Provisto iisc osure: i Dort YES 'o MRL YES �. Forest Land. NO [ ] Landscaping Required: Ye lP [ ] Parking Spaces Ref ' •OP 2 Other I 1 Building Height: UBC Standard [ ] Impervious Surface coverage�rcentage: Resource'Lands&Public: 10% Rural Residential: 25% Rural Indust er UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural lndustrta Lands only [ ] Total Building (s) Size: RVC:20,000 SF CC: 5,000 SF NC:7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified [ ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ ] Road Classification: Road Approach: EXISTING Q'D RAP [ ] SEPA Required: YES [ ] Flood Certificate: i.,, / ;, �i 11.•i 'm.. I [ ] Existing Case(s) &Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO [ ] UGA No Protest Agreement YES NO, s.bmitted: YES NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES 0 [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES No parcel tags found for parcel Cases Associated with APN 712253000 Cases Name Review Type Status Planner BLD14-00151 STATE OF WASHINGTON-DNR I P Application Received: 4/30/2014 Permit Issued/Case closed: Case Finaled: INSTALL VAULT TOILE I Al WILLOUGHBY CREEK CAMPGROUND PRE10-00010 HOH RIVER TRUST M Application Received: 3/9/2010 Permit Issued/Case closed: 4/6/2010 Case Finaled: REPAIR OF THE WILLOUGHBY-CREEK BRIDGE AND ADJACENT S IREAM PROTECTION. SEP14-00048 STATE OF WASHINGTON-DNR P Application Received: 4/30/2014 Permit Issued/Case closed: Case Finaled: Willoughby Creek Campgin ICI \\tidemark\data\forms\R_Parcel_CRMLA.rpt 5/5/2014 Page 2 of 2 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Ma Logand 0 Selected Features Township Lines ,. e 11 , ti:� : x n/ JC_Roada ` L- Parcoisil 2011 Aerial Photos • . 1 FOR INFORMATIONAL PURP• S ONLY- efferson County does not attes the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data co ned in this map is limited by the method and accuracy of its collection. Mon May 05 10:58:42 2014 area cS64\—, "2-j C--(204-■ http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 • Vault Toilet In allation DNR Willoughby Creek Campground Existing structures: Two small wooden outhouses with 250 gallon vaults were removed in 2009. The vaults were pumped,the building materials removed to an off-site location and the vaults were collapsed and then filled with native soil. The area has since returned to natural vegetation. Proposed structure: The new toilet is the Gunnison model manufactured by CXT precast products. CXT manufactures both the vault and the building. The footprint of the new vault toilet is 8.5 feet by 14.5 feet measured at the eaves. The vault has a 1000 gallon capacity, or approximately 15,000 uses. No onsite sewage treatment is planned for this site. Structure Siting: Willoughby Creek Campground is located on state trust lands managed by the DNR. The Jefferson County parcel number is 712253000. The structure will be located 203' from the ordinary ` high water mark on the Hoh River,as shown on the enclosed site plan. Maintenance/Operation Plan: The new CXT vault toilet will be pumped at least once per year,or as needed upon inspection, by a licensed septic pumper. The vault will be inspected at least once per month during the winter and spring months and at least twice per month during the summer and fall months. These inspections will be performed and pumping coordinated by the designated DNR staff person,currently Eric Steffen. o�� • • N a p u «mw W rc2m W dWOCu o /i E°o°E O / t 4 a. ma ea m W m 11tH' a�S wa CJ •N V c...,:, -u Y.^ n�w�� W = ` O F CO 0 1- W $ '8 o .44:4—= . o e H � Lb C o � = a ion Q z ∎ J — 3 x 4 w „a. w ;'-1;,1!u I p aa wgH E �_ e„ti / �aLL°o u ° E w«e�E 2.E E w P1` ..:°-'2,,°. ii,-%'' i I/I // 1f // // // // N M f// 1 ■ -- -- -'ii- 1 ■ m o L() N a m w J J ti • IUILDING PERMIT APPLICATION BLD14-00151 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00151 Received Date: 5/ 014 i SITE ADDRESS: l OWNER: STATE OF WASHINGTON-DNR PHONE: 360-374-2800 PO BOX 47014 OLYMPIA WA 98504-7014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 712253000 Section: 25 Township: 27 N Range: 12 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOD INSTALL VAULT TOILET AT WILLOUGHBY CREEK