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HomeMy WebLinkAboutBLD2015-00208 - 01 PERMIT APPLICATION BUILDING PERMIT APPLIC•ON BLD15-00208 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00208 Received Date: 6/23/2015 SITE ADDRESS: 712 JUPITER LOOP BRINNON, 98320 OWNER: STEVEN J WARNER PHONE: 719-651-9340 MARTHA M WARNER 1240 W SIMS WAY#81 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502094001 Section: 9 Township: 25 N Range: 2V1 CONTRACTOR: TOWN &COUNTRY POST& FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO? NEW GARAGE- NO HEAT- NO PLUMBING J SEP02-00080 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 37,437.00 ADD'L: HEAT TYPE: UK CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: 864 SETBACK: CK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $465.00 SRE 06/23/15 156212 Plan Check $302.25 SRE 06/23/15 156212 APPROVED State Building Code $4.50 SRE 06/23/15 156212 Total: $771.75 JUL 2 U 201 Jew County OCD l\firiom rIelri�f�lfnrmc\F RI fl Ann RW rnt R/91P)m 7/7/2015 Enviro Check, LLC (lb Li) ) 5 202) *11110 1612 Hastings Ave. West . 360-379-9400 Port Townsend, WA 98368 4. &pp t� ! 0*Ai e �� `� -PROPERTY INFORMATION House Location:712 JUPITER LOOP D E /r�1�te' E n y7 E Brinnon v Tax ID:502094001 Mall To: Steven Warner 1240 W.Sims Way •: Use:Residential,Single Family Port Townsend,WA I JUL 7 2015 System Design Flow:360 98368 GENERAL SYSTEM TYPE: Pressure Owner:Steven Warner JEFFERSON COUNTY ON ID: SOM02-00080 DEPT.OF COMMUNITY DEVELOPMENT Fold ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fold Hart Inspected:06/30/2015 - Inspection Type:ROUTINE - Correction Status:All corrections made Hare Company: Work Performed By: Submitted 0613012015 by: Enviro Check,LLC Dale Wurtsmith Dale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development COMMENTS&GENERAL INSPECTION NOTES No Deficiencies Noted 1-What I observed was consistent with"As-built"and revised"Plot Plan"done by Enviro Check,LLC,dated 050914. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected All Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: _--- NO Abnormal ponding present for one or more of the disposal components: NO Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): OSS Components,structures and appurtenances located per as-built/record drawing(If NO,describe YES in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment 1200 Gal This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): YES Compartment 1 Scum accumulation(Inches,if other specify): 2 Effluent filter/screen needed cleaning on arrival NO Compartment 1 Sludge accumulation(Inches,if other specify): 6 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 2 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: ReportlD:449689 View inspection reports online at www.onlinerme.com Page 1 of 2 TANK:Pump Tank 1000 Gal This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches,if other specify): o Pump vault screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 2 Pumping needed: NO Pump Vault Filter leaned(N/A=not present): N/A Approximate Gallons to be pumped(if needed)by Certified Pumper: 'anel:Control-1 Pump,Manufacturer=Aquaworx-Aquaworx Manufacturer:Aquaworx Model:Aquaworx This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 3M Pump 1:off hours(override in parentheses-if present): 11H 57M Pump 1:gallons per dose(override in parentheses-if present): • 60 Pump 1:ETM hours(override in parentheses-if present): 3:57:47 Pump 1:Cycle Count(override in parentheses-if present): .