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Home My WebLink AboutBLD2004-00710 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT UNIFIED DEVELOPMENT CODE TYPE I LAND USE PERMIT APPLICANT: EAGLE EYE INC BRUCE SETON 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 DATE ISSUED: January 14, 2005 DATE EXPIRES: January 14, 2006 MLA NUMBER: MLA04-00639 PROJECT PLANNER: M LINDBLAD PROJECT DESCRIPTION: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). PROJECT LOCATION: Parcel Number 001 285 002 Woodland Hills No. 1, Reserve #1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend, WA 98368 CONDITIONS: 1.) 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. 2.) A stormwater plan for a large project 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. 3.) Only clean earth fill will be shall be placed in the contained site. Clean earth fill shall not contain radioactive waste, extremely hazardous waste, by-products, construction or demolition debris including broken concrete or asphalt, tires or other rubber or plastic materials, garbage, rubbish, wood waste or other organic matter. No problem wastes from any cleanup action shall be deposited on the approved site. 4.) This site shall not exceed a total of 15,000 cubic yards of deposited materials. 5.) If contamination is observed during soil removal and/or placement, sampling of the potentially contaminated media must be conducted. Contact Department of Ecology Environmental Report Tracking System Coordinator at (360)407-6300 for more information. 6.) Erosion control measures must be in place prior to commencing the project. These control measures must be effective to prevent stormwater runoff from carrying soil and other polluntants ino surface water or storm drains that lead to waters of the state. Tracking of sediment by construction vehicles on to paved public roads must be minimum. If sediment is deposited, it should be cleaned every day by shoveling or sweeping. Water cleaning should only be done after the area has been shoveled or swept. 7.) properties adjacent to the site of land disturbance should be protected from sediment depoition through the use of buffers or other perimenter controls, such as filer fence or sediment basins. FINDINGS: 1.) The Administrator finds that this application complies with applicable provisions of the Unified Development Code, all other applicable ordinances and regulations, and is consistent with the Jefferson County Comprehensive Plan and Land Use map. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on November 12, 2004 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Special Aquifer Recharge Protection Areas and Susceptible Aquifer Recharge Areas. 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4) All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 6.) The applicant is proposing to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit tha is no longer utilized for extraction Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a stormwater plan meeting Minimum Requirements#1 through#10 of the Stormwater Management Manual for Western Washington. 7.) Reviewed under the State Environmental Policy Act (SEPA) by Jefferson County Department of Community DEvelpment Development Review Division acting as lead agency. Determination of Non-Significance (DNS) issued on January 14, 2005. 8.) This approval is for a Stormwater Managment Permit 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. 9.) This parcel has been designated as Neighborhood Crossroad (NC) under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 10.) This proposal entails over 500 cubic yards of material, this proposal is subject to the State Environmental Policy Act. The proposal was reviewed under the State Environmental Policy Act (SEPA) by Jefferson County acting as lead agency. Notice of Type I Land Use Application (MLA04-00639) and Preliminary Threshold Determination for a Determination of Non-Significance (DNS) utilizing the optional process (WAC 197-11-355) was published in the December 1, 2004 edition of the Jefferson County Port Townsend Leader. On November 30, 2004 notice sent to agencies, surrounding landowners and applicant/representative. The site was posted on December 2, 2004. There was a general comment letter received from the Department of Ecology dated December 9, 2004. The final threshold determination is incorporated into this decision. 11.) Appeals of the SEPA threshold determination of a DNS must be in writing, conform with the procedures for appeal set forth in Section 8.5.1(e) and be filed within fourteen calendar days after the Notice of Decision is issued. Section 8.5.1(e): A notice of appeal shall be delivered to the Administrator by mail or by personal delivery, and must be received by 4:00 p.m. on the last business day of the appeal period, with the required appeal fee of $622.00. The notice of appeal shall contain a concise statement identifying: i. The decision being appealed and the identification of the application which is the subject of the appeal; ii. The name, address, and phone number of the appellant and his/her interest in the matter. iii. Appellant's statement describing standing to appeal (i.e., how he or she is affected by or interested in the decision); iv. The specific reasons why the appellant believes the decision to be wrong. The appellant shall bear the burden of proving the decision was wrong; v. The desired outcome or changes to the decision; and • vi. A statement that the appellant has read the appeal and believes the contents to be true, signed by the appellant. Any notice of appeal not in full compliance with this Section shall not be considered. 12.) There is no Administrative Appeal process under the UDC for Type I permit as specified by Section 8.10(12) of the UDC. Appeal of a Type I permit requires a Judicial Appeal as specified by Section 8.5(2) of the UDC. 13.) The applicat shall beaware that building and/or septic permits may not be issued on areas where fill has been deposited, (unless structural fill (compacted)to specified standards or certified by an engineer). NOTICE: This permit does not excuse the proponent from complying with other local, state, and federal ordinances, regulations, or statutes applicable to the proposed development. Development pursuant to this permit shall be undertaken subject to the applicable development and performance standards of the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Speaes Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as"critical habitat"for a listed species. Development of property along any marine shoreline,freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -Set back buildings, utilities and roads as far as possible from surface waters (streams, rivers, lakes, marine waters), or at least 150 feet from the edge of the water -All development activities should avoid unstable slopes,wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual, group, or agency can bring suit fora listed species "taking," even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle at(206)526-6613, or the U.S. Fish and Wildlife Service at (503) 231-6121. APPEALS: Pursuant to RCW 36.70C, the applicant or any aggrieved party may appeal this final decision to Jefferson County Superior Court within twenty-one (21) calendar days of the date of issuance of this land use decision. For more information related to judical appeals see UDC Section 8.5.2. The Threshold Determination for this Type I Permit may not be appealed to the Hearing Examiner. For more information lated to SEPA appeals see UDC Section 8.10.12. UDC Administrator Allk JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT UNIFIED DEVELOPMENT CODE TYPE I LAND USE PERMIT APPLICANT: EAGLE EYE INC BRUCE SETON 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 DATE ISSUED: January 14,2005 DATE EXPIRES:January 14,2011 MLA NUMBER: MLA04-00639 PROJECT PLANNER: M LINDBLAD PROJECT DESCRIPTION: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). PROJECT LOCATION: Parcel Number 001 285 002 Woodland Hills No. 1, Reserve #1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend, WA 98368 CONDITIONS: 1.) 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. 2.) A stormwater plan for a large project 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. 3.) Only clean earth fill will be shall be placed in the contained site. Clean earth fill shall not contain radioactive waste, extremely hazardous waste, by-products, construction or demolition debris including broken concrete or asphalt, tires or other rubber or plastic materials, garbage, rubbish, wood waste or other organic matter. No problem wastes from any cleanup action shall be deposited on the approved site. 4.) This site shall not exceed a total of 15,000 cubic yards of deposited materials. 5.) If contamination is observed during soil removal and/or placement, sampling of the potentially contaminated media must be conducted. Contact Department of Ecology Environmental Report Tracking System Coordinator at (360)407-6300 for more information. 6.) Erosion control measures must be in place prior to commencing the project. These control measures must be effective to prevent stormwater runoff from carrying soil and other polluntants ino surface water or storm drains that lead to waters of the state. Tracking of sediment by construction vehicles on to paved public roads must be minimum. If sediment is deposited, it should be cleaned every day by shoveling or sweeping. Water cleaning should only be done after the area has been shoveled or swept. 7.) properties adjacent to the site of land disturbance should be protected from sediment depoition through the use of buffers or other perimenter controls, such as filer fence or sediment basins. FINDINGS: 1.) The Administrator finds that this application complies with applicable provisions of the Unified Development Code, all other applicable ordinances and regulations, and is consistent with the Jefferson County Comprehensive Plan and Land Use map. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on November 12, 2004 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Special Aquifer Recharge Protection Areas and Susceptible Aquifer Recharge Areas. 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 6.) The applicant is proposing to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit tha is no longer utilized for extraction Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a stormwater plan meeting Minimum Requirements#1 through#10 of the Stormwater Management Manual for Western Washington. 7.) Reviewed under the State Environmental Policy Act(SEPA) by Jefferson County Department of Community DEvelpment Development Review Division acting as lead agency. Determination of Non-Significance (DNS) issued on January 14, 2005. 8.) This approval is for a Stormwater Managment Permit 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. 9.) This parcel has been designated as Neighborhood Crossroad (NC) under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 10.) This proposal entails over 500 cubic yards of material, this proposal is subject to the State Environmental Policy Act. The proposal was reviewed under the State Environmental Policy Act (SEPA) by Jefferson County acting as lead agency. Notice of Type I Land Use Application (MLA04-00639)and Preliminary Threshold Determination for a Determination of Non-Significance (DNS) utilizing the optional process (WAC 197-11-355) was published in the December 1, 2004 edition of the Jefferson County Port Townsend Leader. On November 30, 2004 notice sent to agencies, surrounding landowners and applicant/representative. The site was posted on December 2, 2004. There was a general comment letter received from the Department of Ecology dated December 9, 2004. The final threshold determination is incorporated into this decision. 11.) Appeals of the SEPA threshold determination of a DNS must be in writing, conform with the procedures for appeal set forth in Section 8.5.1(e)and be filed within fourteen calendar days after the Notice of Decision is issued. Section 8.5.1(e): A notice of appeal shall be delivered to the Administrator by mail or by personal delivery, and must be received by 4:00 p.m. on the last business day of the appeal period, with the required appeal fee of $622.00. The notice of appeal shall contain a concise statement identifying: i. The decision being appealed and the identification of the application which is the subject of the appeal; ii. The name, address, and phone number of the appellant and his/her interest in the matter. iii. Appellant's statement describing standing to appeal (i.e., how he or she is affected by or interested in the decision); iv. The specific reasons why the appellant believes the decision to be wrong. The appellant shall bear the burden of proving the decision was wrong; v. The desired outcome or changes to the decision; and vi. A statement that the appellant has read the appeal and believes the contents to be true, signed by the appellant. Any notice of appeal not in full compliance with this Section shall not be considered. 12.) There is no Administrative Appeal process under the UDC for Type I permit as specified by Section 8.10(12) of the UDC. Appeal of a Type I permit requires a Judicial Appeal as specified by Section 8.5(2)of the UDC. 13.) The applicat shall beaware that building and/or septic permits may not be issued on areas where fill has been deposited, (unless structural fill (compacted)to specified standards or certified by an engineer). NOTICE: This permit does not excuse the proponent from complying with other local, state, and federal ordinances, regulations, or statutes applicable to the proposed development. Development pursuant to this permit shall be undertaken subject to the applicable development and performance standards of the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8,2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes"listed species(defined as causing harm, harassing,or damaging habitat for the listed species). In addition,the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as "critical habitat"for a listed species. Development of property along any marine shoreline,freshwater shoreline,or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline,freshwater shoreline,or floodplains are advised to do the following: - Set back buildings, utilities and roads as far as possible from surface waters(streams, rivers, lakes, marine waters),or at least 150 feet from the edge of the water -All development activities should avoid unstable slopes,wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual,group,or agency can bring suit for a listed species"taking,"even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle at(206)526-6613, or the U.S. Fish and Wildlife Service at(503)231-6121. APPEALS: Pursuant to RCW 36.70C,the applicant or any aggrieved party may appeal this final decision to Jefferson County Superior Court within twenty-one(21)calendar days of the date of issuance of this land use decision. For more information related to judical appeals see UDC Section 8.5.2. The Threshold Determination for this Type I Permit may not be appealed to the Hearing Examiner. For more information related to SEPA appeals see UDC Section 8.10.12. VIIM■ ._116 _ (2I2t) y-- Administrator FINAL MITIGATED DETERMINATION OF NON-SIGNIFICANCE 0/1 >1' AND LEAD AGENCY STATUS DATE: August 11, 1999 PROPONENT: Eagle Eye,Inc. PROPOSAL: The proposal is to subdivide approximately 302 acres into sixty (60) lots with an average lot size of 4.53 acres and a maximum lot size of 5.00 acres. The proponent will provide 30 acres in open space. The lots would be served by individual on-site septic systems and community drainfields and PUD water. The subdivision lots are proposed for residential use. LEGAL DESCRIPTION: Parcel#001272003, 001273001, 001281001,&001283004, within Section 27, Township 30 North,Range 1 West,WM. PROJECT LOCATION: The proposal is locate don the east side of SR19, just north of County International Airport,Port Townsend. MITIGATIVE MEASURES: 1. A Stormwater Site Plan which meets Minimum Requirements #1-11 of the Stormwater Manual shall be prepared and submitted to the Jefferson County Department of Public Works for review and approval prior to commencing land disturbing activity. 2. An agreement for the continued maintenance of the permanent stormwater management facilities shall be established either by recording a separate instrument and referencing said instrument on the plat or by establishment of an agreement by declaration on the plat. The applicant shall submit said instrument or agreement to the Department of Public Works for review and approval. 3. Prior to commencement of any land disturbing activities on the site, an erosion and sediment control plan shall be developed to the standards of the Washington State Department of Ecology Stormwater Management Manual (current edition) and be submitted to the Department of Public Works for review and approval. Approved temporary erosion and sedimentation control Best Management Practices shall be employed during land disturbing activities. An approved set of plans shall be on site during construction. 