HomeMy WebLinkAboutBLD2005-00576 • I•
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD05-00576
SITE ADDRESS: 274 CEDARVIEW Issue Date: 10/21/2005
PORT TOWNSEND, 98368 Final Date: 7/7/2006
APPLICANT: ROBERT J MILES PHONE: 360-385-3299
PATRICIA MILES
230 CEDARVIEW DR
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#9 Block: Lot: 188
PARCEL NUMBER: 965000328 Section: 27 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NSFR W/ ATT. GARAGE. The proposal will be disturbing approximately
5,000 sq ft (including trees) of this 32,000 sq. ft lot that backs up to Fort
Townsend State Park. The proposal will include the removal of trees in
eagle habitat & the Shelly Ament with WA State Dept. of Fish &Wildlife
has been routed this application for comment on whether an eagle
management plan will be required. Her phone number is (360) 681-4276.
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2003 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/7/2006
Building /Do
Official Signature
Signature Date
tcrerl 4(4
I:\F_BLD_Occupancy.rpt 10/29/19C.
BUILDING PE
RMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00576 Received Date 09/6/2005
SITE ADDRESS: 274 CEDARVIEW Issue Date 10/21/2005
PORT TOWNSEND, 98368
APPLICANT: ROBERT J MILES PHONE: 360-385-3299
PATRICIA MILES
230 CEDARVIEW DR
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#9 Block: Lot: 188
PARCEL NUMBER: 965000328 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156
260 KALA POINT DR
PORT TOWNSEND WA 98368
360-385-3115
Contractor's License: KELLESI150LF Expires: 6/6/2007
PROJECT DESCRIPTION: NSFR W/ATT. GARAGE. The proposal will be disturbing
approximately 5,000 sq ft(including trees)of this 32,000 sq. ft lot
that backs up to Fort Townsend State Park. The proposal will
include the removal of trees in eagle habitat&the Shelly Ament
with WA State Dept. of Fish &Wildlife has been routed this
application for comment on whether an eagle management plan
will be required. Her phone number is (360) 681-4276.
CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER:
Footing: 62.-S--O S
Foundation: (2-S-03
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing: i
Framing:/hIh PfLACg QK fo-0500 �� �L, 2,,-2t-Q4 iNtok
Plumbing: Cam`- Z 1-2--Q A
Propane Tank/Lines:
Insulation: Art,,L. „ Z- 1-Uo 2/2-7/Q 6
Sheetrock: lfi 4.'
Septic Syte Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: 7-4 ^a 6 F ._
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE REVERSE
UILDING PERMIT APPLICA•N MLRAOe 00540
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00576 Received Date: 9/6/2005
SITE ADDRESS: 274 CEDARVIEW
PORT TOWNSEND, 98368
OWNER: ROBERT J MILES PHONE: 360-385-3299
PATRICIA MILES
230 CEDARVIEW DR
PORT TOWNSEND WA 98368 KALA POINT#9
SUBDIVISION: Block: Lot: 188
PARCEL NUMBER: 965000328 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156
260 KALA POINT DR
PORT TOWNSEND WA 98368
Contractor's License KELLES1150LF Expires 6/6/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NSFR W/ ATT. GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,972
VALUATION 282,643.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N SHORELINE:
GARAGE: 690
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: KALA PT
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 3
Total: 2 Total: 3
Routing Date: r ��
y
Type Amount Paid B : Date: Receipt: Approved/Date
Yp V p pp
Plan Check $1,312.06 SLE 09/06/05 76617 A P P R O V L L.
Permit $2,018.55 SLE 09/06/05 76617
State Building Code $4.50 SLE 09/06/05 76617 OCT 2 1 2005
Potable Water Application $53.00 SLE 09/06/05 76617 Jefferson County Planning
Total: $3,388.11 & Building Department
OWNER BUILDER STATE-
The signer of this statement does hereby .'
certify that.iheyy are the Viers. Patoel lefer f :. I s t
toRb dot.: ° '. •.. '• e,..t.�,aay,; �, that
Signature: ; :. -
Date !1 11, EP - 6 2005 -
GENERAL CONTRACTOR OR'MANUFACTURED HOME INSTALLER;
Z Lam.i,.� `�}y r t�;�,��r- r IC PHONE: I�;�(t f1 ;t: L�? ..
MAILING ADDRESS: O i "P-l�^0e) - a 5
CONTRACTOR'S LICENSE as t o a S .._ 00.
NUMBER: _ WAINS
ARCHITECT/ENGINEER:
/ENGINEER: el. ,. ,S� NUMBER •
MAIUNG.ADDRESS: i•-)D frlL NONE'(. ) FAX:( )
ter .. ...