CAMPGROUND TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 17,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYE ES: WATER SYSTEM: BATHROOMS: Exist: Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 MEB 05/01/14 Plan Check $0.00 MEB 05/01/14 State Building Code $0.00 MEB 05/01/14 Total: $0.00 1116inmerNrinM14nrmn\C QI P1 Ann MIA rni A/111(11A • ���g0N 0 s JEFFERSON COUNTY; ,4-N w DEPARTMENT OF COMMUNITY DEVELOPMENT - .NGSG÷ 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communit develo meet Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd�aco ief a us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): Vault toilet replacement at Willoughby Creek Campground Tax Parcel Number. 712253000 Property Size: 5,57 Acres (acres/square uare f e et)Site Address and/or Directions to Property: rty: Turn East on Upper Hoh Road from US 101 at milepost 179, then travel 3.5 miles to site on right. Property Owner(s)of Record: Washin.ton De rt.of Natural Resources Telephone:360-374-2800 Fax 360-374-5446 Mailing Address: 411 Tillicum Lane,Forks,WA 98331 email: eric.steffen @dnr.wa.gov Applicant/Agent(if different from owner): Telephone: Mailing Address: Fax: email: What kind of Permit?(Check each box that applies BBuilding ❑Lot or Road Segregation ❑ Demolition Permit ❑Critical Areas Stewardship Plan 0 Variance❑Single Family 0 Garage Attached/Detached ❑Conditional Use,[C(aj), C(d)oa C]Reasonable Econ� ig �� ❑ Manufactured Home ❑ Modular 8 Commercial*/� fo. ❑Discretionary"D"or Unnam d Us( cet I �■ ❑ Change of Use w ❑Special Use(Essential Publ Fiabtli ) ❑ Address ❑Boundary Line Adjustment --__ Road Approach ❑Short Plat** ,,s �' ❑ ❑Home Business ❑Cottage Industry ❑Propane 0 Binding Site Plan*• I �i ❑Sign ❑Long Plat 1 1 ❑Allowed"Yes"Use Consistency Analysis ❑Planned Rural Residential De ' q� ** ❑Allowed Management ❑Plat Vacation/Alteration** �9p nt(PR ** ❑Site Plan Approval Advance Determination SPAAD * jcF'tER$O� is ❑Shoreline Master Program Exe ptio 1!t ',..;t,to 1- �, iELOPME ❑Temporary Use ( ) 0 Management Substa ❑Wireless Telecommunication* El Shoreline Management Variance "rent*' ❑Forest Practices Telecommunication of Six-Year Moratorium ❑Comprehensive Plan/UDC/Land Use District Map Amendment *May require a Pre-Application Conference ❑Tree Vegetation County Shoreline a Master Program Amendment ❑Tree Vegetation Request Please identify any other local,state or federal permits required for this proposal,if known: I hereby designate DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). 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 owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required la -r i spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli,■on than• o r e wants prior notice. Signature: /',,/I . (� Date: /l - 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 lake"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 action(s)even if yo are in 'm'liance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe -le le resp.`.'lity for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ;/ Date:—_q_-__ _L______________ s 07/24/2013 • • , BUILDER STATEMENT The signer of this st teme I do-s hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu the4-s•. sibility of the General Contractor for the proposed project. G� e'' mil-iy lh Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ' New 5 Wood Existing: U ❑ Sewer C Addition 2 Steel Proposed: / Bank 7 Community System 0 Alteration/Remodel i2"-Concrete Total: / Height: ❑ Individual System o Repair 0 Masonry"Demolition ❑ Other: Bedrooms: Waters Supply: Existing:Existing: 0 Setback: ❑ Private well ❑ Two Part y Type of Heat: Proposed: P 203' 0 Public N/A Precast concrete building Total: 0 203 Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: 3 Proposed: 4 Number of ADA Parking Spaces:I Number of occupants(includes owners,tenants,employees,e tc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Y- No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert . reht0 I evotS telleP I knaT retaWtoH I 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. �.� .$`y`",p k'1. ,'„,..1,-, .o- .:r ��," -44 -: 'yam .,-.1:�, `. ,k.,,„ ri, � «rr"..5.e r�y.'N*'t^ ,% S•uare Foota'e Current Proposed i t1 Y ® F � �.. em ,4"1," ." : p t Main Floor Heated Lt.?.