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JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
1. Project Name j)4~ IMID 1JI,"4.l.iltlJ\ If'.A-u; TT ':P/~.hu:!D tAN j1 CtM'twf"'~~;Il-L
Deue./oo,neNr
,
2. Project Proponent D..,~ A.vl> "'J;~L:_ Lu,,:t+ Rep.
Address 5'R I 4i"-~ .i>-r C<AT- ol=V
POA,... h\AJI.~,g".,D
Phone No. (_I 3Bz;--~'ibl <_I
3. Date received '3 -I ~ - '0 'a
Date Response Due 3-2-'3 -98
4. Preliminary review completed 3~ /7-:68 by
5. Conditions of Approval sent bY
6. Preliminary desi~n reviewed bY
Final desi~ approved bY
7. Prelim. draina~e pllln,rev1i!wed' bY
Final draina~e plan approved bY
8. ConstrucUon approvall
Sub~rade approved bY'
Finish erade approved bY
Draina~e approved by
Surfaci~ approved bY
9. Final review for all condi Uons:
Conditions have been met on bY
s:-k.
Comnenh lA-ND<;'-A:f,'''1>) s:./ln-u ,Se. ,p!flC.f' oS/") /.IS .NOT k
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1. Project Name
JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
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2. Project Proponent
Address
.::7:vnc,L,/
Rep.
7r;:' (/ .._';)) .....f: S::l
"J,r;
Phone No. c-ia;:; ) ,:,'",:;- .- 0':/:;'/ - )
3. Date, received ...5"~- /...5-:_- - f' // Date Response Due .s- -c-:,y- f'1J
4. Preliminary review comp I eted by
5. Conditions of Approval sent bY
6. Prel:l:minary desil!n reviewed by
Final desil!n approved bY
7. Prelim. drainal!!! planr,rev'ie1il'ed' ' by
Final drainal!e plan approved bY
8. Construction approval:
Subl!rade approved by
Finish l!rade approved bY
Drainal!e approved bY
Surfacinl! approved by
9. Final rev iew for a II conditions:
Condi tions have been met on bY
Comments
.. '.
H:AROLD l'(JOE
TR:I:-AREA. CO~TY' DEVELOPMENT
PLAN CONS:I:STENClY RE:V:I:EW
PROPOSAL
The proposal is to construct a six-unit motel on an undeveloped site
consisting of three buildings, each containing 2 one-bedroan units with
kitchenettes. The proposed site is approximately three-fourths of an acre on
the northern side of Foster Street in Hadlock, directly west of the chimacum
Lodge OcldfellCMS Hall on Rhody Drive.
The proponent has requested a, determination on the consistency of ,the
proposal with the T.d-Area COlll1lllnity Developnent Plan.
The site is described as Lot 137 of the Seventh Avenue Acre Tracts within
Section 3, Township 29 North, Range 1 West, 1'l>I.
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PROPOSAL
NUMBER OF UNITS: ~O
LENGTH OF OPERATION (dates): ~~a.r t/.~ JuL"J- '"'1 tJ
METHOD OF MON ITOR I NG (park mai.ntenance): .Jt.6..A..i:...).
4" 1.1.i.a.. r ~ 14<- ~ /J1-1 ~-T,;. 'r;vv"", -r' tJ If':'
gJ. ~Y1r
~j1r~(-; ~.
SIGNS (number,
~
Sl.ze,
type, etc.):
u/ (}-()-(D.f
RECREATIONAL FACILITIES (playground, 'trai.ls, mari.ne dock, etc.)
~~J ~~)1'1 --
PARK ACCESS (road name): t:' A><-<1--p <;,-f-
WATER SUPPLY SOURCE:
METHOD OF SE~VAGE DISPOSAL:
o San i. tary servi.ce company (attach agreement)
~~....."li Dump stateon Lbe. Clt "'clJ=l('o'V1t .s\-c1fe p;)r!:::. A I r .
O\'*~";'-R Other (i.denti.fy): ;P. t& Lt/.-"//--::12;;L, a-CV'rJ~ L~dA 1jJ "I-
C::P ~ ~ ~jJ~w~~~~ ~ O~ Jdu-<-
SITE PLAN
A si..1:e pto.n must accompany t.he arpLLcatLon. It shalL be nO Larger than
8M by 14 i.nches, to scale, and sui.table for copyi.ng. It shall
i.llustrate and i.denti.fy the folLowi.ng features:
o North arrOW and scale
o Development area (property boundary Llnes, sectL9n lLnes, etc.)
" AdjoLni.ng proper ti.es ('owner" and use)
" Property i.mprovements (exi.sti.ng and proposed structures, uti.ti.ti.es,
si.gns, etc.)
G Parl< accoSS
" Proper ty features (exi.s teng and proposed changes to topography and
g.'ound reLi.of, vegetateon, etc.) ,
ACKNOWLEDGEMENT.
I hereby doclaro that tho i.nformati.on provi.ded i.n thi.s appli.cateon i.s
true and cor.'ecl: to thebost of my Imowlodga. Further, I aclmowtodge
that development of tho proposal may not Occur unte t approval has bee"
granted by the Jofferson Count:y Board of Commi..",i.onars.
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N^NCV'S PLAce AGHY
MIKE ~e1I~~b.v-'b~JlE
HADLOCK, W A '8339
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OWNERSHIP CERTIFICATE
To: Jefferson County Engineer
Court House
Port Townsend, vIA 98368
Attn: Carter
Re: Our No. R-28008
Your Purchase Order No. 22~7
This is a certificate as of July 5, 198~ at 8:00 a.m., for
the following described property:
- SEE EXHIBIT A AS HERETO ATTACHED AND MADE A PART HEREOF _
This company certifies that record title is vested in LUCIA
FIFER, as her separate estate; JOE JIMENEZ and FLORENCE JIMENEZ,
husband and wife, as to a portion; and TIME OIL COMPANY, a Washing-
ton Corporation, as to the remainder free from all liens, encum-
brances and objections, except as follows:
1. General taxes for 198~ as follows, together with interest
and penalty, if any, after delinquency:
Tax Account No. Year Amount Billed Amount Paid Principal Balance
90] 024 06] ]98~ $5~7.91 $273.96 $273.95
Affects a portion of said premises.