•
tre .-� y fame Type:-
yO Addition �' Existing: � Sewer Sewage Disposal:
s.,tlew Wood❑ Addition
ion/Remode! OCSteel Proposed: -,S ❑
0 Concrete Total: 0 Commuruly System
0 Repair 0 Masonry -- Heig Indiermjt System
0 Demolition 0 Other Bedrooms: Ater supply:
TypeI-ti ' g; °.. Water S4PI Y
of Heat:
P►riposed: - 0 Pnwate well O Two Party
Total: Nam
tal• � 0 ,Public
e fi System:•
If this Is a Commercial Project u must answer'the foliowin
Number of Parking Spaces: ;Current .... .
Number of Deco Proposed Number of.ADA Parking Spaces:
pants(npludes owners,tenants;_empkryees,,etc) Current IBC pccu n
pa.cy IBC TypeProposed
If this is u ppn ne, of Construction Will you have
Tankatid/or 1iancerInstallation dim mark all�items.below:th al='1 .00d Yes / No
Q 4?-15dorgnQllrfgt.:Mk = ,<-
vet Ifid Tank Size of Pro
Heat Stove ��Q 0 11V pane Tfink:� �q.L..
oojstove � fireplace Insert 0 Hot Water Tank ❑ Pellet Stove :0 :Other
Is this a lianca be. In installed,In a Manufactiureii•/Nobile Home? Yes '1 o'. .IM�cr op#Ying'�O�a;�rrnit.�o,lnsta/l a ro ne dank you inust.also sub*� _
,.iito€ttanfr Ye P a sit_plan showing all of the buildin s"all no
u �S/ze-:nfistartces 1'irom tire: in
includin. 'Nye reserve area pahef`ank to'all ppgp�ty/Ines,buildings and septic°system cornpone ,
S•ware Foots
5' �._ ..
. °aeLs. r... f
4'rp.• : r�r ' <sdY C*" vtid nA ..° R{F"� :y*A YN',-�st
k6 r.
I L
:fMainFrr____ i't �re * riFW;I::\VA%..', rL t t,-"d( . ;.7, K� * ,% .r41 V 6r4-.e A ' : �1 x v, '' na - "A.1 44•k�a3A�2 ° aor K ��Fi+tk 4W x� m ! E/. -v, . . r a
51
t.
-' `t rE ,3 Floo % 7, ^ F 1 • #l4 Fsr .,' xx ' a rh., ,{ ,b „� F . =„..-:.. ._iEe'v-0 �` ,^ S` xaone: ¢ ' rF `g ' ' ° - ' l ;t' 'xF i,P: -' ',1 zl' 1 yf` _ " S ,} . Y, 1 HeatsiBasement. F „ *� - ` a 4-� - t dW, , sg � r ' . : - -. `, _ ` 0'17._. . s,s.ra , ,x, � . ` 'Unheat . Basement k, ) ..' Uirff tr r: a 4 .r.7 -r . "i 5 -gs° aw,' A a f - r am ; $ t` � r�k ' a f hOtherUnh ted _ 6L ` �� *.ui a a �a 41F" r�a �.4r-0S- S d 1t 44 i`r r aL3 5ar ".fir r ,11- � .i?i - §f ieF"SMr` b ,Gamge/VCrpO t
A.11.111
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111111
Other
. tk J •. �`.S Iifiri� . a �•y f 7P b '..e,;^F i.y .
Other ..a¢56fs'0'-,o _, ACT j t1Sp W u L .,1: R r'fi l.J t�511,7�q
t � ..l'�..^!� S OSer .r > .�.�'��a.fir+-�,$, cr*xc�'�s..a�•Py.
dss !v t '3°3..; fi ,1 sir s+. l y,ti r
'ESTIMATED Illir
�` � r i.�' � � �R � .
COST{'REQUIRED) �� a � r,,;: t i rrT >r x 2 rW„ 4 ,,tom
w_,-?
•Pali•market Value of al'REQ °#'D 4. ` u M� 1'f� i�4 _ •° ��' t_tv
materials foundation to finish 5 r*..'- �-�5.',ai�". % . 1 iV m' ' `: 521 �. Asa
G:\PemritG rater\FORMS\DRD FORMS\Master Permit Application 7-8-04-doc
r SUN tr'
tc,r. Oe› JEFFERS•COUNTY
T Aw TTTTTT,DEPARTMENT OF COMMUNITY DEVELOPMENT
.( ii{
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621.Sheridan Street*-#�[t wras d- _tll/as it3gtoo 98368 F.------
360/379-4450 • 360/379-4451 Fax SEPI
0 www.co.jefferson.wa.us/commdevelopment i - 6 )T'=` J
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Master Permit Application
Project Description(include separate sheets as necessary): r ,.i�l4r
`j 1 �...)G1 L F7 ) 1 I C.. 'mac-..k.<../ OC AX._tz. ""1/1r l l-
Tax Parcel 2,5 �i..a 17
Number: 1 6 3 000 3Property M
Size: �a 2, oov /uare feed
(acres
Site Address and/or Directions to Pro j �l- _ C-Et✓P&v 1, 9
R._ .
