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Home My WebLink AboutBLD2014-00417 - 01 PERMIT APPLICATIONI Q,TLDTNG PERMTT orrrGt*BLD14-00417 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERIVIT #: SITE ADDRESS: OWNER SUBDIVISION: PARCEL NUMBER: BLD14-00417 1470 CAMP DISCOVERY RD QUILCENE, 98376 MICHAEL C HOLLAND PO BOX 372 PORT TOWNSEND WA 98368.0372 701224013 Section: Received Date: 111612014 PHONE: 360-731-6989 Block: 22 Township: 27 N Range: 1\ Lot: TX14r CONTRACTOR: REPRESENTATIVE: NIEMAN CONSTRUCTION CO P. O. BOX 846 QUILCENE WA 98376-0846 Contractor'sLicense NIEMACC0lSMZ Expires PHONE: (360) 434-0717 811512016 PHONE: PROJECT DESCRIPTIOT NSF/ NO GARAGE w/ 250 GALLON PROPANE TANK sEP09-00017 zoN09-00086 TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: Exist: 0 Prop: 3 Total: 3 RES NEW 342,000.00 2012 CON l PWELL BATHROOMS Exist: 0 Prop: 3 Total: 3 SQUARE FOOTAGE: MAIN: ADD'L: HEAT BASE UNHEATED OTHER: GARAGE: DECK: 1,087 1,065 HEAT TYPE: HEAT TYPE: # OF STORIES WOD PRO Routinq Date: SHORELINE: SETBACK: BANK HEIGHT Approved/Date APPROVED APR 2 3 2015 Jefferson County DCD 553 Type Amount Paid By: Date: Receipt: Permit Plan Check State Building Code Potable Water Appl ication Total $2,721.00 SRE $1,768.65 SRE $4.50 SRE $67.00 sRE $4,561.15 11106114 11106114 11106114 11106114 151720 151720 151720 151720 \\tidem ark\data\form s\F_B LD_App_Bld.rpt 11t10t2014 =rr=*ro3uJ NTY o DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 | Web: www.co.iefferson.wa.us/communitydevelopment Tel: 360,379.4450 | Fax: 360.379.4451 | Email: dcd@co.iefferson.wa.us Square0ME Resource Center lBuilding Permits & lnspections I Development Review I Long Range Planning November 18,2014 MICHAEL C HOLLAND PO BOX 372 PORT TOWNSEND WA 98368-0372 RE: SITE ADDRESS: 1470 CAMP DISCOVERY RD CASE #: BLD14-00417 Dear MICHAEL C HOLLAND We have started the plan review process on the subject permit. Unfortunately, we are unable to finish the necessary plan review. We are in need of additional information and/or items as listed below: -StructuralCalculations@ie+to''study''wallsupports. -Placement of water heater Please submit the necessary items in order for us to complete the plan review process of this permit lf you should have any questions, please feel free to contact me at (360) 379-4450. Sincerely, [t/arv Blain Plans Examiner c: File PETER BRACHVOGEL NIEMAN CONSTRUCTION CO \\tidem ark\data\form s\F_BLD_Add I nfo_PlnChk. rpt 1 1 /3/1 999 oo DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port'Iownsend, \X/A 98368 Tel: 360.379.4450 | Fax: 360.379.1451 lWeb: wrrv.co.iefferson.rva.us /communit],'development E-mail: dcd@co.iefferson.rva.us PERMIT FEES \TORKSHEET Name Michael Holland Estimated Cost of Project S34r^OOOOO Building Base Fees Building Base Plan Check Review Land Use Review Septic Review Potable Water Technology/Sc State Fee Other Fees Shoreline Exemption Zoning Zoning New Address Public Works Tota! Fees 701224073 $q,gzt.ts Parcel # Permit # \n s, @ $z,72L.oo S1,768.65 S228.oo s7e.00 S1o7.oo s1s.00 s4.so Receipt Number: Cash/Check/CC: Date: lnitials: Office Use O (. o o DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 ' l'el: 360.379.4450 | l.ax: 360.379.4451 web,yary*qi@ E -mail: dcd@co.iefferson.wa.us MECHANICAL PERMIT t-/^J--l_Ev tr[Vtr D nl ON Steps in the Permit Process: -Review required submittal ite CN COUNTY ms to ensure all information is completed prior to submittingrpplication.-- -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -Fees will be collected at intake. Additional fees m after review and ent is uired before rmit is issued. ls this application for use in a Mobile / Manufactured Home? * lf Yes: A permit from Washington State Department of Labor and lndustries, not Jefferson County, is required for appliances installed within a mobile/manufactured home. L&l - 360-4L7-2702* lf No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 Required Submittal ltems - for propane tank only r/ Complete Site plan - Please refer to the site plan checklist to ensure all items are on the site plan. Required Submitta! ltems - for Solar Panel installation only Complete first page and signature block only of Mechanical Permit Application A complete solar panel supplemental application. Receipt #:Date ent #:Related lication #s For Department Use Only Site lnformation Assessor Tax Parcel Number:?Z o( Site Address and/or Directions to Property: | 4# qgP ScttrleAt V6. Quicceanz, br* q9774 Access name of st from which access will be gained b tscoc ED Description of Work:79r.r rLb Str R- Property Owner Name: Address: Phone #: C c*Nb Pol=o{L , (rUA 36y 9A)-731- b?V?E-mail Address: Hrct*ec Hd.t*.tb# PyAtkfi. Please contact Authorized tative with project info --z& Property Owner Signature:(-Date: /f,/,/ horized Name: Phone #: License # ?*^/ ilrfl*t*,t/f/e</f/tLC.a/S^t/. @4 3bo-45+.o+(?E-mailAdd Expiration DateN t o1.l42a Otg 14 L @r0o l,mv ;t Mechanical Application 1 NOV 6 Heat Source {Propane*Electric Heating Oil Wood t/ o Installation manual must be on site at time of inspection or a re-inspection fee will be charged. 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 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 com plia nce with all applicable to Jefferson County a federal, state and county laws and regulations and I agree to provide access and right of entry nd its employees, representatives or purpose of application review o and any required later for visits related to this inspections. applicatio na Applicant may nd subsequent request notice permit issuance. agents for the sole of the County's inte nt to enter upon the property Signature Print Name: Nrc+raac /+/c"{^b Date: fi/<- lndicate Quantity and Fixture Types Below *Propane is prohibited in hazardous locations such as basements or pits or anywhere "heavier-than-air" gas can unsafely collect. *Propane tanks over 125 gallons require a minimum setback of 10 ft. from property line and buildings, and a site plan must be submitted with the application showing the setbacks. lf propane tank is over 500 gallons, a site plan is required to accompany this application, and a separate Fire Code approval is also required. Quantity Fixture Type Description 9 Fan Bath Fan andfor Exhaust Fan t Clothes Dryer Clothes Dryer with Exhaust Vent I Cook Stove Cook Stove, Range Hood Exhaust Fireplace - Gas Fireplace-Gas or Gas Log lnsert Fireplace - Wood Fireplace-wood, Wood Stove, or Pellet Stove Electric Furnace Electric Furnace or HP +l- Ducting I Propane (LP) Gas Furnace Propane Furnace +/- Ducting I Water Heater - Gas Gas WH Vent and Combustion Air Gas Pipe System Gas Pipe System LPG/O|l I Propane Tank LP FuelTank (# eallons: Lfl | Heat Pump 7 Generator Air Conditioner OFFICE USE ONLY Building Permit Fees Mechanical Permit fee ltank swap, woodstove, furnace, etc )S1s2.oo Propane - Lines, tank, and appliance (add'l 576.00) Project Scanning Fee s1e.00 Total Fees* +Additional fees may apply Mechanical Application 2 ( RtrGtrlll:---[Vtr NOV 6 J[TFTRSON COUNIY nF nriull,4l lNllY DtVtt ) ! j' {ile*F,g i.':,{' ifures Lare Su'1e c COLIFORM BACTERIA ANALYSIS County Type of Water System (check only one box) A E Group B Group A and Group B Systems - Provide from Water Facilities lnventory (WFI): System Name: Cell Phone: FAX: adCr-.ss Date Sarrple Ccliected ; l, 1,.' 1,1c.:f 3:i \'?2. -,i . .:- ! c"' Time Sample Ccllected Contact Person: Day Phone: ( ) Eve. Phone: ( Type of Sampte lrrrt.ri6iin[ onf Chlorine Residual: Total-- Free E E coli - GWR source sample E Fecal-Surface. GWl. some springs Eother D Distribution System I Source Groundwater Rule (GWR) (Population of 1.000 or less) Unsatisfactory routine lab number: Unsatisfactory routine collect date: Chlorinated: Yes_ No_ 2. Repeat Sample (after unsatisf actory routine) LAB USE ONLYWATERRESULTSLAB USE ONLY Total Coliform I Ecolipresent E Fecal coliform present E Eco/i absent E Fecal coliform absent Replacement Sample Required: E Sample too old (>30 hours) ! lmproper Container E rrurc E Turbiri culture Bacterial Density Results: plate Count_________1m1. E colr........---/100m1. Total Coliform l100ml. Fecal Code: 2730 Cdiform_=-/l00ml. Date and Time Received;lJethod MICR- plus Date Analyzed: 010 Date Use Oriy: I IIi I I I I I'I I I I I I I I I t tt I II [: ij ii l* I I t II SenC fesulis to: {Print fuil TT >r- t SAMPLE Sample collected by (name): Special instructions or comments: S Specific location where sample collected: box of#1 through #4 listed below) 1.n Routine Distribution Sample Chlorinated: Yes_ No- 3. Raw Water Source Sample Chlorine Residual: Total Free_ fue sFkrE mEtfwile sE nnbstun rdFt Sample Collected for lnformation 0nly lnvestigative_ Construction /0ther_ 4.s. Repairs_ Private 1 n )L e oTWISS LABOI{ATORTES 16276 Trrelr e Trees l-ane.suiteC Poulsbo.\\'.\ 983?0 Telephone(360)779-5111 FAX(360)i79-5150 IOC - SHORT IOC - SHORT b1'Various EPA Approved Methods Source ,/ Point of Entry - Report of Anall'sis Date Collected: Slstem lD \o: Lab - Sample #: Sample Location: Sample Purpose: Sample Composition Send Report To: I li{1201-1 Private 01091202 Well 7 Frost Free SPigot o S ivlichael Holland 5784 Rose LooP NE Bainbridge Island, WA 981l0 Group: Sl stem Nante: Countl': DOH Sourcc,r-o: Date Received: Date Anall'zed: Date Reported: Sarnple T1'pe: Collected B1 : Phone Number: Bill To: Private l-170 Camp Discoverl Rd Jetl'erson t li.l/2014 fit4120t+ fit6t20t4 Pre-treatment/Rart' Ivlichael Holland 360-73 I -6989 Michael Holland 5784 Rose Loop NE Bainbridge tsland. WA 98 I l0 DOH#Analvte - Results u;its - Snl - itieg.. Mai.- - uCr, - Method .l1p Exceeded Init.) nl4l- .