901 024 109 198~ $257.83 $128.92 $128.91
Affects a portion of said premises.
2. EASEr'IENT AND THE TERNS AND CONDITIONS THEREOF:
Purpose
Area affected
Dated
Recorded
Recording No.
Ingress and egress
Portions of said premises
July 2, 1979
,July 6, 1979
25907~ and 259076
3. DEED OF TRUST AND THE TERMS AND CONDITIONS THEREOF:
Grantor
Robert R. Fifer and Lucia Fifer, husband
and Wife; and Joe Jimenez and Florence
Jimenez, husband and wife
Pioneer National Title Insurance Company
Seattle-First National Bank, Port Townsend
Branch, a corporation
Tl'ustee
Beneficiary
- continued _
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ovrRALL PLAN.Cdn~a:rlhn tlny pl"ns tor tuturo IIlldl1lnnr. nXfliln!olnn!i, or rp.lntmJ 1"ll""llvlllc!o, nr ,.I.UI', 1,'1" (,llll,r'.
1 hl1tm8't' ~ f 'nct thn prnJ1C1snJ): None
ENVIRONMENTAL IMPACTS
Yr.'i H'\YIII. '1'1
EARTH
th;."'prorosltl r01ultln:
Unsteblfloor1hcnndlt.lnns (lr C'h1.lngf!s In tllft OOr.'llntJlcol 5ub!;,t'uctureo..?
or_l~up.tloM. dl"plecMllln'h.crll'llpoctlon, or o"",rr:ovnrlna of, 'tho 50117
^ chl'l~'J'" n, torr:.~t'aphy or yround ,.,,, of , eatut'l?S 7
n".:dultrucf~on~"c:ov."n9.0'~tJlflcatlono' eny unlquo gftolOOlco! or physl"cal (e....turt..'.1
Wlndot,'Wah,. (lro,'ol1 tlf ~oll'\. either on or 0' , 1hl'l site?
IloposltlC\nC\r oro<".I,," nf htlllch s""d'S, or chlSnq"... In 'ill tetlon, dllposl1 Ion, nr "ro-.lnn
whIch mftY,llIoc"fy1hn,channol or e rlvar or stt',t'J,nnr 1I1e bed 0' 1hu UCQlln [,r any tooy.
Inl,et,-,~r loktl?'"" ,
cxrLANATION, Some soil will be removed so that underground gasol ine storage tan_~_~_
be installed.
0 0 )It
)( "0 f'l
0 n Jl
[I n ~
n R $C'
0 0 1<
MITIGATIVE MEASUREC5l, Tanks will be buried with clean backfill. Good construction
procedures will be followed.
AIR
fhe propc'l"lal "nult In:
Mr emlul"",, or dMtlrloratlnn n' nrnblonl all' Ilunlltvl
The crtlltln" 0' obJnr.llo".,toll, nltorn1
'I. Thn alt'Jrfttlnn of I'Ilrll""v".Itt'nt. mrll!.turo. nr 1N1lp,.r.'1'uro, or nn.,. chftn!)1J In cllrn.,tp,
.Ith.r lucally or l'etJlo""II.,1
tXl'LANATION,
n
L1
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11 )(
11 oK
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TRANSPORTATION
y!:s HAYBf NO
ff II 0
5tI n [1
n n
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n n
n @
hope for
WI I J tho propos'" rosult In:
'54. A gnnoratlon of r.lddltJo"o' ....nhlcullll'" mo....cmonl'1
35. Efhfcts on mdstlng plllrklng 'ocllltlos or Ii dt'lml'lnd'tor new p....rklny?
36. An lmpt!lct on exl~t log 't,..e"!'Iportd Ion SYfotorns1
37~ Alte,.etlon, to prO~lJnt pottorns o( clrcullltlQn 01'" movom.ent of poople nnd !1onrf.?
'e. Alt6r"'~lnn' ,tn wllIhrborno, ,.,,11, Or" 01,..11"'0"'(:7
.s9. An IncrF.lase In tro"'c hozoards to motor vehicles, bicyclists, or podostrlo"s1
EXPLANATION: By constructing a new gas station and convenience store we
an increase in the amount of business conducted on this property.
MITIGATIVE MEASURECS): 34. Desion aODroaches in accordance with Plannino Department
guidelines.
35. Provide on-site parking to satisfv new parking demand.
36. Work with Planning Department to improve intersection.
ITEM 39: Chanqe to "maybe" wIth an explanation that reads, "TraffIc
to the locatIon of the facl I Ity and because It Is proposed
hours per 'day. H
PUBLIC SERV ICES
WIll tho propo,,,' hllve on affect upnn or I"'A$UIt In" nuM for nnw or clterod !lovornmontnr servlcf'S In My 0'
tho 101 lowing "roll'J:
40. Ffrft protoc1lon7
41. PolIce protoct lon7
42. ::ichopls?
43. Pcrk, Or" othor rer.r"'''tlofllll fncllltles7
44. Mlllntnnnnee 0' public '"cllltt"" IncludIng ronc1s1
4'. Other (Identlfv 5orvlell):
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~ITlOATlvr MEASURCCSI.
rOll"TY CCU,rNTIS), lTENS 40, 41, AND .\4: Chongo to "yos" wIth an explanotlon that reads,
"Thoso public sorv..!cos would bo necossary; however, tho proposed projoct would repl,:ce
nnd couse the removal of t_~.'::~~:!~~_J_aCk.::'~~~.:.2!~~,!_~~_t_~~.~_t_~.:~lon."