-3iIk.-- ,-,V3t. EH Bld App Review: 21°Floor Heated hrt} e al r c:".--\ t �, Consistency Review: 1111 Other Heated 5 Base fee: ,/ � — \\ Mezzanine } 4` � Additional Section: ,� Heated Basement & Plan Check fee: �7C j Unheated Basement � ` L 3 w State Surcharge fee: , -i ,,,VppMF-- 1 4 i rlD ; Other Unheated At a Pot Water Review fee: Garage/Carport r tVe SUBTOTAL Decks , „f,st 911/Rd Approach fee �� _., Other ' . ,- TOTAL: $ ir , r Receipt Number: 11 i=' ;'''.,0% Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish $17000 Initials: 07/24/2013 • tor qae, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 4,111141—1.:1. 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet '/' W,llovh� 1Gt'r. MLA# PROJECT/APPLICANT NAME: VAU['7' '}Di I c'j' iii Skjn1) Ot"' C,r1P.JnrG DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. • -- PARCEL SIZE Q.E..SITEI Size of parcel L ' '7 acres An acre contains 43,580 square feet. Multiply the acreage by this figure. Size of parcel in square feet 2`IZ621 sq/ft Land-disturbing activity is any activity that results in movement of earth,or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include sped - Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,eld r •• and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION.AND VOLUME OF CUT/FILL 1 ` Calculate the total area to be cleared,graded,filled, Answer the following two questions related td excavated,and/or compacted for proposed development conversion of native vegetation: project Include in this calculation the area to be cleared for. �JU /� Does the project convert%acres of moq�;ofi ToiS pi ;F1.�- Construction site for structures '1 sq/ft native vegetation to lawn or landscaped react 1. J Drainfield,septic tank,etc. sq/ft Circle: Yes dzy Well,utilities,etc. sq/ft Does the project convert 2' acres or more of native vegetation to pasture? Driveway,parking,roads,etc. sq/ft Circle: Yes CO Lawn,landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 675- sq/ft Cut 20 cGhr l Fill sct.i/ C) (cu/yd) [over) stormwater talc worksheet—REV.2/2012008 1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios,driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW Z EXISTING Structures(all roof area) 113 sg/ft Structures(all roof area) 0 sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking,roads,etc sq/ft Driveway,parking,roads,etc sq/ft Qther sq/ft Other sq/ft Total New JZ3 sq/ft. Total Existing 0 sq/ft TOTAL NEW+TOTAL EXISTING* /23 sq/Yt "This amount will be used to the • a o • , •'0 The following questions will help determine whether the proposed project is considered / •J lopment. DEVELOPMENT V.REDEVELOPMENT =i Divide the total existing impervious surface above by the size of the parcel and coot tth,= percents.-• WA Nye MO Does the site have 35%or more of existing impervious surface? Circle: ; Z e .,`,,a FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no,the proposal is considered new development and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention-an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices(BMPs) Packet. Proponents of"medium"projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stonnwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation 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 aff ed roperty. C-04 1Y (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) etotmweter celc worksheet—REV.2/2012008 2 • • �iit) DEPARTMENT OF COMMUNITDEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368, 360/379-4450 . 