- .0,i .. i . !!. . ,.lt.r.s/l= 20 ?50 , EPA 300.0 (Kw) EPA 300.0 (KW)20 Chloride __ 3.E9 SRL: Trigger Level: MCL: NA: ND: < (0.00x): (State Reportiug Level), iudicates thc minimurn reporting level requircd b1' llte Washitrgton Departlnent of Health (DOl{). regionat DOH office for ftrrllrer infonnation, llriaximum Contarninant Level), Ifthe contarninant arnounl exceeds lhe MCL, imntediately contact your regiotlal DOH office. iNot enall'zed), in the results column indicates this cornpound s'as not incltlded in the cunent atulysis. iNof Oetected)t i1 the results coltunn indicates this compound rvas anall-zed alld not detected at a level lreater than or equal fo the SRL indicates the cornpomd lvas not detected in the sarnple at or abore the concentration indicated I i I I I i__t It - \:/-' +jLo CLot o3 .g +aco co l, C' ELoILtr o +. Lot,E G' .E+.Go o {.. *.tr G' L. G3 Foz oooE' E".o oo UI rho +, o E+.L(lt CLoo o F €lwArERwFfr REPoRT fttf irlir;I Oridoal & lstclpy - Ecology,2nd copy - owacr,3rdcopy - driller Construcdon/Ihcomnrission ('x " da circlal . p.Constnrction CURRENT Notki of Intcut Wuer Right krrnit No. Ihperty Owner Well Suea ) "7 n Er,r- ORIG I N AL C ON STRU C:TI O N Notic e d Intent City &ltO t cation 5A,+ r,o5!1,a s* ?, H#,t' ' I-at Des - REQUIRED) Long Deg_ I-at tong Mn/Sec Tax hrccl No. WELL CONSTRUCTION CERTINCATION: I. constrrrcted and/or .ac.spt responsibility for consruction of ihis well, and its conrpliance with all Washington well consrucdon standards. Materials used and the informarion Fo;ttc" fJEngineer Drrainee Naalg Dri I IcrlEnginecr/Trainec !jtr,^sati,,zpR*' 'r,- , t aQ? i ContractorsHffiffiNM*?ar Ecotogyis an Equat OpportuEity Employer. ECy OjGl-20 (Rev {Ol) EI ocwatcr Muicipal !TesrWell lndustrial OF WORX: Ownet's numbcr of well (if more than ooe) We[ E Reconditiolcd Mcthod: flSog E Sor.d E Driu"o E] rat a ft. Diarncter of of complcrcd wcll E Btr Diam. from Diam. fiom Diam. from f/' rt-9V-a.?€'n 75'..t to _ft. to to' CONSTRUCTION OR DECOMMISSION PR.OCEDURE Fonnation: Dcscribc by colfi, chs'actcr, sizc of Eutcrirl atrd structurr, ad thc kind rsd.naurc of thc rnatcrial iD erch stratrm pcoctretr4 wi& at least one Etry. fc cacb chaogc of ioformatioo. Indicatc alt watff cocountercd. (USE ADDMIONAL SHEETS IF NECESSARY.) MATERIAL FROM TO E Yc. DAtto aad no. of from toofpcds 'ia. of perfcaor O/Dv.?dMR v-AhR-o 5zs-2 tu 7o 73 73 8AI9zDiam. . Slot Sizc_from_ft. to_-___________ft. Screcm: fivo E D r-rrc GravcUFilter:packed: flygs fl,Xo EI Sizcof Masials placed from_ft. ro fr 6le Sontz,ililB< t*,qL /oo /do /6-rSurfacc Seal: Ev.s E xo r" *Uf J*tr --r, Matcriars'r'"a i" *a /l ff " tZz Ve t ffi O/rlltS: Did any strata cotrtain unusablc water? .OVes ENoTypcofwater? Depth ofstraa Method of sealing srata nff \\ PUMP: Manufacuueds I IL_J WATER LEVEIS: J-and-surfacc elevation above rrean sca lcvcl_ft- Sraticlcvd 3/' ft.bctowopofwett o^n 3-lD-F- Artcian pressurc_lbs.. pcr square inch Date_--:_ (cap,ralve, etc.) Artasian wstcr is contollcd Eilv{F I o ,nnE \l/,...A:n.rr^* Q,,, kt*+-n+e+€ec Yicld gal./mjn. with ft drawdown after_hrs.Yield: gal./mio. with fr drawdown aftct Recovcry daa (inu taLcn as zcro when pump turncd olfNwatcr level measuredftom wcll top to water l*cl) Time Watcr l-cvcl Tlmc Watcr l,evel Tinr Watcr l,evel Tempcrature of water_Was i chcmical analysis made? drawdowo aftcr-.-tl-hrs. amouDt ENo -hrs. [.-lvcr E no Artesian Date of tf Ainest sal./min. with stcm-sct Eairlettat 7 '. girl-/min.with Yield: eal-lmin- watcr tivcl is lowcrcd bclow static level.. hrs. 1YELL TESTS: Drawdown is Was a punrp rest made? f]ycs by wbom? , - .. . drawdowu after_hrs. stArtD&-Z:%:9f Complered DaeE :/O -QS- If rainee. licrirrced driler's Signsutre ard Liceme no. or Traince Liccnse No.2?oo Unique kology Well ID TagNo. 0K€ U'o Ad&€ss FDs &xtn *un+t q q sitr tCrAt ,P,tdu, sravcUsatrd n :r I I Parcel Details Page 1 of2 o o Parcel Number:70t2240t3 Parcel Number: 701224013 C)wner Mailing Address: MICHAEL C HOLLAND PO BOX 372 PORTTOWNSEND WAgB368-0372 Site Address: 1470 CAMP DISCOVERY RD QUTLCENE 98376 Section:22 Qtr Section: SWU4 Township: 27N Range: 1W \ Database Tools Printer Friendly Sdlool Di*ict: Quilcene (48) Firc Dist: Quilcene (2) Tax Status: Taxable Tax Code: 0323 Plannirg arca: South Toandos Peninsula,Coyle Area (9) Sub Division: Assessor's Land Use Code: 9100 - Vacant Land Property Description: s22T27 R1W TAX 14 & 20 SUBJ/EASE & REST/COW #5416671#543528 SEARCH Permit Data Septic MonitorinoJI]la Tax. A/V. Sales, Photos. and Blda Data Mao Parcel Jrlf*rson {ounty HOME I COUNWTNFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later @ windows - uac http://www.co jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO:701224013 lll6l20l4 J e tfer$on (o u ilt M I oo JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street . Port Townsend . Washington gg36g 360/379-4450 . 360/37944b1 Fax http://www. co.jefferson.wa. us/commdevelopmenV Stormwater Gatculation Worksheet MrA# 09-00245 pRolgcr/epplrcANTNAME: MichealHolland DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed firstto classiff the proposal as 'small," 'medium," or "large." The size determines whether a Stormwater Site plan is required in conjunctionwith a stand-alone stormwater management permit-application, building permit application, or otner iand u"u "pprir"i afpriCiiion tnatinvolves stormwater review. The basic information wili also be helpful fJr tompleting a Stormwater Site plan, if required. PARCEL S]ZE (t.E.. SITE) An acre contains 43,560 sguare feet. Multiply the acreage by this figure. sq/flSize of parcel in square feel Size of parc"l 1'154 u"r"s Land'disturbile activitv is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative andnon-vegetalive) and/orthe existing soiltopography. .Land disturbing activities indud6, but are not liirited to crearin!, g;;di;j, nrring,excavation, and compaclion associated with Jtabltiiation of structurej and road construclion. yati.u: Y?setafion is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of thePacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such asDouglas fir, western hemlock, western red cedar, alder, big-leaf maple, ano vine mapte; shrubs such as willow, elderberry, salmonberry,and salal; herbaceous plants such as sword fern, foam floier, and ireweed. Answer lhe following two questions related to conversion of native vegetalion: Does the project convert Y< acres or more of nalive vegetation to lawn or landscaped areas? Circte: Yes @ Does the project convert 2lzaCres or more Of native vegetation to pasture? oLawn, landscaping,etc. 2,000 Construction site for structures 4,000 Drainfield, septic tank,etc. 0 (already installed) Well, utilities,etc. 0 Driveway, parking, roads, etc. 0 (already installedlqal sq/ff sq/ft sq/ft lndicate Total Volumes of proposed: Cut0 Fi[ 0 (cu/yrt) Circle: Yes Calculate the total area to be cleared, graded, filled, excavated, and/or compacted for proposed developmentprqecl. lnclude in this calculation the area to be cieared for: sq/ft sq/ft sq/ft Other compacted surface, etc. 0 Tota! Land Disturbance 6,000 [over] stormwater c6lc mrkshst - REV. 2!20/2006 50 installed) oe lmperuious sufiace is a hard surface that either prevents or retards the entry of water into the soil manfle as under natural conctitionsprior to development. A hard surface area which Gtuses water to run off the surface in greater quantities or at an increased rate of flowfrom the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to rooftops, walkways, patios, driveway_s, parking tots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,and oiled, macadam or olher surfaces which similarly imfede the natural infiltratioh ot siormwlt6r. The following questions will help determine whether the proposed project is considered development or redevelopment. - FURTHER INSTRUCTION-S: lf.the-answer is yes, the proposal is considered redevelopment and the attached Figure 2 should beused.to determine the applicable Minimym Requirements. lf the answer is no, the proposal is considered new deveiopment and theattached Figure 1 should be used. At this juniture, the applicant should refer to the applicable Flow Chart to dstermine lhe MinimumRequirements 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 stormwaler pollutionPrevention-an additional submittal is not required. The'proponent is responsible foi employing tnu i! Elemenls to control erosion andprevent sediment and other po.llutantslrom ieaving_the iite Ourlng the construction phise'of-the prolect. pick up the ConstrucgonStormwater Pollution Prevention (SWPP) Best ilanagement Piactice" fame"y packet. proponents of ,,medium,, proilcts-tnose llat must meet only Minimum Reguirements #1 thro-ugh #S-and for 'iarge' projects-those that musl meet all 10 MinimumRequirements-are required to submit a stormwater site-Plan- DCD has frepared a submittal template of a stormwater site plan,principally for rural residential projects. Complete the template in the Stormwater Site plan lnstructions and Submittal Template orprepare a Stormwater Site Plan using the step-by-step guidance in the S/ormwa ter Management Manua!. APPLICANT SIGNATURE NEW Structures (all roof area) Sidewalks Patios Solid Decks (without inf ltration below) Driveway, parking, roads, Other Total New STORMWATER CALULATIONS - IMPERVIOUS SURFACE EXISTING Structures (all roof area) Sidewalks Patios Solid Decks (without infi ltration below) Driveway, parking, roads, Other Total Existing2,6\4 2,858 This amount will be used to check total lot coverage. etc 400 etc 2,000 TOTAL NEW + TOTAL EXISTING" 4,924 removed2,134 858 and 448 to be 0 r00 0 0 DEVELOPMENT v. REDEVETOPMENT Divide the total existino impervious surface above by the size of the parcel and converl to a percentag ", 5.7 % Does the site have 35% or more of existinq impervious surface? circle: yes @ OR REPRESENTATIVE Worksheet,I as the applicanUowner attest that the information provided herein is true andI also cerlify that this apptication is being made with the full knowledge and consent of all the StormwaterBysigning Calculation tocorrec{the best of my knowledge. ofowners the affected property. Dtormmltr €lc wksh€ot - REV. 2DOr2OO8 0 sqm aal{+ t{ d p Front Parcel Review Parcel 701224013 Printed: November 6, 2014 a9Lu. 1(T MICHAEL C HOLLAND PO BOX 372 PORT TOWNSEND, WA 98368-0372 Site Address(es): 470 CAMP DISCOVERY RD QUILCENE, WA 98376 Parcel Number: 701224013 S-T-R: 22-27N-1W Legal Description 522T27 RIW TAX 14 & 20 SUBJ/EASE & REST/COVT #5416671#543528 Flood District Fire District: 2 School District 48Flood Map (FIRM) Panel No Total Acreage I Land Use: 9100 PlanningArea: ! Zoning: COMP PLAN DESIGNAIION: COMMUNITY PLAN UGA:UGA Trans Plot plan states "property line" ASSessof'S Map groperty lines on submitted plot plan must match the property lines as identified on the Assessor's l/4 map) Legal Access to Property YES No Parcel Tags or Scanned Documents YES NO ESA's: Special Reports N YES NO Designated Ag YES Shoreline NO Shoreline Slope Stability:-vrs No v{vf4 Wkwr t t t t t t t t Stream Type:YES NO FWHCA: YES NO Wetlands: YES NO Rare Plants:YES NO Seismic: YES No Landslide: yPs NO Flood: YES No Erosion: YES NO Stormwater site plan Forest Lands: ygs Aquifer Recharge Area:YES No SIPZ: none At Risk High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ t(YesNo Adjoining Forest Lands: I lf Mineral Lands: YES YESl\/T Agricultural Lands: I tk Archaeology: YES | Iy No Shootin gZone: I L,f Stormwater: New CommerciaV Rural/Inho YES Impervious Surface 4zz Land Disturbing Activity Stormwater Req's: Min Req #2 Min #1 thru #5 Min Req #1 thru #10 IVT Notice Provisions/Disclosure Airport ves No MRl_:ps.