-------"------~.__._--_....__._---_..__.-~-_._--_.__...-..~._-
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OVrRALL PL^N (dn!;crltln nny pltllM ror rU1ur-n:.lidldrry;,~'~l:- ~~fli'"ftlnM, or rf!'latmJ h("1 Ivll ".~~. fir 1.1.111" !ly ulll"r',
1hnt flU",' 4ffcu:t tho- prn/,o,nJ); None _..:_ \ l:i ~.
,____ _ ,..,.' I It ,,:,: \"1-
t~:J. t~~ t~~ '~:"~ lit -~ . M~' .
~--_._---_._..- -.
ENVIRONMENTAL IMPACTS
EARTH
Yr." t'''Yltl. '"
n n }It
)( n ..,
n n Jl
rl &1 )t.
n 0 $('
n n 1<
Will ttlft'prOrnsn','re'\u,lt In:
I~ Unshbl~'nL\r1h cnndlf_lnns or ('h"n(](ls In tllA gC'L?lnr)lcal sublrtruc:tul"'l!''i?
2. Dlsrupt.lon!;, dll\pIOCMl~nts, cl'Jl'l\"octl~n. or o""~rr.(.IVnr!no of tl'lo sol 17
,. A cMl'lrllJu In top~'Jr/Jphy or ground relief feeturl!G1
4. Thedostructlon, coY~r1n!J, or motJlflc:etlnn of ony,unlquQ gftoloQlcDI or physlcol fDntur~~?
5. Wind o!"water aroslon nf'5011", ,Ither on or of( tho slte7
t1npos'ltlr.'ln C\r nrO'"olcln n'.hMCh sMd., or chnnqr..o In ~Il-tctlon, dnposltl~n, nr oroo.lon
wh Ich. nI^Y mOll t fy t hn channo I . n' a ,.. I voror s; r'..Jln nr 1 he bed of t 11\1 ucelln (I'" any boy,
Inl~t"or l.Ilk,,' ,
Some soil will be removed so that underground gasoline storage tanks may
-----
be installed.
MITIGATIVE MCASURECSl' Tanks will be buried with clean backfill. Good construction
procedures will be followed.
r.ou"'TY roM-lE'NT( lj) I
AIR
Will the propc\'iftl r.tult Inl
7. Air etnlulnMur' d",t"rlorfttlnn nf A1"blont air l\unlttyl
tJ. Thft cr."tlnn 0' obJncllotllJl.!', nr.,.r:\7
I). Thn aliurntlnn of 1111" 1110'0',"",,',"., !Mltt"r", or 1 rml"rr.,turo, or ""y ch"n!11J In clltn.tt..,
.liho" ItlcIlly or r~llo""llyt
tXI'LANATION,
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ROUTING - REQUEST
To ~ Ii:-
it::J<::.- t-tu,f ..l.:du
,,4Sc"(5:;C~... -4"....Ydr,..,-~1) lA.;t:
jt/ !<f)("c/ 'I (}-/6) /
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Please
g~D
l::J HANDLE
o APPROVE
and
o FORWARD
o RETURN
o KEEP OR DISCARD
o REVIEW WITH ME
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O'JUlITY CXJl.!'ENTISI:
WATER
tho proposal result In:
Chang os In 'the currents, or tha cour~e of or dlr~c1lon of water movemt:nts, In elthElr
marine or fresh waters?
Changes In the absorption rates, 'drainage pCltterns, or thu rllto Clnd amoun't of surfaco
water run-off?
:AI1erdlons In the course or f low of flood waters?
Achangcln the amount of surface water In any water body?
A dIscharge Into surface ""ators, or In any al'tarat Itln of surface water quality, Includ-
Ing but not limited to ta':1perature, dj~solv~d o:'"'..,.!Jp.n. or 1urLJldlty?
15. A'change Inthe quantIty of ground waters, eIther through dIrect additIons or wlth-
drawals',or through Interception of an aquifer b.,. cuts or excavatIons?
16. Adtlterloratlon In ground water quality. either through direct Injection or through
the seepage of lellchates. ptlosphatcs. detergents. waterborne virus or bacteria. or
othersubstanees Into tho ground waters?
17. A reduction of the all'oOuot of water otherwise avaIlable for pub! Ie water supplIes?
EXPLANATION: ~f thp lot ic:;; rtlrp~dy PrlVPO Thic; propoc;r:tl will inrr"PrlC::P thp.
paved area by about 1,500 square feet.
MITIGATIVE f.l[ASURE(S):
Proper grading of new p~ved are~
n". tJt.'r'I,r Ij{,
0 0 )(
~ 0 0
0 0 "14
0 0 f4
0 0 )(
0 Cl II
0 0 '1f..
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COUNTY CXJt<E,lT(SI: ITEM 17: Chan~e to "ves" with an explanation tha-t reads, "Public water
would be used by -the faclll-ty."
FLORA
Will tho propo!oftl re!iult In:
16. ^ cllbnge In tI,e dlvfIorslty of Srlec.",'~ or null'lburt. c..f .,ny !:.peele~ of f lorn, Including
troes. shrub!i, grnn, crops, mlcrofloro, O'Jnd .,~uat Ie: plMt~7
1~. ,.. r.,ducllon of the mllllnor!. of bny L/nlqlJe. rlln, or f~nd"'l!ln,..o.:l o:.pcclr.s of f lora7
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PHONE DIALOGUE" t!t----
......
