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Home My WebLink AboutZON2016-00042 Permit and Stormwater permit applicationDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, PortTownsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 r� Web: �uwu�v.co.irc�.icFCcrcan.�va.utlSrlpy3k�i�gt}�In �s�zcs�t Lam+ 1Lmail: ricd c(fcc c�n,tvaxr PERMIT APPLICATION ILI 11I N0 V 17 2��6 Steps in the Permit Process: Jir'rt Ol G6 t<Ss l4I�i11' flE -Review application checklist to ensure all information is completed prior to submitting pliCtPcSPir -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Related Application #s: Building Permit # MLA # Site Information Assessor Tax Parcel Number: 1B¢ OGo -f f-0 q'9 -f cev ¢! Z 98¢ 'V60 ¢/¢ Site Address and/or Directions to Property: g/ PZ.fl£ jnrpy POP 2- t vDGow Access (name of street(s)) from which access will be gained: piivE W,4fY Present use of property: Jresipe"'Ce Description of Work (include proposed uses): OeRo-VIR SE'PTie SYSTEM •K lAl Sr.4LL c v/, vE,27' i,'i S7 -2e q/M Wastewater - Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES NO X If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: X Septic Septic Permit #: $C- FV& -Oo 1067 Pl20,"osEh Community Septic Name of System: Case #: Are other residences connected to the septic system? He Additions or repairs to sewage system: 5e -F/'0 -DD/?a, (P/2opoSE0 Is it a complete or partial system installation: Complete X Partial Has a reserve drainfield been designated? Yes No X Date of Last Operations & Maintenance check: g - 3/-/ j Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: Wt4l_ Raeelett> 9,6_<rR/er1'V6 e0Vf fA17' Fad 1 3 P"q;pCEz-s Permit Pog' 142 The authorized agent/representative is the primary contact for all project -related questions and correspondence. The County will mail / e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. itis the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e., County email is not blocked or sent to "junk mail"). Applicant/Property Owner Information Property Owner: Name: 4XN>011V Address: ! P/NE W-434 poPZTLUPJIe0WWim? yB3lvS Phone #: 3&0 — ¢ 37 - 0 azo E-mail Address: 7, Z,47— U[a1 oL YP�.tl, eo/t-q X Please cont�7itl* projeco) (select only one). Property Owner Signature: Date: Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. Applicant: Authorized Agent/Representative (If other than owner) Name: Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Eanstiltarrt- Name: MIC-1-1we L S, U E'r�E ' License # 5'/610/10 :50plye v4W5r6,^1 Address: P0 BOX -7787, W1cr 48360, Phone #: 31o0— sf5 7-1n35 3 E-mail Address: M /KEGS' G DS 4 yaV, eaM Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: 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 or her 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notic t ttit County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signaturea�dw,�,Print Name i11 f S 'f vieD 1 Date:%f" Pcrmir \pplic ition Parc 2 of 2 SON DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Shcridnn Strcct, Part'Fownc:cnd, WA 98368 Tel: 360.379.4450 1 Vim 360.379,4451 Web:��yyy,git,�c:{fortiuu.wo�,u>1x'ctnnnnnitrcicty�hct n �V P. -mail: tied # � jrffcratm.tua.0 } �' fpsfi_ SO' U'i ti (/IN J PERMIT APPLICATION All, Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting app iL tI SON COQ -Make sure septic has been applied for and water availability has been proven. [D -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit #4L Related Application #s: MLA # Site Information Assessor Tax Parcel Number: 984000406 Site Address and/or Directions to Property: I Access (name of street(s)) from which access will be gained: Paradise Bav Road Present use of property: Single Family Residence Description of Work (include proposed uses): Install culvert in non -fish habitat stream as pari of waiver for reduced setback to Wastewater -Sewage Disposal _ This property is served by Port Townsend or Port Ludlow sewer system? YES NO If not served by sewer identified above, identify type of septic system Type of Sewage System Serving Property, V/ Septic Septic Permit #: SEP88-00203 below: Community Septic Name of System: Case #: Are other residences connected to the septic system? No v� Additions or repairs to sewage system: N.A. Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? Yes No ( Date of Last Operations & Maintenance check: 7/21/11 by Linda Atkins? Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: The authorized agent/representative is the primary contact for all project -related questions and correspondence. The County will mail / e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below, The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e,, Countv email is not blocked or sent to "funk mail" ). Applicant/Property Owner Information Property Owner: 1 Name: Mahieddine Haddadi Address: 17812 Wallingford Ave. N., Shoreline, WA 98133 Phone #: 206-228-9389 _ _ E-mail Address: mahi.haddadi@hotmail.com Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. Applicant: Authorized Agent/Representative (if other than owner) Name: Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Michael S. Deeney License # S/ /O Address: P.O. Box 2787, Port Angeles, WA 98362 Phone #: 360-457-6353 E-mail Address: mike@cds4you.