- 26 V-o ump:Effluent Pump • This component was: - Fully Inspected Component appears to be functioning as intended: ' ' YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) NO Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) YES Tested gallons per minute flow: 20 grainfield:Pressure This component was: Fully Inspected Component appears to be functioning as intended: YES Lateral lines flushed: YES Average squirt height(if performed)(feet,if other specify): 5 Ponding present?If YES explain in comments: NO This repot}indicates certain characteristics of the onsite sewage system at the here of visit In no way is this report a guarantee of operation or Mace performance. ReporttD:449689 Vew inspection reports online at www.onlinerme.com Page 2 of 2 li 15- Z�F� • • 7/1/2015 Enviro Check, LLC 1612 Hastings Ave. West 360.3794400 Port Townsend, WA 98368 PROPERTY INFORMATION House Location:712 JUPITER LOOP Brinnon Tax ID:502094001 Men To: Steven Warner 1240 W.Sims Way#81 Use:Residential,Single Family Port Townsend,WA System Design Flow:360 98368 GENERAL SYSTEM TYPE:Pressure Owner:Steven Warner ON ID:SOM02-00080 Fold ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fold Here Here Inspected:06/30/2015 - Inspection Type:ROUTINE - Correction Status:All corrections made Company; Work Performed By: Submitted 06/30/2015 by: Enviro Check,LLC Dale Wurtsmith Dale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES No Deficiencies Noted 1-What I observed was consistent with"As-built"and revised"Plot Plan"done by Enviro Check,LLC,dated 050914. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected All Components accessible for maintenance.secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: NO Abnormal ponding present for one or more of the disposal components: NO Subsurface components adequately covered YES ----- Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): _ OSS Components,structures and appurtenances located per as-buit/record drawing(If NO,describe YES in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): The house/structure was vacant or used infrequently,assessment of the dremfield was not possible. NO Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL ANK:Septic Tank-2 Compartment 1200 Gal This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): YES Compartment 1 Scum accumulation(Inches,if other specify): 2 Effluent filter/screen needed cleaning on arrival NO Compartment 1 Sludge accumulation(Inches,if other specify): 6 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): _ 2 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: ReportlD:449689 View inspection reports online at www.onlinerme.com Page 1 of 2 ,--(2 . • !,G i . • • SON cG DEPARTMENT OF COMMUNITY DEVELOPMENT �� �� 621 Sheridan Street,Port Townsend,W.-\98368 W 1I 'I'c1:360.379.4450 lax:360.379 4451 f� V I�rr��- Web www_co leff41noi. �'S.SlSfctia iaim1t;,_4IS;Y4.15>�1.[ra..t I r� 0 E [ E �� I;.-mail dcd 1OcuIeffcrson wa.us L`-'� 49 S,/j N C3 A�? \D (�� r------- 2015JUN 2 3 i�' PERMIT APPLICATION j �� 11 ;� �' Steps in the Permit Process: ll JEFFERSON COUNTY -Review application checklist to ensure all information is completed prior to submitting.fs I •t JMUNITY DEVELOPMENT -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. I For Department Use Only Building Permit# I Related Application#s: MLA# Site Information Assessor Tax Parcel Number: 562 U V e/Dr) / p Site Address and/or Directions to Property: 71Z ,,/Lpi 7I-/e ZiwOfib Access (name of street(s)) from which access will be gained: .,JUP-T Cz,c 2./ Present use of property: ...el it-4C .kel rte} Description of Work(include proposed uses): 21/ r 34, (22,,---7- 4,-7-z? /rt sy ext- _5"/M4lei hc7 Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES NO k: If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit#: 56,f o 2-pa'j po _ Community Septic Name of System: Case#: Are other residences connected to the septic system? No Additions or repairs to sewage system: ,,0 Is it a complete or partial system installation: Complete _ Partial _ _ Has a reserve drainfield been designated? Yes _ �c _ No _ _ Date of Last Operations&Maintenance check: 5--9- /y Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: Permit APPG<atioo Pagel 0f 2 \)-31'-‘)6 --' -295 • • • • The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/ e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the ap lication. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email e. County email is not blocked or sent to `junk mad"). App'cart Property Owner Information Property Owner: / Name: S" Un/ f`/1412n1 .�f4.A.E:A? Address: /1510 kJ, j, G/dd y A'd'/ lgT 7c74.44,.52---A /1/4 9:P36,V. Phone#: 7/9-G c/-y3 y9 E-mail Address: _ Please con act A oriz Agent/Representative with project info. (select only one). e Property Owner Signature: 1 Date: 23itt Note: For projects with multiple owners,at ch a separate sheet with each owner(s)information and signatures. Applicant: Authorized pp Agent/Representative Of other than owner) Name: Address: Phone it: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: 7- oc! �rlrn,.- •r ; 45 TO iiAJGPFo99LT fo,3o Address: /WS.2/ rFy 99, 5;4 C.. Lyn,.v4dee u=/fri 9<Pti3 7 Phone#: y2i_7; . s5'S E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professponal,' is ff tis an Authorizetl AgerttfRepresentetive for tFt�s protect? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: Permit Application Page 2 of 2 .,..�,a�.-,.S TSE A Engineering'' Date Sent: 09/22/15 '.�i_� P®' 4 Name: Building Official •' irg ASbg, �' Total pages: 1 `c° /� � ��- From: Terry Powell, P.E. r•=,. .. W Subject: "Warner" Post Frame Building ,' int)64 712 Jupiter Loop Rd. . 494, ---„A4 Brinnon, WA 22 /S" COMMENTS A large rock occurs 4'-0" deep below grade at the corner post location shown below. At this location it is acceptable for the corner post bear on the rock (rather than a concrete pad) and the hole to be backfilled with sand per the backfill note on the original plan. !g'01,4.lW wN(r KG., ,-,6/24,,,,(z ' ` r — — — — — — -- • ■ rf ■ 11 N 12 12. 12 k i k-`1, , � 2' AA p..,1 POUF 1v lu GFRki 'y !'.Y to' X / 41,v6.LF/Tr 93 w1 47 /1-1-711 r'`aCER-m6s.H.� 2H .7-i'.. 12 I .5.HUI' 7r Nl y1 i . I ■ .� 12810 N.E. 178th Street Suite 218 A Woodinville, WA. 98072-8702 (425) 481-6601 A terry©tse-aep.com 77 • • (----- �0N coV DEPARTMENT OF COMMUNITY DEVELO I' L� V3 G627 Sheridan Street,I ort Townsend,V(A 98368 `1 l Tel:360.379.4450 � Fax:360.379.4451 ' �� �C Web.www.co.jcffcrson wa us/communitl�devclopmcnt I E-mail:dcd@a co�cffetson.wa us I ri ; JUN 2 3 2015 I // I1 L,; I 9 ti f N 6\CVSUPPLEMENTAL APPLICATION '---------- I JEFFERSON COUNTY RESIDENTIAL OR COMMERCIAL BLDG PERMIT Cr-rn^^R„llPITY FVFInPrrENT— For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: ' Assessor Tax Parcel#: Type of Building New X Replacement Relocated Addition Repair Demolition * `A separate permit is required Select One: ���,9 Single Family Residence Modular Other Srn,Ac-;f- 5t Proposed Building/Project Number of floors / #new bedrooms existing _ total bed #new bathrooms existing total bath Heat Source Select all that apply: •% . - (......0 NEA-1 - ('�1C) P(l-' 16l NC) g Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor / / 4,- Residential/Commercial Second Floor 6 -3”. Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage heated/unheated , Q fa�J� / Attached Garage-heated/unheated '�j/ , G' Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered 4 /ag Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ .2 4.7 pic Supplemental SFR 1 11 3914 21 . I Z- • • List existing buildings on property(i.e. house,garage,accessory dwelling unit, shed, barn, mobile home,other): All Existing Buildings on Property Use fid aIr' SF# Dttie��,,. 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 compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may request notice of the County's intent to enter upon the property for visits rel ted to this applica on and subsequent permit issuance. Al / ^� XSignature: A- c • Wel _Print Name: /IA I( L16'� - Date: •2i�/✓�'2e� Estimated Cost of Project $ �. ���� For Department Use Only 1 Building Base Fees Building Base _I (05 . OD Plan Check Reviewer 2S Land Use Review inn Septic Review $.7g:0(1,.._ Potable Water S-157.43fL Technology/Scan $19.