I (Name) ~ ---.-
Talked witt, ::r;;?~ ShdP of -/ ~ CJ~{ __
Ii I called ~IIed Time ~MC/{J4'Oate ~ -y'{, -:J>t{___
Sub,ect _~.&~~pa;- $-J? ~~t///" Is '__~$:. ~O::__~_
What I .ald: .1t!.~_~/!I7I;.vr~l!.jlr~, , h:::<.'-o/Z:-',_:S~_..-
::{~~f~ a/'!:l.._~h<.f__?t_k~_~-If!:!/~~{db..fJ, a.-
-~-':t~~sj;11t~::;,~~;'~.~}1Y~,/-~)Ld~<::1?Y~'!!~'c~
ta._ ,----- ----7:1 -1----- .----------------;----------------------
Wha' party ,all': _-':;:5...:........"_,t(!f,.,<t_E~ -;;.~S,'''!!'~-'____....______
I:) -
____" (l(--~r.IfJ~.(. .!;.-t!~tf~:l?/A!~:"._.:._0~~:-
.'eloon Needed 4ll J;c.t_1 jl~!U d;,"l __*"'~-*t'-fK~ ,. .. . _ ________
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JErFERtN COUNTY ENVIRONMENTAl crftKLlST
11.,' n.,~ld":11"I. '...1.110- [,.,11""..;",(,1...11 P,"lllcy A~1 (r~.C""". 4~.;.'lCl 111'lUlt..! .,11 ~.ti,1l' :Jr.,j 1"..<11 qINl!rr.r!ol;;~,d
nJlI"c:I,"~ '1., cu,,:..;ldcr IJnvlIIHr.,cnt~1 valu..... 1.01h fer 1/,011'" o..r. .let lOll!> iJod ft.O~.I' f'l.:lmlttlll~1 Ilr Ival~ pl"'C-'I'(J~,i1I:...
1111.1 ~urr'(J~l.: '.:)1 1111~ C"ltC"!I'.1 I:. 1u heir' d:l(.'flr.lc>~ Involv\.d de:1uf"lfllnc d culljllt~1(...1 l'(ol',-".i.Il'!. (.'fI11,c pc.1C:'n1i.,I
1/'''ImC'l on 1/...: (j(,vlrOl,IIIl'nl ~11,j ti,e !.1'3t.lllc.,ncC! ot 11/<:11 Iml,u(.1.
APPLICNH: Time Oil CO.
A!JDRESS: P.O. Box 24447 Terminal Annex :-5.e.A ttl p. WA qR124
TClEPIlCtlE: Ct.orne) N/A (tlus"l{!~sl (206) 2B5-2400
AUTIIOPIZED REPRE5D;,ATlVE: _.-J..JL~JJ:~
ADU"EOS: 2737 Wes t Commodore WaY~S.ftilt.tle>--.YIA..-9Rl qq
THEPHOIlE: (1,""0) (206) 522-5G28' (1,",.1...",1
(206) 285-2'tQO
DIRECTIONS
. Conto!lct the Joffersnn Cbunty PllInnlng Dapar1mnnt for 1I1d In filling out thlsclit:c1dlst lIndfor,lnstruc-
tlons on fur1her admlnlstrf.ltlve procedures rt;qulred 10 ccmplote Its processing.
.-An!.wor 1I11 quest Ions completoly. Cl'%Ci"W(! pJ.int or t.ypo.) Quur.tlon!. thllt do nc.t upply to tho prDrlOr.;,1 ~
answc:r'wlth "no." Under EXPLANATIOt~. Idl:ntlfy rOCl!.ons for till "yes" and "maybe" lIn5wl:lr::o,' Under MITIGATiVe
M(ASURE(S), !dentlf)' any operations. activities. design consldurallons, e1c. that are to be part of the proposal
t,hat wlllle~sen the Identified envlrorvnenhllmpacts.,' Dc. not write In the splice under-COUmYCo-MENHS),
. Attach lIny lIddltlonal In"Jrmlltlon (reports, studies. maps. Illustrlltlons. lease~.permlts. etc.J,that mllY
furtherdp.scrlbe tho proposlIr or ba required by Joffers.on Cbunty.
. Answers' to some quest Ion!. m",y requ i rc spec I a I expert 150 or t echn I ca I ass I stance f rom qua II f I ad ,pers.ons'~
The cost of obtaining such Information Is the responsibility of tl,e applicant.
. Review under the Wastdngton State EnvIronmental Polley Jlct does not cons111ute approval of lIproposal.
Cunpllance wlth,loclll.state. and"federal. regulatIons appll~blc to the proposal ::ohall constitute appro...al.
CI.ecf<. with lIpproprlate agencies to determine whbt "pprovals fire required.
PRoPOSAL AND PROPERTY DESCRIPTION
REQUIRED APPROVALS (Iden1lfy all local. ::otbte. and fodural approvals r~qulr~d): Jefferson County Planning/
Building Department, Jefferson County Fire ~larshall, Jefferson County Health Department
PRCPOSEO PROJECT OESCRIPTIOU (descrlbo the proposed d~...elopml'lnt. Itscl0'llcn1s. and 115 purpo!>e---oll f~ctors
the1 will glvo an accurat& understar.olng of It!. score llnd nllture): Demolishexistinq buildinCls on
site including existi~Yice station.
building 33' x 60'. Install new gasoline
underground gasoline storage tanks.
Construct new one-story c~~ck
pump islands with a canopy. Install new_
PROPERTY #10 MfA DESCRIPTION (Idontlfy the !lonerol nnd I09lll locotlon. physIcal clll'lrl'lc1orls1Ics, ftnd c)Ctent of
land arOll to b~ ftffoctod-coll hctc.rs that wIll gl~o on bccurate undc,rshrldlng of tho property and Its on...lron-
",ont)o Please see legal description attached. Property is a flat lot located at the
corner of Irondale County Road and Ness Corner County Road in Hadlock, Washington.
PROf'osro PitOHeT CO-'PlCTlOfl OArr. (OPfo,.o.lmatc); ~r 1984
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mUlITY COM<ENTlSI:
VlATER
Will the proposal result In:
10. Cheng os In the currents, or the cour~c of or dlr~c1lon of ....ator rnovemt:nts, In either
marino or froshwater51
e Changes In the absorption rates, dralnago patterns, or the rota and amount of 5urfacB
water. run-ol f?
