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HomeMy WebLinkAboutBLD2015-00158 - 01 PERMIT APPLICATION tILDING PERMIT APPLICATS BLD15-00158 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00158 Received Date: 5/13/2015 SITE ADDRESS: 334 PORT HADLOCK HEIGHTS RD PORT HADLOCK, 98339 OWNER: KATHRYN GRIM PHONE: 54 PORT HADLOCK HEIGHTS PL PORT HADLOCK WA 98339 9895 - PORT HADLOCK HEIGHTS MH SUBDIVISION: Block: Lot: 1-45 PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 1111 CONTRACTOR: CANTERBURY CONSTRUCTION PHONE: 360-460-7298 PO BOX 2714 BELFAIR WA 98528 Contractor's License CANTEC*021 NC Expires 2/5/2009 REPRESENTATIVE: PAT RICHARDSON PHONE: 360-460-7298 271 ELCAMINE DR SEQUIM WA 98382 PROJECT DESCRIPTIOI` NEW GARAGE NO PLUMBING NO HEAT SEP04-00077 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 11,560.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GA 400 SETBACK: 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 $179.00 SRE 05/13/15 155989 Plan Check $116.35 SRE 05/13/15 155989 ��� ���® State Building Code $4.50 SRE 05/13/15 155989 MAY 1 c 2015 Total: $299.85 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 5/13/2015 • BLD15-00158 BUILDING PERMIT APPLICION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00158 Received Date: 5/13/2015 SITE ADDRESS: 334 PORT HADLOCK HEIGHTS RD PORT HADLOCK, 98339 OWNER: KATHRYN GRIM PHONE: 54 PORT HADLOCK HEIGHTS PL PORT HADLOCK WA 98339 9895- PORT HADLOCK HEIGHTS MH SUBDIVISION: Block: Lot: 1-45 PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 1 ■ CONTRACTOR: CANTERBURY CONSTRUCTION PHONE: 360-460-7298 PO BOX 2714 BELFAIR WA 98528 Contractor's License CANTEC*021NC Expires 2/5/2009 REPRESENTATIVE: PAT RICHARDSON PHONE: 360-460-7298 271 ELCAMINE DR SEQUIM WA 98382 PROJECT DESCRIPTIOI NEW GARAGE NO PLUMBING NO HEAT SEP04-00077 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 11,560.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE 400 SHORELINE: CONST TYPE: DECK: SETBACK: I BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: houtinq Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $179.00 SRE 05/13/15 155989 Plan Check $116.35 SRE 05/13/15 155989 State Building Code $4.50 SRE 05/13/15 155989 Total: $299.85 1\tidemark\data\forms\F_BLD_App_Bld.rpt 5/13/2015 • • SOS ok' c 06 DEPART ENT OF COMMUNITY D r 4, 2 (2I Shr i,J.n'r r 1) n 7 nyi.srl:c \\ \ 056s fl r c - \ � C � a ` E r : el )6(13 9.41 11 ti:360379.4451 Web.P ill.co IL o:: a US cOff)ma 'xA do CIO:) en I D 4 , ,, 11-1112:I.dccll 1c fie 1:,in. :u; 1\,; MAY 1 3 2015 li�s �o IIi NG 1 PERMIT APPLICATION JEFFERSON CCUttlY ___ DFPT OF COMMUNITY DEVELOPMENT Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -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 su pp lemental 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 Its: MLA# Site Information Assessor Tax Parcel Number: `1 Bzi Sop @ c) ( ii Site Address and/or Directions to Property: 94 -Pori Had lock 14EAc., '' 1M . Access(name of street(s)) from which access will be gained: Present use of property: Description of Work(include proposed uses): Tit b4e.k\ ci 20 y, T Wastewater-Sewage-Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES ,/ NO — If not served by sewer identified above,identify type of septic system below: 3 c - ziccq Type of Sewage System Serving Property: II ,, ��,,,,,,,��rr Septic Septic Permit#: 1' �`-t- ' c�C.ti ✓ Community Septic Name of System: ,` Case#: Are other residences connected to the septic system? Y eg Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _✓ _ Partial _ Has a reserve drainfield been designated? Yes ✓ No _ Date of Last Operations& Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: • • The au:horized agent;rep nan'.e :Ile a and co:::aci :ot ;ilri pr :ect leiated questions and COffeSp mdellCe. The Colim': will mail : e-mail requests and inform n about the application to the authorized agent/representative and o. ll copy icc. the owner noted below. The authorized ale 7 epee<e:1 L'i flt'e is responsible for communicating the information to all parties involved w;tn the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts Counn- email;i.e..County email is not blocked or sent to "junk mau';. Applicant/Property Owner Information • Property Owner: p '� Name: .ioders f 7, c . Address: 1 S0 3 old 6,4,,k,,,, ICJ p T <S.3AS Phone #: _ 34 c '7 el l - 7 VA_ E-mail Address: — — Please contact Autho ized Agent/Representative with project info. (select only one). Property Owner Signature: ,�- r°rrs, 64ktrs,7dc Date: 13 fi\ul -2(..24_5 Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative Of other than owner) Name: ' - -k r.te L0.