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt# Date: Cash/Check/CC: Supplemental SFR 2 2 ' • • 4��gON ('off DEPARTMENT OF COMMUNITY DEVELOPMENT�1 E D Uv ,cL `2 621 Sheridan Strcet,fort Townsend,WA 98368 :�.1/ „: ti 'fel:360.379 4450 Fax:360.379.4451 ( � + jt f Web:www.co.jefferson.wa.us/communitydevelopment JUN 2 3 2015 li mail:dcd1 co.icffcrson wa.us IJ, �; f ii 1 NCO JEFFERSON COUNTY L FP1 OF�O SMI/NI1Y DEVELOPMENT STORMWATER CALCULATION WORKSHEET - MIA# PROTECT/APPLICANT NAME: i,,- MIA DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as "small," "medium," or "large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application,or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E..SITE) Size of parcel /a zS acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet Z"-7j CG L' sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be Geared,graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: ��y Does the project convert'/,acres or more of Construction site for structures sq/fl native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes l Well, utilities,etc. sq/ft Does the project convert 2'/z acres or more of native vegetation to pasture? Driveway,parking, roads,etc. sq/ft Circle: Yes Lawn, landscaping,etc. sqfit Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 844' sq/ft Cut Fill (cu/yd) Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways,patios,driveways, parking lots or storage areas,concrete or asphalt paving,gravel roads, packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. stormwater calc worksheet—REV.10/20/2014 1 STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) /4)53 sq/ft Structures(all roof area) Z/Y(.) sq/fl Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks 3q- sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads, etc 471g6 o sq/ft Driveway, parking, roads,etc `)zeLN sq/ft Other sq/ft Other sq/ft �3 Total New / 3 sgfft Total Existing // Gk'S sglft TOTAL NEW+TOTAL EXISTING* l- . sq/ft *This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: r', f� % Does the site have 35%or more of existing impervious surface? Circle: Yes No Y FURTHER INSTRUCTIONS:If the answer is yes,the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimum Requirements#1 through#5—and for"large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. tj ,X RI X ,3Ja,1 zC fi 1LANDOWNER r- .1 HORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE OWLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No stormwater talc worksheet—REV.10/202014 • • 6/4/2015 Enviro Check LLC ,� n 1612 Hastings Ave. West ) 3e0l 9- 1 Port Townsend, WA 98368 • l U N 2 3 2015 i lI - PROPERTY INFORMATION - House 4 Location:712 JUPITER LOOP JEFFERSON COUNTY Brinnon '21 COMMUNITY DEVELOPMENT Tax ID:502094001 Mae To: BARBARA LEWIS PO Box 303 Use:Residential,Single Family BRINNON,WA System Design Flow:360 983200303 GENERAL SYSTEM TYPE:Pressure Owner:BARBARA LEWIS ON ID:SOM02-00080 Fold e— • - . . r I y r , , . Fold Here Here Inspected:05/09/2014 - Inspection Type:PROPERTY SALE - Correction Status:Some Corrections Made Company: Work Performed By: Submitted 05/09/2014 by: Enviro Check,LLC Dale Wurtsmith Dale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficiencies Noted:deficiencies must be corrected to ensure proper longevity of the Onsite Sewage System. 1-The timer settings were different from the design plan,but is correct on dosing amount.Three separate 1M draw downs done to verify correct dosing. 2-There is light brush on small area of the drainfield that could be removed before before it gets large. 3-SYSTEM-What I observed was consistent with"As-built". APPURTENANCES-A revised"Plot Plan",ref-House and tank location to house only. 4-Note-Outlet baffle filter should be cleaned on a regular basis. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected All Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: NO Abnormal ponding present for one or more of the disposal components. N/A Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): ............ OSS Components,structures and appurtenances located per as-built/record drawing(If NO,describe NO-See Comments- • in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO __ ... Is the SEP case in a finaledlcompleted status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL ANK:Septic Tank-2 Compartment 1200 Gal This component was. Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): YES Effluent filter/screen needed cleaning on arrival NO Compartment 1 Scum accumulation(Inches,if other specify): 2 Compartment 1 Sludge accumulation(Inches,if other specify): Compartment 2 Scum accumulation(Inches,if other specify): 0 ReportlD:374472 View inspection reports online at www.onlinerme.com Page 1 of 2 Compartment 2 Sludge accumulation(Inc other specify): 2 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: TANK:Pump Tank 1000 Gal • This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches.if other specify): 0 Pump vault screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 2 Pump Vault Filter cleaned(N/A=not present): N/A Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: •anel:Control-1 Pump,Manufacturer-Aquawonr-Aquaworx Manufacturer:Aquaworx Model:Aquaworx This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 9 Pump 1:off hours(override in parentheses-if present): 12 Pump 1:gallons per dose(override in parentheses-if present): 180 Pump 1:ETM hours(override in parentheses-if present): 355:46:21 Pump 1:Cycle Count(override in parentheses-if present): 2523 V-3 'amp:Effluent Pump This component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) YES See Comments Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute flow: 20 P rain field:Pressure This component was. Fully Inspected Component appears to be functioning as intended: YES Lateral lines flushed: YES Average squirt height(if performed)(feet,if other specify): 3 Ponding present?If YES explain in comments: 1 N/A EUVIE l •�_,� JUN 2 3 2015 ( fJ JEFFERSON COUNTY ^`--PT.OF COMMUNITY DEVELOPMENT This report indicates certain alarecterisfics orthe onsite sewage system at the time o/rise.In no way is this report a guarantee of operation or totem performance. ReportlD:374472 View inspection reports online at www.onlinerme.com Page 2 of 2 • • ,_$ON e� DEPARTMENT OF COMMUNITY DEVELOPMENT , ,,, 631 Sheridan Street,Port Townsend,WA 98368 e, fel:360.379.4450 ! Fax:360.379.4451 Web:www.co.jefferson.wa.us/conamunit)'development _.............) ii. � � E-mail:dcdaico.iefferson.wa.us �Sf7I N CO-() PERMIT FEES WORKSHEET Name warner Parcel# 502094001 Estimated Cost of Project $37,437.00 Permit# Building Base Fees Building Base $465.00 Plan Check Review $302.25 Land Use Review $234.00 Septic Review $129.00 Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning New Address Public Works Total Fees $1,154.25 Office Use Only Receipt Number: 1 (:-.:k)2.. I 2--- Cash/Check/CC: ESA'I (.0 Date: (N ? J IS Parcel Details • Page 1 of 2 • Jefferson County w likSather&tabun .. ` " tease nk- !Kt 41itant Home County Info Departments Search Parcel Number: 502094001 SEARCH Parcel Number: 502094001 Printer Friendly Owner Mailing Address: STEVEN J WARNER MARTHA M WARNER 1240 W SIMS WAY #81 PORT TOWNSEND WA98368 Site Address: 712 JUPITER LOOP RD BRINNON 98320 Section: 9 School District: Brinnon (46) Qtr Section: SE1/4 Fire Dist: Brinnon (4) Township: 25N Tax Status: Taxable Range: 2W Tax Code: 0441 Planning area: Brinnon (11) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S9 & 10 T25 R2W TAX 14 BND BY BLA #95223 Tax, A/V, Sales, Photos,and Permit Data Bldo Data Map Parcel lats&Surveys i I Septic Monitoring Info Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later dig Windows - Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?value=502094001 6/23/2015 411UILDING PERMIT APPLICAIN BLD15-00208 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00208 Received Date: 6/23/2015 SITE ADDRESS: 712 JUPITER LOOP BRINNON, 98320 OWNER: STEVEN J WARNER PHONE: 719-651-9340 MARTHA M WARNER 1240 W SIMS WAY#81 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502094001 Section: 9 Township: 25 N Range: 2V1 CONTRACTOR: TOWN &COUNTRY POST& FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO? NEW GARAGE- NO HEAT- NO PLUMBING SEP02-00080 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 37,437.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: 864 SETBACK: CK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $465.00 SRE 06/23/15 156212 Plan Check $302.25 SRE 06/23/15 156212 State Building Code $4.50 SRE 06/23/15 156212 Total: $771.75 \lfirfomarlrlrlafalfnrn,c\F RI (l Ann RIrl rnf A/9'3/9(114 /. O1 0,. DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 Fax:360.379.4451 fl77 �) Web: .A.1. • 's I . ; t e .Mt niJevelopmen3PERMIT APPLICATION JEFFERSON COUNTY Steps in the Permit Process: DEPT.OF COMMUNITY DEVELOPMENT -Review application checklist to ensure all information is completed prior to submitting app ica to . -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: jL 4, L. 2'VGG 7 p Site Address and/or Directions to Property: `7/, ,jLP)7-tlg bwo./ D Access(name of street(s)) from which access will be gained: ji.1,4r (A raiajej� Present use of property: ig,(,qt,�7Z S,o&,'"7,4 c--- Description of Work(include proposed uses): .,;76/;i•.,;76/;i• ,3 'D --S'ACrfeD sr- # "snS,-T,0 Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES NO v)C If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit#: t5�/wo Z-oco 90 _ _ Community Septic Name of System: Case#: Are other residences connected to the septic system? NU Additions or repairs to sewage system: ,gyp Is it a complete or partial system installation: Complete p� Partial Has a reserve drainfield been designated? Yes _ k. _ No Date of Last Operations& Maintenance check: 5S-9- /4/ Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: Permit Application Page 1 of 2 The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/ e-mail requests and information about the application to the authorized agent/representative and will copy(cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e.,County email is not blocked or sent to `junk mail"). Applicant/Property Owner Information Property Owner: Name: �scUEn/ fl rite f ��J''/v6--/e Address: /Z4/0 /, Smol5 L afy 'S/ / - T.iAlsevv ui4i- 9°36,6 Phone#: _ 7/1-GSY-93 E-mail Address: — _ Please c•nta uthorized Agent/Representativ ith pr ' ct info. (select only one). VProperty Owner Signature: / •-•"--- Date:w J,..n 2c)(15 Note: For projects with multiple owne s,attach a separat sheet with each owner(s)informat n and signatures. Applicant: Authorized Agent/Representative (If otherthan owner) Name: X Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor x Contractor Consultant Name: 7 v/1'u.u/4y/7r,44nFtju/GDin/GS To ti iv PFo99Lr Ori. 5-- Address: /4,5-,2/ Af[F f/99/ Silt G Lyiv.a/z.✓eso/ 'At 9037 Phone#: ',/Z5-.793-/y 5 S E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: _ Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: Permit Application Page 2 of 2 .77 • • N DEPARTMENT OF COMMUNITY DEVELOI7Fir r�, 621 Sheridan Street,Port Townsend,WA 98368 j x j 7'el 360.379A450 I Ina 360 379.4451 L), -C Web:www.eo4efferson wa.us/communiqdevelopment nf�t I:? mail:dcd n•co*Jfcrsonwa u ' I J U I\ L J 1:��15 N c;v- SUPPLEMENTAL APPLICATION �`-____[T JEEFERSC d COUNTY RESIDENTIAL OR COMMERCIAL BLDG PERMIT OF COME/U'NIrY DEVELOPMENT For Department Use Only Receipt#: Date: Related Application#5: Payment#: Site Information Owner Name: S H /¼,, -/? Assessor Tax Parcel#: c V4/0(1)/ Type of Building New x Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other _____ _ ist Proposed