12. Alieratlons In the course or t low of .flood waters7
13. A change In 'the amount ,of surface waier In any water body?
14. A dlsdli!lt"gO Into surface waters, or In anY,alteratlon of surface water qualIty, Includ-
Ing but n01 ,limited to'1(r.lperllturc, dj~solv~d o.~yg(m.or turLJldlty?
15. A dlange Inthe quantity of ground waters, eIther through direct addl110ns or with-
drawals, or through Inferceptton of. an aquifer by cuts or e;(cav~tlons?
16. A ,deterioration In ground water quality. eIther through dIrect InjectIon or through
'the seep~ge of leaehatcs. pllOSenates. defergents. waterborne virus or bacte,rla. or
at her substances Into t he ground wat ers 1
17. Arcducf Ion of the arr.ount of wafer ofller-wlse available for public water supplies?
EXPLANATION: Most of thp lot is ~lrPiHJy p~vprl Thic:. propnt:;~l will inrrprtc:p thp
paved area by about 1,500 square feet.
MITIGATIVe MeASUREIS): Proper grading of ne\Ljlilved area
OOUNTY a:n.tE,lT(S):
FLORi\
WIll tho r.ropoul result In:
Ie. A cl1llnge In tt,e dlvbrslty of sp..t:lt."'!'. or numbl1rt. c..f nny !.recl~!O of florn. IncludIng
trof!s. shrubs. gran. c:rops. micro' lora, O1nd It:;UlIt Ie plttnts?
1'1. ^ roduct Ion of 1ho numbors of lIny Lonlque, ran. or fmdo'lngoro.1 !;.poc:lns of flora?
H.... '~~Yhr Ii'"
0 0 ~
'Jil 0 0
0 0 14
0 0 14
0 0 pc
0 0 ~
0 0 ,~
0 0 ~
o
n J1'
n H
o
.
.
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TRANSPORTATION
)'1': ~; ,.fll,,(IIf /10
>;{ 11 0
~ n f1
11 n 5Y
IiC f' n
n n t!
(1 Cl p(
hope for
WIll tho propo:.;el.ro5uI1 In:
@. Agnncl"'Z31lon of nc.1dlt lon~1 Yf+hleul",... rnovcmont?
@. (((t;dSOn'fH<1st Ina parklnl) ("clllflos or tI dnmnnd 'for new f'll'lrklny?
@ Anlmpec1 on exlsflng .r,..anjipor1~tlon ~yr.1I)rns7
@. AI1(jrntlons1opro~f)nt plllttorrls of c!rcul..,tll)n cw movomantot pno/Jle nod !~onrtIll7
3et AI,1torn'llnno; fro ....ot"'rborno, rel', (Jr 01r-1rolllr:1
@ M Incro/Jsaln traffic htucrds to motor vehicles, I."cycl Ish., or pedosfrlClTlS?
eXPLA/lATION, __~onsj:ryctin~J:las station and convenience store we
___._._~!l..J_~_ase~.!he amount of business conducted on this propert1-:._
..,ITIGATlVEML:ASURECSl, ~~.!l...llil.Q.roaches in accordance with Plannin.9.....!lepill:.t!I!g!lL--
quidelines.
35. Provide on-site parkinq to satisfy new parkinq demand.
36. Work with Planning Department to improve intersection.
aJUNTY Wf< ENTI S) ,
PUBLIC SERV ICES
Will tho p"OI)~5'" heve en lit feet u(lon or rp.5lJlt In C IHlttd fDr nnw 01'" eltcrod Qovornmontol scrvlc'rs 'n any of
1ho followlno orotls:
rlro protoct lon7 n C1 )If
rei lea protoc11on7 C1 rJ rfi/
~chopl,7 0 n ~
"~t'ks or othor rftt:r"tl1lonal hcllltlos1 n 0 pc
~ftlntnnance 0' public 'l'Iclllf If'S, Includlno ronds? n n 14
O!hpr (lcfen11fy snt'vlco)I n n Jl
[XPLANAT ION:
MITIGATive ~EA5lJR[(SI:
l'nJNTY COt<ftlTlSI.
---.----.---.-------.-.-------.--
.'
180
168
156
144
132
120
108
96
84
1II 72
w
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;!: 60
s
54
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o i5
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~ .36
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:l 33
i5
18
15
12
IV",AU 0' .'U8LIC ItOAOS "'AN_ .,,,
10,000
8,000 EXAMPLE
6,000 0&42 Inch.. 13.5 ,,,II
5,000 0-120 eh
4,000 HW' HW
0 'ut
3,000 III 2,' 8,8
2,000 IZl 2,1 7,_
131 2.2 7.7
'0 In fut
1,000
aoo
600
500
400
300
1II
U.
U
;;:
200
100
80
GIOO" Iftd Wllh
h'Gdwoll
Groove .nd
plOj.e.tlng
a
5
4
To II" teol. 12) or (3) "roj.d
horllonloll, II) tcolt'IJ,thU
u.. llrolllhllllc.lhl.d Iln. ""oIlOh
o and Q teOln, or ,n.'" 01
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5.
6, 5,
5, 4,
4,
4,
3,
3.
3,
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2, 2;-
2, 1.9
1,5 1.5
1,5
- I.ZS"
1.0. 1,0,
1,0
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.9
.a .8
,a.'.
,7 ,7
.7
,8 .6
,5
.5 '
,5
HEADWATER DEPTH FOR
CONCRETE PIPE CULVERTS
V(ITH INLET CONTROL
CHART 3
27
2000
...
z ...
1000 ~ z
~
800 120
600 108
500 96
400 84
300 12
66
200 60
en
"- 54
"
;,; en 0.48
"" 48-_
_2 :J: ,/"
100, " ...---
z '12
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'"
...~"'''-a::~' 80-==~o,-..
.. ~~ e 36
:J:
" 60 a:
en 33
C ""
50 ...
.... 30
40 ::E
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is 21
30-
10
15
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6
5
12
4
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SUBMERGED
CHART 3-7
'p&pl!)I.Jj
2, Y (t'&GOI"f"Q
\--"'-~ ~
\ H Z,8
,-._"~.,.
