HomeMy WebLinkAboutBLD2010-00026 • 110
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
Carl Smith, Director/Building Official
PERMIT#: BLD10-00026
SITE ADDRESS: 427 LANE DE CHANTEL Issue Date: 08/31/2010
PORT TOWNSEND, 98368 Final Date: 8/27/2012
APPLICANT: COLUM P TINLEY PHONE: 360-385-5244
409 LANE DE CHANTEL
PORT TOWNSEND WA 98368-8815
SUBDIVISION: Block: Lot: TX 7+
PARCEL NUMBER: 001302012 Section: 30 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NSFR W/ATT GARAGE &A/G 100 GAL PROP TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006
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 8/27/2012
\\tidemark\data\forms\F_BLD_Occupancy.rpt 9/6/2012
Jefferson County Building Alton Permit Nu•: BLD10-00026
Applicant: TINLEY
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks f Per owner stakes
v.7
Setbacks Minimum setback from Lane De Chantel Road right-of-way shall be 20
feet. Minimum side yard setbacks shall be 5 feet and a minimum of 75
feet from the stream to the northwest of parcel.
Erosion Control SEE CONDITION 2&3
Foundation Footing g n,�_
Foundation Footing 3/15/2010 1�'7
Footing Drains /1 - -/0 0
Foundation Stem Wall 8/30/2010 l 1/"
Foundation Stem Wall I�_ p 10 >P
Underground Plumbing 2-2o-to r 6
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing ee
et ti4.614 4 coot". 410-l t
Rough in Plumbing �,�`'
Shower Pan
Framing ! (6
Blocking
Airseal <3'1- ((
Insulation:Walls
Insulation: Floors `�
Insulation: Ceiling
1")— It
Int. Shear Wall Nailing
Wallboard Nailing / - _ - (I"
Gas Line: Interior . „C-10 Fe)
w
Gas Line: Exterior
Propane Tank ��
Heat/Chimney Clearance
Drywell/Alt Drainage f oZ 7, �J/`Z SEE CONDITION 1
0 '
Address Posted ��7 ,1(? (/_
Miscellaneous Special inspection A325 bolts
Miscellaneous pre-mfg wall panels
Miscellaneous 8/30/2010 floor pan inspection per AL
1
Miscellaneous 6/3/2010 ill floor slab IN
FINAL INSPECTION (1?- ,)-2- jL Fri7
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
JILDING PERMIT APPLICA•N MRA e0 000 21
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00026 Received Date: 1/25/2010
SITE ADDRESS: 427 LANE DE CHANTEL
PORT TOWNSEND, 98368
OWNER: COLUM P TINLEY PHONE: 360-385-5244
409 LANE DE CHANTEL
PORT TOWNSEND WA 98368-8815
SUBDIVISION: Block: Lot: TX 7+
PARCEL NUMBER: 001302012 Section: 30 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: HENRY M SOUZA PHONE: (360) 379-8338
DESIGNS BY SOUZA INC (360) 379-9136
164 SWANSON
PROJECT DESCRIPTIOP NSFR W/ ATT GARAGE &A/G 100 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,768
VALUATION 335,426.00 ADD'L: 449 HEAT TYPE: HTP
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE 728 SHORELINE:
CONST TYPE: DECK: 60 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,315.35 LYK 01/25/10 113694 APPRDVEt)
Plan Check $1,504.98 LYK 01/25/10 113694
State Building Code $4.50 LYK 01/25/10 113694 3(
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Potable Water Application $98.00 LYK 01/25/10 113694
Total: $3,922.83 Z,`*`' .
•
CONDITIONS for Building Permit# :BLD10-00026
1.) STORMWATER FROM HOUSE ROOF WILL BE TIGHTLINED FROM GUTTERS TO
FOOTING DRAIN PIPE AND DAY LIGHTS NORTH OF THE HOUSE TO THE RAVINE.
2.) A SILT FENCE SHALL BE INSTALLED AROUND THE PERIMETER OF THE CLEARED
CONSTRUCTION AREA PRIOR TO ANY LAND DISTURBING ACTIVITY TO PROTECT
THE STREAM AND LANDSLIDE HAZARD AREA BUFFERS.
APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT
DOES NOT ENTER THE STREAM.
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
3.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
4.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
5.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
6.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area located outside the 200 foot shoreline jurisdiction. All buffers shall
be measured perpendicularly from the top of the Landslide Hazard Area.
7.) A Geotechnical Report dated January 3, 2001 prepared by Stratum Group was submitted
in conjunction with this application. The report addressed the stability of the geologic
hazard area. A minimum setback of 150-feet shall be measured perpendicularly from the
top or toe of the geologic hazard to the proposed single family residence.
8.) •
Landslide Hazard Areas and their associated buffers shall remain naturally •
vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
9.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
10.) All construction activities shall not encroach upon the landslide hazard area buffer. This
includes the storage or preparation of materials.
11.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer(located outside the 200 foot shoreline jurisdiction) from the remainder of the
subject property through installing logs, trees, a hedge row, or any other prominent
physical marking approved by the UDC Administrator.
12.) 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.
13.) The identified Fish and Wildlife Habitat Area (Type Ns Stream), shall maintain a
vegetative buffer setback of 75 feet for that portion located outside the 200 foot shoreline
jurisdiction. The setback shall be measured horizontally from the Ordinary High Water
Mark (OHWM) to the proposed single family residence.
14.) An additional setback of five (5) feet is required from the edge of the stream buffer area
for that portion located outside the 200 foot shoreline jurisdiciton to the proposed single
family residence.
15.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained for that portion located outside the 200 foot
shoreline jurisdiction. Such separation can include installing logs, trees, a hedgerow, or
any other prominent physical marking approved by the UDC Administrator.
16.) Stream 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 be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
17.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat
management plan.
18.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
19.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
•
20.) Not more than 2 unlicensed vehi shall be stored on any lot unless totally s ed
from view of neighboring dwellings nd rights-of-way. Such screening shall me all
applicable performance and development standards specific to the district in which the
storage is kept, and shall be in keeping with the character of the area. Screening shall
meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
21.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
22.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
23.) The building height is not to exceed 35 feet.
24.) Minimum setback from Lane De Chantel Road right-of-way shall be 20 feet. Minimum
side yard setbacks shall be 5 feet unless a critical area is present. The proposed
residence is located greater than 200 feet from Ordinary High Water Mark.
25.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
26.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
27.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
28.) Maintaining ground cover will help reduce erosion from surface runoff. Any bare areas
that develop should be revegetated. Native low growing vegetation that requires little or
no irrigation would be the most beneficial
29.) Tree limbs, lawn clippings, etc. should not be thrown over the bluff because these piles
have a tendency to damage/kill the underlying vegetation which in turn increases the
erosion potential of the bluff soils. These piles also add unnecessary weight to the bluff
soils, especially when saturated with water.
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•
JEFFERSON N
DEPARTMENT OF COMMUNITY DEVELOPMENT
'"' 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4 c$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: kC) - 2-
Project Description(include separate sheets as necessary):
77fLET .t.C5rb6/GE
Tax Parcel Number: v 0 i 3 D 2- 0 /Z Property S• a
p y Size: 7 (acre quare feet)
Site Address and/or Directions to Property:
4d-7 GAA!E DC C.H/iAiTAL- 10pi- 73wads N15
Property Owner(s)of Record: CnL-.4ry 7/NLE�/
Telephone: at- - 3es -S"2..4-'f Fax: / email:
Mailing Address: 401 G4NC p E GHAr v- ?c i r T.vI /5 Eni.k. i l tiv4 q e3/n
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address: r
Wh t kind of Permit?(Check each box that applies 0 Lot or Road Segregation
Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
M"Single Family t 'Garage ttache /Detached ❑ Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* El Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business El Cottage Industry El Binding Site Plan**
ErPropane 0 Long Plat**
❑Sign - ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* El Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* El Comprehensive Plan/UDC/Land Use District Map Amendment
El Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference El Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate '6 1 / SDU�h to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE a eA9 Date: /,/7// -
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that hpx sh want for nice.Signature:.___)L, i / /— Date: // Y//v
The action or actions Applicant will undertake as a suit 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-transfrable respons. ility f r adh�rplg to • mplying with the ESA. The Applicant has read this disclaimer nd igns and dates it below.