___xo__Foresf I lf Landscaping Required: Yes N I yy Parking Spaces NOr UBC nn^rO l(.Gz4 I ().zBulldine Heisht: uired wu&1, tv t4 tv{ Impervious Surface coverage percentage: Resource Lands & Public: l0% Rural Commercial: 60oh Rural Area of Buildingo , o",,llr1lii:::'Jt:rH'":,;'" u' Total Building (s) Size RVC:20,000 SF CC Setbacks: Front: 5-000 SF NC: 7-500 SF GC: 10.000 Ai Left Side: {Right Side:{ Rear: { SF All others: subject to septic & water constraints/None specilied Shoreline Setback: LSHA Setback: Road Classification Road Approach: SEPA Required: Flood Certificate RAP tv{ i{t( tv( ttr Existing Case(s) & Condition(s) Violations: Yes No Recorded Date of Subdivision: Plat Conditions: Lots/Require Declaration of f, * UGANo Protest Agreement f, ff Site Visit conducted YES I l) Require Final ZoningApproval YES I lr( ADMIN: Setbacks entered in Permi Over 5 yrs:tIDC <5yrs:Plat Conditions on plat or Old Ordinance YES NO AFN t Plan case YES NO YES New Parcel Tags entered in Permit Plan YES Special Reports Scanned C'', yps No parcel tags found for parcel Cases Associated with APN 7012240'13 ReviewCases Name Tvpe Status PlannerCAMI4-00550 HOLLAND NA M David Wayne Johnson Application Received: l0ll12014 Permit lssued/Case closed: l0ll12014 Case Finaled: Can I extend my SPAAEfSTT6-months? What is considered a c6hllEtE?p-plication? MLA09-00093 SEP09-00017 MLA09-00093 HOLLAND F Michelle Farfan Application Received: 212612009 Permit lssued/Case closed: 512912009 Case Finaled: l1l5l20l4 SEP99-187 valid and n6EE-FZffif this system & filed here. MLA09-00245 New conventional septiEl5lern SEP99-00187 WARD F Application Received: 612911999 Permit lssued/Case closed: 712811999 Case Finaled: 7125/2001 info filed to SEP09-17 soM99-00187 Application Received: 712512001 HOLLAND Permit lssued/Case closed F Case Finaled: USRO5-OOO46 HOLLAND Application Received: 611312005 Permit lssued/Case closed this well proposed to beThZEtlTilh parcel 701224013 \\tldemark\data\forms\R_Parcel_CRMLA. rpt 111612014 Case Finaled A Paee 2 of 2 ZON09-00086 MLA09-00245 HOLLAND I A Michelle Farfan Application Received: 712312009 Permit lssued/Case closed: 1111212009 Case Finaled: SPAAD - SITE PLAN APPROVAHDVANCED DETERMINATIONn6'iESftfeTIfal development & ROW Setback Variance cAR99-00272 WARD F Application Received: 612911999 Permit lssued/Case closed: 7ll2ll999 Case Finaled: 7ll2ll999 o a bmittins appt!g%t$n. DEPARTMENT OF COMMUNITY DEYELOPMENT 621 Shcridan Strcct, l)ort'l'ownscnd, WA 98368 ' l'cl: 360.379.4150 | Hax: 360.319.4451 Web: I i-r.r.rail: dcd(gJco.icfterson.wa.us PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to su -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 350-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued For Department Use Only Related Application #s: Building Permit # MLA # I IY IY DIVTI OPI4ENT Site lnformation w4 oAssessor Tax Parcel Number: Site Address and/or Directions to Property I +74 u*/Pot Access (name of street(s)) from which access will be gained 6; sFi< 1- Description of Work (include proposed uses): Present use of property: This propety is served by Port Townsend of Port Ludlow sewer system?YES lf not served sewer identified above, ide belowof Community Septic Name of System: CoNVeAtT?baL<L Are other residences connected to the septic system? Additions or repairs to sewage system: ls it a complete or partial system installation: Has a reserve drainfield been designated? Date of Last Operations & Maintenance check: Complete yl _ Partial _Yes;l No _ NIZ'VCF USe b Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: -a/g+o?7 Type of Sewage System Serving Property:-seP Case #: X s"Pti'Septic Permit #: Pcmit ,\pplication Prgc I of 2 r- /^ r= n \// I-.Elr: \*,2 L:- ll v/ lL- , m --# Wastewater - o a contact for It is the the authodzed or sent to N+ Date: // Agent/Representative with project info. (select only one). Property Owner: 3Go"1>t :6?El ct$trl-7?z E-mailAddress:@ _ Please Property Owner Signature: Name: Address Phone # with multi attach a rate sheet with each information ande atures.Note: For ibe,,va LJ4 Name: Address: Phone #: €. E-mail Address: Professional:ls this an for this project?--B Consultant -Engineer Name: Address: Phone #: Architect Surveyor t/ Contractor Y8 * +3+- o E -m ai Add rESS ens^/,4o*1 Professional:ls this an Authorized for this project?NO YES Engineer Name: Address: Phone #: _ Architect K Surveyor Contractor Consultant B*rc{GeL 7C :rl?7 A lf w* E-mail Address Professional:ls this an Authorized for this project?NO YES Engineer Name: Address: Phone #: Architect Surveyor Contractor Consultant E-mail Address: Professional:ls this an for this project?NO _ YES_ ConsultantEngineer Name: Address: Phone #: Architect Surveyor Contractor E-mail Address Attach additional pages if necessary Builders Statement The signer of this st ent certifies that they are the Owners of the parcel referenced herein, that they are not licensed contracto Signature uming the responsibility of the General Contractor for the proposed project. Print Name://r.u*Lu &taL+r.rt> Date: rr/r/t4 rsa will Pcrmit ,\pplicrtion Pri:c 2 of 2 the the to information to all with and owner to ensure their accepts County and County will the owner for the Applicant/ProperW Owner lnformation Applicant: Authorized Agent/Representative (rf otherthan owner) -s --- Pa #Related A lication #s: For Department Use Only DEPARf,ENT oF CoMWN .621 Sherid.rn Streer. Port Tonnser-rd, 1y69836=-. Tel: 36a379.115C I Fa-x: 36C.379.4451 I ITY DEVELOPMENT il\\Yeb: nrr"ir,.co.jeff erson.sa.us/con'rmunitrdevelopment E-mail dcd@co.ieffenon.rva.us NTAL SINGLE FAMILY RE,SIDENCE PERMIT OR DUPLEX Enter the uare footage () that a in each field Site lnformation Assessor Tax Parcel #:L zz(I eof e Family Residence or D New K Addition Select One Modular Duplex .Single Fa mily-Residence ,k +A separate permit is required Replacement Repair Relocated Demolition > --L,\ Number of floors 2-existing# new bedrooms # new bathrooms total bed total bathexisting n- Select allthat apply Electric Heating Oil Propane K Structure 'Existing Sq/Ft Proposed Sq/Ft Main Floor .a,o 4s# 1og+I 44',t7=' 1O6d Additional Floors - heated / unheated I Basement - unfinished Basement - finished ace or habitable Detached Gara - heated / unheated lh Attached Garage - heated / unheated I Garage 2nd fl- unfinshed storage --=-<E-L 2nd - finshed space or habitableGara Car rt - 2 walls or less Deck - uncovered AqqS 372 sr Covered rch ZZI gF Other shed, barn, pole bld etc Estimated Cost of Project (Requi ooo i.: /Fl!= \\l 1/ r-t-= 0y T Owner Name: Heat Source I Second Floor tif.qEB'€P 2*.t: rtl a List existin buildi son i.e. house accesso dwelli unit sh mobile home other Resolution #99-90 requires building permit applications to provide evidence of an adequate potable water supply per the conditions of RCW lg.Z7.Og7 andthe GuidelinesforDeterminingWoterAvailabilityforNewBuildings.http://www.co.jefferson.wa.us/commissioners Signatu re Date By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is trie jnd dorrect td gre Uest of his, her or its klnowledge. Any material falsehood or any omission of a material fact made i;t t# o*neriagent with respect to this application p5cket niay result in making any issued permit null and void. Print Name ilrctt-rat /1o tCr+ND r,'i i UseAll Existing Buildings on Property C'R.+r<rv coL>caBtN Public Health lnformation Proposed AttachExistiWater Source of: 1) Well Logs (if no log report on file, a L hr stabilization test may be substituted.) t/21 Lab analysis tested within 3 years of application. -Total Coliform, Nitrate-N, Chloride Private well \a--T- Items above AND recorded Operations & Maintenance agreement and recorded Easement. 2-Party Well Provide justification and design perJefferson County Environmental Health policy 97-01 http://www.jeffersoncountypublichealth.org/pd f / Policy -97 - 01 Rainwater Collection .pdf Alternative System: Valid Water Right Permit: Generally applies to springs, attach copy -Submit Water Availability Notification form completed by your water purveyor. Public Water:Name of Water Provider: NOTE: lfanyoftheaboveutilitiesneedtobeinstalledanddisturbancewill occurinapublicmaintainedorunmaintained road and/or Ri ht-of-Way easement, then a Ri -W application will be needed. FOR OFFICE USE ONLY 1) Water Right Permit # 2) Public Water Supply WS lD# 3) lndividual Well Meets Water QualitY Standards?Yes No ln Compliance Yes _ No _ WRIA 17 Subbasin SIPZ -Coastal/ Moderate / High Based upon information provided by the applicant, it appears that the potable water supply: 'i - Meets __:_ conditionally.Meets Dqgs nPlJvle€t .. Yes No /-ln property for o STRATUM GROUP P.O. Box 2546, Bellingham, WA 98227 Phone (360) 714-9409 April 15,2015 Michael Holland 5784 Rose Loop NE Bainbridge Island, WA 98110 Re Stormwater Plan Jefferson County Parcel: 7 01224013 1470 Camp Discovery Road Quilcene, Washington Dear and Mr. Holland: I have reviewed the proposed development plans for your property and reviewed the geology hazatd assessment for the property (Stratum Group, 2008). fhe pioposed developr.nt *ilifrly disperse stormwater consistent with the Ecology Stormwater Management Manual for Western Washington (2012) with sheet flow dispersion from the existing roud thut crosses the property and the proposed parking area consistent with Ecology (2012) and infiltration and/or sptastr - blocks for roof run off consistent with Ecology (2012). Stormwater management in this manner is consistent with the Ecology (2012) and is consistent with the geology ,iazardreport previously prepared for the site and is consistent with my own assessment of geoiogic and soil conditions atthe site. The site is underlain by very well drained gravel and sandioilsierived from glacial runoff. Setbacks and Slope Stability The Stratum Group (2008) geology hazard,assessment regarding geology conditions concluded that no landslide hazard was present on the site. A moderately steep tow Uluff slope is located to the west of the proposed home site and the geology hazard,assessment recommended that the home be set back from that slope by 20 feet. The slope and area above the slope are underlain by very well drained soils and infiltration and dispersion of water above the slope area will not cause slope stability or erosion issues on the slope. Stormwater Management The proposed stormwater plan meets the recommendations of the geology hazard,assessment (Stratum Group, 2008) and is consistent with the Ecology (2012) rio.