~ L.o-'
SlOp. 50- "'~'~",'"H'''.''~'''
OUTl.ET CULVERT FLOWING FULL
HW. H. ho-LSo
7
,4
,5
For ou1l,1 'rOwn not 1\llImllO.d, campul, HW II,
1'II"hod.- dncribtd in Ih, duiQn pro"dur.
,8
CHART 8
,6
~.9J~"# 1.0
---
--
.....---'
.
. .,
. 0
O-..,~;-
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8
10'
20
HEAD FOR
CONCRETE PIPE CULVERTS
FLOWING FULL
n=0.012
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(C.S, W.S, Paper 1687, 88. 89 Average Natural
Part 12. 13. 14 and Aldridge- Annua I Drainage Over! and Sewe red
810dgett Repor h) Runoff Bas ins Flow Areas
0.5 J .00 0.30 0.25
Regions 0.5 - 1.0 0.60 0.20 0.15
8 - C 1.0 - 10 + o.qO O. J 5 0.10
~ ([9.0) 0.30 0.25
Wcs-tern Washingtun 30 - 50 0.80 0:20 0.15
and Regi Cin A 50 - 70 0.50 0.10 0.10
70 - 100 + 0.30 0.05 0.05
TABLE 1-1
To = Ct(L n /JS )0.6
Tc = Time of consentratton, in min.
Ct CoeffLcLent Por ave. annual runoPP and basLn type.
L . Length of draLnage basLn.
n . FrLctLon factor
5 . Slope of prLncLple channel Ln ft/ft,
TYPE OF AREA
"n" VALUE
Average Noitloral Channels. overall
Paved Chat'lnels
Over! anc! flow and Improved Channels:
Smooth pa....ing
8.HC packl..'d 50 i I
Poor grass cover
A~(Jr.ll](' gra~s CO'/(,'(
Dt:,':..t~ 9r.l~!'o cover
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-...W
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0.016
0.100
0.300
0.400
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., AJJ tlmf' of pj.t'd,mJ ,.lllol,'(,nlel time} for small arel1:\ z..lwr, It IS a slena/leant
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~
lLJ .: ~
(!), ..J .01 0
~:~~ UJ a..
...1It eo....eer o.'e....... .101 .".. :I: ~ .008 ....
'o:;er:~~:l~-.-:;Irl:.;'::. ~!;::. r::u_. .. - ~ .0' <( .007-' .. (I)
.-=-~.o..'~e~~cc.~~~~;~.=,_.;;;_.,."'~_-==~--'- ;=.,~ _~~~="""-',.:'"~"CC _"';~~~~;;,,~
~-~.~ IJ.. .005 ~
:~';::=: ~::.:::ou.'" -----.:---- 0 0
."~,' 1 - ,. UJ .004..- a:
ll. 0
__:;:'.:::':.::.~:.. L~,_:'!< ,',' ~ .00' "~
..........'01... 0
..IO'~'-";---'-"--~-'
,06
.0'
.04
0"1..'.' 01"."01 10'.~ ""....01 ,.
ur'.e IlCI,O... hl.1I1l .0..0..... 10.
:.I":~('f) o. '. "n,o.. . '0. or.,.
.002
,0'
I-
~
J:
l-
ll.
UI
o
.02
. ,~.:.~.:::;:' .:::::::~ rt4tJ,. "J'
'O~~O. '."."1;"0. I j t
'00".'. OUC..... '. .1_. ,,:
IHIIO.. U U'''.'O "./1.,', .
01"" . loti.,. O. ,~.
'~O., ."'0 '. ...0 01"" " r..e..,,' O. .,.
.001
.01
NOMOGRAPH FOR FLOW
IN TRIANGULAR CHANNELS
CHART 34
44
Vl
UJ
:c
..,
~
~
e
"'1
16a
156
144
132 ,
2
120 d
w
0-
loa ~
-'
96 ;i
i
a4
"1 (J)
"-
60. , 0
;;
54 g
...
a:
UJ
>
..J
::>
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UJ
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a:
'"
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/~
"- 42 / 0
~ ./
~ ~6
UJ
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o
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33
:i
d
"
..
;l
z
;!
'"
30
21
la
15
12
BLlIt[Ay 0' PUBLIC "OAO. .IA"'. Itl)
10,000
a,ooo EXAMPLE
6,000 0- 36 inchu (3.0 hill
5,000 al66 eh
4,000 HW. HW
3~000 -. l'UII
(II I.. ...
2,000 /2J 2.1 6,'
lOJ 2.2 G,'
'0 In lu'
1,000
aoo
(I)
6. (2)
(3)
~. 6.
5. 6.
5.
4.
3. 4.
3.
3.
600
500
400
2.
--- ---
2:
2.
,/'"
/8
/ ~
,/" :E
......,/"
....y d
.>-
/"
100 ./
~ao/
300
I.~
200
1.5
Vl
a:
UJ
...
UJ
~
"
o
1.5
50 1.0'
40 1.0
30
.9
H.od..oll .a .a
(2._____Mlh('d 10 con'orm___"
lo'lopI
131 Projtetlnv :7
.7
.7
To u" leal. IZl or (31 prolect
horluntoll, to lcol. (II, IIl'n. .6 .6
lilt "rolth' l"clln.11 11110 throv9h
o Gnd Q ICO''', or ,,,,,.. at .6
IlIu,',ollll.
.5
1.0
.5
HEADWATER DEPTH FOR
C. M. PIPE CULVERTS
WITH INLET CONTROL
CHART 4
28
EV"L~^TION
Agreo. Dtsagreo Mtttgnte
0 l'.holt klnd und amount .of vogotul:lon would he rernoved or at tered? 0 0 0
q () ";6 "T1'l 'P.P Rt'lHOtJe D .
:!5. LLst throu toned or cndlmgorcd SPCClO5 kno\\in ~o be on or. noar tho '0 0 ,0
st to: ~IDAJt:!