Signature: i—'- Date: 1/8//
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Ann1;r-at;r,.,5_7QJ)R Ary
• •
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 response y of the eneral Contractor for the proposed project.
Signature: � >{� Date: /A/�
1
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:
,.K New ;(Wood Existing: ❑ Sewer
❑ Addition 0 eel Proposed: Z Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: 2- _ Height: 1 Individual System
O Repair ❑ Masonry SEP Permit# 04-Da)-3?
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
•T of He Proposed: Zr Public
y,I i- ) t) Total: Z Name of System:AA 6 "Ifi
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:
i Underground Tank '6/Abovegrpand Tank Size of Propane Tank: !et)
I Heat Stove i i
ook Stove eWoodstove 1 Fireplace Insert 1 Hot Water Tank i Pellet Stove I Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes <9
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.
F'i r5
Square Footage Current Proposed Off pg U . 1 r y Amok V to
Main Floor Heated /.. ,`g d lga3 EH Bld App Review: -
-2`x'Floor Heated 44 Consistency Review: I
Other Heated Base fee: 2315.35
Mezzanine °°- ' -eetera" /1(�l -
Heated Basement Plan Check fee: S
Unheated Basement State Surcharge fee: 5-1
Other Unheated Pot Water Review fee: , I
Garage/Carport 72 0 ) 1440 SUBTOTAL
/11�iy3.K3
Decks 911/Rd Approach fee:
649 1943 £x_%si)
Other TOTAL: $ it-743
Receipt Number: I t I I
a : Cash/Check Number: /�� `j
ESTIMATED COST D Date: (•
.Fair mark a of all labor pnd mate foundation to finish '
-
3 ew6,, Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Perurit Application 5-29-08.doc
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JEFFERSON COUNTY
4 DEPARTMENT OF COMMUNITY DEVELOPMENT
J ,. 621 Sheridan Street • Port Townsend • Washington 98368
S`ING1SO http:/360/3
� 79-4450
/www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# I C ) 'c L f PROJECT/APPLICANT NAME: ---17/I/L Cy R E's/(?ENCg
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.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
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5. Describe the existing site hydrology (i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each. 7741E- /Vc Z) P2D•01-R-J-1 L/NE ,c1,t.1-0 77ir 1y9 4 Cdoliou
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APPROVED
6. Describe any excess levels of noise generated blpFORe9tWilksTERctpitcAN
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Required
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7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map. /V D w&5-?_/4N6s ON Pe,01'E47y •
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas
(streams,wetlands, lakes, steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g• Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for"large"projects or projects that involve the potential for dispersion of contaminants.]
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it Describe the performance goals and standards applicable to the project.
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12. Describe the flow control system.r- ..... .. .. ...._ 4
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stormwater site plan template—rev.10/21/2008 i 'I 6
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13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
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15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals
here. /
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements, describe those conditions or
restrictions here.
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stormwater site plan template—rev.10/21/2008 7
• •
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at Volume II Section 3.2.3 of the Manual (beginning
on page 3-7).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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2. Establish Construction Access.
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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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stormwater site plan template—rev.10/21/2008 8
• •
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices (BMPs).
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12. Manage the Project.
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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 of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/21/2008
9
• •
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.,erodibility, settleability, permeability,depth, texture, soil structure).
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5. Construction Phasing.
a. Construction sequence
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6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
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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 Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. N/
b. Diversions. /4
c. Waterways.
d. Runoff/Stormwater Detention Calculations
10
stormwater site plan template—rev.10/21/2006
• •
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 SWPPP 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.
f. Detail stabilization techniques for outletfinlet.
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.10/21/2008
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.
m_ I ///7/2":71 b
I
(LANDOWNER OR AUTHORIZEESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/21/2008 12
Apr 08 2010 2: 52PM HP4ASERJET FAX p. 1
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