-*ut.. manual adopted by Jefferson County. The proposed stormwater management for the site is for dispersion of run off consistent with Ecology (2012) volume v, chapter 5.3 for on-site treatment. Existing Impervious Areas The subject property has approximately 2,858 square feet of existing impervious surface on the APR 2 2 2015 Ef, i ,;I::l:,l;. ,ti VED ]il.TE,RSON COUNTY DEPT. 0r c0 ljilviu Niu oEVELoPIIENI- APR 2 2 2015 E cef,v a a April 15,2015 Stormwater Plan site consisting of the existing road that crosses the property (2,000 square feet) and an existing dilapidated cabin, old small barn and an old chicken coop. The existing dilapidated cabin wilibe removed from the site. New Impervious Surface Areas The proposed home and parkingareawill add 2,614 square feet of impervious surface. part of the home will be located an areaof existing impervious area where the existing dilapidated cabin is located. Total Impervious Surface Areas The total coverage of existing and proposed impervious surfaces is approximately 5.7yoof the property. The total area of existing and new impervious surface will be approximately 4,924 square feet. Stormwater BMPs for the Site The stormwater generated by the existing road on the site is currently infiltrated into the ground via sheet flow to the sides of the road area. Sheet flow and infiltration from the existing riad areas consistent with Ecology BMP T5.12 will continue. The additional proposed parking area and walk way to the home from the parking area will also utilize sheet flbw1o the sides of tf,. parking area that will infiltrate readily into the underlying gravel and sand soils at the site. No new driveways or access roads will constructed. Stormwater from the roof areas will be managed by BMP T5.10 (infiltration). Stormwater from the roof areas will be infiltrated via splash blocks or via an infiltration trench located to the west of the home. Soils underlying the proposed development area consist of very well drained native soils of gravel and sand. o 2 Stratum Group File:2.10.15 o o April 15,2015 Stormwater Plan -l ^?6 t. s. l )E '.t.__. tclll.otel ''_'"__''. wrArc€ffiu-a@Na-o 'x.tcuNl qct. /r@'. B6q s{ T,PELANP BEACH SITE PLAN X,t- Figure 1. Stormwater Site plan NmrH The subject property is appropriate for infiltration as the soils at this location are well drainedwith soils in the vicinity of the proposed building site consisting of Everett gravely sandy loam.This soil is very deep and has no restrictive layer atdepth of at ieast 80 inch-es. For roof drains, splash blocks are appropriate atthis site for infiltration or altematively roof drains may be direct water to infiltration areas or dry wells. If infiltration trenches are used theinfiltration trenches should be at least l0 feet long for every 700 square feet of roof area is level.Typical design per Ecology recommendations for infiltration and splash blocks is presented below. 3 i,i, d.D rJ{l 6,t<J 16 lrb(*,:;. ilry Stratum Group File: 2. I0. l5 ,-\=,.,fiorEj 3F SkEEi NOI TO S4ri-E tF OTIER tlrAll fl' x 1r t o Typical dispersion trench, splash block or dry well for dispersing stormwater. Any of these methods is acceptable for this site April 15,2015 Stormwater Plan Source Ecology kc XBtaq 4 rri .;rq D drl E 0 7 a :78:q. it. )7CO s.ll. l{/.r rdr,,vehododl TRENGH X+ECTIOH Ycf6< miq ?t _ffiE-- PlA!_YlEU_qI_Eeor NTS wll odcrh L\sii cryilddnir il Fs1 pil8 CB 9t€nchlu drq€$rcntErch v/ rscrEd gft# bcErd lergth r d Fq r@ lrl f- of pcl qEq seB Fgrre t.a r.i- cfth Srrfare Udernmi gn Martrrl leld lrencfee tr( tBth iC/ rnn.Yql{(trc epa3h :lox rcd to:ru0 rr. oarcd sphrh tlrcl: dJylrre u a,{u sion NT$ pEY-!E__r.! PUilttS MS DRY V'ELL s€cTtoN -T llr3 Stratum Group File:2.10.15 , a April 15,2015 Stormwater Plan Conclusion Sincerely yours, Stratum Group Dan McShane, M.S., L.E.G. Licensed Engineering Geologist O Vegetation Current vegetation outside of the exiting road area, dilapidated cabin, small barn and chickencoop consists of hydrologic mature forest of a mix of mature trees and understory. The onlyvegetation removal will be at the proposed home site area. Some grass and brush covered areaswill be cleared at the proposed home site and a few small trees. No other tree removal isanticipated on the site other than the small trees at the development site and possibly somehazard tree removal if present near the proposed home site. The proposed development will retain over g)Yonative vegetation consistent with Ecology BMpT5.30 for full dispersion which recommend s 65%ovegetati"on retention. Based on my site assessment it is my opinion that development of the site and the following ofthe stormwater plan will not cause unyidu"rr. impacts to the stability of the site or adjoiningsites' Furtherrnore, the stormwater plan utilizing dispersion and infiltration of stormwater willnot cause any degradation to surface water or the shoreline. Stratum Group appreciates the opportunity to be of service to you. Should you have anyquestions please contact our offrce at (360) 714_9409. 5 Dcnia!McShano Stratum Group File: 2.10. I5 ltlff*d* a a JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -6Zt SneriOan Street, Port Townsend, Washington g8368 360137 9-4450 voice, 360137 9-4451 fax h ttp : //www. co. j effe rso n. wa. u s/co m m d eve I o p m e n U STORMWATER SITE PLAN SUBMITTAL TEMPLATE tttu# 09--245 pRoJECr/AppLtcANT NAME: Michael Holland Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicantmay choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separatestormwater site plan map. 2. Project Overview Describe the proposed developed conditions of the site. lndicate position and relative size of proposed improvements on thesite map. This project involves a single family residence to be built where an existing dilapidated cabin already is located.Total building footprint willbe 2,234 square feet. The existing cabin which is approximately 448 squar" feet will beremoved. A parking area of 400 square feet will be added in an area where paitring previously at least partiallyexisted immediately adjacent to the existing road that crosses the property. - ' Describe the existing vegetation. lndicate native vegetation areas on the site map. Outside of the existing cleared areas and existing road on the site, the property is covered with a hydrologic mature forerwith a mix of tress with Douglas fir being the dominant species and an undersiory that includes sword fein and otherbrush. Grasses and herbaceous plants and brush cover a low area between the giavel beach and the base of the low blul Existing Conditions Summary Describe the existing topography. lndicate contours on the site map. The property is 100 feet wide and 522 feet long and extends from a beach/tidal area on the west side of the propertyacross a raised vegetated beach area up a 30 degree slope to a nearly level area where the home is proposed. The tevelhome area extends to Camp Discovery Road which crosses the property from north to south. A level to genfle slope areais located east of Camp Discovery Road. This area is partially cleared oi trees and includes a small barn, chicken coopand the septic tank and drain field. Further to the east the site slopes up to the eastern boundary of the site through aforest area with slopes on the order of 15 deqrees with a portion of the'upper slope sloping off tb the north away from thrsubject property. 3. 4.Describe the existing soils. lndicate soil type on the site map. The propefi is mapped by the USDA as being underlain by Everett gravelly sandy loam. This soil is very welldrained and has no restrictive layer. On site soil observations are consistent with the USDA soil mappin! as the siteis underlain by gravelly glacial outwash deposits. Describe the existing site hydrology (i.e., drainage; behavior of water on the site-above, below, and on the ground). lndicateexisting stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, ifapplicable, and indicate acreage of each. 5 1 The property consistssuui,.rtceiilil;;;$fi",x".1;;'i"e1ffi"il:;:,,..*?,.?,J;llHffi"f;ffiii".:3[::#:,,8:1,:fr""".,#;,,,: groundwater in the area where developmenuredevelopment is proposed is anticipated to be on the order of 25 feet basecon slope angle and elevation to the shore. 7 I 6. 9. 10 11 12 Describe any excess levels of noise generated by the proposed use or activity short-term construction related noise only. No long term noise sources. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as welands, streams,steep slopes, etc.) on the site. lndicate location on the site map. The property is bordered on !!re west by Dabob Bay. There are steep slopes on the discrete areas of the site but thegeology hazard assessment did not identify any landslide risks and irre sieep stopel *iri not be disturbed. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/criticalareas (streams, wetlands, lakes, steep slopes, etc.). The subject property in the east shore of Dabob. Bay. The.property and adjoining properties along the bay in this areaare accessed via Camp Discovery Road. The lots aiong the bay are developed with homes above the shoreline area.The slopes above the low bank area of residential deve-l,cpmenf are forested. Sensitive areas include Dabob Bay and the tidelands and shore land area adjacent to the bay. Permanent Stormwater Control plan This portion of the stormwater site Plan consists of the selection and installation of the appropriate stormwatercontrol BMpsand facilities to remain in place after construction of the project i. "orp[teo. "Medium" size projects are required to have the totals calculated of all im.pervious surfaces, pollution-generating impervioussurfaces, and pollution-generating pervious surfaces to verify that the thresholds for treaiment facilities and flow controlfacilities are not exceeded. Describe the developed site hydrology, as proposed. lndicate whether stormwater will be fully dispersed (i.e., per BMp T5.30in the Manual) or, if not, what types of stormwater flow control will be utilized for the Je ol. r[""in" threshold discharge areaswithin the site Locate these facilities on the site plan and differentiate proposed facilities from existing facllities.site hydrology will not be altered' stormwater will be allowed to sheet flow off of the existing access road as itcurrently does' stormwater from the roof areas will be directed to a dispersion/infiltration trench or simply directedinto the ground via splash blocks. Dispersed stormwater will infiltrate deep into gre g;;;na. BMP T5'30 Full Dispersion will be utilized on this site. ln total the cleared areas of the existing and proposed buildingsite and access road and parking are much less than 65% of the site. The area not cteareJ will be left primarily as treecovered with native brush in a hydrologic mature condition. The property is a ,rial single-family residentialdevelopment and forestry area and well unier '10% of the area will be covered with impervious surfaces. lf the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposedfor use on the site Locate these facilities on the site plan and differentiate pioposed facilities from existing facilities. [-his isnormally for "large" projects or projects that involve the potential for dispersion ot conraminanis.j The area of pollution-g-e-n-erating impervious surfaces will be the existing road and the proposed parking area andtotals approximately 2,000 square feet. water from the existing roao currenfly sheet flows off to the sides of the roadinto areas where the stormwater infiltrates into the ground rio ttis will behaintrin"o.lr," proposed parking areawill be 400 square feet and water will sheet flow or itris area and infittrate into the ground. The existing access roadis very lightly used. Describe the performance goars and standards appricabre to the project. stormwater will be fuily dispersed and infiltrated into the ground. Describe the flow control system. All stormwater will be fully dispersed. The site does not require flow control. Describe the water quality system. Dispersion trenches or splash blocks will be used to disperse and infiltrate stormwater from the new structure builton the site' Plant areas will be maintained and left in tact "" ,r"h as practical oetrreen dispersion areas and theshoreline down slope from the dispersion trench and/or splash utocxs. sheet run ori to the sides of tne eiisting 13. access road and tt " pro?""d parking area on the site wift infinrate?o through vegetated areas. the ground with minimum surface flow 14. 15. 16. 17 18 19. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. No fill material witl be required except for the necessary drainage fill sand and gravel for the foundations. Excavatedmaterials will be relocated onsite within existing cleared areas or around the pen:meter areas of the building site. Describe the conveyance system analysis and design. No conveyance is required other than piping to direct water from structures to dispersion areas. Proposed methods of placement and compaction consistent with the applicable standards on Appendix chapter 33 of theUniform Building Code. A compactor will be used as necessary to achieve 90% of maximum density for foundation support. Describe the proposed surfacing material. No new surfacing materials are anticipated. Disturbed areas around building sites will be planted with grass andselected plantings. 20. 21 List here and include any special reports or studies conducted to prepare the Stormwater Site plan. Geologic hazard assessment completed by Stratum Group (september 22,2oogl. List other necessary permits and approvals as required by other regulatory agencies. lf those permits or approvals includeconditions that affect the drainage plan or contain more restrictive drainage-r6lated requirer"nt., describe those conditions orrestrictions here. The septic permit does not impact the stormwater plans for the site. CoNSTRUGTION STORMWATER POLLUTTON PREVENTTON PLAN (Swppp) The Construction SWPPP addresses sediment and erosion control during construction. The BltIpsindicated by the applicant in the template that follows must be installeJ on the ground during allconstruction phases of the project. The proponent is responsible for preventing sediirent and erosionimpacts to environmentally sensitive areas and off-site areas. Consuit the Construction StormwaterPollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. I . CONSTRUC SWPPP NA RATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWppp elements has been or will beaddressed. ldentify the type and location of BMPs used to satisfy the required element. lf an element is not applicable to the proposal, Describe methods for restoration of the site. Any disturbed sites will be restored with a mix of native plants: grasses, salal, sword fern and oregon grape. An Operation and Maintenance Manual is required for each flow control and treatment facility. [-his is normally required for'large" projects only and only those for which facilities are required to control flow or treat runotf.l lf included, list the Manualshere. N/A lusilryinwriting. Descriptionsottnerz?mentsarefoundatsection 2.s.2oftherrnr"fin,nningonpage2-15). 12 Required Elements - Construction SWppp 1. Mark Clearing Limits. The proposed home wil! be staked prior to any ctearing and grading and foundation excavation work. The clearing grading areawill be staked ahead of time for both building sites. 2. Establish Construction Access. construction access already exists to the building site via the existing road across the site and the parking area for the existingcabin. 3. Control Flow Rates. 5. Stabilize Soils. Native vegetation will be maintained as a wide vegetated strip between the proposed building site and the shoretine consistentwith BMP C243 (Ecology, 2005)' The area betnveen the proposed building area and the shoreline is initially level and then gengedown to a slope of approximately 30 degrees and then a level brush and wooded low area is located between the base of theslope and the shoreline beach area' Soiis throughout this area are well vegetated and are underlain by well draining soils. Giventhe conditions it is expected that sediment trapi will not likely be requiredl 4. lnstall Sediment Controls. Soils at this site consist of very well drained sand and gravel and a wide area of well vegetated ground is located between theproposed building site and the shoreline. As such no sediment controls are required as-long as the construction remains withinthe clearing limits. Stockpiled soil and areas exposed for short periods (less than two days between october I and April 30 and less than one weekP9t"9n May 1 and September 30 may be stabilized using appropriate measures from the following: mulch, straw or nets andblankets. 6. Protect Slopes. Construction activity willstay within the clearing limits. 7. Protect Drain lnlets. There are no drain inlets that can be affected. 8. Stabilize Channels and Ouflets. There are no channels or outlets on the site and none are anticipated. Existing vegetation will be left in tact between theproposed home site and the shoreline. 9. Control Pollutants No vehicle maintenance will be performed and construction debris will be safely stored. 10' Control De-watering (the act of pumping groundwater or stormwater away from an active construction site). No construction dewatering will be conducted. 11. Maintain Best Management practices (BMps). BMPs will be maintained. All temporary and permanent BMPs shall be maintained, repaired and enhanced as necessary toassure continued performance of their intended functions. All BMPs should oe inspettedat a minimum on a weekly basis, duringand immediately following s significant storm event (any storm exceeding 0.5 inches within 24 hours or 2.0 inches of rainfall withinTdays). O O 12. Manage the Project. All construction work shall follow the above described actions. lf circumstances arise that require additional BMps beyond those!isted' it is the owner/contractor's responsibility to implement those BMPs. The owner/contractor should inspect the site for BMpimplementation on at least a weekly basis and more fiequently during significant rainfall events or during the period when sitedisturbance is taking place in preparation for building foundaiions. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, weflands, residential areas,roads). The shoreline to the west is separated from the proposed building area by a vegetated slope and low area byapproximately I 10 feet. b' Description of the downstream drainage path leading from the site to the receiving body of water (minimum distance of 400yards). Stormwater will be infiltrated into the ground. Soils throughout the area between the proposed development and theshoreline to the west are underlain by very well drained gravel and sand soils. 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. The property is bordered on the west Dabob Bay. b. Description of special requirements for working in or near environmentally sensitive areas. All work will be within the limits of the clearing area. 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, soilstructure). The soils within the area proposed for development are well drained. All run off from the proposed building site will directed towardsthe sides into well drained soil. 5. Construction Phasing. a. Construction sequence lnitial phase will clearly mark the extent of area needed to be cleared and graded for construction of buildingfoundations' All excavated soils and disturbed soil will be limited to the mirked clearing areas and will be stabilized assoon as foundation work is completed. Stormwater dispersion/infiltration areas will be ionstruci"a in pr"p"."tion forcompletion of the home and hooked up to the roof drains upon completion of the roof unless splash uiocxs are usedinstead. b. Construction phasing (if proposed) This project is for the construction of a single home and phasing is not needed beyond the appropriate constructionsequence described above. 