800/831-2678 • 360/379-4451 Fax '-'„, nOTh�N1 STORMWATER CALCULATION SHEET Pursuant to Unified Development Code (UDC) section 6.7, all new development and redevelopment must conform to the standards and minimum requirements set by the Washington Department of Ecology Stormwater Management Manual for the Puget Sound Basin (SMM). For specific information regarding the stormwater minimum requirements refer to UDC section 6.7. Generally, the minimum requirements and thresholds for developing specific plans are as follows: • Small Parcel Erosion and Sediment Control Plan [see UDC section 6.7.3(b)] — Generally, this is required for all development that: (1) creates or adds less than 5,000 square feet of impervious area [individual detached single-family residences, accessory dwelling units, or duplexes creating or adding less than 3,000 sq/ft of impervious surface shall follow Best Management Practices (BMPs) but are not required to submit a plan]; (2) land-disturbing activities of 10,000 sq/ft or more but less than one acre. • Small Parcel Erosion and Sediment Control Plan and Permanent Stormwater Quality Control Plan [see UDC section 6.7.4(a)] Generally, this is required for all development that: (1) creates or adds less than 5,000 sq/ft of impervious surface that covers more than 50% of the site; and (2)the creation or addition of 5,000 or more sq/ft of impervious surface. • Large Parcel Erosion and Sediment Control Plan [see UDC section 6.7.4(b) — Generally, this is required for all development that includes: (1) land disturbing activities of one acre or more. If this is required you should contact a licensed engineer. Stormwater Disposal Policy Along Marine Shorelines Pursuant to UDC section 3.6.5(c)(3) all new development activity, including single-family residential construction, located on Marrowstone Island, Indian Island and within 500 feet of any marine shoreline is required to infiltrate stormwater runoff on-site, to the maximum extent practicable. This provision is intended to prevent seawater from intruding into underground aquifers, reduce non-point source pollution to marine waters, and reduce the potential for shoreline erosion due to tightline failure. This provision is interpreted as establishing a hierarchy in which the first and best alternative is on-site infiltration using drywells or other methods, the second best alternative is upland off-site disposal, and the least preferred alternative is direct discharge into marine waters through a stormwater tightline. In order to utilize the least preferred alternative (a stormwater tightline discharging directly into marine waters) applicants must demonstrate through a geotechnical or similar report prepared by a licensed professional that both on-site infiltration and upland off-site disposal are not practicable or feasible. The report must include cost figures for comparison. Please note that if a stormwater runoff tightline that terminates at or near the marine shoreline is allowed to be included in a development application, review under the Jefferson County Shoreline Master Program, the State Environmental Policy Act (SEPA) and other agency approvals (such as Hydraulic Project Approval from the Department of Fish and Wildlife) may be required. A Joint Aquatic Resources Permit Application (JARPA) form would need to accompany any permit application which includes a stormwater tightline at or below the ordinary high water mark. [over] 0 • Stormwater Calculations IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 123 sq/ft Structures(all roof area) sq/ft Driveway sq/ft Driveway sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft Other sq/ft Other sq/ft Total New 123 sq/ft Total Existing 0 sq/ft TOTAL NEW+TOTAL EXISTING* 123 sq/ft *This amount will be used to check total lot coverage Please also indicate the amount of land disturbing activity, in addition to the creation of impervious surface,that will take place: LAND DISTURBING ACTIVITY Drainfield area cleared 0 sq/ft Well, Structures, Utilities,etc. 95 sq/ft Driveway 0 sq/ft Other 0 sq/ft Total Land Disturbance 95 sq/ft A\ v , A`. Fc,<'601"}Ct's), Map Output IS Page 1 of 1 ArcIMS HTML Viewer Map rr ! - '-f--------- likrioi I .. 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Mon May 05 11:01:56 2014 ti f a http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output Page 1 of 1 ArcIMS HTML Viewer Map 1 420•441 1 -- --- j (- ` , rte Logand —J --- j t., ❑ Selected Feaases I'--- L — r,. �', ~ , .� r + .� r/ Township Lines i r 2W j I1 2]N�1W e 1— t ? ? ! r i Spotted s � ; j r 1 1..1..__ Iii 1 Yaps Rid M.