4. All Class II wetlands identified under the Wetland Determination Report prepared by Polaris Engineering& Surveying,Inc. shall have a minimum 50-foot wide buffer. 5. All Class III wetlands identified under the Wetland Determination Report prepared by Polaris Engineering& Surveying, Inc. shall have a minimum of a 25-foot wide buffer. 6. All buffers shall be measured perpendicularly from the wetland boundary as surveyed in the field. 7. Buffers shall remain naturally vegetated except where the vegetation has been disturbed, invaded by highly undesirable species (e.g., noxious weeds), or would substantially benefit from the increased diversity of introduced species. Where buffer disturbance has occurred during construction, replanting with native vegetation shall be required. Minor pruning of vegetation and removal of undesirable species (e.g., alders)may be permitted by the Administrator on a case by case basis. 8. A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation may consist of logs, a tree or hedge row, or other prominent physical marking approved by the Administrator. 9. Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall remain in place prior to and during approved construction activities. The signs shall contain the following statement: "Wetland & Buffer—Do Not Remove or Alter Existing Native Vegetation". 10. Building envelopes for proposed Lots 1, 10, 13, 18 & 19 and related improvements shall be graphically portrayed on the face of the final long plat. 11. The proposed rights-of-way for Open Space "C", `B" and Lot 1 shall be relocated outside of the designated wetland buffer areas. 12. A minimum 15 foot streamside buffer width shall be applied to each side of the stream. The buffer shall be graphically portrayed on the face of the final mylar. NOTE: The applicant may request for a reduction in buffer width based on criteria set forth in Subsections 10.508 & 10.510 of the Jefferson County Critical Areas Ordinance. 13. All buffers shall be measured perpendicularly from the ordinary high water mark, or the top of the bank where the ordinary high water mark cannot be identified. 14. Buffers shall remain naturally vegetated. Where buffer disturbance has occurred during construction,replanting with native vegetation shall be required. 15. Buffers shall be retained in their natural conditions, however, minor pruning of vegetation to enhance views may be permitted by the Administrator on a case by case basis. 16. 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 building or structure. Ground level lighting is encouraged. 17. Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. 18. Lots 18, 19, 20, 1, and Open Space Area "C" are adjacent to a forest Preserve. No public access to the reserve is allowed without specific permission from the Jefferson Land Trust. • 1 2 NOTICE OF LEAD AGENCY: Jefferson County has determined that it is the lead agency. NOTICE OF NON-SIGNIFICANCE: Jefferson County has determined that the above-described proposal, conducted in conformance with the mitigation measures, would not have a probable significant adverse impact on the environment, and an environmental impact statement is not required under RCW 43.21C.030(2)(c). This decision was made after review of a completed environmental checklist and other information on file with the Jefferson County Development Review Division and an inspection of the site, and consideration of comments submitted in response to the Mitigated Determination of Nonsignificance issued on March 4, 1998. COMMENT PERIOD: This final determination is issued pursuant to WAC 197-11-340(2)(f). Jefferson County has considered comments on its preliminary mitigation determination of nonsignificance. There is no additional comment period. Any appeal of this determination on the basis of noncompliance with the provisions of Chapter 43.21c RCW (State Environmental Policy Act) must be submitted in writing before 4:30 PM, Wednesday, August 21, 1999, to the Jefferson County Permit Center, 621 Sheridan Avenue,Port Townsend,WA 98368 for consideration by the Jefferson County Hearing Examiner. Al Scalf, SEPA Responsible Official Jefferson County Permit Center STATE ENVIRONMENTAL POLICY ACT .r ENVIRONMENTAL CHECKLIST CASE # Yh1-11-°4 —(2)637 The State Environmental Policy Act (SEPA), RCW43.21 C, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal; reduce or avoid impacts from the proposal, if it can be done; and help the agency decide whether an EIS is required. PROPONENT: 61 rf cL ADDRESS: 4$qO . o. DisCovU 'D. toom-Krilo J (NA- 61836g TELEPHONE: (home) (business) ( b()) ass o—tG 3 AUTHORIZED REPRESENTATIVE/CONTACT: SEAN (jmS' oki /b2ke2 SEMI.) ADDRESS: LJ LJQ Dlscov.e .9 'D. ener- vvIstiv-cQ wA- g83‘„8 TELEPHONE: (home) (business) (&) 385-0213 DIRECTIONS This checklist asks you to describe some basic information about your proposal. The questions apply to the entire proposal, including those phased over a period of time or on separate parcels of land. Answer each question accurately and completely to avoid unnecessary delays in processing this checklist. If you do not know an answer, write "unknown," or if a question does not apply, write "not applicable." Answers to some questions may require special expertise or technical assistance from qualified persons. The cost of obtaining such information is the responsibility of the proponent. Attach any additional information (reports, studies, maps, illustrations, leases, permits, etc.) that may further describe the proposal or be required by Jefferson County. Contact the Jefferson County Development Review Division for assistance in completing the checklist and for information on the administrative procedures for its processing. PLEASE PRINT IN INK OR TYPE EACH ANSWER. DO NOT WRITE IN THE AREA DESIGNATED "EVALUATION." PROPOSAL AND PROPERTY DESCRIPTION PROPOSED PROJECT DESCRIPTION (include all factors that will give an accurate understanding of its scope and purpose): RECIA EX15110 &/M L- Pr( wrra+ imPok7ED nna--rE-4 s Page 1 of 10 PROPERTY AND AREA DESCRIPTION: Address: Ailk Legal (from property tax statement): Lot: Block: l a � Subdivision: (,0061N-4119 }i(lL5 Tax Parcel: AKeeZ_. !4 Quarter Sections: _ 50/4 SS./4 Sic 2'•g Section:, a$ Township: 'O N Range: j.. WM Tax Number: 00/2,5500 Land Area (dimensions): .90 /ice• Describe the location, physical characteristics, and extent of land area to be affected: include all factors that will give an accurate understanding of the property and its environment: e-1.5 l IJ v 6Ritve7, P►r is Loci- ,4 -m-E m,o DL.E of d P Ce.L L. IRE 14-r i-r is Reim P1r Frig FIELD MMNal? PA-stu e USE. SCHEDULE (beginning and ending dates of the proposal, including phases): ee6I ►nl i ■lt. f?5 SaoNi AS tUg(13 0 A-vb be1A6 {h1o41 cA81. sus mor6wIfic. 15 11 1r.4B4 doe- NExr 1- a Yes. OVERALL PLAN (describe future additions, expansions, or related activities or plans by others that may affect the proposal): ritrUR6 ggfarc00110E CA) si BY Dwe,,- REQUIRED APPROVALS (all local, state, and federal approvals required for the completion's of this proposal and if any approvals are pending that are related to the proposal): PAIN S tbotrie. rniw Alf i -r e6,4&) ENVIRONMENTAL DATA (any existing or proposed environmental information such as studies or documents related to the proposal): Page 2 of 10 ENVIRONMENTAL COMMENTS • EARTH EVALUATION 1. Check the item that describes the site: ❑flat ❑rolling hilly ❑steep slopes ❑mountainous /other: PtT 2. What is the steepest slope on the site: Identify the approximate percent of the slope: I/570 (err swees ) 111RTld€ AgeAs f1,2E o -1-a 15 0 3. What general types of soils are found on the site (sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland: 4. Are there surface indications or a history of unstable soils in the immediate vicinity? If so, describe them: 1• 0 5. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Identify the source of the fill: o Pc �3w,� O ream ftm�- fn1 Cral 6. Could erosion occur as a result of clearing, construction, or use? If so,generallydescribe it: (Jo 4190 Ct4,'N v 1 lL Ai-0L5 A Cerrrrtw Eb /nl Eki TT 1J 6 Ir 149-&-A- 7. About what percent of the site would be covered with impervious surfaces after construction of the project (that is, asphalt or buildings)? NON E 8. Describe proposed measures to reduce or control erosion or other impacts to the earth, if any: Eis71i.1(& -r�G /nl PLRGE AIR EVALUATION 9. What types of emissions to the air, if any, would result from the proposal during construction and when the project is completed (dust, car odors, industrial wood smoke)? Generally describe and give approximate quantities, if known: JVoni e- 10. Are there any off-site sources of emissions or odors that may affect your proposal? If so, generally describe them: fq() Page 3 of 10 AIR (continued) EVALUATION 11. Describe proposed measures to reduce/grcontrol emissions or other impacts to the air, if any: N/!' WATER EVALUATION Surface Water 12. Is there any surface water body on or in the immediate vicinity of the site, including year-round or seasonal streams, salt waters, lakes, ponds, and wetlands? If yes, describe the type and provide names. If appropriate, state what stream or river it flows into: o�OsrnE prrew rows INra , FF clown! RPaer -I- PM -ri i (AM F� eurr4Ry OF 6611in f&etM agEeiS 13. Will the project require any work over, in, or adjacent to the described waters (within 200 feet)? If yes, describe the work and attach available plans: /\(Q 14. Estimate the amount of fill and dredge material that would be placed or removed from the surface waters or wetlands and indicate the area of the site that would be affected. Identify the source of the fill material: NO/J 15. Will the proposal require surface water withdrawals or diversions? Give a general description and/ identify the purpose and approximate quantities, if known: /4 0 16. Does the proposal lie within a )00-year flood plain? If so, note the location on the site plan: NO 17. Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge: N O Ground Water EVALUATION 18. Will ground water be withdrawn or will water be discharged to groundwater? Give a general description and identify the purpose and approximate quantities, if known: NO Page 4 of 10 Ground Water (continued) EVALUATION 19. Describe the waste material that would be discharged into the ground from septic tanks or other sources, if any (domestic sewage; industrial wastes and chemicals contained; agricultural wastes). Describe the general size of the system; the number of such systems; the number of houses to be served, if applicable, or the number of animals or humans the system(s) is expected to serve: NCAI C Water Run-Off EVALUATION (including storm water) 20. Describe the source of run-off, including storm water. Describe the method of collection and disposal, if any, including any known quantities. Where will this water flow? Will this water flow into other waters? If so, describe it: RunJ-Orr Fieam -w L (STflJ(, 19if AR41- Is coaeeo j i o,J-.5'rrr 5c-rrzfkn Tf 1 a.1 PIA cenl gzoc l� c im&i,Al6 DPL�°Ans) 21. Could waste materials enter ground or surface waters? If so, generally describe how: p 22. Describe proposed measures to reduce or control surface, ground, and run-off water impacts, if any: ekl5fl e.ottfen-,03 �)Q � ! f��e+� PLANTS EVALUATION 23. Check the types of vegetation found on the site; Deciduous tree: Alder (a'fnaple aspen ❑other: eOli21. &) fJD Evergreen tree: it Vcedar Opine ❑other: pGg j hrubs ,BGrass OPasture ❑Crop/Grain Wet Soil Plants: Ocattail ❑buttercup ❑bulrush ❑skunk cabbage Dother: Water Plants: Owater lily ❑eelgrass ❑milfoil Dother: Other: 24. What kind and amount of vegetation would be removed or altered? Ai me, 25. List threatened or endangered species known to be on or near the site: 26. Describe the proposed landscaping, use of nature plants, or other measures to preserve or enhance vegetation on the site, if any: 6aD '77) 68465 Page 5 of 10 ANIMALS EVALUATION . 27. Check any birds and animals that have been observed on or near the site or are known to be on or near the site: Birds: ❑hawk Oheron ❑eagle gongbirds ['other: Mammals: /deer ❑bear De lk Obeaver ❑other: Fish: Obass ❑salmon ❑trout ❑herring ❑shellfish Dother: 28. List any threatened or„engered species to be on or near the site: 29. Is the site part of a migratipn route? If so, how? 30. Describe proposed measures to preserve or enhance wildlife, if any: WOW eXPfM1U 4-1 t8?Tj4"r ENERGY AND NATURAL RESOURCES EVALUATION 31. What kinds of energy (electric, natural gas, oil, wood stove, solar) would be used to meet the completed project's energy needs? Describe whether it would b used for heating, manufacturing, etc.: tlo'JQ- 32. Would the project affect the potential use of solar egergy by adjacent properties? If so, generally describe the affect: 0 33. What kinds of energy conservation features are included in the plans of this proposal? List other propos pmeasures to reduce or control energy impacts, if any: NN //T� ENVIRONMENTAL HEALTH EVALUATION 34. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of This proposal? If so, describe the hazards: p 35. Describe special emergency sefyivcgsthat might be required: 36. Describe proposed measures to rq duce or control environmental health hazards, if any: N Tf Page 6 of 10 NOISE 37. What types of noise exist in the area that may affect your project (traffic, equipment, operation)? A ONE 38. What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (construction, traffic, operation)? Indicate what hours noise would cqme from this site: Cht-rgli -Tlok) &" tPm 39. Describe proposed measures to reduce or control noise impacts, if any: KEe-lA11 F-it b .) eftO - c r- LAND AND SHORELINE USE 40. What is the current use of the site and adjacent properties? Sf-re" - eA/tleP °II- ,11 at , I -- ....e.e - .!% l ; ! 41. Has the site been used for agriculture? If so, describe the use: lrmB - 42. Describe any structures or the site: 43. Will any structures be demolj,hgd? If so, what structures? 44. What is•the current comprehensive plan or community development plan designation of the site? Identify the plan: Mat Ltri- k .c/DP.,t7l R(- (JEV ZOP cr1o.rf- 45. If applicable, what is the current,5J oreline Master Program designation of the site? N!l Ff' 46. Has any part of the site been classified is an "environmentally sensitive" area? If so, specify the part: ( ) 47. Approximately how many pqople would reside or work in the completed project? N ne. 48. Approximately how many people would the completed project displace? F)Ong 49. Describe proposed measures tpiaxoid or reduce displacement impacts, if any: N �- Page 7 of 10 LAND AND SHORELINE USE (continued) EVALUATION 50. Describe proposed measures to ensure the proposal is compatible with existing and proje ted land uses and plans, if any: I t41l11 frf 0A.) HOUSING EVALUATION 51. Approximately how many units would be provided, if any? Indicate whether the housing is high, middle, or low income: AIanJC, 52. Approximately how many units, if any, would be eliminated? Indicate whether the housing is high, middle, or low income: JQAJE, 53. Describe proposed measures o reduce or control housing impacts, if any: N 1' AESTHETICS EVALUATION 54. What is the tallest height of any proposed structure(s), not including antennas? What is the principal exterior building material(s) proposed? 55. What views in the immediate vicinity would be altered or obstructed? Ncn e. 56. Describe proposed measures to reduce or control aesthetic impacts, if any: JQttY.A11Y1A'11 nk LIGHT AND GLARE EVALUATION 57. What type of light or glare would the proposal produce? What time of the day would it mainly occur? (JQnf Q - 58. Could light or glare from the finishe ,project be a safety hazard or interfere with views? n! !f 59. What existing off-site sources of light or glare may affect your proposal? 60. Describe proposed measures to . reduce or control light and glare impacts, if any: N RECREATION EVALUATION 61. What designate and informal recreational opportunities are in the immediate vicinity? ( 41 Page 8 of 10 RECREATION (continued) EVALUATION 62. Would the proposed project displace any exiting recreational uses? If so, describe the displacement: N tV 63. Describe the proposed measures to reduce or control impacts on recreation, including recreational opport pities to be provided by the project or proponent, if any: NAle., HISTORICAL AND CULTURAL PRESERVATION EVALUATION 64. Are there any places or objects listed on or proposed for national, state, or local preservation registers known to be on or next to the site? If so, generally describe them: N(✓ 65. Generally describe any landmarks or evidence of historic, cultural, archaeological, or scientific importance known to be on or next to the site: �I� 66. Describe proposed measures to reduce or control impacts, if any: Nie TRANSPORTATION EVALUATION 67. Identify public streets and highways serving the site and describe the proposed access to the existing street system. Show on the site plat. Kt , WvrotAn/p Dk)ie. ! C-orrugooDO CM K- 68. Is the site currently served by public transit? If no, what is the approximate distance to the np�r,@st transit stop? 69. How many parking spaces would theppcpleted project have? How many would the project eliminate? II 70. Will the proposal require any new roads, streets, or improvements to existing roads or streets, not including driveways? If so, generally describe them, indicating whether they are public or private: No 71. Will the project use water, rail, or air transportation, or occur in the immediate vicinity of these faci i ieess? If so, generally describe the use: fr Page 9 of 10 1 TRANSPORTATION (continued) EVALUATION 72. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur: 73. Describe proposed measures to reduce or control transportation impacts, if any: SErigt3 PUBLIC SERVICES EVALUATION 74. Would the project result in an increased need for public services (fire protection, police protection, health care, schools)? If so, generally describe the results: N (� 75. Describe proposed measures to Lice or control direct impacts on public services, if any: N UTILITIES EVALUATION 76. Check which utilities are currently available at the site: ,'water kiilectricity [Mature! gas ❑refuse service /telephone ❑septic system ❑sanitary sewer Dother: 77. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity that might be needed: ACKNOWLEDGMENT I acknowledge that all information provided in this checklist and all attached material is true and correct to the best of my knowledge. understand the lead agency is relying on this information to make its decision. In addition, I understand that review under SEPA does not constitute approval or a proposal; compliance with local, state, and federal regulations applicable to the proposal shall constitute approval. (Check with appropriate agencies to determine what approvals are required.) SEPA approval is based on the information I have provided. If found inaccurate, approval could be withdrawn. By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. � //22/r (authorized signature) (date) FEE _ RECEIPT# CHECK# INITIALS DATE h:1home1pincntrlinfopinglsepa.doc 01/00 Page 10 of 10 JEFFERSON COUNTY PUBLIC NOTICE OF TYPE I LAND USE APPLICATION AND PENDING SEPA DETERMINATION MLA04-00639 APPLICANT: EAGLE EYE INC Affidavit of Publication 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 STATE OF WASHINGTON) Application Received Date: November 12,2004 SS Application Complete Date: COUNTY OF JEFFERSON) November 19,2004 Application Notice Date: December 1,2004 SITE ADDRESS AND PROJECT I, Hali K. Johnson, Legal Publications Coordinator of the Port LOCATION:WOODLAND DR - Townsend & Jefferson County Leader, a weekly newspaper which has Parcel Number 001 285 002 Woodland tY Y Hills No. 1, Reserve #1, in Section 28, been established, published in the English language and circulated Township 30, Range 01 West, WM, Lo- cated on Hwy 19, Port Townsend, WA continuously as a weekly newspaper in the town of Port Townsend in 98368 PROJECT County and State, and general county PROJECT DESCRIPTION AND y , d for eneral circulation in said count for REQUIRED PERMITS/STUDIES: more than six (6) months prior to the date of first publication of the STORMWATER MANAGEMENT PER- MIT: to dispose up to 15,000 cubic Notice hereto attached and that the said Port Townsend & Jefferson yards of clean fill materials to an existing County Leader was on the 27th day of June 1941 approved as a legal gravel pit that is no longer utilized for ex- traction. In addition,this proposal will be newspaper by the Superior Court of said Jefferson County and subject to Sections 3,6.6 and 6.7 of the Jefferson County Unified Development annexed is a true copy of the Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the JEFFERSON COUNTY State Environmental Policy Act(SEPA). COMMENT PERIOD AND WHERE TO PUBLIC NOTICE OF TYPE I LAND USE VIEW DOCUMENTS: APPLICATION The application and any studies may be reviewed at the Jefferson County Depart- AND PENDING SEPA meM of Community Development. All in- terested persons are invited to (a)com- DETERMINATION ment on the application; (b) receive no- tice of and participate in any hearings; MLAO4-00639 and(c)receive a copy of the decision by APPLICANT: submitting such written comment(s)/ re- quest(s)to the Jefferson County Depart- EAGLE EYE INC ment of Community Development,Devel- opment Review Division, 621 Sheridan Street,Port Townsend,WA 98368,(360) 379-4450. Comments concerning this As it appeared in the regular and entire issue of said paper itself not in application should be submitted to the a supplement thereof for a period of 1 week, beginning on the 1st day Department by 4:30 p.m. on December 15,2004. If the last day of the comment of December, 2004, ending on the 1st day of December, 2004, that period falls on a weekend or holiday, then the comment period shall be ex- said newspaper was regularly distributed to their subscribers during all tended to the first working of this period. That the full amount of$ 75.87 has been paid in full, at day after the weekend or holiday. Com- ments submitted after this date may not the rate of$ 7.75 per column inch for each insertion. be considered in the staff report. SEPA INFORMATION: The optional DNS process of WAC 197- Subscribed and sworn to before me this )5 day*U . 2005. 11-355 is being used. This may be the only unity to comment on onmentalrimpacts of the p oposahe envi- ' \`\\\\ �... . JDy • The optional DNS process of WAC 197- ^`1\ (4r gel �i 11-355 is being used. This may be the Hali K. Jo • : }• NOTq , ` 2j• • r only opportunity to comment on the envi- ronmental impacts of the proposal. The Notary Public in and for the State of Washin on RejAat j senci Department expects to issue a DNS for - this proposal. If the proposal is ap- �T�; � VBL I G ` proved,policies and performance stand- .,O, ards found in the Unified Development i� �•or3.200� :'`-. Code and Jefferson County Comprehen- sive Plan will be used to form permit con- 0�//VAjs H; • ditions intended to mitigate adverse envi- ronmental impacts. Additional conditions or mitigation measures may be required under SEPA. Project Planner:M LINDBLAD, 360-379-4450 For further information, please visit the Jefferson County Department of Com- munity Development web page at www.cojefferson.wa.us/commdevelopmen1/ 2898 12/1 A, S O ` JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 9 4O 360/379-4450 • 360/379-4451 Fax –411 NO http://www.co.jefferson.wa.us/commdevelopment/ \ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 04—63 7 PROJECT/APPLICANT NAME: Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stomiwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. 1'4 'i�y x 711!= !!- Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. ."^ 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. v -./ jacm/s` 6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED t41 STORMWATER PLAN JA-N 1 4 2905 JEFFERSON COUNTY storrnwater site plan template—rev.10d/2003 Pt.OF CQM:NUNIT D tV# 5 SIGNATURE: t � –P j a r 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. 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.). d 34 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. 9. 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 f cilities from existing facilities. '-"47°// r ..C3f-CJ:` 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] tieo 11. Describe the performance goals and standards applicable to the project. 12. r. ,cribgge the flow control system.. WO f 4" stormwater sfe elete4 m —sv.tdlr000 :ry 6 • 13. Describe the water quality system. ? <� t 14. Describe the conveyance system analysis and design. d N j. Ipt 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 00.40 x404 . , 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. p 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the site. 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. Af03 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. stortmvater site plan template—rev.10/1/2003 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 section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. 2. Establish Construction Access. 3. Control How Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. a ,'-eel- S-4fl . 7. Protect Drain Inlets. stormwater site plan template—rev.10/1!2003 0 12 Required Elements—Construction SWPPP(continued) • 8. Stabilize Channels and Outlets. /„., .a F Ve.4 ip 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices (BMPs). ' } 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. tie Nf- stormwater site pan template—rev.10/1/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability, permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence M ce4,` of Ailiergervle- b. Construction phasing(if proposed) ,J>1/ 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. felie b. Proposed wet season construction activities for environmentally sensitive areas. A./ 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. d,?.) W° J g ' 7-0:1r..r ► r_7+ r .. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. CJ b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations storrnwaler site plan template—rev.10'12003 10 SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan, and/or a separate Construction SW PPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes, ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices (BMPs). Identity location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s), pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical'details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/1/2003 11 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. • APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. //- , ? -,4 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: storm-Mar site plan template—rev.10/12003 12 I Z ") O r' 2 � ° m _ n * 0 = 0 ;3 C) 00ZFZ _< I I o m DISCOVERY z Z Z = y )l ROAD o Om ! ! - % oN II II II = O Z � � / P 1 n � D E a 0 WILD CHERRY N) Z 00 � CZZm ROAD • Ail Z O � N › OCO zA °po��/ °fo • A rn m Dr ci ( "' N r /Y / _ m . Or- z�_. __, -- (/) Z -n M X \-1 :_i telt: __ :: . it„ VJ_•1 ono 2 . . l\) 2::'./2 ; <°r-r2 • d0 0 6 / ��Sv' \ DRIVE 1 � � 'o � ' X36 / �� d oa / - . 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N A \ rn ll l ♦ z y z J I ! 5 o DIMENSION / I I DIMENSION DIMENSION y o rN / '� �/ � DX / / a n6 aN $ I F rn z N z L z � o rna `a rnC\ z I 0rna rn erj I 1 11 xi 73 z z� I — _L — Ai— O ii •N 0 I � N o = 0 0 7n �. � — — 'Ne I \ DIMENSION IROPERTY LINE \ 2 (s) —\--- CENTERLINE VI EW STREET C' 70 x . -I 0 Design Firm z Project Name Designer Sheet Title Project Address if Applicable Address and Phone number of person preparing drawing t TAX PARCEL NUMBER sTarF, w,nu ; . ter 9d,889 e STATE OF WASHINGTON DEPARTMENT OF ECOLOGY PO Box 47775 • Olympia, Washington 98504-7775 • (360)407-6300 December 9, 2004 M. Lindblad ^\\ Your address Jefferson County Community Development IS Irl the Development Review Division S QL1 , ,� 621 Sheridan Street Port Townsend,WA 98368 r =—' watershed Dear M. Lindblad: Thank you for the opportunity to comment on the optional determination of nonsignificance/notice of application for the Gravel Pit Reclamation project(MLA04-00639) located on Highway 19 in Port Townsend as proposed by Eagle Eye,Inc. We reviewed the environmental checklist and have the following comments: TONICS CLEANUP: Chuck Cline(360)407-6267 If contamination is currently known or observed during construction or soil removal (placement), sampling of the potentially contaminated media must be conducted. If contamination of soil or groundwater is readily visible, or is revealed by sampling,the Department of Ecology must be notified. Contact the Environmental Report Tracking System Coordinator at the Southwest Regional Office at (360)407-6300. For assistance and information about subsequent cleanup and to identify the type of testing that will be required contact Mr. Chuck Cline at(360)407-6267. If contamination is identified, this issue maybe referred to your jurisdictional health department as a solid waste concern. WATER QUALITY: Betsy Dickes(360)407-6294 Any discharge of sediment-laden runoff or other pollutants to waters of the state is in violation of Chapter 90.48,Water Pollution Control, and WAC 173-201A,Water Quality Standards for Surface Waters of the State of Washington, and is subject to enforcement action. Waters of the state include but are not limited to water in roadside ditches. Coverage under the National Pollution Discharge Elimination system(NPDES)and State Waste Discharge General Permit for Stormwater Discharges Associated with Construction Activities is required for construction sites which disturb an area of five acres or more and which have or will have a discharge of stormwater to surface water or a storm sewer. During construction, all releases of oils, hydraulic fluids, fuels, other petroleum products, paints, solvents, and other deleterious materials must be contained and removed in a manner that will prevent their discharge to waters and soils of the state. The cleanup of spills should take precedence over other work on the site. Provision should be made to minimize the tracking of sediment by construction vehicles onto pad 0 2004 public roads. If sediment is deposited, it should be cleaned every day by shoveling or sweeping. Water cleaning should only be done after the area has been shoveled out or swept. 0 December 9,2004 Page 2 Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent stormwater runoff from carrying soil and other pollutants into surface water or storm drains that lead to waters of the state. Sand, silt,clay particles, and soil will damage aquatic habitat and are considered to be pollutants. Properties adjacent to the site of a land disturbance should be protected from sediment deposition through the use of buffers or other perimeter controls, such as filter fence or sediment basins. Source control best management practices such as plastic covering,mulch,temporary seeding, and phased clearing(for example) should be used to control erosion during construction. More examples of effective source control Best Management Practices can be found in Washington Department of Ecology's two stormwater management manuals,Stormwater Management Manual for Puget Sound(1992) and Stormwater Management Manual for Western Washington (2001). Soil in stockpiles should be stabilized or protected with sediment-trapping measures to prevent soil loss. All exposed areas of final grade or areas that are not scheduled for work,whether at final grade or otherwise, shall not remain exposed and un-worked for more than two days,between October 1 and April 30. Between May 1 and September 30,no soils shall remain exposed and un-worked for more than 7 days. If you have any questions or would like to respond to these comments please contact the appropriate reviewing staff listed above. Department of Ecology Southwest Regional Office (AW: 04-8230) cc: Betsy Dickes, WQ Eagle Eye,Inc. (Proponent) Bruce Seton, Seton Construction, Inc. (Representative) DEC 1 0 2004 GL/4CER so * r s- Y CLEAN SOIL ACCEPTANCE POLICY Glacier Northwest is permitted to accept"clean soil"for disposal at five sites. In order to avoid confusion about what can be accepted and try to protect Glacier Northwest and our customers from expensive cleanup or litigation in the future,we have developed a clean soil pre-screening policy. Clean soil is defined more by what it does not contain, than by what it does contain. Clean soil is earthen material that does not contain the following: ➢ The soil can not contain radioactive waste, extremely hazardous waste,by-products (all of which terms are specifically defined and regulated by federal, state and local environmental regulations). ➢ The soil can not contain any construction or demolition waste,broken concrete or asphalt,tires or other rubber or plastic materials, garbage,rubbish, wood waste or other organic matter. D The soil can not be from any cleanup action whether regulated by environmental laws or not ("problem wastes"). Soil meeting all of these characteristics is"Clean Soil". At the Glacier Northwest locations where Clean Soil is accepted by the cubic yard, it will be agreed that a truck and trailer will transport 22 cubic yards and a solo truck will transport 10 cubic yards. If you think your material qualifies as clean soil, you will be required to complete the following steps before Glacier Northwest can accept your material: 1. Complete and submit a questionnaire describing the soil, the project and any other relevant information. Glacier will require soil sampling to confirm the absence of contamination. You will be asked to have the soil sampled and tested at your expense. The soil sample results indicating the 'material is"clean soil"must be delivered to Glacier Northwest before the material will be approved. No deliveries of soil will be allowed until soil sample results have been received from the lab(s) by Glacier Northwest, reviewed and the soil has been approved by our Environmental Department. 