-0 Address: 21L Ifc,.•,<ro 1> , �Prt,,wt , WA2 Phone#: 3L )-4(e0_ -129.1f; E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor f Contractor Consultant Name: ' n) C©ASA-(Ncktor, q . Address: 111 ElCuM',rto lDr " bi.itM UI)t 14b3S2. Phone#: 3(00- L4fpO• 1 lig E-mail Address: nay ic o4 i o. J 5rria• l • rmr% 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 Autho_rized 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: . • • ��S ON co DEPARTMENT OF COMMUNITY DEVELOPMENT G r_'i shy ,, v cet,POr;T W:1Se d \\ 2 "Ii _6:∎ .-'1.4:5,1 Yap 36?.+-94751 Y r < Web:.,vv,-,\-.co.:1:iferson.wa.us-coi:-:muo7,. c ;J•: .:c" _ L-:nail:■ ce!ct c:,.•etScr:on.wa.us `SXi NG-C9 SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT 'For Department Use Only Receipt#: Date: l (Related Application#s: Payment#: I Site Information Owner Name: A'\42-1i11-1 n Grc Assessor Tax Parcel #: 9Bis0000a Type of Building New ,f Replacement Relocated Addition Repair Demolition * •A separate permit is required Select One: Single Family Residence Modular Other &otos( , list Proposed-Building/Project Number of floors ( #new bedrooms existing total bed # new bathrooms existing total bath Heat Source . Select all that apply: Electric Al y{ Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation(Office Use) Residential/Commercial Main Floor Residential/Commercial Second Floor Additional Floors-heated/unheated i Basement-unfinished 'Basement-finished space or habitable Detached Garage-heated//nheate qoo -Li fry i I '23(eCD Attached Garage -heated/unheated Garage 2nd fl-unfinished storage !Garage 2nd fl-finished space or habitable I I 'Carport-2 walls or less I Deck- uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ $ • • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property IUse t11Qnu14�1-ul2 I}oMP �in51t twM l� r,� Velfialq • .J 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 t e will be assuming the responsibility of the General Contractor for the proposed project. Signatur I Print Name:�aC Gr 0Son Date: 511(1201C- ; • • By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with resp o t ' p ication packet may result in making any issued permit null and void. Signatur Print Name a4 "R∎el(1otcgo. Date: 5111 12.015 For Department Use Only Building Permit Fees Building Base Plan Check Review o 5S- Land Use Review $234.00 Septic Review -5+30448—l Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning • Zoning Other • New Address Road Approach Total Fees I �� (AL'3S' Receipt # Date: Cash/Check/CC: • • 5/13/2015 Shedd Excavating Inc. PO Box 179 360-385-0480 Port Hadlock, WA 98339 • PROPERTY INFORMATION Location:54 PORT HAD LOCK HEIGHTS RD Port Hadlock Tax ID:989500001 Mod To: BRODERS INC Use: PORT TOWNSEND,WA 983689778 Owner. BRODERS INC ON ID:SOM04-00077 Foa r ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fee Here Inspected:08/13/2014 - Inspection Type:ROUTINE - Correction Status:No corrections needed Here Company: Certification-Level 2 Work Performed By.: Submitted 08/14/2014 by: Shold Excavating Inc. Timothy Johnson Timothy Johnson 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 -This septic system is connected to a community drainfield. 