Building/Project Number of floors / #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: /7/O /le-,1 r NO P/dN1 //1 Electric Heating Oil Wood Propa Enter the square footage(sq/ft) that applies in each field: Structure Existing Sq/Ft Proposed Sq/FYI Residential/Commercial Main Floor Residential/Commercial Second Floor GPS Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated S'64/ 8F / Attached Garage-heated/unheated Y P i Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered /1678 Covered porch Other(shed,barn, pole bldg,etc.) Estimated Cost of Project(Required): $ o 6t 0 Supplemental SFR I • • List existing buildings on property(i.e. house,garage, accessory dwelling unit,shed, barn, mobile home, other): All Existing Buildings on Property Use ease 5-Ax! Pic e 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 compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may request notice of the County's intent to enter upon the property for visits related d to this applicationIand subsequent permititissuance.isJ /,/9 X Signature: Gte��Q tL%L-- Print Name: /l/n-4A " w Date: ‘-'13 77" A' Estimated .ost of Project $ , � For Department Use Only Building Base Fees Building Base Plan Check Review Land Use Review - `-- - n V k $228.00 Septic Review �11 7 11 v $79.00 Potable Water 2 3 2.015 IIS $107.00 Technology/Scan J f,ri ERSON GD NNTY $19.00 State Fee -iiMMUNITY DEVELOPMENT $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt ## Date: Cash/Check/CC: Supplemental SFR 2 z • • ¢goN �o DEPARTMENT OF COMMUNITY DEVELOPMENT-- „,,,,, `�--, q �� 621 Sheridan Street,Port Townsend,WA 98368 -1 1 Tel:360.379.4450 � IJax:360.379.4451 ) t]UN 2 3 ���� Web:www.co.jefferson.wa.us/communitydevelopment ` E-mail:ilcd@cniefferson.wa.us :EP, �__�_ IIEFFERSON COUNTYZysH f NCJ�O ___. OF COMMUNITY DEVELOPMENT STORMWATER CALCULATION WORKSHEET MIA# PROJECT/APPLICANT NAME: kl/keiVE/C DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as "small,” "medium," or "large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application,or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E..SITE) Size of parcel 6i.5 / acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet Z g7,OG v sq/ft Land-disturbing activity is any activity that results in movement of earth,or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION.AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures goy sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes Well,utilities,etc. sq/ft Does the project convert 2'/a acres or more of native vegetation to pasture? Driveway, parking, roads,etc. sq/ft , '�� Circle: Yes C'% Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance R64 sq/ft Cut Fill (cu/yd) Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios,driveways, parking lots or storage areas,concrete or asphalt paving,gravel roads, packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. stormwater ram worksheet-Rev.10/20/2014 1 • • STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) jG 5-3 sq/ft Structures(all roof area) Z%y6 sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads,etc iige, sq/ft Driveway, parking, roads, etc ,14.C. sq/ft Other sq/ft Other sq/ft 7 Total New f5. 6 sq/ft Total Existing // GFc; sq/ft TOTAL NEW+TOTAL EXISTING* _/3 c2-11 sq/it *This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: ,/, `/ % Does the site have 35%or more of existing impervious surface? Circle: Yes n No VI FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimum Requirements#1 through#5—and for"large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Storm water Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property / x1;72/71�-- z3J.4,4 Ifc'si (LANDOWORIZED REPRESENTATIVE SIGNATURE) (DATE) IF,'...!.-',.. .. ' ,-,-,,,,,w,r,. .:‘,.k . ':.•'. - - , :1,:nig, -,4,,,::. . ...,c,;.:•.,:,,.4c:31,.:,-..- -.E.,R:,.:Niv,. :., ,.. ::.::.:;.,: - storrnwter calc worksheet-REV.10/20/2014 2 I