2. Sign a Clean Soil Contract. All jobs bid prior to completing these steps are done so with the understanding that the"bid price and acceptance of clean soil is conditioned upon the environmental approval of the material and execution of the Glacier Northwest, Inc. Clean Soil Contract." Exhibit 1 to Contract for Acceptance of Clean Soils Clean Soil Questionnaire and Certification Form 1. General Information Owner of Soil: Name: Address: Contact: Telephone: Fax: Transporter of Soil: Name: Address: Contact: Telephone: Fax: Billing Address (if different than owner): Name: Address: Contact: Telephone: Fax: 2. Information about Site Attach a map of the immediate vicinity with the site and location of soil to be removed clearly identified. (A Thomas guide map and a hand drawn site diagram will satisfy this request). Exact Location of Site (Street/Nearest Cross Street, City): Business Currently Conducted on the Site and to the extent possible all information about former businesses on the site (please consult current owner/operator of the site to complete this question): Identify all hazardous substances and petroleum products produced, stored or used at the site (please consult current owner/operator of the site to complete this question): Questionnaire Page 1 of 2 Describe the surrounding area as completely as possible, especially identifying all businesses, industrial activity, chemical or petroleum storage and all general uses of the property. The more detailed the description, the better able Lone Star is to move to the next step of approval: 3. Information about Soil Fully explain the reason the soil is being excavated(for example, describe the project and why the soil will not be used as part of the project): Estimate the volume of clean soil to be disposed (yards/tons): Has there been any geotechnical work performed on the clean soil or soil in the immediate vicinity? If so, please provide a copy of the report. Have any soil or groundwater samples been taken on the clean soil or soil or groundwater in the immediate vicinity? If so, please provide a copy of the sample results and report (consult current owner/operator of the site to complete this question). Is there any other solid material in the soil (construction waste, asphalt, concrete, wood waste, garbage, rubbish, ashes, tires, plastic, rubber)? Describe: 4. Certification Your company certifies, represents and warrants that the information is complete and accurate to the best of its knowledge. Signature and Title of Company's Authorized Agent Date Return the completed questionnaire and signed certification to Elizabeth Gaddy, Lone Star Northwest, P.D. Box 1730, Seattle, WA 98111. Telephone: (206) 764-3072 Facsimile: (206) 764-3012. K:GcMalwPdc6aldeatm tar Questionnaire Page 2 of 2 Testing Procedures for the Acceptance of Clean Soil Sampling requirements are based upon the project site and history that is supplied by the contractor on the Clean Soil Questionnaire. Lone Star has established a standard testing table for the three most common types of projects. The two tests that are most commonly used are method NWTPH-Dx which tests for total petroleum hydrocarbons and diesel and Total Metals(RCRA 8)which tests for Arsenic,Barium,Cadmium, Chromium, Lead,Mercury, Selenium and Silver. Please find listed below a sample of the more common project sites and Lone Star's testing requirements. 1. Projects that involve roadway material(i.e.the shoulder off of the roadway or excavation of the actual roadway)are required to test for NWTPH-Dx and Total Metals. We not only require these particular tests,but also take a more conservative approach on the testing frequency. (See Table A). There is also a clause in the contract which stipulates that Lone Star will not accept any material which tests positive or contains roadway material(i.e.asphalt or concrete). 2. Projects that involve wooded,non-residential areas are only required to test material using method NWTPH-Dx. This type of area is considered virgin soil because there has been no construction or activity in the area surrounding the excavation. With these particular areas we are also a little bit more liberal on the testing frequency. (See Table B)We do not,however,accept any wood waste or other matter. This is also noted in the contract. 3. Projects that involve residential areas(i.e.housing,churches and schools)require the same testing as item number two listed above,but the testing frequency in slightly more conservative(See Table C). Testing Table A for Standard Roadway Project (Table based on 5,000 cubic yards) Number of samples required NWTPH-DX Total Metals 2 samples for the first 500 yards taken to Lone Star X X Northwest 1 sample taken and tested for every 500cy from 500 to 2,000 cubic yards taken to Lone Star X Northwest. 1 sample for every 750 cy from 2,000 cy to 5,000 taken to Lone X Star Northwest. Testing Table B for Standard Non-Residential Project (Table is based on 5,000 cubic yards) Number of samples required NWTPH-Dx Total Metals 3 samples for the first 1,000 cubic yards taken to Lone Star X Northwest. I sample for every 1,000 cubic yards from 1,000 to 5,000 taken X to Lone Star Northwest.. Testing Procedures Page 2 04/24/98 Testing Table C for Standard Residential Project (Table is based on 5,000 cubic yards) Number of samples required NWTPH-Dx Total Metals 2 samples for the first 500 cubic yards taken to Lone Star X Northwest. 1 sample for every 500 cubic yards from 500 to 2,000 cubic X yards take to Lone Star Northwest. 1 sample for every 1,000 cubic yards from 2,000 to 5,000 cubic X yards taken to Lone Star Northwest. If a customer would like to haul more material than his/her contracted amount,Lone Star will review the lab reports and re-evaluate the testing procedure. If the results are testing negative on a consistent basis and Lone Star is comfortable with the project site,we will issue an amendment to the contract. The amendment shall layout a new testing guideline,generally more liberal,and will increase the disposal amount requested by the contractor. • .gsoly � ,.� w o& JEFFERSON COUNTY n in DEPARTMENT OF COMMUNITY DEVELOPMENT i1 �1i� 1 a iiii ..1.:J j `� 621 Sheridan Street Port Townsend Washington 98368 1 360/379-4450 • 360/379-4451 Fax JEFFERSON COUNTY 1 o www.co.jefferson.wa.us/commdevelopment DEPT. OF COMMUNITY DEVELOPMENT Master Permit Application MLA: C 9-to Q Project Description (include separate sheets as necessary): -2//J'1 .., }l/-G /2z T Number:, '7©/ 2 `� O Z.-- Property 9 G Size: ' � (acres/square feet) Site Address and/or Directions to Property:-5.F, eat'; .../r;• " / f/9 �L /djGQ.4rl. « ,k00' Property Owner(s)of Record: ,L , /.r/c" ,� - a r." 7.r;(7--;',e,k: Telephone: ,j85 " 452 4j Fax: .8'56 – 6✓,0 I email: Mailing Address: 4` '"fir. .--• 1/2•r"4"‘•16"#' P6Ii 4' Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building LJ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d), or C]** ❑ Single Family D Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** LI Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** 13 Commercial* ❑ Binding Site Plan** D Change of Use ❑ Long Plat** ❑ Address Li Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments"* ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis El Shoreline Master Program Exemption/Permit Revisions*" ,Df Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment D Wireless Telecommunication* El Jefferson County Shoreline Master Program Amendment D Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **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 it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. ) 7 '. �Signature: Date: / //J 6/es/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"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe esponsibility for hen g to and complying with the ESA. The Applicant has read this disclaime and si s an/.dates it below. Signature: , ...1.--Z-4.-4-1.-- Date: I/ &364 (G:\PemlitCelter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc /// OWNER 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 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 ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: H Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank C Above ground Tank Size of Propane Tank: ❑ Heat Stove C Cook Stove L Woodstove r Fireplace Insert ❑ Hot Water Tank C Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2ND Floor Base fee: 3 d Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ /l 91 )Q Decks Receipt Number: 6 F6 Other Cash/Check Number: U 1� ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish / V Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc AFFIDAVIT OF POSTING PUBLIC NOTICE JEFFERSON COUNTY UNIFIED DEVELOPMENT CODE ORDINANCE #03-0702-01 State of Washington) County of Jefferson) ( Y1et-pew !3- Sir:-/ra^' , being duly sworn of oath say that I have posted one (1) public notice poster on or near the site identified in the following development description: PROPOSAL: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). These two notices were posted in full compliance with UNIFIED DEVELOPMENT CODE on: the 2 day of ,' i; 2004. (Signature of person posting notice) Subscribed and sworn to before me on this v, day of 11GCf ,t; , 2004. Acknowledgement: ( !!! Notary Public i : for the State of Washington, otaR ;' residing in .50)IM Washington. S r7 u - • - N My commission expires: 0'I 1/ 0.4Q-7 Nom% '01, . x 7/ 9�'"0-1-0 i-fl�-' i9_ /!/!!t!aF1WASN\ NOTARY STAMP MLA Number: MLA04-00639 Proponent(s): EAGLE EYE INC I:\F_MLT_NtcApp14_APO_U.rpt M ° " rti DEC - 3 2004 JEFFERSON COIMY PkRMIT CENTER CASE NO. ,L-11-O — to 'q n� CERTIFICATION OF MAILING I make the following certification: I am competent to testify and make this certification based upon personal knowledge. On this day of AA L 2004,I deposited into the U.S.Mail with first class postage affixed,true and correct copies of .)tt L e L.) -(1 A-c P f t c O L in the above matter,addressed to: 1 f➢ Adjacent Property Owners: See attached list. [3 Agencies: See attached list. 0 Interested Parties: See attached list. a Applicant/Representative-Posting Packet: I set of laminating sheets with Notices,Posting Instruction,Affidavit,and a copy of Notice. e-v_ ` , C j (z © Newspapers �" " fl I/U Official Posting Places(x3) -0 Other: I declare under penalty of perjury under the laws of the State of Washington that the foregoing certification is true and correct. EXECUTED this day of-De e Ceu.4-(P"2004 at Port Townsend, Washington. - h:lhomelpinentrlpinclerk lfonnt\rnailcert.doc 4/7/2004 JEFFERSON COUNTY PUBLIC NOTICE OF TYPE I LAND USE APPLICATION AND PENDING SEPA DETERMINATION M LA04-00639 APPLICANT: EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 Application Received Date: November 12, 2004 Application Complete Date: November 19, 2004 Application Notice Date: December 1, 2004 SITE ADDRESS AND PROJECT LOCATION: WOODLAND DR Parcel Number 001 285 002 Woodland Hills No. 1, Reserve #1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend, WA 98368 PROJECT DESCRIPTION AND REQUIRED PERMITS/STUDIES: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act(SEPA). COMMENT PERIOD AND WHERE TO VIEW DOCUMENTS: The application and any studies may be reviewed at the Jefferson County Department of Community Development. All interested persons are invited to (a) comment on the application; (b) receive notice of and participate in any hearings; and (c) receive a copy of the decision by submitting such written comment(s)/request(s) to the Jefferson County Department of Community Development, Development Review Division, 621 Sheridan Street, Port Townsend, WA 98368, (360) 379-4450. Comments concerning this application should be submitted to the Department by 4:30 p.m. on December 15, 2004. If the last day of the comment period falls on a weekend or holiday, then the comment period shall be extended to the first working day after the weekend or holiday. Comments submitted after this date may not be considered in the staff report. SEPA INFORMATION AND PRELIMINARY DETERMINATION: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The proposal may include mitigation measures under applicable development regulations, and the project review process may incorporate or require mitigation measures regardless of whether an EIS is prepared. A copy of the subsequent threshold (final) determination may be obtained upon request, and will be mailed to any person commenting upon the notice of application. The SEPA Official has determined that: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The Department expects to issue a DNS for this proposal. If the proposal is approved, policies and performance standards found in the Unified Development Code and Jefferson County Comprehensive Plan will be used to form permit conditions intended to mitigate adverse environmental impacts. Additional conditions or mitigation measures may be required under SEPA. This will be the only opportunity to make comments related to SEPA. There will not be another comment period after the threshold (final) SEPA determination is made. In addition, since this is a Type I permit application, the threshold determination cannot be appealed except to Superior Court. PUBLIC HEARING INFORMATION: This is a Type I Permit Application and there will be no public hearings. The final permit decision for this Type I permit application will be made by the Administrator. The decision cannot be appealed except to Superior Court. APPEALS: Appeals of SEPA decisions are described above in the SEPA Information and Preliminary Determination section. Project Planner: M LINDBLAD,360-379-4450 For further information, please visit the Jefferson County Department of Community Development web page at www.co.jefferson.wa.us/commdevelopment/ Please publish one time. PUBLISH DATE: December 1, 2004 BILL: Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 JEFFERSON COUNTY PUBLIC NOTICE OF TYPE I LAND USE APPLICATION AND PENDING SEPA DETERMINATION MLA04-00639 APPLICANT: EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 Application Received Date: November 12, 2004 Application Complete Date: November 19, 2004 Application Notice Date: December 1, 2004 SITE ADDRESS AND PROJECT LOCATION: WOODLAND DR Parcel Number 001 285 002 Woodland Hills No. 1, Reserve #1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend, WA 98368 PROJECT DESCRIPTION AND REQUIRED PERMITS/STUDIES: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). COMMENT PERIOD AND WHERE TO VIEW DOCUMENTS: The application and any studies may be reviewed at the Jefferson County Department of Community Development. All interested persons are invited to (a) comment on the application; (b) receive notice of and participate in any hearings; and (c) receive a copy of the decision by submitting such written comment(s)/request(s)to the Jefferson County Department of Community Development, Development Review Division, 621 Sheridan Street, Port Townsend, WA 98368, (360) 379-4450. Comments concerning this application should be submitted to the Department by 4:30 p.m. on December 15, 2004. If the last day of the comment period falls on a weekend or holiday, then the comment period shall be extended to the first working day after the weekend or holiday. Comments submitted after this date may not be considered in the staff report. SEPA INFORMATION: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The Department expects to issue a DNS for this proposal. If the proposal is approved, policies and performance standards found in the Unified Development Code and Jefferson County Comprehensive Plan will be used to form permit conditions intended to mitigate adverse environmental impacts. Additional conditions or mitigation measures may be required under SEPA. Project Planner: M LINDBLAD, 360-379-4450 For further information, please visit the Jefferson County Department of Community Development web page at www.co.iefferson.wa.us/commdevelopment/ • Please publish one time. PUBLISH DATE: December 1,2004 BILL: Jefferson County Department of Community Development 621 Sheridan Street,Port Townsend,WA 98368 JEFFERSON COUNTY PUBLIC NOTICE OF TYPE I LAND USE APPLICATION AND PENDING SEPA DETERMINATION MLA04-00639 APPLICANT: EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 Application Received Date:November 12,2004 Application Complete Date:November 19,2004 Application Notice Date:December 1,2004 SITE ADDRESS AND PROJECT LOCATION:WOODLAND DR Parcel Number 001 285 002 Woodland Hills No.1,Reserve#1,in Section 28,Township 30,Range 01 West,WM,Located on Hwy 19, Port Townsend,WA 98368 PROJECT DESCRIPTION AND REQUIRED PERMITS/STUDIES: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition,this proposal will be subject to Sections 3,6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act(SEPA). COMMENT PERIOD AND WHERE TO VIEW DOCUMENTS: The application and any studies may be reviewed at the Jefferson County Department of Community Development. All interested persons are invited to(a)comment on the application;(b)receive notice of and participate in any hearings;and(c)receive a copy of the decision by submitting such written comment(s)/request(s)to the Jefferson County Department of Community Development, Development Review Division,621 Sheridan Street,Port Townsend,WA 98368, (360)379-4450. Comments concerning this application should be submitted to the Department by 4:30 p.m.on December 15,2004. If the last day of the comment period falls on a weekend or holiday,then the comment period shall be extended to the first working day after the weekend or holiday. Comments submitted after this date may not be considered in the staff report. SEPA INFORMATION: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal.The Department expects to issue