+lersm Cory Cares Ss„es GIS 0INIIIIMI 1522f1 FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Mon May 05 11:02:27 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output Page 1 of 1 A IMS HTML V M— - 4_ __.. MI&Trri' Lagend a � f `f TorrrsNp Lines JC Roads Parcels-H wi Priority Habitats and Species --1 I I Maps prvn6+d by Jallarsma Caury Cerra&moss GS 0 IMOMMI111111■1 t522ft FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection. Mon May 05 11:03:00 2014 `-A6V 1 L 7 — — — http://gisserver/servlet/com.esri.esrimap.Esrimap.ServiceName—ovmap&ClientVersion-4.0&Form—True... 5/5/2014 Map Output Page 1 of 1 ArcIMS HTML Viewer Ma iiiipifr: 471:1„,,,, 1 *,,, ..', .1 J Legend , Selected Features a I r 1 Township Lint +;=..1 .! JC Reads parcels-H . ■ Wetlands 7— tit_ I I I Mso Prodded M Alamo Canty Coring Sanwa GtS 0■11116k. 111166. FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with II respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its ollection. Mon Ma 05 11:03:32 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output Page 1 of 1 • ArcIMS HTML V - Tv - Ma• i ' "IIIIIIIMil 1,17 4. Legend 0 Selected Features '� ' Township Lines *' 1,' .-. .0/4,/ JC_Roads i-1 Parcels44 FERIA FIRMS In I A L _ ■ Aa,1 11.1 XKO 11111 Mar 1 Yaps-try•kfosa Carry Cattrai Sw.xm(IS 0■••136411 FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its ollection. Mon Ma 05 11:03:59 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output • Page 1 of 2 ArcIMS HTML Viewer Map i 1 iiiiiii, I Bk it If 1, 1 �'H �:' , __T, 1_-i„- =�f z J M#e 00.0.1 by delbem Car.Iy Caring&races QS ■ http://gisserver/servlet/com.e sri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output . Page 2 of 2 Legend 0 Salactad Features Township Linos ./ JC_Roads I Psrcals41 County Zoning 1111R-SF Tnda Real RariYaial 1:8 Rural Rawkla dYi 1:10 Real RrirNrii 1:20 ■ 11111110t4ingls FarrOy ■ MPII.MuRtaniy MFRdtrort Campion Pules and Rvaalion . MN`•°psn Spud . Rand Fart • Conanadd Fond Inholding Parma • many Industrial ■ Airport SW ■ Mort-Nips Cantor ■ AP 1:20 ■ Rural Vise Cada • Rasaar Bud M ® ups lydashid • MPR4Rrrrtlan ■ Wars Mara OPP LNM ■ LK • Crosenadar2C • Crwoaads-CC ■ Cronaoads.MC ■ AL 1:20 • UOA.Urban Caanadal . „ UGAdLaan light industrial UGA.MCit UOA4iOR 11GA.Nwic UOA.LOit • UGA-walla Orisand Can need MPR.MN.Boon Itt Cpd6MRLOCannoedFaad- Miiaal RuaamOaaby FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Mon May 05 11:08:38 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 Map Output Page 1 of 1 • ArcIM HTML V - as - Ma. i NI.", 1 t -N,J ' . ,..., I `` lime i — 0 Selected Features 1 /4,1 JC_Roads { . Parcols41 8GP_8twnline Environmental Dasigrntlens EjAquatic jiiiii............ NuConraheasy ® Night ® Natural __—_ ` NA in Pauly Aquatic _,_1_r ® ahau isa I i i 1,iaarsoboil iay.latllsva Caly Con*Somas GIG 0 146111 FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its ollection. Mon Ma 05 11:09:02 2014 http://gisserver/servlet/com.e sri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/5/2014 • Jefferson County Building Division Permit Number: BLD14-00151 Applicant: STATE OF WASHINGTON-DNR BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next 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 Framing 5/12/2014 Miscellaneous SEE CONDITION 1 FLOOD ELEVATION CERTIFICATE REQ'D PRIOR TO FINAL INSPECTION lanning Approval A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD14-00151 1.) PRIOR TO FINAL BUILDING INSPECTION, PROPONENT SHALL PROVIDE THE (o• 11 —15 DEPARTMENT WITH AN ORIGINAL"FINISHED" CONSTRUCTION" FLOOD �I. �,�y ELEVATION CERTIFICATE THAT HAS BEEN VERIFIED BYA LAND SURVEYOR, £��a. b dt�` ENGINEER, OR ARCHITECT AUTHORIZED BY LAW TO CERTIFY ELEVATION '�' INFORMATION IN THE STATE OF WASHINGTON. THE FLOOD CERTIFICATE SHALL ort DEMONSTRATE THE FINISHED CONSTRUCTION COMPLIES WITH ALL ANCHORING AND FLOOD PROOFING REQUIREMENT FOUND IN CHAPTER 15.15 JEFFERSON COUNTY CODE. 2.) Nonresidential Construction. New construction and substantial improvement of any commercial, industrial or other nonresidential structure shall either have the lowest floor, including basement, elevated one foot or more above the base flood elevation; or, together with attendant utility and sanitary facilities, shall: (i) Be floodproofed so that below one foot or more above the base flood level the structure is watertight with walls substantially