:!6. Oescrtbo proposed lnndscoptng, us. of naturo plants. or othor' 0 0 0
moasures to preserve or enhance'vegel-utton on tho sttn, If any:
:t':I/Y-' r=eeNs';" R.t-lODle... - /l>.ZALI"As"- HI'P,lll-uR-e
-r:-R ee.<;
ANIMALS
:!7. Check any btrds and onlmals that have been observed On or nonr tho 0
til to or' arc knoivn to be on or ncar tho st te:
o 8lrds: 0 h.:mk 0' heron 0 eagle 0 songbtrds )ill othar-tdontlfy:
SPARl?tmc.. o/"'~OR~IV.s
o Manwn~Ls: 0 doer 0 hoar 0 elk 0 beaver 0 othor-ldent'lfy:
1\1 0 /IJ (->
o Flsh: 0 bass Oso.lmon O' trou.l: 0 horrLng 0 shoLLftsh:
I
o other-LdenHfy:
1\1 () kJ e
:!B. Ltst any throal:ened or ondangered specLos to be on or neor tho
aLt., t>.IOl\I@
29. Is the stto part of a mLgrnHon rOuto? If so, o>lpLnln how:
I'lO
30. Oeser-Lbo proposed rnea~ures 1:0 preserve or enhance ''It ldll fo, L l' 0
ony. AI(\ LVI LD L'II: e (;XIs,r ()f\J PROF\<'erY
ENEr.CV AND NA TUf~AL ~E!iOURC~S
31. l..ha~ klnds of' c"orgy (t .0. olGQ~rtQ, nnturoL gos, oLl, wood stovo, 0
nnd 'Solor) "ould be u!led ~o moat tho completed proJoct1ft anorgy
needs? Oncrlba Mlhethor Lt ~lIould bo usad for hontLng, mn",,~f'ac::~ur..
(nX. .teol -r,~ e ~ I-IClP POR.T,OAl 0 f= RlJ/LDIMr..
..I.!&Ll.J) r>.e l)/.J-Ilf?ATel) - nj:e:I~1l.:J:l.QAL.LAlOOL./:)
~et\'l'PD RV {;.( €crld'c l-!-eA, AJHP.
3J. ";ould UUII proJee~ affect tho potl!l"HoL uu of' aalnr onorgy by
.IdJillcont pruper-Hea. r f ftO, gflnorlllly dOllerLbo tho nrfccb
~,
33. \\hat klnds of ""nr8Y (,lonllo,.votto,., fOdh.....aa tarn lneLudod In the
pLAit. of tll,. propo..l? Llllt othnr proposed mootlul"oa to' r-ttducft or
control enorn'f 'nlpaclll, Lf anyl -5.11L~oiJJ.G-~L..O-
_B.~CQJ.J..S.I&.U.c:z::..EL.) -m s.~
--eJJ..E.C...!r~S:m.Al-'~ll_~~E1J F'OR ell; {'} a~
-CQI.U,'>IY Bill~lliAJ~ DC?Pi:
o
o
o
o
o
o
o
o
o
,0
o
o
o
[J
1;1
o
o
o
\
\
,
,
.
::~ r l
t>frlll:(U"'C~ hI.: dWTluli; ~1,C!d?
I f ~;o. 1\11011 ~l,..u(.;t""IH;?
NCl
...... :'.llOlt t~ (110 r.u"rc.'nt- COrlllll"cIICl.:"LVC pl;ln or communi l"y dvvoLupmunl'
pl.1n d('!~i~n.ltion of the sile? Idl!llltfy thc'pLnn:
/i'-".....'de~t.;;".:/
~s.
I" OlPflLtc~lblc.
,~hat i. 50
Lhe Current' sllor-eli-nO' nliJ~tc,.. p"Ogrllm
riM
dt'SLRn.d:i.on of the si. to?
.hi. U.15 .1.")' pur-t of the 51 to been cLusslftcd as
"envi.ronmentnlLy
~H.'nsi.t.i.\"c""iU'c.i1 If so. speci.fy"thc piJrt; liD
~:" .
App,..o~i.mdt-eLy how "'"'My pc>opLo ","QuLd resi.de or worK In
s- /()
the
cl,)"'plet~d project'?
..\Pf,,'o:o..i.matcl) ho,,, mj,n)' peepl c would the completed project
dispLace?
nc'"'---L-
Descri.be proposed mo:u!Ourcs to ;lvoi.d or- reduce dispLitccmcnt
i.noPdctS. if .any: N !l
jr-SlJ. Dc~c,..i. be proposed meiJsurcs to cnSur-e the pr-opo!'iollL i. 5 compll.t ibL ~
....ith I'!xi~tin.s and projected land uses and pLans, if any;
HOUS I NC
.
f:V^U;,\1/0",
^/-;r/'"ll: Ui~'lgr'uc :.Ii! iH"L(!
o
Q
o
0 0 0
~~ h
'~
../-"'"
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
o 0 0
iv'?ip/~ .L/"';;;~~
/--c..~ ~__~
:-/ .-4:<-..!c- p~~-a
31. App~o:o.;im.lll'l), hOl\ nlJny units ",o~,Ld be provided, if nny? Indlcnt.c 0 0 0
I\h..>th...r tflt.' housi"" is hi..h. middLfl, or low Lncom~: J/ ,!,.J ../~'
o 0 '1 /<-_<9......,.,-<<- /~.~4:_
h__ Ch--<"-"-:i~
5'. Appro:...im.;.ltel,. 110.... "lOin)' llni ts, if ;.In.... ""ollld be eliminatl'!d1
lootc.d~ "'u",thfl'''' the llo":oi.nJ~ if; hiJ;h, middle. or lnw i."(',omn1
1/ R
SJ. O",,,"cri br flrnposrcJ nliC'ln.urn,; to "f'Od~ICC 0,.. control hOll'Joi.ng impncts,
i,' OIn)': )J R
Ar:STIn:TIC~
:.~, ,',1\"11 i.!o Ihr t..tll,'~..t IIl.,,:hl of n") P"'OIHl~Prl ~lr"ct\l~(.It.J. "",t
i:neluc,hn,; l'nll."ruto1 ~',II.11 ..it, lIu. "r~nr.i.....,l ",..t'l'I"'jClI"' b"ildi.n,;
=':~~~~~l._~:::~:":~'~~_ ~----,tJL~___=:_~~~~L=:==
o
o
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o
JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
1. Project Name 7+.iJ. ()"y 4n V""'TIST Sc~
2. Project Proponent 7-ti lMv AOV<<.vt"/STS' Rep. .::1. (!;. CHl1./$TUI"'5<><J
Address /34-2..e./1I1,gI1.I&r.N;STl>"~ ~b. AJ"~D:
Phone No.