a DNS for this proposal. If the proposal is approved,policies and performance standards found in the Unified Development Code and Jefferson County Comprehensive Plan will be used to form permit conditions intended to mitigate adverse environmental impacts. Additional conditions or mitigation measures may be required under SEPA. Project Planner:M LINDBLAD,360-379-4450 For further information,please visit the Jefferson County Department of Community Development web page at www.co.jefferson.wa.us/commdevelopment/ Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360) 379-4450 POSTING INSTRUCTIONS Please post the attached notice on a 2-foot by 3-foot board provided by this department in a conspicuous location visible to vehicle traffic and pedestrians on or reasonably near the proposed development by December 1, 2004. The clear adhesive paper can be put over the notice after you mount it to protect it from the elements. Additional notice boards may be required where the site does not abut a public road, for a large site that abuts more than one (1) public road, or the Administrator determines that additional notice boards are necessary to provide adequate public notice. Notice boards shall be maintained in good and legible condition by the applicant during the notice period, be in place at least fifteen (15) calendar days prior to the date of the hearing, and be removed within fifteen (15) calendar days after the end of the notice period. Complete the affidavit, have it notarized, and return it to this office within three (3) days of posting. If the affidavit is not filed as required, any scheduled hearing or date by which the public may comment on the application will be postponed in order to allow compliance with this notice requirement. If you have any questions, please contact this office at (360) 379-4450. MLA number: MLA04-00639 Proponent(s): EAGLE EYE INC AFFIDAVIT OF POSTING PUBLIC NOTICE JEFFERSON COUNTY UNIFIED DEVELOPMENT CODE ORDINANCE#03-0702-01 State of Washington) County of Jefferson) I, , being duly sworn of oath say that I have posted one (1) public notice poster on or near the site identified in the following development description: PROPOSAL: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). These two notices were posted in full compliance with UNIFIED DEVELOPMENT CODE on: the day of , 2004. (Signature of person posting notice) Subscribed and sworn to before me on this day of , 2004. Acknowledgement: Notary Public in and for the State of Washington, residing in , Washington. My commission expires: NOTARY STAMP MLA Number: MLA04-00639 Proponent(s): EAGLE EYE INC I:1F_M LT_NtcApp 14_APO_U.rpt • JEFFERSON COUNTY PUBLIC NOTICE OF TYPE I LAND USE APPLICATION AND PENDING SEPA DETERMINATION MLA04-00639 APPLICANT: EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 Application Received Date: November 12, 2004 Application Complete Date: November 19, 2004 Application Notice Date: December 1 , 2004 SITE ADDRESS AND PROJECT LOCATION: WOODLAND DR Parcel Number 001 285 002 Woodland Hills No. 1, Reserve #1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend, WA 98368 PROJECT DESCRIPTION AND REQUIRED PERMITS/STUDIES: STORMWATER MANAGEMENT PERMIT: to dispose up to 15,000 cubic yards of clean fill materials to an existing gravel pit that is no longer utilized for extraction. In addition, this proposal will be subject to Sections 3, 6.6 and 6.7 of the Jefferson County Unified Development Code and will be required to obtain a Stormwater Management Permit. This project is subject to review under the State Environmental Policy Act (SEPA). COMMENT PERIOD AND WHERE TO VIEW DOCUMENTS: The application and any studies may be reviewed at the Jefferson County Department of Community Development. All interested persons are invited to (a) comment on the application; (b) receive notice of and participate in any hearings; and (c) receive a copy of the decision by submitting such written comment(s)/request(s) to the Jefferson County Department of Community Development, Development Review Division, 621 Sheridan Street, Port Townsend, WA 98368, (360) 379-4450. Comments concerning this application should be submitted to the Department by 4:30 p.m. on December 15, 2004. If the last day of the comment period falls on a weekend or holiday, then the comment period shall be extended to the first working day after the weekend or holiday. Comments submitted after this date may not be considered in the staff report. SEPA INFORMATION AND PRELIMINARY DETERMINATION: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The proposal may include mitigation measures under applicable development regulations, and the project review process may incorporate or require mitigation measures regardless of whether an EIS is prepared. A copy of the subsequent threshold (final) determination may be obtained upon request, and will be mailed to any person commenting upon the notice of application. The SEPA Official has determined that: The optional DNS process of WAC 197-11-355 is being used. This may be the only opportunity to comment on the environmental impacts of the proposal. The Department expects to issue a DNS for this proposal. If the proposal is approved, policies and performance standards found in the Unified Development Code and Jefferson County Comprehensive Plan will be used to form permit conditions intended to mitigate adverse environmental impacts. Additional conditions or mitigation measures may be required under SEPA. This will be the only opportunity to make comments related to SEPA. There will not be another comment period after the threshold (final) SEPA determination is made. In addition, since this is a Type I permit application, the threshold determination cannot be appealed except to Superior Court. PUBLIC HEARING INFORMATION: This is a Type I Permit Application and there will be no public hearings. APPEALS: Appeals of SEPA decisions are described above in the SEPA Information and Preliminary Determination section. The final permit decision for this Type I permit application will be made by the Administrator. The decision cannot be appealed except to Superior Court. Project Planner: M LINDBLAD, 360-379-4450 For further information, please visit the Jefferson County Department of Community Development web page at www.co.Iefferson.wa.us/commdevelopment/ A- Ce9 t cAk.-COI L449 BLD04-00710 r BLD04-00710 EAGLE EYE INC,.•°�r h.S r J' JCFPD#6 BRUCE SET-014 I4 ) 11A1-1 3850 CAPE GEORGE RD 4640 S:DISCOVERY RD PORT TOWNSEND,WA 98368 PORT TOWNSEND, WA 98368 BLD04-00710 BLD04-00710 PORT TOWNSEND SD#50 CITY OF PT-BLD/COMM DEV 450 FIR STREET JEFF RANDALL PORT TOWNSEND,WA 98368 181 QUINCY ST-STE#301 PORT TOWNSEND, WA 98368 BLD04-00710 BLD04-00710 JEFFERSON CO HEALTH DEPT JEFFERSON CO PUBLIC WORKS RANDY MARX JIM PEARSON BLD04-00710 BLD04-00710 JEFFERSON CO ASSESSOR JEFFERSON TRANSIT SHERRIE S/JODI C 1615 W. SIMS WAY PORT TOWNSEND, WA 98368 BLD04-00710 BLD04-00710 PORT OF PORT TOWNSEND WSD OF TRANSPORTATION OLYMPIC REG PO BOX 1180 DALE SEVERSON PORT TOWNSEND,WA 98368 PO BOX 47440 OLYMPIA,WA 98504-7440 BLD04-00710 BLD04-00710 WA STATE DNR SEPA REVIEW WDFW SEPA REVIEW EXTERNAL PROJECTS 1111 WASHINGTON ST. SE. PO BOX 47015 OLYMPIA,WA 98504-3135 OLYMPIA,WA 98504-7015 BLD04-00710 BLD04-00710 WDFW SEPA REVIEW EAST JEFF CO DOE SEPA REVIEW AREA HABITAT BIOLOGIST PO BOX 47703 502 HIGH ST. #108 OLYMPIA,WA 98504-7703 PORT ORCHARD, WA 98366 BLD04-00710 BLD04-00710 JAMESTOWN S'KLALLAM TRIBE PORT GAMBLE S'KLALLAM TRIBE 1033 OLD BLYN HWY 31974 LITTLE BOSTON RD SEQUIM,WA 98382 KINGSTON, WA 98346 BLD04-00710 PENINSULA DAILY NEWS LURIE BOGUES 1939 E SIMS WAY 5�Z PORT TOWNSEND,WA 98368 b X Pa 0-4" �� 999900122 1285004 FARRELL D BIBB LAURENCE H SOMERS 1002 CASS ST CAROL A SOMERS PORT TOWNSEND, WA 98368 15 STATION PRAIRIE RD PORT TOWNSEND, WA 983689564 1285002 EAGLE EYE INC 4890 S DISCOVERY RD PORT TOWNSEND, WA 983689022 999900121 MARK D FISHEL MARGO L FISHEL 453 PROSPECT AVE PORT TOWNSEND, WA 983689580 1275008 ROGER A HARDING BETTY C HARDING 284 WOODLAND DR PORT TOWNSEND, WA 983689559 991300002 JOSEPH J KAARE ELAINE D KAARE 63 COTTONWOOD CT PORT TOWNSEND, WA 983689563 1335001 ROBERT A LINGENBRINK LINDA L LINGENBRINK 4590 NW NEWBERRY HILL RD SILVERDALE, WA 983839208 1284006 PORT OF PORT TOWNSEND PO BOX 1180 PORT TOWNSEND, WA 983680980 SEPA REVIEW FORM APPLICATION� 11 '',, APPEAL SUBMITTED FILE NUMBER: 1 `i 6�1 0 APPEAL TO THE BOARD APPLICANT: DATE OF APPEAL: REPRESENTATIVE: n (' - NOTICE PUBLISHED: e-A_D `e- (,�e 4 Isrb(,t € S of NOTICE MAILED: NAME OF PROJECT: 4 TYRCTSTON RFCFTVV'n• PLANNER: IAA L,,1,461i---• 10 VI ( �laLe ('�/� I APPLICATION RECEIVED: �� :AMINER APPLICATION COMPLETE DATE: Lt A'u'k NOTIFICATION LETTER MAILED: r APPLICATION NOT COMPLETE: VY`� � `-a 1 1 S r �w s REQUEST INFORMATION BY: UU� Q,l t1—(-r RECEIVED: q� mac,�n,f 1:-1A. l (A SEPA REVIEW J SLUE INSPECTION DATE: iLvivc sp Vv Cie L NOTICE OF APP. &PENDING THRESHOLD: �� MAILED: � POSTED: BY: PUBLISHED: (1-'1 I i 644 COMMENT PERIOD: LLF DAYS FROM: l ( II b'* TO: ( 4I ( 5r 0 4, 0 BOCC HEARING COMMENTS CEIVED: II HEARING DATE: TIME: HD: PWD: NOTICE MAILED: THRESHOLD: DS NS MDNS MAS- R A •JIANG LIST MAILED: AP S AP% INTERESTED PARTIES PUBLISHED: ,/ FIRE DISTRICT 1 2 3 4 50 COMMENT PERIOD: DAYS 1.r1 SCHOOL DISTRICT 20 121 46 48 49 CI FROM: TO: '�,2i CITY OF PORT TOWNSEND 0 PUD#1 HEALTH DEPARTMENT: LA LF RM DF COMMENTS RECEIVED: 0 JEFFCO NATURAL RESOURCES: DC HD: PWD: \ PUBLIC WORKS DEPT: BOMI JIM P FINAL: FDS FDNS FMDNS U,/i ASSESSORS OFFICE DATE: tK JEFFERSON TRANSIT END OF APPEAL PERIOD: la PORT OF PORT TOWNSEND MATT PD: 12' WSD OF TRANSPORTATION WSD OF ECOLOGY SEPA REVIEW VARIANCE 0 WSD OF F &W,PORT ANGELES ADMINISTRATIVE y ADMINISTRATIVE DECISION: ' WSD OF F &W, OLYMPIA YES NO COMPLETED: 0/ WS DNR , FORKS // WS DNR, OLYMPIA,S I°A- YL&vi IN) U HEARING EXAMINER REVIEW 2 PORT GAMBLE S'KALLAM TRIBE DATE OF HEARING: 0 OLYMPIC ENVIRONMENTAL COUNCIL NOTICE MAILED: 0 PORT TOWNSEND LEADER NOTICE PUBLISHED: 0*PENINSULA DAILY NEWS POSTED: BY: 0 BOCC RECOMMENDATION REC.: 0 LMC COMMITTEE DATE RECOM. MAILED: 0 JEFFERSON COUNTY SHERIFF'S DEPT i F('MelrbwlJ y e t.?} ,L41-M IR 96 1 / — C, u,r.2 (pr ricer - 1161-12e X11 H:\PERM IT PLNCNTR\DRDREV 1EWFORMS 11199 }i yis 1H it � I • •ic,,:soN c06. JEFFERSON COUNTY i i' DEPARTMENT OF COMMUNITY DEVELOPMENT �F'.. `.4 621 Sheridan Street • Port Townsend • Washington 98368 �y 360/3G79-44 50 360/379 4451 Fax i JEFrEh O COJ# Fy www. ojefferson.wa.us/commdevelo ment L=` i 191: (�" " ro '` ° D?f l)T Master Permit Application MLA: (` ''" ] l Project Description(include separate sheets as necessary): Tax Parcel ; Property Number: -1- `f '- L� 1 C`_: Size: (acres/square feet) Site Address and/or Directions to Property:-. `.r+ '" Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) O Building n Variance(Minor,Major or Reasonable Economic Use) 0 Demolition Permit 0 Conditional Use[C(a),C(d), or C]-- 0 Single Family n Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached 0 Special Use(Essential Public Facilities)** 0 Manufactured Home 0 Boundary Line Adjustment 0 Modular 0 Short Plat** 0 Commercial* 0 Binding Site Plan** n Change of Use 0 Long Plat** 0 Address 0 Road Approach D Planned Rural Residential Development(PRRDYAmendments'* O Propane ❑ Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis El Shoreline Master Program Exemption/Permit Revisions** O Stormwater Management D Shoreline Management Substantial Development** O Site Plan Approval Advance Determination(SPAAD)• D Shoreline Management Variance 0 Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* D Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **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 it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void.' I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: .L .—. Date: // ✓ e /45/ 1j The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the *Endangered Species Act"or"ESA.'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferag5responsibility for eri g to,and plying with the ESA. The Applicant has read this disclaims and signs and dates it below. �c°m /p err Signature: ,.yZdJZ.t� % �[_,,. Date: ./I/ ;'�71,•�• G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc OWNER 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 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 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: n Individual System ❑ Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this Is a Commercial Proiect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:__ Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have 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 0 Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being Installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2ND 2 Floor _fee: ,-- Ilr o 3"'Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL $ J C " 1 G 0 Decks (:Number. % "% t rf j Other Cash/Check Number. r' l_ ESTIMATED COST(REQUIRED) Date: f-, , -- Fair market value of all labor and materials foundation to finish r ,f t L, L r'- Initials: , , % G:\Per itCenter\FORteMS\DRD FORMS\Master Permit Application 7-8-O4 doc (,-,--e":50N-c--7-8�' %_, JEFFERSON COUNTY 444 DEPARTMENT OF COMMUNITY DEVELOPMENT p��` � 621 Sheridan Street Port Townsend Washington 98368 360/379-4450 • 360/379-4451 Fax , ;httpJ/www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# L ' --' I PROJECT/APPLICANT NAME: .. . . • Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. E 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. • . 6. Describe any excess levels of noise generated by the proposed use or activity: stormwater site plan template—rev.10/1/2003 5 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. 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.). 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 stomiwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 10. If the project requires the use of stomiwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the performance goals and standards applicable to the project. 12. Describe the flow control system stormwater site plan template—rev.10,12003 6 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. 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. 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the site. 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. ,'/ s' 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. stormwater site plan template—rev.10/1/2003 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 section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. 2. Establish Construction Access. 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. r 7. Protect Drain Inlets. 8 storm m water site plan template-rev.10/1/2003 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. • 10. Control De-Watering(the act of pumping groundwater or siormwater away from an active construction site). 11. Maintain Best Management Practices (BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwaler Bile plan template—rev.10/1/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability, depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30 a e 2-21 of the (P 9 Manual). I. Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. =1 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.101/2003 10 SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SW PPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe,and/or other filtering devices. Cx f. Detail stabilization techniques for outlet/inlet. g. Detail controVrestrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. 11 stormwater silo plan template rev.10/1/2003 • 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 o affected property. ( 4, (LANDOWNER OR AUTHORIZE)REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • stormwaler site pan template—rev.1011/2009 12 STATE ENVIRONMENTAL POLICY ACT ENVIRONMENTAL CHECKLIST CASE # ► ' fLo1$'"(v 7 The State Environmental Policy Act (SEPA), RCW43.21C, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal; reduce or avoid impacts from the proposal, if it can be done; and help the agency decide whether an EIS is required. PROPONENT: ate- cyc ADDRESS: 4 0CI O �D• DlSca,l -go. pUR 11fM$(it/ tl,U - q831,8 TELEPHONE: (home) (business) (3W) 38S:310-0,20 AUTHORIZED REPRESENTATIVE/CONTACT: Sera►,► (in,crkAc tel /bc.P Se7DIJ ADDRESS: IRAQ 6, b iscdviey R�. ener-ratnist44 c4A ci 3b8 TELEPHONE: (home) (business) 63(10) 385-0213 DIRECTIONS This checklist asks you to describe some basic information about your proposal. The questions apply to the entire proposal, including those phased over a period of time or on separate parcels of land. Answer each question accurately and completely to avoid unnecessary delays in processing this checklist. If you do not know an answer, write "unknown," or if a question does not apply, write "not applicable." Answers to some questions may require special expertise or technical assistance from qualified persons. The cost of obtaining such information is the responsibility of the proponent. Attach any additional information (reports, studies, maps, illustrations, leases, permits, etc.) that may further describe the proposal or be required by Jefferson County. Contact the Jefferson County Development Review Division for assistance in completing the checklist and for information on the administrative procedures for its processing. PLEASE PRINT IN INK OR TYPE EACH ANSWER. DO NOT WRITE IN THE AREA DESIGNATED "EVALUATION." PROPOSAL AND PROPERTY DESCRIPTION PROPOSED PROJECT DESCRIPTION (include all factors that will give an accurate understanding of its scope and purpose): (ecaun IS nl6 Al' et- to ,zr IL A-TEKAt5 Page 1 of 10 PROPERTY AND AREA DESCRIPTION: Address: N, Legal (from property tax statement): Lot: Block: Subdivision: WOOINA-(4O RILLS 1 Tax Parcel: P,�,Rrr t Quarter Sections: _ _ 56-14 S l4 5Cc a8 Section:, 4q43 Township: 30 N Range: 1- WM Tax Number: QQIa$SQDa. Land Area (dimensions): 6.94 Ac. Describe the location, physical characteristics, and extent of land area to be affected: include all factors that will give an accurate understanding of the property and its environment: E LS l n1C Gi i ve p IT IS LOCktkTED /rj 71-1-E iMoDL€ of - it PI4 CL. /4-T6---n17 1$ 73 AZ44-im lifg. PiT 6< Frew t4iUd/a2 PRsn RE USE. SCHEDULE (beginning and ending dates of the proposal, including phases): 6E61N►J in3C, /1S Sbon) AS iiO Stet. f$Jb 6th/, ►SUM cABL t s kip 16 AvAitI 1 64-- Nexr 1- OVERALL PLAN (describe future additions, expansions, or related activities or plans by others that may affect the proposal): rreTZV E RF & JJcf am 64-E 8y ott.rve_g_ REQUIRED APPROVALS (all local, state, and federal approvals required for the completion's of this proposal and if any approvals are pending that are related to the proposal): 126-WIN( STbKmwAW/2. 