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 N/A 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,Manufacturer= Local Manufacturer-Concrete Manufacturer: Local Manufacturer Model:Concrete 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(NIA=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): a Compartment 1 Sludge accumulation(Inches,if other specify): 2 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 0 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 ReportlD:392322 View inspection reports online at www.onlinerme.com Page 1 of 2 • • • TANK:Pump Tank,Manufacturer= Local Manufacturer-Concrete Manufacturer: Local Manufacturer Model:Concrete 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 NIA Compartment 1 Sludge accumulation(Inches,if other specify): 0 Pump Vault Filter cleaned(N/A=not present): N/A Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 -anel:Control-1 Pump This component was: Fully inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): Demand Pump 1:off hours(override in parentheses-if present): Demand Pump 1:gallons per dose(override in parentheses-if present): 180 Pump 1:ETM hours(override in parentheses-if present): N/A Pump 1:Cycle Count(override in parentheses-B present): N/A Pump: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) NO Tested gallons per minute flow: 30 This report indicates certain characteristics ofthe ansife sewage system at the time or visit M no way Is this report a guarantee of operation or future performance. ReportiD:392322 View inspection reports online at www.onlinerme.com Page 2 of 2 • 4 �5�� ooh DEPARTMENT OF COMMUNITY DEVELOPMENT �' - '1,=A 621 Sheridan firer,-firer,-1)(in Townsend;\C.\9836/i Tel 603-9 3430 Fnxi 360379.4431 \\eb www.co.iefielson.wa.usicommunirydcvelopment � E `J L., E-mail dcd a co.ieffe6,on.wa.us ■1 -141 N G 0 �' MAY 1 3 2015 .; PERMIT APPLICATION ' Li 0 ' JEFFER O;alLIN Y Steps in the Permit Process: rcr OF COMMUNITY DEVELOPMENT -Review application checklist to ensure all information is completed prior to submitting application. -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: o 850000 I , r -�v Site Address and/or Directions to Property: Sit Dior[ Nod 4 lock jA r1. Access (name of street(s)) from which access will be gained: Present use of property: Description of Work(include proposed uses): "fyt�lFa« q 2,0 .t. 2.0 .5cac st r cl oovi- vto P!MAN Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES / NO If not served by sewer identified above, identify type of septic system below: 5 - Type of Sewage System Serving Property: �`' i Septic Septic Permit#: t _ ,/ Community Septic Name of System: Case#: Are other residences connected to the septic system? e5 Additions or repairs to sewage system: Is it a complete or partial system installation: Complete ✓ _ Partial Has a reserve drainfield been designated? Yes ✓ _ No Date of Last Operations& Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: t. • • • The authorized agent/representative is the primary contact for all proicct-related questions and correspondence. The County will mad / e-mail requests and information about the application to the authorized agent/representative and Neill copy (ccl 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: J tsrt - Name: L BreCtier , 7■■ c - / -CtJ-he Lne Gri Address: 930 3 C7/oil /3 T 78345 Phone#: _ 0 7 q 1 -7 22 E-mail Address: Please contact Autho ized Agent/Representative with project info. (select only one). — — Property Owner Signature: forts, Brr rs,7.r( Date: 13 )1\4 2o45 Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(If other than owner) n Name: �gkeiNSon Address: 211 �!'ICA�n;ho DI , ect,i w We `?�3a Phone#: p_wet),---12c63 E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor f Contractor Consultant Name: N� (©,1s4(H4.k%on Address: lit £ifaAA*no 1Dr cuitery ( J4 6M3'2- Phone#: 3(Qp- 1.Q,D- g E-mail Address: nay ioia(iaz® (1,14, cenv 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: , SONT DEPARTMENT OF COMMUNITY DEVEL ' F n V co l _ ��� � C31 �hc�id:,, Strcer Yor lovvnscad_AV�.19S31� � � � i .� .