impermeable to the passage of water; (ii) Have structural components capable of resisting hydrostatic and hydrodynamic loads and effects of buoyancy; (iii) Be certified by a licensed land surveyor that the design and methods of construction are in accordance with accepted standards of practice for meeting provisions of this subsection based on their development and/or review of the structural design, specifications and plans. Such certifications shall be provided to the official as set forth in JCC 15.15.070(3)(c)(ii); (iv) Nonresidential structures that are elevated, not floodproofed, must meet the same standards for space below the lowest floor as described in subsection JCC 15.15.080(2) (a)(ii)of this section. 3.) All new construction and substantial improvements shall be anchored to prevent flotation, collapse, or lateral movement of the structure. new and replacement sanitary sewage systems shall be designed to minimize or eliminate infiltration of flood waters into the systems and discharges from the systems into flood waters; On-site waste disposal systems shall be located to avoid impairment to them or contamination from them during flooding. Construction Materials and Methods. (i)All new construction and substantial improvements shall be constructed with materials and utility equipment resistant to flood damage. (ii)All new construction and substantial improvements shall be constructed using methods and practices that minimize flood damage. (iii) Electrical, heating, ventilation, plumbing, and air-conditioning equipment and other service facilities shall be designed and/or otherwise elevated or located so as to prevent water from entering or accumulating within the components during conditions of flooding. Locating such equipment below the base flood elevation may cause annual flood insurance premiums to be increased. 4.) Flood hazard reduction measures are to be used as required by the Jefferson County Flood Damage Prevention Ordinance 07-0515-06 (Jefferson County Code Chapter 15.15). • • 5.) Fully enclosed areas below the lowest floor that are subject to flooding are prohibited unless designed to automatically equalize hydrostatic flood forces on exterior walls by allowing for the entry and exit of floodwater. Designs for meeting this requirement must either be certified by a registered professional engineer or architect or must meet or exceed the following criteria: a. A minimum of two openings having a total net area of not less than one square inch for every square foot of enclosed area subject to flooding shall be provided. b. The bottom of all openings shall be no higher than one foot above grade. c. Openings may be equipt with screens, louvers, or other coverings or devices provided that they permit the automatic entry and exit of floodwater. 6.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 7.) The project shall adhere to the Best Management Practices(BMPs)to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 8.) The site plan as submitted on April 30, 2014 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated May 5, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 9.) This approval is for a relocate vault toilet at Willoughby Campground only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 10.) zal \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 6/11/2014 4, • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 . PERMIT#: BLD14-00151 Received Date: 4/30/2014 SITE ADDRESS: Issue Date 6/11/2014 Expiration Date 6/11/2015 OWNER: STATE OF WASHINGTON-DNR PHONE: 360-374-2800 PO BOX 47014 OLYMPIA WA 98504-7014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 712253000 Section: 25 Township: 27 N Range: 12 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: INSTALL VAULT TOILET AT WILLOUGHBY CREEK CAMPGROUND TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 17,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DEC K: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $245.00 MEB 05/13/14 148669 Exist: Plan Check $159.25 MEB 05/13/14 148669 Prop: 1 State Building Code $4.50 MEB 05/13/14 148669 Total: 1 Total: $408.75 NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE ATTATCHED