1Y►41∎1 Avon r P/ ENVIRONMENTAL DATA (any existing or proposed environmental information such as studies or documents related to the proposal): l[�1�Sr�ou�n Page 2 of 10 ENVIRONMENTAL COMMENTS EARTH EVALUATION 1. Check the item that describes the site: ❑flat ❑rolling ❑hilly ❑steep slopes Dmountainous /other: 6:411) , PJ-r 2. What is the steepest s,lIop�e/on/the site: Identify the approximate percent of the slope: �5'% (Ptr 6 5LOPES� AlR-(!d€ flee-- -I-D 5420 3. What general types of soils are found on the site (sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland: 6411)EL. 4. Are there surface indications or a history of unstable soils in the immediate vicinity? If so, describe them: 5. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Identify the source of the fill: lik1J-77 AZ- aril a PaR T�-oz50 � FRam fees; dnf 6. Could erosion occur as a result of clearing, construction, or use? If so,generallydescribe it: /JO AdXirnc&3'G CLEhRING j /It 44E45 AIP cen-TAttJ in) lals-TOJG if s. 7. About what percent of the site would be covered with impervious surfaces after construction of the project (that is, asphalt or buildings)? NON 8. Describe proposed measures to reduce or control erosion or other impacts to the earth, if any: &-i(is-rf ?ESC. /AI PLATE �RQY►'� f�AUEL (1)1011)6 oiPeR no'5 . AIR EVALUATION 9. What types of emissions to the air, if any, would result from the proposal during construction and when the project is completed (dust, car odors, industrial wood smoke)? Generally describe and give approximate quantities, if known: Nog 10. Are there any off-site sources of emissions or odors that may affect your proposal? If so, generally describe them: j40 Page 3 of 10 • AIR (continued) EVALUATION 11. Describe proposed measures to reduce r control emissions or other - impacts to the air, if any: N// !!'f WATER EVALUATION Surface Water 12. Is there any surface water body on or in the immediate vicinity of the site, including year-round or seasonal streams, salt waters, lakes, ponds, and wetlands? If yes, describe the type and provide names. If appropriate, state what stream or river it flows into: .5/R J r atos nE Dr2�+ Fcow5 m- ,' fCoa&i ftweeer( 4— peAl o Ee -m 4- fitau.pley / 13. Will the project require any work over, in, or adjacent to the described waters (within 200 feet)? If yes, describe the work and attach available plans: NC 14. Estimate the amount of fill and dredge material that would be placed or removed from the surface waters or wetlands and indicate the area of the site that would be affected. Identify the source of the fill material: NonJ 15. Will the proposal require surface water withdrawals or diversions? Give a general description and/ identify the purpose and approximate quantities, if known: /4 0 16. Does the proposal lie within a 100-year flood plain? If so, note the - location on the site plan: No 17. Does the proposal involve any discharges of waste materials to surface waters? If so, describe the :type of waste and anticipated volume of discharge: NO Ground Water EVALUATION 18. Will ground water be withdrawn or will water be discharged to groundwater? Give a general descripti9n and identify the purpose and approximate quantities, if known: N Page 4 of 10 Ground Water (continued) EVALUATION 19. Describe the waste material that would be discharged into the ground from septic tanks or other sources, if any (domestic sewage; industrial wastes and chemicals contained; agricultural wastes). Describe the general size of the system; the number of such systems; the number of houses to be served, if applicable, or the number of animals or humans the system(s) is expected to serve: njp,��' Water Run-Off EVALUATION (including storm water) 20. Describe the source of run-off, including storm water. Describe the method of collection and disposal, if any, including any known quantities. Where will this water flow? Will this water flow into other waters? If so, describe it: Runt-G' Fats Eyisna& Of IS Co(L -E 1 kr *0 Ord-Si'te SEhztenarr/ Cll ithln►3 P#A,10 Ce r�euL 7 O 66 I1JE nlp1 l& OPIi°ATQ6 21. Could waste materials enter ground or surface waters? If so, generally describe how: rk 22. Describe proposed measures to reduce or control surface, ground, and run-off water impacts, if any: ek167106 epa � J & PLANTS EVALUATION 23. Check the types of vegetation found on the site; Deciduous tree: balder rafnaple ®s pen Dother: t Off IJ R)aoD Evergreen tree:fair Zcedar Opine ❑other: tiFinaeg )at hrubs atrass ❑Pasture ❑Crop/Grain Wet Soil Plants: ❑cattail ['buttercup ❑bulrush ['skunk cabbage Dother: Water Plants: ❑water lily Deelgrass ❑milfoil Dother: Other: 24. What kind and amount of vegetation would be removed or altered? Al°t e- 25. List threatened or endanger d species known to be on or near the site: NO Ai 26. Describe the proposed landscaping, use of nature plants, or other measures to preserve or enhance vegetation on the site, if any: D ?D 6RA-55 Page 5 of 10 ANIMALS EVALUATION 27. Check any birds and animals that have been observed on or near the site or are known to be on or near the site: Birds: ❑hawk ❑heron ❑eagle Songbirds ❑other: Mammals: )edeer Obear ❑elk ❑beaver ❑other: Fish: ❑bass Osalmon ❑trout ❑herring Oshellfish ❑other: 28. List any threatened or endangered species to be on or near the site: tiOAV 29. Is the site part of a migratipn route? If so, how? NO 30. Describe proposed measures to preserve or enhance wildlife, if any: WNW EXPAND 6-frJ4"1-- ENERGY AND NATURAL RESOURCES EVALUATION 31. What kinds of energy (electric, natural gas, oil, wood stove, solar) would be used to meet .the completed project's energy needs? Describe whether it would b used for heating, manufacturing, etc.: tto1Q- 32. Would the project affect the potential use of solar energy by adjacent properties? If so, generally describe the affect: Q ' 33. What kinds of energy conservation features are included in the plans of this proposal? List other proposed p measures to reduce or control energy impacts, if any: I(\ ift ENVIRONMENTAL HEALTH EVALUATION 34. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of This proposal? If so, describe the hazards: D 35. Describe special emergency seffi ghat might be required: 36. Describe proposed measures to f�duce or control environmental health hazards, if any: Tf Page 6 of 10 NOISE 37. What types of noise exist in the area that may affect your project (traffic, equipment, operation)? Ai0Af 6 38. What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (construction, traffic, operation)? Indica a what hours noise would c me from this site: hSrKricf`1o16 -4'U Pa 39. Describe propose measures to reduce or control noise impacts, if any: /(KCGMi Ali o,k) PRooi ' I LAND AND SHORELINE USE 40. What is the current use of the site and adjacent properties? 6 try- - 1W4tleP Pei- 14-A1-469A.4-- Resr61ti-ham . 41. Has the site been used for agriculture? If so, describe the use: mBg 42. Describe any structures ort thp site: 046.-- 43. Will any structures be dem $ olj IX? If so, what structures? 44. What is'the current comprehensive plan or community development plan designation of the site? Identify the plan: ` (-Ur i? StDe+rngfc- (Jnvfr2ovr-ia-itf 45. If applicable, what is the current,1SJ oreline Master Program designation of the site? n/f9FJ' 46. Has any part of the site been classified As an "environmentally sensitive" area? If so, specify the part: IVO 47. Approximately how many people would reside or work in the • completed project? None. 48. Approximately how many', 11people would the completed project displace? fV one 49. Describe proposed measures N j tpiayoid or reduce displacement impacts, if any: Page 7 of 10 LAND AND SHORELINE USE (continued) EVALUATION 50. Describe proposed measures to ensure the proposal is compatible with existing and proje ted lanct uses and plans, if any: 1fna&J HOUSING EVALUATION 51. Approximately how many units would be provided, if any? Indicate whether the housing is high, middle, or low income: Notje, 52. Approximately how many units, if any, would be eliminated? Indicate whether the housing is high, middle, or low income: fjQNe, 53. Describe proposed measur l (o reduce or control housing impacts, if any: AESTHETICS EVALUATION 54. What is the tallest height of any proposed structure(s), not including antennas? What is the principal exterior building material(s) proposed? Note, 55. What views in the immediate vicinity would be altered or obstructed? 56. Describe proposed measures to reduce or control aesthetic impacts, if any: &AM11-7 D/J LIGHT AND GLARE EVALUATION 57. What type of light or glare would the proposal produce? What time of the day would it mainly occur? 58. Could light or glare from the finishQtl kroject be a safety hazard or interfere with views? NNI 59. What existing off-site sources of light or glare may affect your proposal? N L- 60. Describe proposed measures to. �e�duce or control light and glare (I impacts, if any: T 11 • RECREATION EVALUATION 61. What designate and informal recreational opportunities are in the immediate vicinity? reVAL{(,U Page 8 of 10 RECREATION (continued) EVALUATION 62. Would the proposed project displace any existing recreational uses? If Nso, describe the displacement: I C 63. Describe the proposed measures to reduce or control impacts on recreation, including recreational opport nities to be provided by the project or proponent, if any: N 614-, HISTORICAL AND CULTURAL PRESERVATION EVALUATION 64. Are there any places or objects listed on or proposed for national, state, or local preservation registers known Ito be on or next to the site? If so, generally describe them: NO 65. Generally describe any landmarks or evidence of historic, cultural, archaeological, or scientific importance known to be on or next to the site: NiDN t 66. Describe proposed measures!? %duce or control impacts, if any: AI Iv TRANSPORTATION EVALUATION 67. Identify public streets and highways serving the site and describe the proposed access to the existing street system. Show on the site plat. Iii' j tui7DO1k t 1 iUe j Corral&oaf) CoVR; 68. Is the site currently served by public transit? If no, what is the approximate distance to the nprrast transit stop? 69. How many parking spaces would the N (.r pcp pleted project have? How many would the project eliminate? 70. Will the proposal require any new roads, streets, or improvements to existing roads or streets, not including driveways? If so, generally describe them, indicating whethgr they are public or private: 71. Will the project use water, rail, or air transportation, or occur in the immediate vicinity of these faci i1iens? If so, generally describe the use: Page 9 of 10 TRANSPORTATION (continued) EVALUATION 72. How many vehicular trips per day would be generated by the completed project? r If known, indicate when peak volumes would occur: N g (41-11tPLi l&k. 73. Describe proposed measures to reduce or control transportation impacts, if any: PUBLIC SERVICES EVALUATION 74. Would the project result in an increased need for public services (fire protection, police protection, h lth care, schools)? If so, generally describe the results: N(1 75. Describe proposed measures to {eJj.ce or control direct impacts on public services, if any: N -r' UTILITIES EVALUATION 76. Check which utilities are currently available at the site: water electricity ❑natural gas ❑refuse service /telephone ❑septic system ❑sanitary sewer ❑other: 77. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity that might be needed: � Ups) ACKNOWLEDGMENT I acknowledge that all information provided in this checklist and all attached material is true and correct to the best of my knowledge. I understand the lead agency is relying on this information to make its decision. In addition, I understand that review under SEPA does not constitute approval or a proposal; compliance with local, state, and federal regulations applicable to the proposal shall constitute approval. ICheck with appropriate agencies to determine what approvals are required.) SEPA approval is based on the information I have provided. If found inaccurate, approval could be withdrawn. By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. (authorized signature) (date) FEE RECEIPT# CHECK# INITIALS DATE h:\home\pincntr\infopIng\sepa.doc 01100 Page 10 of 10 � O o� � mr = m — r- OZrO _< ? 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IIM■gi■■■■■.�sr' r ■►�■ . a ■�r■■■�■■►el�r r;.�a11 ■■ I NAI•■ UMI■yam.■■■ 111■■111111■ ''J■111r 1■■\■11 !1�i11® � ! 1111 :'��"11\■iii, ii sr11■■11■■■t°'. ■■■■IIIS ■■■LIc : ■ ■R s■ 111WA 1■aIi■■■■■■L■ �■■IIIwi■■■1Ik MU \11 0.M11■■1■U■■■■■■■ ■L'! ' 11`IUU■■1E`:1■■U'i° wI/,rliIU■■11■■■■■■■■ma e? lir `°y Mo-chi Zoe Lindblad From: Legals [legals @ptleader.com] Sent: Monday, November 29, 2004 11:23 AM To: Mo-chi Zoe Lindblad Subject: Re: Legal Publication - MLA04-00639 Your legal ad request has been received and your ad will publish on the date(s)stated in your email. Thank you, Hali Johnson Legal Coordinator The Leader 226 Adams St. Port Townsend, WA 98368 (360)385-2900 on 11/29/04 10:55 AM, Mo-chi Zoe Lindblad at mlindblad @co.jefferson.wa.us wrote: > Here is a copy with correct font size. > Thanks. > Mo-chi » Original Message » From: Mo-chi Zoe Lindblad >> Sent: Monday, November 29, 2004 10:48 AM >> To: Leader(Legal Publication) (E-mail) >> Cc: David W. Johnson » Subject: Legal Publication - MLA04-00639 >> Please publish the attached notice once in December 1, 2004 edition. >> Please reply to this e-mail to confirm receipt of the same. >> Thanks. >> Mo-chi Zoe Lindblad, Associate Planner >> Jefferson County Department of Community Development >> 621 Sheridan Street >> Port Townsend, WA 98368 >> 360.379.4462 »> «MLA04-00639.doc» 1 V0114P9 lG8 .3168V. :f -- y 8 'l h.; GBZe<< 2 --1 At 12N 341 j O $ ,1 /��; ,\ a\ ° �0j °� iZ /N0 r-fii y \\-..:1';_\ 2 _ i !II f� O $ 00 - b Cy \ �\R91 l� --Via t 4 D °—��_ Sf a., a, ni V N ]•-- _ __ M —u __ N/•rT'Ff'_ Ants:57 =S d aii�� 1.J9 - ,. /NMII'/G'F 8 p l f! rn.x ti v 1 F .:- " } *¢: ° -x o 0 \'%*: C o 91 y a ` * sib 4°�� n 0 q ~I I� CI"( 2 I I s 1 an xi �p14 ° ° w4 � ° / / 'I _off o x 5::' ° � � <cz,z ^ O ° 1. �` I � oc � m W°tiNi^0 , I fl� W I N / y ` D � �$ y �� a / dy 4 .PSI " g o a T ° 1e,wrw ' ffi rg-- 6 l 8F \ :•• %/ /� V a _o ti ` 0t / ! i I C) a .� \\ a p a-a . ,.. m O �a \\ 8 a ' p 4.5 a4,$ 1 Z1 1 nMD00 2 �° 6� v °0 ]S's 94 O \ 8� m Z 37 T o �\ nzsn�/,��inJ Z 9 a -4 4\ 4I co rn C 0 ° `` o k ^ '1 O na1 --I 4 � a1 j a � O \" ' \ 1/�I Ir�I I(lI (AS6r` a\ p€ 1 II 11 I r,. 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Ul Eason: i,9 � Gi -- — Wf3N/NGRN CO-DRO SYSTEM A l ff m MONO. 1 ttial l ∎IN4A NORTH zone) E °m p c T �n a O N \ �A l'''''8a ■■pp■ MIMIC �i,MOi u Aa kos, �e;�ok IA; � ^ � eav � � '1,,:., � Sy (4R CRP 4777P/- REA AER AL MAPP/NG O /9O) o a III Seton 3 71 Construction, Inc. 4640 S. Discovery Rd. Port Townsend, WA 98368 dam. 2-1 /, 19-2/1250 !'�� I PAY T1 THE 1 O $ " GS® ' ORDE�OF � C ,,• s i'l- .DOLLARS • Port Townsend Brand 055707 P.O.Box se - .�J Port Townsend WA 98366 T FOR •I J • 371 �. L25000024�. 307►.6 30911 0 OF`® r-- JEFFERSON COUNTY ±, ~) . = NO. 68726 DATE ( ! (';>L: F i (-I" RECEIVED FROM Q.-AN L, t ' \ )1,I i i t I '',;'( BARS* AMOUNT DESCRIPTION ._., CURRENCY':� o- - . COIN ' ' ) } --.) .1. 1 ---.-. �d�.. t r t :t i,�CHECKS I\�f "`: tC co D r- v'_.'ham. 1 --„, i . 1 `v ■ ;' VII r,,' RECEIVED BY `- , TOTAL ;, Y t `: r.i+M1:'•:sd•f2w`vaiw^°-v.?-� .i4"Se«nl• .xr..'ke'1[ w- -,•�,v l r.- ----- _lw'su:.a..ytuiuvI`''in:. -.•'6FC,°1 'YS+.ziu.+l_ei_+.Sa+`` IP ('-iiv °11 h ,. ; \\\ . ��, JEFFERSON COUNTY �C DEPARTMENT OF COMMUNITY DEVELOPMENT e� '� ,. ,_ ., 621 Sheridan Street • Port Townsend • Washington 98368 A \ r,4`e> �O 360/379-4450 • 360/379-4451 Fax Q p.': ;N` Its, http://www.co.jefferson.wa.us/commdevelopmenU , fit-' j 4'4'1\ Stormwater Calculation Worksheet � MLA# PROJECT/APPLICANT NAME: "` -,'."