5. Construction Schedule. Wet season is October 1 through April 30 (page 2-21of the Manuat). l. Provide a proposed construction schedule. No set schedule. Soils are very well drained at this site so no wet season restrictions will be necessary ll. Wet Season Construction Activities. a. Proposed wet season construction activities. ' No restrictions necessary ar; the very well drained soirs on the site. O b. Proposed wet season construction activities for environmentally sensitive areas. Environmentally sensitive areas will not be at risk as tong as the BMPs proposed are followed. 7. Financial/Ownership Responsibilities. a' ldentify the property owner responsible for the initiation of bonds and/or other financial securities. Michael Holland b' Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. Property owner will contract only with licensed, insured, and bonded trades peopte. 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 NA NA NA NA o SECTION II_ EROSION AND SEDIMENT ROL 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 Site Plan. a. Legal description of subject property. b. North arrow. c. lndicate boundaries of existing vegetation (e.9., tree lines, pasture areas, etc.). d. ldentiff and label areas of potential erosion problems. e. ldentify FEMA base flood boundaries and Shoreline Management boundaries (if applicable). f. Show existing and proposed contours. g. lndicate 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. lndicate locations and outlets of any dewatering systems. Location of Detention Best Management Practices (BMPs). ldentify location of detention BMps 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. lndicate the trap/pond storage required and the depth, length, and width dimensions. d. Provide typical section views through pond and ouflet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outleUinlet. 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. l. lndicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. Detailed Drawings' Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. Other Pollutant BMPs. lndicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment (e.9., concrete wash water). Monitoring Locations. lndicate 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. o 2 4 5 6 7. 8. Storr*.t", Site Plan Changes ' O lf the designer wishes to make changes or revisions to the originally approved stormwater Site plan, the proposed revisions shall besubmitted to DCD prior to construction. The submittal shall inclu?e srosiiirte pages that include all proposed changes, revised drawingsshowing any structural changes, and any other supporting information that explaini and supports the reason for the c6ange. Fina! Corrected Plan Submitta! lf the project included construction of conveyance systems, treatment facilities, flow control facilities, or structural source control BMps (notstandard on-site stormwater management BMPs), the applicant shall submit a final corrected plan (,,as-builts',) when the project iscompleted' These should be engineering drawings (stamped by a licensed civil engineerJ-thrt """rrrtely represent the project asconstructed. APPLICANT SIGNATURE By signing the Construction swPPP worksheet, I as the applicanuowner attest that the information provided herein is true and correct tothe best of my knowledge. I also certifiT that this applicaiion is being made with the full knowledge and consent of all owners of theaffected property. kl*l fit+[t{ (LANDoWNER oR AUTHoRIZED REPRESENTATIVE SIGNATURE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: (DArE) \ a JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 | Web: www.co.iefferson.wa.us/communitydevelopment Tel: 360.379.4450 | Fax: 360.379.4451 | Email: dcd@co,jefferson.wa.us o SguareOIVE Resource Center I Building Permits & /nspections I Development Review I Long Range Planning January 23,2015 MICHAEL C HOLLAND PO BOX 372 PORT TOWNSEND WA 98368-0372 RE: SITE ADDRESS: 1470 CAMP DISCOVERY RD CASE #: BLD14-00417 DeaT MICHAEL C HOLLAND: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. Michael, Per the Geotech Report prepared for the SPAAD, engineered stormwater plans utilitizing infiltration trenches are required for home placement within 20 feet of top of slope. Also, an addedum to the Geotech Report will be required for re-location of the "cabin" on the upper portion of the parcel. A shoreline exemption fee of $532.00 is required under the Shoreline Master Program JCC 18.25 Please submit the above information to the Department of Community Development within 90 days of the date of this letter which would be 412312015. As required by Jefferson County Code, JCC 18.40.110(3) and (6), if the information is not submitted or additional time to submit the required information within the ninety (90) calendar day period is not requested, the application would be considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson County Code provides that the Department of Community Development shall not be responsible for notifying the applicant of an impending expiration, thus any further notification would not be forthcoming. Sincerely, Department of u Development Staff c: File 1t23t2015\\tidema rk\data\forms\F_lt/ LT_Add I nfo-Req ust. rpt o DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: wr*rv.co.ie fferson.wa.us / communiwdevelooment E-mail: dcd@co.iefferson.wa.us UPFRONT REVIEW TEAM INTAKE CHECKLIST o a)CASE: DATE:LI C ,&D NLoq2,t.' Was your application deemed complete Yes Noi Has the site plan been stamped approved and signed?: Has the consistency review checklist been attached to this form?: d lf yes, Reviewers complete the next section Land Use Reviewer: ls your review complete?: lf, no, what remains to be tf yes, has all relevant data, including cond been a Any additional Environmental Health Specia Iist: ls your review complete? lf no, what remains to be done?: Any additional notes or information appl rca nt? Plans Examiner:Fz..^hB ring into demark?: n provided to the applicant (Stormwater, standard conditons?) q/.-P o Lr,\ ls your review complete? lf no, what remains to be done?: Any additional notes or information to applicant? Road Approach Tech ls your review complete?: lf no, what remains to be done?: Any additional notes or information to applicant? lf no, complete other side OVTR T]PITRON'I' REYI EW'I'EANI I N'I'AKF] CI I EC KLI S a lf no, what still needs to be submitted to make it complete? You will have 90 days to submit your additional information to make your application complete or risk forfeiting your fee. I have received a copy of this intake checklist: ApplicanVAgent Signature Date i JCC18.40.110 Submission of acceptance of application determination of completeness - Additional information and project revision. (a) If the applicant receives a determination that the application is incomplete or that additional information is required, the applicant shall have 90 calendar days to submit the necessary information to the administrator, or to appeal the decision to the hearing examiner in accordance with the procedures for Type II projects. Withifl 14 calendar days after the applicant has submitted the additional information, the administrator shall again make the determination described in subsection (2) of this section. (b) If the applicant refuses to submit additional information, does not request additional time to submit the required information within the 90- calendar-day period, or does not appeal the decision, the application will be considered abandoned and therefore udthdrawn and the applicant shall forfeit the application fee. The department of community development shall not be responsible for notifiiing the applicant of an impending expiration. o vlit PFRON']'It \{,,I.F]AII I NI'AKT.] CHI]CK ( JBFFBRSON COUNTY BUILDING & COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend, WA 98368 (360) 379-4450 Fax: (360) 379-4451 WSEC hesidential Constructrvn Checklist Washington State Energy Code (WSEC) 2001 Residential Construction Checklist Complete this form in addition to WSEC forms. Please answer the following questions: ew construction, or addition over 750 square feet Must meet whole house and spot ventilation requirements, and show full WSEC compliance as a stand-alone project. A detached, habitable structure such as on Accessory Dwelling Unit regardless of size must also meet these requirements. ! House addition under 750 square feet Possible trade-offs are allowed with the existing buildingfor WSEC compliance, such os increasing ceiling insulation. See WSEC component performance forms. NOTE: A house addition less than 500 sq. ft. does not require whole house ventilation. Spot ventilation is still required. TYPE OF HEATING - Please check all that apnlv: Electric ! Wall Heater ! Baseboard tr Forced Air Furnace ! Radiant Floor (Boiler) ! Other _ Non-Electric: Propane:fl Radiant Floor/Baseboard (Boiler) tr LPG Stove n LPG Furnace ! Other LPG n Heat il^p tr Oil Furnace) Woodstove (can only be used as secondary heat source) VAPOR RETARDERS: Vapor retarders shall be installed toward the warm surface as represented below. Select one option for floors, walls, and appropriate ceilings: o Floors: E Plywood with exterior glue Xpofy plastic (greater than or equal to 4 millimeter thick) tr Backed batts o Walls: n Poly plastic (greater than or equal to 4 millimeter thick) -tr Face-stapled, backed batts ! Low-perm paint o Ceilings: tr Not required where ventilation space averages greater than or equal to 12 inches above insulation ! Face-stapled, backed batts $foly plastic (greater than or equal to 4 millimeter thick) f, Low-perm paint SEE BACK G:\PermitCenter\FORMS\BLDG FORMS\WSEC 2001 - ResidentialEnergy Code Checklist.doc o o Washington State Energy Code: 2001 Second Edition, Prescriptive Worksheet Zone 1 Effective 111lO3 Conditloned Floor Area 2/43 Glazing Area Feet2 Area Weighted Vertical Overhead 602.7.2 Exception, Area X Glazing Area Gtazing To Floor Area aatioWfr Glsing AEa Total / Codllkm6d Floq Arca 602.7.2 Exception 602.7.2 Glazing Area Tolal / TABLE 6.t PRESCRIPTIVE REQUIREMENTSOJ FOR GROUP R OCGUPANCY CLIMATE ZONE I Aroa, mt to orc€6d 'l% One Serec, Optlon E Scc codc tcxt fur fuotlotc rcferences Copyright 2002 WSUCEEP 02-143 Copied by permission from Washington State University Cooperative Extension Energy Program. (see copyright restriclions) 'l'19, ;;? 