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant _ - Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant _ Name: License # .-- -- Address: Phone #: E-mail Address: 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 or her 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. vI Print Name: �r�� P b i IM �1,HCh.41 ISG Date: � � — Signature: „.1 2;,. 1 Jefferson County Health Department 615 Sheridan St. Port Townsend, WA 98368 Subject: Culverting Stream To whom it may concern; I, the undersigned, Mahieddine Haddadi, owner of Parcel Number 984000406 (residence at 3380 Paradise Bay Rd., Port Ludlow, WA 98365), acknowledge and grant permission for Christine Ardoin, owrier of Parcel Numbers 984000410, 984000412, and 984000414 (41 Pine Way, Port Ludlow, WA 98365) to culvert the stream running across Parcel Number 984000406. This culvert is pending approval by Jefferson County (and any other required regulatory agencies) of the repair septic system being proposed by Christine Ardoin for Parcel Numbers 984000410, 984000412, and 984000414 (41 Pine Way, Port Ludlow, WA 98365). Said culvert must meet all requirements set forth in said septic system repair permit approval. Culvert shall be placed in the same location as the existing stream path. Additionally, both the proposed and existing culverts shall be backfilled with sandy loam soil to match the adjoining existing grade (for a smooth even grade across the area of proposed and existing culverts). Sincerely, Mahieddine HaddWi ` 17812 Wallingford Ave. N. Shoreline, WA 98133 Of- 12�- 2191.. JEFFERSON COUNrl' 010alaMpMLTRIPermission to Culvert SlreannWaddadi, 3380 Paradise Bay Rd, 984000406, Culverting Stream (Rev 1) .wpd FEEw ON DEPARTMENT OF COMMUNITY DEVELO 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 NOV 1 7 2016 Web: www.co.iefferson.wa.us/communitvdeveloornent E-mail: dcd@co.iefferson.wa.us JEFFERSON COUNTY SUPPLEMENTAL APPLICATION _ DKPT. O COMMUNITY CfE:uE1_0laM1 STORMWATER MANAGEMENT PERMIT MLA# PROJECT/APPLICANT NAME: Christine Ardoin Applications for grading projects or land -disturbing activities which require a stormwater management permit shall include the following information. This information may also be provided on other diagrams, plans, studies, or attachments submitted with the project application. If so, please indicate such on this permit application. The Administrator may waive specific submittal requirements determined to be unnecessary for review of the application. 1. Source of fill material and deposition of excess material. Fill for backfilling culvert will come from excavation for septic tank, pump chamber, and Glendon Biofilter containment vessels. Any excess material will be hauled off site. 2. Physical characteristics of fill material: Native sandy loam to loarny sand 3. Proposed methods of placement and compaction consistent with the applicable standards in the International Building Code. Back . 4. Proposed surfacing material. 5. Proposed method(s) of drainage and erosion control. Per apprnved HPA permit (Permit -N umber 2016-6-558+0 1, Appi icatiQn 1 D 7 .9442), silt fencinq will be promided downslope of all rionstuiction activities withio 50 feet of the non -fish h;ihiitqt.-,trPgm 6. Methods for restoration of the site. Will replant disturbed area with 2rass. The sand areas of the Glendon Biofilters may be planted with either grass, white clover, or any one of the plants on the list approved for Glendon Biofilters at http://www.glendon.comriindex.php?main_page=page&id=11 7. Demonstrate that instream flow of water will remain unobstructed. Construction will be during the dry time of year between 7/15/17 to 9/1/17 er approved HPA permit no. 2016-6-558+01, Appl. ID: 9442. Flow if any) will be diverted to a lined pit and pumped to a point in the stream downslope of construction. 