Property Owner(s)of Record: t�13 ± 17e-1- jA4 t �e C
Telep
hone:, 5-3 -q `t_..... �.tia x: email:
Mailing Address: 2-310 ' "t.PsaVt(4„" 'j,yz_ _ "j` .,or 5'8 3A-9
Ir >✓St�x �
Applicant/Agent(if different from owner): �t . E • H 1el-OS /c..J c- ,
Telephone: `�$S —T 15l� Fax 38 S - 311 )
g 6 email: S.t e[�s fit: t`h. )�.�. 'f
Mailing Address: a. Ca �� �--
What kind of Permit?(Check each box that applies)
Building 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
Single Family 0 Discretionary"D"or Unnamed Use Classification
Al.Garage ached/Detached 0 Special Use.(Essential Public Facilities)--
0 Manufactured Home 0 Boundary Line Adjustment
❑ Modular
❑ Commercial* 0 Short Plat**
0 Change of Use 0 Binding Site Plan**
0 Add ❑ Long Plat**
0 Road Approach 0 Planned Rural Residential Development(PRRD)/Arnendments**
ro ane ❑Plat Vacation/Alteration**
0 Aliowe "Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit rmit Rev
❑Stormwater Management 0 Shoreline Management Substantial Development
**1Ons.*
0 Site Plan.Approval Advance Determination(SPAAD)* 0 Shoreline-Management Variance
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
CI Wireless Telecommunication* 0 Jefferson County Shoreline Master Pr
0 Forest Practices Act/Release of Six-Year Moratorium rogram Amendment
*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:
I herebydesign 1 DESIGNATION OF AGENT
g ``" `t .I. ., 43 C to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURES
Date: `7-(c, Ltn 2 �
By signing this appli lion form, owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or ifs knowledg eriai falsehood or any omission of a material fact made by
mayresultin this the owner/agent with respect to this application packet
permit being null and void: -
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys 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 arrest and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and r inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Date:
Signature: --C...„------)--- (� 7 CO<
The action or aAp I' nt will undertake as a result of the is
suance 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- erab e sibilityfor adhering to and complying with the ESA. The Applicant has read this disclaim r and signs and dates it below.
Signature: ..
Date: `7/ , �t J
✓
G:\PermitCenter\F RMS\DRD ORMS\Master Permit Application 7-8-04.doc C�� }}TJ��� CS
•
SPECIAL CONDITIONS FOR Cl4SE A BLD05-00576
1.) The northwest corner of the home must be located 60' min. from the north property line
and 75' min. from the west property line to permit sufficient area for the septic system, see
SEP05-286.
2.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
3.) VOLUNTARY MEASURES OF COASTAL&AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
5.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
6.) A stormwater plan for a medium 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.
7.) A minimum of two (2) on-site parking spaces are required for the single family residence.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) Not more than two (2) unlicerl,sed or inoperable vehicles shall be stored on lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) The front setback is 20 feet from the edge of the right-of-way Cedarview Drive. Minimum
side setbacks are 5 ft. The rear setback is 20 feet from the edge of the emergency
access easement.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
Jam - , P1
5IT PLAN A1\n 51COMWAf i? PLAN ,�i'�
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1\ \�9 � c��55 cay�mer�
\o a
,...1" - 30"4111 f(-"/' e-ff \
�� %e5ilt Fencing
ilkotmay,, I
besilt Fencing 1 •
5
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Concrete I'atb ` I 15
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20 Iwo-I3edroom Nome
APPRO ' D --_
SITE PLA °0,1, io+'
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OCT 2 1 2005 \
-------\ \1
181' 1 Garage
JEFFERSON COUNTY
flEPT.OF CO MUNITYL VELOP i 120GAp
'NATURE: ip
`j// aie `
50' Exposed Aon,brlveway
Pt rA9F-k Y.
LOT #188, P1V, 9, KALA POINT
PAJCfL #969000328 -
QIM\IEI?