4t, 6i{ -?47 t7.ll Option Glazing Arearo: 7o of floor Glazlng U-Faclor Doors U-Faclor Ceiting2 Vaulted Ceiling3 Wallr2 Above Grade Wallo hf Bolow Grade Wall. exta Below Grade Fbof Sliabo on Grad6 Verlical Overheadll L l2y.0.35 0.58 0_20 R-38 R-30 R-15 R-15 R-10 R-30 R-t0 II lSYo o,40 o.56 o.20 R-J6 K-JO K-Zr x-21 R-to K-to t(-lo III 2s% Group R-l Ocuupaucy Only 0.40 0.58 0-20 R-3E / U=0.031 R-30 / U=0.034 R-21/ U=0.060 R-15 R-10 R-30 / U=0.029 R-to IV.Ualimited Group R-3 Occupancy Only 0.40 0.5t 0.20 R.3E R-30 R-21 R-21 R-10 R-30 R-10 Unlimited Croup R-l Occupancy Only 0.35 0.58 0.20 R-3E / U=0.031 R-30 i u:0.034 R-21 / U=0.060 R-15 R-10 R-30 / U=0.029 R-t0 llztzslzwz 1of 3 Efl *ASHINGTON,,O,,QNTILATION ND rNDooR ArR O*tt" (2ooo code): Type of ventilation used throughout the house: E HVAC Integrated Option yfExhaust Option Whole House Fan for "Exhaust Option": o In what room is your whole house fan located t l*upppy' frA4l o What size is the whole house exhaust fan?,r. -'o-75 CFM 1i-zbedroom house) X 80-120 CFM (3 bedroom house) ! 100-150 CFM (4 bedroomhouse) tr 120-180 CFM (5 bedroomhouse) Note: the whole house fan shall be readily accessible and controlled by a24-hour clock timer with the capability of continuous operation, manual and automatic control. At the time of final inspection, the automatic control timer shall be set to operate the whole house fan for at least 8 hours aday, and have a sone rating at 1.5 or less measured at 0.10 inches water gauge. Spot Ventilation: Source specific exhaust ventilation is required in each kitchen, bathroom, water closet, laundry room, indoor swimming pool, spa and other rooms where excess water vapor or cooking odor is produced. Bathrooms, laundries or similar rooms require fans with a minimum 50 cfm ruting at 0.25 inches water gauge; kitchens shall have a fan with a minimum 100 cfm rating at 0.25 inches water gauge. Outdoor Air Inlets: Outdoor air shall be distributed to each habitable room by means such as individual inlets, separate duct systems, or a forced-air system. Habitable rooms include all bedrooms, living and dining rooms but not kitchens, bathrooms or utility rooms. Where outdoor air supplies are separated from exhaust points by doors, undercutting doors a minimum of % inch above the surface of the finish floor covering, distribution ducts, installation or grilles, transoms or similar means where permitted by the Uniform Building Code. When the system provides ventilation through a dedicated opening, such as a window or through-wall vent, these openings must: o Have controlled and secure openings o Be sleeved or otherwise designed so as not to compromise the thermal properties of the wall or window in which they are placed. o Provide not less than4 square inches ofnet free area ofopening for each habitable space. What type of fresh air inlet will be installed? (See figure below) X Window Ports ! Wall Ports G:\PermitCenter\FORMS\BLDG FORMS\WSEC 2001 - Residential Energy Code Checklist.doc Page 2 of 2 o Washington State Energy Code: 2001 Second Edition, Prescrlptive Worksheet Zone 1 Effective 111103 o Exterior Doors Plan Component UARef. Door Percent U Glazed width Feetrm Sum of Area and UA Area Weighted U = UA/Area I Height Glazing Door Door* Area Vertical Glazing (Windows, Doors uslng Exception 602.6 #1) Plan Compon€nt Glazing Sum of Area and UA (do not include exempt door) AreaWeightedU-UNtuea Width Height htr rID i xJr Glazing Area rrA ?11.r U,q.4 I Copyright 2002 WSUCEEP 02-143 Copied by permission from Washington State University Cooperative Extension Energy Program. (see copyright restrictions) /{t/*ztr, kzktl ?Gea*t /84,.U F.ri&I 3 1 u 4-01 <;1 rt!,CtI)rl.I ,,l 1)7,1 One Exempt Dar,lt 24 Square Feet or Less.1 5 D JE v r{r*t-A ?8fr/8d stta frcirt.lrto *1 A 1,t.t)It ila*t/ttn*- tbtlt"4/t),79 l)al.i,Mno )o e (-4 A 1t ,l lj h i t ir ,o llt tt ,l rl ,u fr7 ill tt-t*. fi1wf*hqn NFttc "?,?p,,l It lL ,{) e lnuk, ii,aneCtTp ,NFr-t ,'lu IAU-O*tn fitotr(ao{o CQD h.,fi tt ,ltl u tt ,lAtlilnzl ttat'taltro L,?,q .E il-t,la ,dl ( g ,o 7 1)0 r) I l1 d ?o 4 ,4 4 it d','a 7)o 9'Ia Stl. T.L )I 6 6 ,,I b //Z ,l {b 't/)4 ?-D I at t, t)Ul) A/{o 6 D I S DU 7 d'^/t/.L b"b to- +7-tl Z (r- 79,3 ^'|',| (2r2r., .60e /*,? '40r 8,'.|-*4n 'zl, 40 .1f,r '?J^ bo 7:1.{a q.u -b,b t.?3 i{4.3< ,6o ?.9,72 1{lo,lU.40 ,€Lfr 4,f /L..tb 1212312002 2ot 3 o Washington State Energy Code: 2001 Second Edition, Prescriptive Worksheet Zone'l Effective 111103 o Overhead Glazing Plan Component Section 602.7 .2 Exception Plan Component Location of l/vlol6 House Fan: Choose f] Centrat Bathroom "k centratHattwav Width Height lnch lrdr Sum ofArea and UA Area Weighted U - UA/Area Width Height 6lhar Glazing UID Area lnd) Sum of Area and fuea X3 WHOLE HOUSE VENTII,ITION \ FEsh Ah lntako: Choose One [F wnaor pors [--l watt ports l--l tnlbgrateo wForced,Air ]leating system This last option requires a &incfi diameter duci to the retum plenum with a damper that regulales flow at 0.35 ACH MIN to 0.50 ACH lJlA)(, end an automatic tirner to the fumace fan- ln€rl Copyright 2002 WSUCEEP 02-143 Copied by permission from Washington State University Cooperative Extension Energy Program. (see copyright restrictions) U Nln I A =UXA II I filz3nii2 3 of 3 Prescriptive Energy Code Comp Projecl lnformation lotu/efplL/ Matl S F. R-, tc" for All Climate Zones in Washing,"O Cantaci lnfornalion r? *au*/n 76-'77i-6qfl This project will use the requirements of the Prescriptive Path below and incorporate the the minimum values listed. ln addition, based on the size of the structure, the appropriate number of additional credits are checked as chosen by the permit applicant. Authorized Representative Date AII Climate Zones R-Value'U-Factor" Fenestration U-Factorb nla 0.30 Skylight U-Factor nla 0.50 Glazed Fenestration SHGC"'"nla nla Ceiling dq 0.026 Wood Frame Walle'^'l 21 inl 0.056 Mass Wall R-Valuei 21,21t'0.056 Floor 30e 0.029 Below Grade Wall''k 10115121 int + TB 0.042 Slabd R-Value & Depth 10,2ft nla -Table R402.1.1 and Table R402.'1 .3 Footnotes included on page 2 Tabte R406.2 Summary De / o n S L_l l-lU tr trnnI tr T tr tr 0.0 0.0 0Total Credits *Please refer to Table R406.2 for complete option descriptions ily dwellings and townhousesr as defined in Section 101.2 o{ the International Residential Code shall comply with sufficient options from Table R406.2 so as to achieve the Dwelling units less than 1500 square feet in conditioned floor area with less than 300 square feet of fenestration area. Additions to existing building that are less than 750 square feet of heated floor area. Medium Dwelling Unit: 1.5 points All dwelling units that are not included in #1 or #3, including additions over 750 square feet. IS. Large Dwelling Unit: 2.5 points Dwelling units exceeding 5000 square feet of conditioned floor area Each dwelling unit in one and two-fam lowing minimum number of credits [1. Small Dwelling Unit: 0.5 points 1a Efficient Building Envelope 1a 0.5 '1b Efficient Building Envelope 1b 1.0 'l c Efficient Building Envelope 1c 2.0 2a Air Leakage Control and Efficient Ventilation 2a 0.5 2b Air Leakage Control and Efficient Ventilation 2b a^ZL Air Leakage Control and Efflcient Ventilation 2c 1,5 Jd High Efficiency HVAC 3a 0.5 3b High Efficiency HVAC 3b 1.0 ?n High Efficiency HVAC 3c 2.0 3d High Efficiency HVAC 3d 1.0 4 High Efficiency HVAC Distribution System 1.0 E^Jd Efficient Water Heating 0.5 5b Efficient Water Heating 1.3 6 Renewable Electric Energy 0.5 http://www.ene . v"/s u.ed u/Docu me nts/2 012%2 0 Res%20Enersv. p df "120 I #-n 1.0 Table R402.1.1 Footnotes For Sl: 1foot.= 304.8 mm, ci .= continuous insulatio0, inl .= intermediate framing. 'R-values are minimums. t.,-factors and SHGC are maximums. When insulation is installed in a cavity which is less than the labeior design thickness of the insulation, the compressed R-value of the insulation from Appendix Table 4101.4 shall not be less than the R-value specified in the table. b-," The fenestration U-factor column excluCes skylights. The SHGC column applies to allglazed fenestration. Exception:Skylights rnay be excluded fronr glazed fenestration SHGC requirements in Climate Zones 1 through 3 uvhere the SHGC for such skylights does not exceed 0.30. '"1,0115121.+TB" means R-10 continuous insulation on the exterior of the wall, or R-15 on the continuous insulation on the interior of the wall, or R-21cavity insulation plus a thermal break between the slab and the basement wall at the interior of the basement wall. "1.01!512L.+T8" shall be permitted to be met with R-13 cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior or exterior of the wall. "10f 1"3" means R-L0 continuous insulation on the interior or exterior of the home or R- 113 cavitv insulation at the interior of the basement wall. "TB" means thermal break between floor slab and lbasement wall. o R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1. 'There are no SHGC requirements in the Marine Zone. r Basement wall insulation is not required in warm-humid locations as defined by Figure R301.1and Table R301.1. s Reserved. h First value is cavity insulation, second is continuous insulation or insulated siding, so "13.+5" nleans R-13 cavity insulation plus R-5 continuous insulation or insulated siding. lf structural sheathing covers 40 percent or less of the exterior, continuous insulation R-value shall be permitted to be reduced by no more than R-3 in the locations where structural sheathing is used to maintain a consistent total sheathing thickness. i The second R-value applies when more than half the insulation is on the interior of the mass wall. For single rafter- or joist-vaulted ceilings, the insulation may be reduced to R-38. k lnt. (intermediate framing)denotes standard framing 16 inches on center with headers insulated with a minimum of R-10 insulation. I Log and solid timberwalls with a minimum average thickness of 3.5 inches are exemptfrom this insulation requirement. ' Nonfenestration U-factors shall be obtained from measurement, calculation or an approved source or as specified in Section R402.1.3. o o DEPARTMENT OF COMMUNITY DEVELOPMENT 6f 1 Shcridan Strcct, Port'l'orvnsctld, Wi\ 98368 't'cl: 360.379.4450 | Fax: 360.379.445'l Web: E-mail: dcd@co.iefterson.rva.us PERMIT APPLICATION r=alL-G,EIIVtE "-"t '., L----- Steps in the Perrnit Process:i:iSCi.] COiiNTY -Review aPPlication checklist to ensure all information is completed priorto su raiiil D!