8. Demonstrate that erosion and sedimentation from outflow channels will be minimized by vegetation or other means, and demonstrate that pond runoff will be controlled to protect adjacent property damage. Per approved HPA permit (Permit Nurnher 9n16-6-558+01, Application 07 9U9), outflam channals By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected PrPI� (L NDOwNER OR AUTH Rlz D R PRESENTATIVE SIGNATURE) (DATE) G:\PerrnitCenter\##NFORMS###\DRD\Stormwater\stormwater mgml permit FINAL doc REV 10/20/2014 Page 3 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 Web: www.co.lefferson.wa.uslcommunitvdevelonment E-mail: dcd@co.iefferson.wa.us STORMWATER MANAGEMENT APPLICATION Purpose All new development and redevelopment must conform to the standards and minimum requirements set by the Washington Department of Ecology Stormwater Management Manual for the Puget Sound Basin (SMM) currently adopted by Jefferson County and be accompanied by a stormwater management permit if required by JCC 18.30.070(5). You will submit a Master Land Use Application Form in conjunction with this supplemental application. The Administrator may require additional measures as indicated by the environmental review or other site plan review. For projects that involve a building or land use permit, stormwater review will occur as part of your overall application review. A stand alone stormwater management permit is required for clearing and grading activities exceeding 7,000 sq/ft that do not involve a building permit or other land use approval (ie. preparing land for future construction, clearing for speculative purposes, etc.). A stormwater management permit is required for the following activities: • All grading of 500 cubic yards or more; except for those activities exempted under JCC 18.30.070(5) • All clearing and grading activities within environmentally sensitive areas as defined within 18.22 of the JCC; • Land -disturbing activities of 7,000 square feet or more; or • Creation of 2,000 square feet or more of impervious surface Exempt Grading Activities The following activities are exempt from the requirements for a stormwater management permit (if located outside of an environmentally sensitive area) under the provisions of 18.30.070 of the JCC: • Maintenance of gravel roads; • A SEPA-exempt residential driveway; • Construction of a Class 1 -III logging road (per RCW 76.09.050 and WAC 222); • Construction of drainage improvements in accordance with the JCC; or • Construction of a pond of one-half acre or less which is not in a regulated wetland. Stormwater Disposal Policy Along Marine Shorelines Pursuant to JCC 18.22.130(2) all new development activity, including single-family residential construction, located on Marrowstone Island, Indian Island and within 500 feet of any marine shoreline is required to infiltrate stormwater runoff onsite, to the maximum extent practicable. This provision is intended to prevent seawater from intruding into underground aquifers, reduce non -point source pollution to marine waters, and reduce the potential for shoreline erosion due to tightline failure. This provision is interpreted as establishing a hierarchy in which the first and best alternative is on-site infiltration using drywells or other methods, the second best alternative is upland off-site disposal, and the least preferred alternative is direct discharge into marine waters through a stormwater tightline. In order to utilize the least preferred alternative, a stormwater tightline discharging directly into marine waters, applicants must demonstrate through a geotechnical or similar report prepared by a licensed professional that both on-site infiltration and upland off-site disposal are not practicable or feasible. The report must include cost figures for comparison. G:%PermilCenleAl##FORMS###%DRD\Stormwaterlstormwater mgmt permit—FINAL doc REV 10/20/2014 Page 1 Please note that if a stormwater runoff tightline that terminates at or near the marine shoreline is allowed to be included in a development application, review under the Jefferson County Shoreline Master Program, the State Environmental Policy Act (SEPA) and other agency approvals (such as Hydraulic Project Approval from the Department of Fish and Wildlife) may be required as well. A Joint Aquatic Resources Permit Application (DARPA) form would need to accompany any permit application which includes a stormwater tightline at or below the ordinary high water mark. Criteria Prior to issuance of a stormwater management permit, the applicant shall submit a Master Land Use Application (MLA) and the required stormwater management plans to the Administrator for review and approval. The development definitions, criteria and thresholds for determining stormwater management plan requirements from the adopted Stormwater Management Manual (SMM) are found in 18.30.070 of the JCC. This includes minimum requirements and thresholds for developing a: • Small Parcel Erosion and Sediment Control Plan; • Large Parcel Erosion and Sediment Control Plan; • Permanent Stormwater Quality Control Plan (PSQC) Process The Administrator of the Department of Community Development will issue the stormwater management permit consistent with a Type I (administrative) permit process only upon a finding that the proposed use or activity meets all applicable requirements of 18.30.060 and 18.30.070, and any other applicable requirements of the JCC. G:\PermitCente FORMS###1DRD1Stormwaterkstorrnwater mgmt parmit_FINAL doc REV 10/20/2014 Page 2