C30I3 ANn PAt MIL5
230 CN2A2 VIEW E7 IVY
PO1"1"OWNSNNn, WA 9868 AP ' ROVE
.� rON1�Ari-CP/ OWNP'S I:EP; • STOR WATER PD
(LLY 51- 0Ln5 INC (KFLLF51150L ) --_ -- 126' - LAN
260 KPLA POINT IPIVF _ G. i OCT ''t
P01;1'tOWN5FNn, WA 9868 ' ; i SEP 6 \ 2 1 .t
360-389-7196 (0) 560-389-3119 (F) __ - -_-
"- — JEFFERSON COUNTY
l�f 1,C C J -. _ OF-CO. MU 'IT
_ SIGNATURE. VF.I_ p NT
.. , JEFFERSON COUNTY
4.4 q DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street•Port Townsend•Washington 98368 "' ' 1 �- - I
360/379-4450-360/379.4451 Fax l '
7-4.17NO httpilwww.cojefferson.wa.us/cornnadevelopmenti SEP
- 6 2005
STORMWATER SITE PLAN SUBMITTAL. TMPLATE 1
as Courm
AA
MLA.# D C�s � J 4D PRbJECTfAPPLIc�tNFtd{hME: - ----
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.
le-ort-et o, , TJ e„ry er--o w,.,t t -
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
F- Ar" - -Pz u-r j, S PG
Ou vt c-L
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
- Pen QC .F4
4. Describe the existing soils. Indicate soil type on the site map.
r+ Stn'y-o 4.4)e+
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 enerated b the o sed use or a
APPROVED
STORMWATER PI .AN
OCT 2 1 2005
slommaater srle plantemplale.doc—rev.10/122003
5
JEFFERSON COUNTY
DEPT.OF COMMU�' Y DF,V OPME
SIGNATURE
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.
^ kb. Kr.-k' P.M FO r 7'o w WerYe14,0 Q 0.94-
8. Describe the general.vicinity of the site,including adjacent land uses and structures ufrti" s
streams,wetlands,fakes,st-ee sib es,e a_ — - _
- e-,...0;› (:)4. ce.optavt to...) LA-A.Je . li-l',1\\
\flj\ SEP - 6 2005 �..
I
Permanent Stormwater Plan JEFFERSON COUNTY
DEPT.OF COtv5tvlUNITY DEVELOPf�iEN7
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 exr ded.
g_ Describe the developed site hydrology,as proposed. Indicate whether stormwater will be fully dispersed(i,e.,per BMP T5.30
in the Manual)or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
withinthe•site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
TX%,ASIZs„coo To -Yt%-r. i,mot. V era enoPri o J ,
10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities propn-ed
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 sae plan templatelbc—rev.10/12/2003 6
13. Describe the water quality system.
- ND l i i-dr R-C r,G.l r--) I --
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14. Describe the conveyance system analysis and design. t ',' S E P 6 2005 1 J
Li 'i.i
,•-- '- JEFt Lk:pur-COUNTY
DEFT.Of oommUN!TY nFVFLOPMENT,
15. D...ssenbe the source of fill material,physical characteristics of fill material,and deposition of excass material.
— M 11.) t tnk In._ d ti c ire G.1 r/ F-i L. - 2 S- c r ±.
1
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code
I T. Describe the proposed surfacing material.
C.R-VSt.'iti4 (1--e ms FO it Ar .S \I o N'b , C..0?-i c r. s"
PT .,C)to L'OA•L Pt...WTI t I
18. Describe methods for restoration of the site. /
L Pry DS C.,/k-'l�l.Ne PL—Yl K-ibiZA PO / S?71"f—+ 0 AV,Zs .
._ .. _.
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 inducted,list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related:requirements,describe those conditions or
restrictions here.
stomrwater site plan temptate_&C—rev_10/1212003 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
wilt 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 2.52 of the Manual(beginning on page
215).
/2 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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a, Establish C��onst►u/ettion Access,
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3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6_ Protect.Slopes.
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7. Protect Drain-Inlets.
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12 Required Elements—Construction.SWPPP(continued)
S. Stabilize Channels and Outlets.
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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).
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JEFFERSON COUNTY
12. ManagetlteProject DEPT. OF COMMUNITY DEVELOPMENT
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of4tx)
yards).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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b. Description of special requirements for working in or near environmentally sensitive areas.
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4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibifity,settleablity,permeability,depth,texture,soil structure).
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5. Construction Phasing.
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a. Construction sequence '
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b. Construction —r"—�`--phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
1. Provide a proposed construction schedule.
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11. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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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.
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b_ Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
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8_ Engineering
g neering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runofi1Stormwater Detention Calculations
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Stormwater Site Plan Changes
tithe 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 stntbturat 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, 1 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:
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(LANDOWNER OR AUTHOR?Fn REPRESENTATIVE SIGNATURE) (pp
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
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sbrmxater site plan templale.doc—rev.10/1212003
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