\JiiOPMENTT -Make sure septic has been a pplied for and water availability has been proven -Make an appointment to me et 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' Add itional fees may apply after review and payment is required before permit is issued. For DePartment Use OnlY Building Permit # MLA #Related ication #s: V\//4 +7o OA,LIP OIAssessor Tax Parcel Number: Site Address and/or Directions to Property: Access (name of street(s)) from which access will be gained ,4c; SFR'/ Description of Work (include proposed uses) Present use of ProPertY: Wastewater - This property is served by Port Townsend of Port YES m belowsewer identified alf not served o ofid Ludlow sewer system? JC S"Pti. Seotic Permit #: CommunitY SePtlc Name of SYstem: other residences connected to the septic system? Additions or repairs to sewage system: ls it a complete or partial system installation: Has a reserve drainfield been designated? Date of Last Operations & Maintenance check Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: NE s2- .-o/8?o?*axtt7 Case # Type of Sewage System Serving Property:.SEP Are Comp _ Partial _ No- Attach last report to aPPlication lete ;C Yes ;( use b i'.rrrrir -\1.1r!;crrr,'r: l',,, l,,i'l Applicant/Property Owner lnformation E-mail Addressi _ Please contag AuffroriTed Agent/Re Property owner signature: ,.P{--l H}o"tu, /t /r/r4 N presentative with project info. (select only one). Property Owner: ba'a7i , b?6'l c4rte/- 712- Name: Address: Phone #: Note: For proiects with multiple owners, attach a separate sheet with each and signatures. Appl icant: Authorized Agent/Representative (lf otherthan owner) Name: Address: Phone #: A AS 4i7ou G- E-mailAddress Professional:ls this an -s_ // ContractorEngineer Name: i addr"r' I Phone #: Architect Surveyor i/-c,t,ta aJ"+ 'Upo* +3+-o1-(E-mail Address: firc1<4xl <' &tt?t'rt.( taTat ur-tc e *t sa/, 4> *r I Professional:ls this an Authorized ntative for this project?NO YES Engineer Name: Address: Phone #: _ Architect K SurveYor _ Contractor Consultant G€L DC -Jlffw4 E-mail Address: Professional:ls this an Authorized for this project?NO YES Engineer Name: Address: Phone #: Architect Surveyor Contractor Consultant E-mail Address Professional:ls this an Authorized Age nt/Representative for this project?NO YES Engineer Name: Address: Phone #: Architect Surveyor Contracto r Consultant E-mail Address Attach additional pages if necessary Builders Statement The signer of this nt certifies that they are the Owners ofthe parcel referenced herein, that they are not licensed contractors a ming the responsibility of the General Contractor for the proposed project. Print Name: r{lr.rl-irc* l.:tC<-^tls will Date J41/4 i',11;1,r \1.;,i,r ri:,ri l'.r,., f..l f the It is the contact for a-ll the to 1S the authodzed information to and owner to ensure their for email is not for this project? Signature: DEPATOMENT oF coMMuNrrY DEO -621 Sherid,rn Street. Pon Tonnsend, 1971 9$58=-. TeL i6C.179.1+5C j Fa-x: 15C.179.4451 \\reb: *.s,rr'.co.iefierson.sa.rr-s/commlrnitlt'ler,elopment E- mail: dcd@ co.ieffenon.na.us LOPMENT ::-ArPnn,,/r;:IE\91=UVi='---- -- -'--'i .l\i SINGLE FAMILY RESIDENCE PERMIT OR DTIPEK-jLi i cti:j . Enter the square footage (sq/ft) that applies in each field I i lriY For Department Use Only Related Application #s:Payment #: Assessor Tax Parcel #: aO t ZZ (Owner Name.013 Type of Single Family Residence or Duplex , Relocated Demolition * *n s"prratu porit is required New K' Addition Select One Modular Replacement ' Repair # new bedrooms # new bathrooms =Z,{ existing existing total bed total bath -o *4- Number of floors 2- Heat Source Select all that apply Electric Heating Oil K Structu re . txtsttng 5q/l-t Proposed Sq/Ft Main Floor llq.P3g.zo ,/obT Second Floor rit.,{:8'oD ZEffi' loaf Additional Floors - heated / unheated I Basement - unfinished Basement - finished space or habitable Detached Garage - heated / unheated /h Attached Garage - heated / unheated I Garage 2nd fl - unfinshed storage t_ Garage 2nd fl - finshed space or habitable Carport - 2 walls or less Deck - uncovered Q.qq:.972 sr Covered porch t: ?.8"'ZZI $F Other (sl-red, barn, pole bldg,etc.)?eacr:+s Estimated Cost of Project (Required): . - ----''---_---+Ree-eipt St . ,, Site lnformation -------------<- ooQ UseAll rxisting Buildings on Pro i4/n 74G( List existi buildi on t.e accesso dwelli UN shed ba bile home othe Resolution f99-90 requires buildi ng permit applications to provide evidence of an adequate potable water supply per the conditions of RCW 19.27.097 and the Guidelines for Determining Woter Avoilobility for New Buildings. http://www.co.iefferson.wo.us/commissioners By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is fie inO dorrect id tne Oest of his, her or its knowledge. Any material falsehood or any omission of a material fact made 6y th; il;"r/agent with respect to this application picket niay result in making any issued permit null and void. Signature Print Name l,/rciuxt- l4nLt +Nj)Date:rr/? i Proposed Attach Copies ofWater Source Existi 1) Well Logs (if no log report on file, a t hr stabilization test may be substituted.) c-r-Z) Lab analysis tested within 3 years of application -Total Coliform, Nitrate-N, Chloride Private well Items above AND recorded Operations & Maintenance agreement and recorded Easement. 2-Party Well Provide justification and design per Jefferson County Environmental Health policy 97-01 http ://www.jeffe rso ncou ntypublichea lth.org/pdf/Pol icy-97- 01 Rainwater Collection pdf Alternative System: Valid Water Right Permit: Generally applies to sprlngs, a[tach copy -Submit Water Availability Notification form completed by your water purveyor. Public Water:Name of Water Provider: NOTE: lfanyoftheaboveutilitiesneedtobeinstalledanddisturbancewill occurinapublicmaintainedorunmaintained then a cation will be needed.-of-aroad and/or Right L) Water Right Permit # 2) Public Water SuPPIY WS IDB ln ComPliance 3) IndividualWell Meets Water Quality Standards? WRIA 17 Subbasin SIPZ -Coastal/ Moderate / High Baseduponinformationprovidedbytheapplicant,itappearsthatthepotablewatersupply: ...i Meets -- Conditionally.Meets . --- Doesnot-Meei NoYes Yes No Yes No c *-tork f ac>'DaL>C rl9txl -. :,:' ::'.: ., 'l'ii. USEFOR o a DEPARTMENT OF COMMUNITY DEVELOPMENT 62 I Shcritl;rn Strt cT. l)rrrt 'lirs nscrrd. \\' \ 98368 'l'el: 36t.t.319.-l-l5u I I ;rr: 3(rt-t.3-9.1-15 I \\'cl;: s s * .co.igftirsorr.s'rr.rrs /cr xnurrrnit) tlqvclnprrrcrrt l'l-rr.rlil: clctl? co.ie t-itrson.s a.us STO RNTSTATER CALCULAT ION WO RKS HEET MLA #q-oaL PRO]ECT/APPLICANT NAM E: 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. Lond-disturbing octivity 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 vegetotion 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. lmpervious surfoce 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 increasedrateofflowfromtheflowpresentundernatural conditionspriortodevelopment. Commonimpervioussurfacesinclude, 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. I _l PARCEL SIZE (I.E.. SITE) An acre contains 43,560 square feet. Multiply the acreage by this figure. {o,goa sq/ftSize of parcel in square feet sizeof p"r".t {,f6 1".r"" sq/ft No {//,t No Lawn, landscaping sq/ft sq/ft sq/ft sq/ft etc. EvlSf,r Nc /N*rt Drainfield, septic tank, etc. Well, utilities, etc. Other compacted surface, etc.NoNs- Total Land Disturbance I +aa lndicate Total Volumes of Proposed: cut l'{? Fil .,;. (cu/yd) Calculate the total area to be cleared, graded, filled, excavated, and/or compacted for proposed development project. lnclude in this calculation the area to be cleared for: Construction site for structures lt ,rS Answer the following two questions related to conversion of native vegetation: Does the project convert Yt acres or more of native vegetation to lawn or landscaped areas? Circle: Yes Does the project convert 2Yz acres or more of native vegetation to pasture? Circle: Yes Driveway, parking, roads, etc. 5OO "o,o stormwater calc rcrksheet - REV. 1Ol2OnO14 t-|rcaeL htc,ao-a LAND DISTURBING ACTIVITY. CONVERSION OF NATIVE VEGETATION. AND VOLUME OF CUT/FILL oo STORMWATER CALULATIONS - IMPERVIOUS SURFACE TorAL NEW + rorAL ExtslNG. 3 *?3 "ilft Driveway, parking, roads, etc 11.i / sq/ft Total New Total Existing *This amount will be used to check total lot coverage Other j sq/ft sq/ft sq/ft sq/ft Sidewalks Patios Solid Decks NEW Structures (all roof area) Sidewalks Patios Solid Decks (without infi ltration below) sq/ft sq/ft sq/ft EXISTING Structures (all roof area) - 1; sq/ft (without infi ltration below) Driveway, parking, roads, etc Other DEVELOPMENT v. REDEVELOPMENT Divide the total g4fs'llgg impervious surface above by the size of the parcel and convert to a percentage'. | "1 .O Yo Does the site have 35Yo or more of existing impervious surface?\NoCircle:Yes The following questions will help determine whether the proposed project is considered development or redevelopment. FURTHER INSTRUCTIONS: lf the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. lf 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 MinimumRequirementsforstormwatermanagement, DCDstaffwill helpverifytheclassificationoftheprojectandtheapplication requirements. For proponents of "small" projects who must comply only with Minimum Requirement f2-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 lnstructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stornwoter Monogement Monuol. APPLICANT S!GNATURE 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. oR AUTHoRTzED REpnrsrrurltrvr steutunr)(oarr) FOR USE ONLY MEDIU LARGE_ REDEVETOPMENT_ Stormwater Site Plan: Yes- stomMler calc rcrksheet - REV. lOnOnO14 I * rt f,fr a