/C '` 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(I.E., SITE Size of parcel acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet2e_ / i 1■ 4, 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 species such as Douglas fir,western hemlock,western red cedar,alder,big-leaf maple, and vine maple;shrubs such as willow,elderberry,salmonberry, and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert 3/4 acres or more of Construction site for structures sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well,utilities,etc. sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway,parking,etc. sq/ft Circle: Yes No Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 3.-4/4"-""7 sq/ft Cut Fill/ -' (cu/yd) [over] storrnwater talc worksheet-REV.10/12003 1 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. STORM WATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING �` Structures(all roof area) sq/ft Structures(all roof area) 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 sq/ft Driveway sq/ft Other sq/ft Other sq/ft >( Total New sq/ft Total Existing sq/ft TOTAL NEW+TOTAL EXISTING* `' sq/ft 'This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 2' ' % Does the site have 35%or more of existing impervious surface? Circle: Yes `�N° 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 Stormwater 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 the affected property. (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) t oP CEVS e � 3 w sa t -'-.a,.�.. eta to..a a e i 4? � _ erg.,," ® +t .' ma,? storrrwaler calc worksheet—REV.10'12003 2 JEFFERSON COUNTY ti °°�� DEPARTMENT OF COMMUNITY DEVELOPMENT 1 a 621 Sheridan Street �'y�0$ Port Townsend, WA 98368 Al Scaif, Director November 19, 2004 EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 61-14(...t(...0 X--GfF1--) RE: SITE ADDRESS: MLA#: MLA04-00639 Dear EAGLE EYE INC: Jefferson County Department of Community Development staff have reviewed the application materials for the above project proposal and have determined that the application is substantially complete. Please see attached letter for additional information. Additional information needed for project review may be requested in writing by the Director or Project Planner. Please call the Department of Community Development if you have any questions. Sincerely, Department of Community Development Staff c: File • Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 JEFFERSON COUNTY e—ON °°6,� DEPARTMENT OF COMMUNITY DEVELOPMENT ti c 621 Sheridan Street O$ Port Townsend, WA 98368 1`91IING'S Al Scalf, Director November 19, 2004 EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 RE: SITE ADDRESS: MLA#: MLA04-00639 CASE #: BLD04-00710 Dear EAGLE EYE INC: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. This proposal entails over 500 cubic yards of material, therefore is subject to the State Environmental Policy Act (SEPA). Please complete the enclosed Environmental Checklist and return to this office. Please note that there is a fee of$564.00 for SEPA review. Call me at(360)379-4462 with any questions. Please submit the above information to the Department of Community Development by February 17, 2005. Pursuant to Unified Development Code Section 8.2.3.c and f., if the applicant refuses to submit the additional information or does not request additional time to submit the required information within the ninety (90) calendar day period,the application will be considered abandoned and therefore withdrawn and the applicant shall forfeit the application fee. The Department of Community Development shall not be responsible for notifying the applicant of an impending expiration. Sincerely, \Cni c,t^; /ca-NoozA_A Department of Community Development Staff c: File Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 , P (.1—$0N---68. JEFFERSON COUNTY , ,.4 DEPARTMENT OF COMMUNITY DEVELOPMENT �. ' O''' 621 Sheridan Street • Port Townsend • Washington 98368 �SI�NG`� 360/379-4450 • 800/831-2678 • 360/379-4451 Fax STATE ENVIRONMENTAL POLICY ACT ENVIRONMENTAL CHECKLIST Purpose of checklist: The State Environmental Policy Act (SEPA), Chapter 43.21C RCW, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to help the agency I decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Jefferson County uses this checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or give the best description you can. Answer each question accurately and carefully, to the best of your ability. In most cases, you should be able to answer the questions from your own observations or project plans without the need to hire experts. If you do not know the answer, or if a question does not apply to your proposal, write "do not know" or"does not apply". Complete answers to the questions now may avoid unnecessary delays later. The county can assist you in filling out your checklist. Some questions ask about governmental regulations, such as zoning, shoreline and landmark designations. Answer these questions if you can. If you have problems, Jefferson County can assist you. The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining if there may be significant adverse impacts.• To . 5€r L-ONs i rV\/-A-t L i Cam) C:\WINDOWS\TEMP\sepa info form_FINAL.doc • STATE ENVIRONMENTAL POLICY ACT ENVIRONMENTAL CHECKLIST CASE # The State Environmental Policy Act (SEPA), RCW43.21C, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal; reduce or avoid impacts from the proposal, if it can be done; and help the agency decide whether an EIS is required. PROPONENT: ADDRESS: TELEPHONE: (home) (business) AUTHORIZED REPRESENTATIVE/CONTACT: ADDRESS: TELEPHONE: (home) (business) DIRECTIONS This checklist asks you to describe some basic information about your proposal. The questions apply to the entire proposal, including those phased over a period of time or on separate parcels of land. Answer each question accurately and completely to avoid unnecessary delays in processing this checklist. If you do not know an answer, write "unknown," or if a question does not apply, write "not applicable." Answers to some questions may require special expertise or technical assistance from qualified persons. The cost of obtaining such information is the responsibility of the proponent. Attach any additional information (reports, studies, maps, illustrations, leases, permits, etc.) that may further describe the proposal or be required by Jefferson County. Contact the Jefferson County Development Review Division for assistance in completing the checklist and for information on the administrative procedures for its processing. PLEASE PRINT IN INK OR TYPE EACH ANSWER. DO NOT WRITE IN THE AREA DESIGNATED "EVALUATION." PROPOSAL AND PROPERTY DESCRIPTION PROPOSED PROJECT DESCRIPTION (include all factors that will give an accurate understanding of its scope and purpose): Page 1 of 10 PROPERTY AND AREA DESCRIPTION: Address: Legal (from property tax statement): Lot: Block: Subdivision: Tax Parcel: Quarter Sections: Section: Township: N Range: WM Tax Number: Land Area (dimensions): Describe the location, physical characteristics, and extent of land area to be affected: include all factors that will give an accurate understanding of the property and its environment: SCHEDULE (beginning and ending dates of the proposal, including phases): OVERALL PLAN (describe future additions, expansions, or related activities or plans by others that may affect the proposal): REQUIRED APPROVALS (all local, state, and federal approvals required for the completion's of this proposal and if any approvals are pending that are related to the proposal): ENVIRONMENTAL DATA (any existing or proposed environmental information such as studies or documents related to the proposal): Page 2 of 10 ENVIRONMENTAL COMMENTS EARTH EVALUATION 1. Check the item that describes the site: Of lat ❑rolling ❑hilly ❑steep slopes ❑mountainous Bother: 2. What is the steepest slope on the site: Identify the approximate percent of the slope: 3. What general types of soils are found on the site (sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland: 4. Are there surface indications or a history of unstable soils in the immediate vicinity? If so, describe them: 5. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Identify the source of the fill: 6. Could erosion occur as a result of clearing, construction, or use? If so,generallydescribe it: 7. About what percent of the site would be covered with impervious surfaces after construction of the project (that is, asphalt or buildings)? 8. Describe proposed measures to reduce or control erosion or other impacts to the earth, if any: AIR EVALUATION 9. What types of emissions to the air, if any, would result from the proposal during construction and when the project is completed (dust, car odors, industrial wood smoke)? Generally describe and give approximate quantities, if known: 10. Are there any off-site sources of emissions or odors that may affect your proposal? If so, generally describe them: Page 3 of 10 AIR (continued) EVALUATION 11. Describe proposed measures to reduce or control emissions or other impacts to the air, if any: WATER EVALUATION Surface Water 12. Is there any surface water body on or in the immediate vicinity of the site, including year-round or seasonal streams, salt waters, lakes, ponds, and wetlands? If yes, describe the type and provide names. If appropriate, state what stream or river it flows into: 13. Will the project require any work over, in, or adjacent to the described waters (within 200 feet)? If yes, describe the work and attach available plans: 14. Estimate the amount of fill and dredge material that would be placed or removed from the surface waters or wetlands and indicate the area of the site that would be affected. Identify the source of the fill material: 15. Will the proposal require surface water withdrawals or diversions? Give a general description and identify the purpose and approximate quantities, if known: 16. Does the proposal lie within a 100-year flood plain? If so, note the location on the site plan: 17. Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge: Ground Water EVALUATION 18. Will ground water be withdrawn or will water be discharged to groundwater? Give a general description and identify the purpose and approximate quantities, if known: Page 4 of 10 I Ground Water (continued) EVALUATION 19. Describe the waste material that would be discharged into the ground from septic tanks or other sources, if any (domestic sewage; industrial wastes and chemicals contained; agricultural wastes). Describe the general size of the system; the number of such systems; the number of houses to be served, if applicable, or the number of animals or humans the systemls) is expected to serve: Water Run-Off EVALUATION (including storm water) 20. Describe the source of run-off, including storm water. Describe the method of collection and disposal, if any, including any known quantities. Where will this water flow? Will this water flow into other waters? If so, describe it: 21 . Could waste materials enter ground or surface waters? If so, generally describe how: 22. Describe proposed measures to reduce or control surface, ground, and run-off water impacts, if any: PLANTS EVALUATION 23. Check the types of vegetation found on the site; Deciduous tree: ❑alder maple Espen ❑other: Evergreen tree: ❑fir ❑cedar Elaine ❑other: ❑Shrubs OGrass ❑Pasture ❑Crop/Grain Wet Soil Plants: ❑cattail ❑buttercup ❑bulrush ❑skunk cabbage ❑other: Water Plants: ❑water lily ❑eelgrass ❑milfoil Lother: Other: 24. What kind and amount of vegetation would be removed or altered? 25. List threatened or endangered species known to be on or near the site: 26. Describe the proposed landscaping, use of nature plants, or other measures to preserve or enhance vegetation on the site, if any: Page 5 of 10 ANIMALS EVALUATION 27. Check any birds and animals that have been observed on or near the site or are known to be on or near the site: Birds: ❑hawk Liheron Deagle ❑songbirds ❑other: Mammals: Odeer ❑bear ❑elk Ubeaver ❑other: Fish: ❑bass ❑salmon ❑trout Oherring ❑shellfish ❑other: 28. List any threatened or endangered species to be on or near the site: 29. Is the site part of a migration route? If so, how? 30. Describe proposed measures to preserve or enhance wildlife, if any: ENERGY AND NATURAL RESOURCES EVALUATION 31. What kinds of energy (electric, natural gas, oil, wood stove, solar) would be used to meet .the completed project's energy needs? Describe whether it would be used for heating, manufacturing, etc.: 32. Would the project affect the potential use of solar energy by adjacent properties? If so, generally describe the affect: 33. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: ENVIRONMENTAL HEALTH EVALUATION 34. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe the hazards: 35. Describe special emergency services that might be required: 36. Describe proposed measures to reduce or control environmental health hazards, if any: Page 6 of 10 NOISE 37. What types of noise exist in the area that may affect your project (traffic, equipment, operation)? 38. What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (construction, traffic, operation)? Indicate what hours noise would come from this site: 39. Describe proposed measures to reduce or control noise impacts, if any: LAND AND SHORELINE USE 40. What is the current use of the site and adjacent properties? 41. Has the site been used for agriculture? If so, describe the use: 42. Describe any structures on the site: 43. Will any structures be demolished? If so, what structures? 44. What is'the current comprehensive plan or community development plan designation of the site? Identify the plan: 45. If applicable, what is the current Shoreline Master Program designation of the site? 46. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify the part: 47. Approximately how many people would reside or work in the completed project? 48. Approximately how many people would the completed project displace? 49. Describe proposed measures to avoid or reduce displacement impacts, if any: Page 7 of 10 LAND AND SHORELINE USE (continued) EVALUATION 50. Describe proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: HOUSING EVALUATION 51. Approximately how many units would be provided, if any? Indicate whether the housing is high, middle, or low income: 52. Approximately how many units, if any, would be eliminated? Indicate whether the housing is high, middle, or low income: 53. Describe proposed measures to reduce or control housing impacts, if any: AESTHETICS EVALUATION 54. What is the tallest height of any proposed structure(s), not including antennas? What is the principal exterior building material(s) proposed? 55. What views in the immediate vicinity would be altered or obstructed? 56. Describe proposed measures to reduce or control aesthetic impacts, if any: LIGHT AND GLARE EVALUATION 57. What type of light or glare would the proposal produce? What time of the day would it mainly occur? 58. Could light or glare from the finished project be a safety hazard or interfere with views? 59. What existing off-site sources of light or glare may affect your proposal? 60. Describe proposed measures to reduce or control light and glare impacts, if any: RECREATION EVALUATION 61. What designate and informal recreational opportunities are in the immediate vicinity? Page 8 of 10 RECREATION (continued) EVALUATION 62. Would the proposed project displace any existing recreational uses? If so, describe the displacement: 63. Describe the proposed measures to reduce or control impacts on recreation, including recreational opportunities to be provided by the project or proponent, if any: HISTORICAL AND CULTURAL PRESERVATION EVALUATION 64. Are there any places or objects listed on or proposed for national, state, or local preservation registers known to be on or next to the site? If so, generally describe them: 65. Generally describe any landmarks or evidence of historic, cultural, archaeological, or scientific importance known to be on or next to the site: 66. Describe proposed measures to reduce or control impacts, if any: TRANSPORTATION EVALUATION 67. Identify public streets and highways serving the site and describe the proposed access to the existing street system. Show on the site plat. 68. Is the site currently served by public transit? If no, what is the approximate distance to the nearest transit stop? 69. How many parking spaces would the completed project have? How many would the project eliminate? 70. Will the proposal require any new roads, streets, or improvements to existing roads or streets, not including driveways? If so, generally describe them, indicating whether they are public or private: 71. Will the project use water, rail, or air transportation, or occur in the immediate vicinity of these facilities? If so, generally describe the use: Page 9 of 10 TRANSPORTATION (continued) EVALUATION 72. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur: 73. Describe proposed measures to reduce or control transportation impacts, if any: PUBLIC SERVICES EVALUATION 74. Would the project result in an increased need for public services (fire protection, police protection, health care, schools)? If so, generally describe the results: 75. Describe proposed measures to reduce or control direct impacts on public services, if any: UTILITIES EVALUATION 76. Check which utilities are currently available at the site: ❑water ❑electricity ❑natural gas ❑refuse service ❑telephone ❑septic system ❑sanitary sewer ❑other: 77. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity that might be needed: ACKNOWLEDGMENT I acknowledge that all information provided in this checklist and all attached material is true and correct to the best of my knowledge. I understand the lead agency is relying on this information to make its decision. In addition, I understand that review under SEPA does not constitute approval or a proposal; compliance with local, state, and federal regulations applicable to the proposal shall constitute approval. (Check with appropriate agencies to determine what approvals are required.) SEPA approval is based on the information I have provided. If found inaccurate, approval could be withdrawn. By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. (authorized signature) (date) FEE RECEIPT# CHECK# INITIALS DATE h:\homelpinentr\infopinglsepa.doc 01/00 Page 10 of 10 Map Output Page 1 of 1 FEATURES NOT SURVEYED - 001 285 002 I BLD04-00710 4.ti ; I t ./ z s % � ll , *.,. ,,,,,:v; 1 t : , r r , thnrVS ; ALL 4 it r r '1 "4' � '. 1. pc' .�x Legend p?�d Selected Features Y t O !v Road System "A 1 1 Parcels-YI 0 p .. 2000 Aerial Photos Vi 'e * O Boundaries y , 4 ."•,.r 3°f .. '�fr O 'Nab' :x Yqe ,,,,fli „e, e e ... n CnUw Ccxrrlm � r yr. , � fir, , a. 4.1..... 5. ^;`'f i "• '` ti 3 qgJ [" w r .. f 1 ��x, ,n v' t . y�Fr Y� a C ' nd : . t +h� 1pYry n� :' 'fie .irb .,,� n''''-:''- 41-4 r s .,•ate+.=�' : l'i' d'�; '' ly // S'' _2:r..'.x * 't ; xr 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 collection. Fri Nov 12 08:53:51 2004 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=Tru... 11/12/2004 Map Output Page 1 of 1 FEATURES NOT SURVEYED - 001 285 002 / BLD04-00710 999900128 99991%1108 999900137 949909128 _ O tl� X19900125' 'tu- .99091.10107. 0900001093 99990)t.os 9499112T "0 +090000106: 9900-'0124" - y Q 00127'r X. HI 001284002 VISTA r 4P. .73F41../ � tlt a. rr r j t 9999470123 + 001284002 001285303: 061275012 Legend ; 0 Selected Features !v Road System 03 1284006 CI 27 r f.1- ` I Parcels-ti `T RD Critical Aquifer Recharge Areas 001285001 o 0 6.1 SUSC-LINK n ... W127501' n ;AIWA a SUSC SC .. 661335001 :y47PA SWtPA+LINK :_ i t'+.' i Boundaries ,Snrscre Cm* .0 133101 001 vie ,, ., fl ons a curi 7'177=1 . c....re. A.07...Ir.� 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. Fri Nov 12 08:45:27 2004 • http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=Tru... 11/12/2004 CASES, FINDING, CONDITIONS, PERMISSIONS FOR Parcel 001285002 Printed: November 12, 2004 Cases Name Review Type Status Planner BLD04-00710 MLA04-00639 EAGLE EYE INC P M LINDBLAD Application Received: 11/12/2004 Permit Issued/Case closed: Case Finaled: STORMWATER MANAGEMEN I No findings, conditions, or permissions found. SEP04-00262 EAGLE EYE INC P Application Received: 10/14/2004 Permit Issued/Case closed: Case Finaled: SAND LINED No findings, conditions, or permissions found. Page 1 of 1 Parcel Print Page 1 of 1 Parcel Number: 001285002 06/11/2004 Owner Mailing Address: EAGLE EYE INC 4890 S DISCOVERY RD PORT TOWNSEND WA 983689022 Site Address: Section: 28 School District: Port Townsend (50) Qtr Section: SE1/4 Fire Dist: Cape George(6) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 161 Planning area: Tri-Area (4) Sub Division: WOODLAND HILLS NO 1 Land Use Code: 9100 - VACANT LAND Property Description: WOODLAND HILLS NO 1 I RESERVE #1 V10/P198-201 E No Photo Available http://www.co.j efferson.wa.us/assessors/parcel/parcelprint.asp?PARCEL_NO=001285002 11/12/2004 ' Map Output Page 1 of 3 Features not surveyed Parcel # 001285002 111110:i 111111 ./:- avej 999003125 ' 9090001z? MO NI A .777- CO1276011 ■.. t()1285004 001284002 9994,30121 , ..A4, IA • Oil' '_ --- / // '• d,X 4° ,- 4'001284008 ig% -—....,_ sticf3 1 001275038 _-., __ - ------ 2)001275008 1 ái; / / , A . 4: - 001285002 0%*47 0 —— --1-01----- 00133101 001:50 _ --- 2171__°— 4 A , 001345001 1 ■ 031335001 ■ , CO1335003'- 40 001345002 -----•- 001331002 001335002 1 // Al vs. , 401331011 *4\ 001335003 ....„ / / /, //// / 4, 001335004 '-'4 7/ ,y Z 001331009 Idiot permled tyy Jaime=Cr* Coital Senices GIS l_ .,. 0 /1/ /A http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceNarae=ovmap&ClientVersion=... 11/12/2004 JEFFERSON COUNTY 4.) .- 0 DEPARTMENT OF COMMUNITY DEVELOPMENT W, 4\-k r3' ti vo -C 621 Sheridan Street 4SNG*S,® Port Townsend, WA 98368 Al Scalf, Director November 12, 2004 EAGLE EYE INC 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 RE: CASE#: MLA04-00639 LOCATION: Parcel Number 001 285 002 Woodland Hills No. 1, Reserve#1, in Section 28, Township 30, Range 01 West, WM, Located on Hwy 19, Port Townsend,WA 98368 Dear EAGLE EYE INC: Jefferson County Department of Community Development staff have received the application materials for the above project proposal and have assigned your case to: Mo-chi Lindblad (360) 379-4462 E-mail: mlindblad @co.jefferson.wa.us Fax: (360) 379-4473 Please direct all questions to Mo-chi Lindblad and refer to MLA04-00639. If you need to speak with Mo-chi Lindblad in person, please call to schedule an appointment in order to ensure availability. Review times vary depending on the type of application and how complete the application is upon submittal. For more information, please visit the Jefferson County Department of Community Development web page at www.co.jefferson.wa.us/commdevelopment/. Thank you. Sincer ,, 1 Department of Community Development Staff c: File Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 CC 0 H 0) O 07 C3 LL .— -C3 _CD = LL_ —. C) 0 H 0 CO Pte- •-- CD CO t CC 0 4- a) — co CV CI) Z co O — LI) a O O L J -0 = CC -O -1--J CO O C) 0 = F— W Co Z -+' -0 CO DI Q (5---- .. = S S C_) V Q -_O C ) C) Q ,t),.. („7",, Z 0 CL o_ O 1;0.6 tao-(6 N a) CV 4C--> CC \ l 4,?„,'. 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C d -/ - _ a OJ / i&d Bye $ U0 Big� ag� / ,,,�' /-/ .- q n1. 1 Bi; r / r R °=d 14 d 70 i c <J\ �,:$ONC, w4 , .� JEFFERSON COUNTY i ,4 DEPARTMENT OF COMMUNITY DEVELOPMENT 0$ 621 Sheridan Street • Port Townsend • Washington 98368 IS Nt, 360/379-4450 • 800/831-2678 • 360/379-4451 Fax STATE ENVIRONMENTAL POLICY ACT ENVIRONMENTAL CHECKLIST Purpose of checklist: The State Environmental Policy Act (SEPA), Chapter 43.21C RCW, requires all governmental agencies to consider the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it can be done) and to help the agency decide whether an EIS is required. Instructions for Applicants: This environmental checklist asks you to describe some basic information about your proposal. Jefferson County uses this checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer the questions briefly, with the most precise information known, or give the best description you can. Answer each question accurately and carefully, to the best of your ability. In most cases, you should be able to answer the questions from your own observations or project plans without the need to hire experts. If you do not know the answer, or if a question does not apply to your proposal, write "do not know" or"does not apply". Complete answers to the questions now may avoid unnecessary delays later. The county can assist you in filling out your checklist. Some questions ask about governmental regulations, such as zoning, shoreline and landmark designations. Answer these questions if you can. If you have problems, Jefferson County can assist you. The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels of land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining if there may be significant adverse impacts. I ,Aliblo .).-- C:IWINDOWSITEMPIsepa info form_FINAL.doc 10/9/01 )- 7 {To /I ��` _ URGENT / /�:(�j� A.M. Date & Time 0 /0 P.M. WHIL 9 WERE OUT From A •O I • oil rrrnritT, Phone �L! Area C•"= t -r xt. Fax .4 .. Arm, !�_4.. Area Code Number Telephoned U'" Please Call MN Came to see you I. Wants to see you Ell Returned your call - Will call again - Message A/-' .. Signed4 Quill Corporation 1.800-789-1331 #7-92001 Reorder No. 1 /14oc#4 i /1/7-4- 4:415 rm iaJ „#/ , (,3 ITN B e.ocE SE-7DA) Be 7r -ra I 'I/ 2-0 IrT C- o, lT" 3 srras Ae rviL-.S ' • , m/ -4P t 72,t- AL_... 6cln/& rnsE $,mss, _74(14 TD Cam. ___ 7 . 3o4m DEVELOPMENT REVIEW TIME SHEET EAGLE EYE INC MLA04-00639 Date Time Comments M LINDBLAD I:\R_MLT_Case_CRMLA.rpt November 12,2004 /r f UDC CONSISTENCY REVIEW Project Planner: M LINDB • b Master#MLA04-00639 Review Type Project Description BLD04-00710 STORMWATER MANAGEMENT Primary: EAGLE EYE INC Site Address: 4640 S DISCOVERY RD PORT TOWNSEND WA 98368 PORT TOWNSEND WA, 98368 Project Location: Parcel Number 001 285 002 Woodland Hills No. 1, Reserve#1, in Section 28,Township 30, Range 01 West, WM,Located on Hwy 19, Port Townsend,WA 98368 Parcel Number: 001285002 S-T-R:28-30N-01W Total Acreag 6 Legal Description WOODLAND HILLS NO 1 RESERVE#1 V10/P198-201 Land Use: 9100 Flood District: Fire District: 6 Plannin Area: 4 Flood Map(FIRM) Panel No: 5300690170B School 50 Zoning: L COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: MPR: WATER SUPPLY UTILITY: Service Area PUD: [ ] Plot plan states "property line" . [ ] Assesor's Map(Property line n submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ ] Legal Access to Property Y jab L [ ] Parcel Tags or Scanned ocumen - if NO h�YV 6' it ODI [ ] ESA's: Special Reports Ne��y YES t', Shoreline Designati •YES lNS�' Stream Type:YES N Fish&Wildlife:YES IZI Wetlands: YES • Rare Plants:YES Seismic: YES V" Landslide: YES "r Flood: YES Erosion: YES gr, L f V Aquifer R: .:, :e Ar: NO 90 k'1 d lit. ? SIPZ: non: At •isk • •. Risk Coastal Stoimwater si - plan submitted:io No [ ] Forest Lands: YES Adjoining Forest Lands: _ Commercial/ Rural/ Inholding [ ] Mineral Lands: YES _ . :: 10.1 /Gn�l [ ] Stonnwater: New Impervio . urface I _Land Disturbing Activity , ESA's Y Stormwater Req's: Min Reg#2 Min Req#1 thru#5 Min Req#1 thru#10 Eng Bring [ ] Notice Provisions/Disclosure: Airport s NO 1' YES NO orest Lands YES- [ ] Landscaping Required:Yes yir [ ] Parking Spaces Required 41 2 Other [ ] Building Height: 35' UB. :tandard [ ] Impervious Surface coverage percentage: Resource Lands&Public: 10% Rural Residential: 25% Rural Industrial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ ] Total Building(s)Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: 10,000 SF All others:sutject to septic&water corstrairts/None specified [ ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: [ ] Road Setback: 1- t ( W' Ctv.A � /ifion: • f Road Approach: G Nor REQ'D RAP [ ] SEPA Required: EXEMPT of kni Sg' cpt,(. y&---A . [ ] Flood Certificate: [ ] Existing Case(s)&C (s): Violations: Yes o'�J t , � '30 1/ [ ] Recorded Date of Subdivision: \q/114 111 _ AFN 001 tl61'� ti°' Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance Lots/Require Declaration of Restrictive Covenant YES l , submitted: YES NO [ ] Site Visit conducted YES NO [ ] ADMIN: Setbacks entered in Permit Plan ca N/A YES New Parcel Tags entered in ermit Plan N/ YES Special Reports Scanned YES Title No es Updated Parcel tags found for parcel 001285002 1.) AIRPORT NOISE A 5/3/96 Associated CASES status issued finaled description (101285002 MLA04-00639 BLD04-00710 P STORMWATER MANAGEMENT SEP04-00262 P SAND LINED Z J _J Z O O NELSON'S LANDING RD W 0 >Q 0 o� a d, a N� �d KALA POINT VICINITY MAP N.T.S. LOT 22 EX. 2" SURFACE MONUMENT 8'f NW OF C/L POWER VAULT - y6. 18'04" E = 245.61 W OO D _._rLAN L1 LOT 21 -i L-- L_S F. 6a EX. 2" SURFACE MONUMENT 8'f SOUTH VARIES / OF C/L SOUTHERLY BOUNDARY OF WOODLAND HILLS NO. 2 PHASE 1 i �O \ ". Z \ `Jo o, a S 29'16'53" E 8.77' 10 o JEFFERSON COUN IOD o A = 03'50'39" ELOPMENj � F CON1`�UNtTY DE\1 LA1�TD _ cD _ - \ .� R = 2070.00 ' DEPT. Q 49,10., DRIV � \ \ L = 138.89 122.05• E E A = 34. 31'03" \ LOT 9 R = 630.00 L = 379' 54 (TO BE RELOCATED) n6RFACE (BASE PT.) FOUND 1/2 REBAR \' 2 MONUMENT �' �� EX. 2 BRASS & YPC BY "DEA" \ °'o, X o� PARCEL A 2DIt N. ON SURFACE C/L 0.04' SOUTH OF LINE \ \ � �•' - � ASP1 i g (TO BE RELOCATED) � �� TAX PARCEL 001285002 / o. RDAL .T 2 17 -7-7 i U i RESERVE 1 / RESIDENTIAL LOT) A� o .g0 O (UNDEVELOPED) �\ \ 6.96 ACRES "BASE POINT A" LOT 10 60 FOUND 2" IRON PIPE 136 FF' \ W \BRASS DISC I N CASE ® PT A = 13'05'36"' / Q�L�1 P � `) G��P�\�� 0 05' 10'28" ` `o (01/09/04) 38.35 LR = 145.88 L 186.94' \ , ��""" R = 2070.00' \ \ » » \ EXISTING 12'DIAM. CONC. PARCEL B �� \ DISK SET TFOR SECTION ARMY" BRASS FOUND 1/2 REBAR ' p TAX PARCEL 001285001 & YPC BY "DEA" S� O CIRCA 1895= PRESENT SEC. COR. S62'55'E -0.1 1' FROM �� OQO LO T 17 (01 /07/2002) &_"01 /09/2004) s THEO. CORNER NOTE: _ – – SEC. 28 THE SOUTHERLY MARGIN OF WOODLAND DRIVE SEC. 33 S 88'06'2 8'06'24" E AS DEPICTED ON THE ORIGINAL SURVEY OF WOODLNAD HILLS NO. 1 IS NOT CONSISTENT WITH PLAT CENTERLINE MONUMENTATION AS PORT USED FOR WOODLAND HILLS NO. 2 PHASE 1. O -� • � \�,o� OF LEGEND -)3 A PORT TOWNSEND SURVEYOR'S CERTIFICATE This map correctly represents a survey made by me or under my direction in conformance with the requirements of the survey recording act at the request of Eaale Eve Mam't. Inc. in June , 2004 . ��.•oF egs�yj'�j; 0: 0894 zA� EXPIRES 3 APRIL 2006 FOUND 1/2 REBAR $p; \ THIS MONUMENT DOES NOT 4.75 ACRES & YPC BY "DEA" 19 \\ � � MATCH BASELINE A -B .; /i SEC. 28 - - - 0.09' NORTH OF LINE I O -�'8 27 SEC. 33 � i � � PROPOSED \,A 33 34 I I 30' ACCESS & 30' UTILITIES i j �A\ ci a UTILITIES EASEMENT EASEMENT r FOUND 1/2 REBAR `L\ I &YPC BY "DEA" n \ N00'54W -0.11' FROM \ 3 z I I 139'2 THEO. CORNER �� o LOT 11 IC A��„ W~ 0 QI I i� S�OZ KI In g l 30'1 30' DRAWN BY: I KAS I SURVEY FOR FOUND 1/2 REBAR & YPC BY DEA" S52'45'E -0.26' FROM THEO. CORNER I 100 0 100 200 DATE: JULY 2004 BOUNDARY LINE ADJUSTMENT JOB NUMBER: 04— S4652X WOODLAND HILLS NO. 1 FIELD BOOK: Scale: 1 " = 100' CHECKED: I PETE SEC. 28 & 33,TOWNSHIP 30N., RANGE 1W., W.M. SCALE: 1 =60 1 JEFFERSON COUNTY WASHINGTON LO T 16 300 VIA> X. 01 CP i ID \ LO T 15 \`O ,. �o – �' "BASE POINT B" \ FOUND MONUMENT \ W \BRASS DISC IN CASE (01/07/02) / J i i i i APPROVALS: DIRECTOR, JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT DATE JEFFERSON COUNTY ASSESSOR DATE SHEET 1 OF 1 A• D•A ENGINEERING, LLC SURVEYORSNENGINEERSr- PLANNERS P.O. BOX 847 .D.A. POULSBO, WA 98370 PHONE: (360) 779 -6633 B.I. PHONE: (206) 842 -6123 FAX: (360) 779 -7031 NEI 14, NEI 14 (SEC. 33) & SEI 14, SEI 14 (SEC. 28) AUDITOR'S CERTIFICATE Filed for record this day of 20 .M., in Section , Township , Range , W.M., at the request of A.D.A. Engineering, L.L.C., Auditor File No. , Survey No. County Auditor Deputy Auditor = PROPERTY LINE = RIGHT OF WAY ' \�/ \ -- - - — = CENTERLINE 1) \ O \ \ = EXISTINGMONUMENT (AS NOTED) (1 \ = • EXISTING IRON PIPE (AS T NOTED) 6 () N \ \\ \ = TO BE SET 3/4" IRON PIPE & 2" x 2" LOT STAKE (X) NOTES: � 1) This survey meets the minimum required 4) The purpose of this Boundary Line Adjustment surveying standards per WAC 332 - 130 -090. is to adjust the Northerly and Westerly boundaries 2) This survey accomplished by field traverse of Lot 17 and to increase the size of Reserve 1 procedures using a two second total station both in Woodland Hills No. 1 (Volme 11, Page 50 and /or five second theodolite and calibrated of Surveys) due to the vacation of Station Prairie steel tape. County Road. 3) Statement of Intent with Legal descriptions recorded under A.F.N. REVISIONS: SURVEYOR'S CERTIFICATE This map correctly represents a survey made by me or under my direction in conformance with the requirements of the survey recording act at the request of Eaale Eve Mam't. Inc. in June , 2004 . ��.•oF egs�yj'�j; 0: 0894 zA� EXPIRES 3 APRIL 2006 FOUND 1/2 REBAR $p; \ THIS MONUMENT DOES NOT 4.75 ACRES & YPC BY "DEA" 19 \\ � � MATCH BASELINE A -B .; /i SEC. 28 - - - 0.09' NORTH OF LINE I O -�'8 27 SEC. 33 � i � � PROPOSED \,A 33 34 I I 30' ACCESS & 30' UTILITIES i j �A\ ci a UTILITIES EASEMENT EASEMENT r FOUND 1/2 REBAR `L\ I &YPC BY "DEA" n \ N00'54W -0.11' FROM \ 3 z I I 139'2 THEO. CORNER �� o LOT 11 IC A��„ W~ 0 QI I i� S�OZ KI In g l 30'1 30' DRAWN BY: I KAS I SURVEY FOR FOUND 1/2 REBAR & YPC BY DEA" S52'45'E -0.26' FROM THEO. CORNER I 100 0 100 200 DATE: JULY 2004 BOUNDARY LINE ADJUSTMENT JOB NUMBER: 04— S4652X WOODLAND HILLS NO. 1 FIELD BOOK: Scale: 1 " = 100' CHECKED: I PETE SEC. 28 & 33,TOWNSHIP 30N., RANGE 1W., W.M. SCALE: 1 =60 1 JEFFERSON COUNTY WASHINGTON LO T 16 300 VIA> X. 01 CP i ID \ LO T 15 \`O ,. �o – �' "BASE POINT B" \ FOUND MONUMENT \ W \BRASS DISC IN CASE (01/07/02) / J i i i i APPROVALS: DIRECTOR, JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT DATE JEFFERSON COUNTY ASSESSOR DATE SHEET 1 OF 1 A• D•A ENGINEERING, LLC SURVEYORSNENGINEERSr- PLANNERS P.O. BOX 847 .D.A. POULSBO, WA 98370 PHONE: (360) 779 -6633 B.I. PHONE: (206) 842 -6123 FAX: (360) 779 -7031 NEI 14, NEI 14 (SEC. 33) & SEI 14, SEI 14 (SEC. 28) AUDITOR'S CERTIFICATE Filed for record this day of 20 .M., in Section , Township , Range , W.M., at the request of A.D.A. Engineering, L.L.C., Auditor File No. , Survey No. County Auditor Deputy Auditor