(;2 1 x&.3')4431 fay �G�i 9-}-ISl \"L':::\r v �L4 -G Web:v zvzr.c o i :erson.wa.us,'ca mm�nde doncrear i )�Al 3 �o 5 C)� E roil:uc Ja co etferson vca us (1 i -i ask N SUPPLEMENTAL APPLICATION ' oMMw°E W°PMENT oc RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#5: Payment pp ment#:y Site Information Owner Name: .440,41Af,i h GC%M Assessor Tax Parcel#: q 845000O Type of Building New Replacement Relocated Addition Repair Demolition * 'A separate permit is required Select One: Single Family Residence Modular Other 6ae45t list Proposed Building/Project Number of floors ( #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: Electric AiA Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (office use) Residential/Commercial Main Floor Residential/Commercial Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage - heated/unheate 400 A 1110 Attached Garage -heated/unheated Garage 2nd fl- unfinished storage Garage 2nd fl-finished space or habitable I Carport-2 walls or less Deck- uncovered Covered porch Other (shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ $ • • List existing buildings on property(i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use r (� man f0,,vic • Sln t lt aM ty otNt114nR J 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 t e will be assuming the responsibility of the General Contractor for the proposed project. Signatur Print Name:---44,CIGlI hareson Date: 51141201$` i By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with resp o t ' -p ication packet may result in making any issued permit null and void. Signatur Print Name04 .elrtotcYgon Date: Slit 17.015 For Department Use Only Building Permit Fees Building Base I -OCR Plan Check Review 1r • 'jam Land Use Review $234.00 Septic Review $89-99-12 I' o° Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt# Date: Cash/Check/CC: • • x.4.1 coG� JEFFERSON COUNTY �� ��^',. W '+` ,- DEPARTMENT OF COMMUNITY DEVELOPMENT ' v { i _ _ 621 Sheridan Street • Port Townsend • Washington 98368 ` ',Li M(a� .\ 3 2015 1 ■ I �S, O 360/379-4450 • 360/379-4451 Fax 1i ` F3IN0 httpJ/www.co.jefferson.wa.us/commdevelopment/ , 1 �, .�,`dia1V FMEN- Stormwater Calculation Worksheet I t1Gt� MLA# PROJECT/APPLICANT NAME: " \t V y� k, ■ I� , I 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 II.E., SITE Size of parcel �S acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet I 0 8 9 0Q. 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 Y.acres or more of Construction site for structures 2'000 S5 et sq/ft native vegetation to lawn or landscaped areas? Drainfield, eptic tan, etc. lib s`1 fl sq/ft Circle: Yes No Well,utilities,etc. N I A sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking,roads, etc. RIND .5c 1' sq/ft l Circle: Yes No Lawn, landscaping, etc. '500 51 41- sq/fl Other compacted surface, etc. r0' sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 3 U ��1 y 4 O SS 1 , sq/ft Cut n) /t_ __ Fill N I IA (cu/yd) [over] M • 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 CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures (all roof area) LAW sq/ft Structures(all roof area) 13414 sq/ft Sidewalks sq/ft Sidewalks -3' sq/ft Patios ✓ sq/ft Patios -0- sq/ft Solid Decks ✓ sq/ft Solid Decks 38t-1 sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc sq/ft Driveway, parking, roads, etc SOO sq/ft Other sq/ft Other sq/ft Total New 1400 sq/ft Total Existing .Z.1 2 8 sq/ft TOTAL NEW+TOTAL EXISTING* 214,2i3 sq/ft *This amount will be used BY STAFF 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: 'dZ % Does the site have 35%or more of existing impervious surface? Circle: Yes No 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 ow r oft - te. property. I • t 5/13 \ oic (LANDOWNER■- •UTHORIZED REPRESENTATIVE SIGNATURE) (DATE FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No slormwaler ralr wnrkchaal Rnv 4q_7ntn_Pr%/0I0l0n141 5/13/2015 Shold Excavating Inc PO Box 179 360-385-0480 Port Hadlock, WA 98339 fIM E PROPERTY INFORMATION I! Location:54 PORT HADLOCK I-IEIGHTS RD1' 1 3 2015 Port Hadlock rvl AY Tax ID:989500001 Mail To: BRODERS INC Use: IEFFE83G;:;CvUPdTY PORT TOWNSEND,WA 983689778 Owner BRODERS INC OOf N C OIDSUOiY M 0D4 EV0L00P77 ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fos Here Inspected:08/13/2014 - Inspection Type:ROUTINE - Correction Status:No corrections needed Here Company: Certification-Level 2 Wort(Performed By: Submitted 08/14/2014 by: Shold Excavating Inc. Timothy Johnson Timothy Johnson 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 -This septic system is connected to a community drainfield. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected At 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 N/A Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system propedy). 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 l 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 1 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,Manufacturer= Local Manufacturer-Concrete Manufacturer: Local Manufacturer Model:Concrete 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): 8 Compartment 1 Sludge accumulation(Inches,if other specify): 2 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): 0 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 ReportlD:392322 View inspection reports online at www.onlinerme.com Page 1 of 2 I Manufacturer: Local Manufacturer Model:Concrete 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 deaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 0 Pump Vault Filter cleaned(N/A=not present): N/A Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper, 0 Panel:Control-1 Pump This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): Demand Pump 1:off hours(override in parentheses-if present): Demand Pump 1:gallons per dose(override in parentheses-if present): 180 Pump 1:ETM hours(override in parentheses-if present): N/A Pump 1:Cycle Count(override in parentheses-if present): N/A '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) NO Tested gallons per minute flow: 30 • This report indicates certain characteristics or the onsrfe sewage system at the time of visit.In no way is this report a guarantee of operation or future performance. ReportlD:392322 View inspection reports online at www.onlinerme.com Page 2 of 2 Parcel Details Page 1 of 2 • S Jefferson County vvearrtan-... _— #7aabe3 Home %. County Info Departments Search Parcel Number: 989500001 SEARCH Parcel Number: 989500001 Printer Friendly Owner Mailing Address: BRODERS INC 4503 OLD GARDINER RD PORT TOWNSEND WA98368-9778 Site Address: Section: 11 School District: Chimacum (49) Qtr Section: NE1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 0211 Planning area:Tri-Area (4) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: 9895 - PORT HADLOCK HEIGHTS MH PARK Assessor's Land Use Code: 1500 - Mobile Home Parks and Courts Property Description: PORT HADLOCK HEIGHTS MH PARK BINDING SITE PLAN LOTS 1 THRU 45 Tax,A/V,Sales, Photos,and Permit Data Bldg Data Map Parcel Plats &Surveys Septic Monitoring Info Jefferson County HOME 1 COUNTY INFO l DEPARTMENTS I SEARCH of Best viewed with Microsoft Internet Explorer 6.0 or later 0 Windows - Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?value=989500001 5/13/2015 R N D CONSTRUCTION Page 1 of 2 II III Home Inieio en Espanol Contact Search L&I StARCH A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries R N D CONSTRUCTION Owner or tradesperson 271 El Camino Dr NAJERA,JAVIER DIAZ SEQUIN,WA 98382 360-775-7810 Principals CLALLAM County NAJERA,JAVIER DIAZ,OWNER Doing business as R N D CONSTRUCTION WA UBI No. Business type 602 253 224 Individual License Verify the contractors active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. RNDCOND867CK Effective—expiration 02/1212014—02112/2016 Bond American Contractors Indem CO $12,000.00 Bond account no. 100240579 Received by L&I Effective date 02/12/2014 02/05/2014 Expiration date Until Canceled Insurance . _......_...._.... Contractors Bonding&Insuranc $1,000,000.00 Policy no. C11SK0479 Received by L&I Effective date 12/18/2014 02/05/2014 Expiration date 02105/2016 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602253224&LIC=RNDCOND867CK&SAW= 5/13/2015 R N D CONSTRUCTION Page 2 of 2 I Workers' comp 11110 •I Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is closed. 162,647-o0 Doing business as JND CONSTRUCTION Estimated workers reported NIA L&I account representative T2/HAN CHUNG(360)902-4713-Email:CHUK235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. S Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602253224&LIC=RNDCOND867CK&SAW= 5/13/2015