_l
-I~71s~
(_> ,39$"- "7$"1
Date Response Due S-/-t/e-f
3. Date received
4. Preliminary review completed 4/l.3/af' bY at-
'5. Conditions of Approval sent S~ 7 -8" bY G(l..
6. PrelIminary desi~n reviewed bY
Final desil!napproved by
7. Pre I im, drainal!e pI Bt'I"revlew'ed . bY
Final drainaee plan approved bY
8. Construction approval:
Suberade approved bY
Finish l!rade approved bY
Drainaee approved bY
Surfacinl! approved bY
9. Final review for a II conditions:
Condi tions have been met on bY
COrTments
.
.
I "
O','/I;"'ll "lAtI (elt.l:::.r;, I hI.: Dny pl,uls fur luflln' illJdlt Ion.... o:-'p;ln~lrlw;,. (,r ,.:IIII'Il.l ......11'0'11111,.. Ilr 1.lllr.,. IIY Cj1l.(:I'~
,
11, ,I ."'1, ~f (,'cr tilt} l.n'I.'I'''''): _~~];.~~. _~.c?!'_13_~~ tions _.~ ~_..0.~_ p.r.~~.~nj.._!-!m!3._. '___._____...__ ____ .
----~-~---._-_._---.,------
.---:..---:..-----,~_._----:-.__.,--_.- -----....--.-.------- -. .,- ":' ..--...-
ENVIRONMENTAL IMPACTS
YES HAVRE NO
EARTH
Will the proposal result In:
I. Unstable earth conditions or ct.an9(1~ In the !Jeologlcal !iub~1ructurcs?
2. Olsruptlon~, dr~plzscements, cr..mpllctlon, or ovCtrca....orlr.g of the soil?
3. Achanoe In topcuraphy or ground rellof foatures?
4. The destruction, coverIng, or modlf1cutlon of any unique ooclo~Ic<)J or physical features?
I-lInd or wah,; r~rosron nf soll~. el1her on or off 1ho sftc7
DeposItion or cro~lon of beach s"nds, or ct,arllJc;s In !:.lltbtlon, d"pcs l1" Ion, or erosion
which may modIfy the chlinnel o.f 8 /"Ivor or streulJlor 1he bl':ld of the oealtn or any bay,
Inlet, orlake1 .
EXPLANATION: '21; l" will be necessary to gr';de the site for construction
The bUilding will be on two ~ vels.with a ground level entrance for each level.
~his will be minimal as result of grading
n n @
@ 0 [1
@ 0 0
0 0 e-
n @ D
n n @
MITIGATIVE MEASURE(Sl:
5) Turf will be planted on all graded areas
r,(JUNTY, CO'-7-1EUT(S):
AIR
WI I I ,1hoproposnl rosult In:
7. Air cmfsslons or dotorloratlon of :lItlblont aIr qutdl"ty7
e. iho crobtlon of obJcctlolloldo odorr.?
9. Tho altoratJon of air t!Il)VUllftnt. w"~turo, or tomfl('lr~turo. or no,! clllln:)o In clln'kJtp.
olther, loellllV or roglolltl"y?
o
o
D
o
o
o
@
~
[xPLA'/AT 101/:
.
.
1,~lll'-,f\lIV[ t.I[,'l,;;LJIH:(S):
-------------~---_._------_._------_.
yr~ '.~,.'(h[ 1Ii,
roUflTY CJ:M.1E"NTCSJ:
WATER
wl'l tho proposal rosult In:
lci~ Changos In the currents, ",.-tho cour::.e o( or direct ton of wotor movom~nts, In althc1r
rr.arlno C'Ir frosh wotnrs?
Chon!}o!; In tho absorption r~tp.~, drdlr'lllgo pnttort":::;. or thu ("Dtn llnd ..me-unt of ~urfm=n
..."ter run-oft?
12. Alterdloos In the course or f 10.... o( flood wa-fers?
13. .A change In .the amount of surf,.,ce water In any w<ltor body?
14. A'dlschargo Into surfoce waters, or In ally al"teratl(.ln of !illrfilCO "ator quality, Includ-
Ing but not I Imlted to tU1p13rllturo, di$50Iv(:d CI."~)'!J"m. c..r 1urlddlty? '
15. A chan!)e In the qu;:,ntJty of ground waters, either through dtr~ct addlllons or ....'th-
draw:tls, or through Intercoptlon of I:ln oqul fer by cuts or ({A'cllvallons?
16. ^ deterioratIon In ground wi'ttor quality, rdtf,er through dIrect InjectIon or through
tho scepagu of Ic<schates, ptlo!>r,hute~, deterDonf!>, waferborflo virus, or bocterla, or
othor substancos Into the gro~"rld wi!Jtors7
A reduetlon of tho lln.ount of w01tur othorwfso) aval faille for publIc water ~LJppl les7
17) Public wa~er will be used
MITl(iATlVE ~'E'ASUf<E{S):
COUNTY rof4WTlSI,
FLORA
WII' tho propo!olll rO~IJI1 In:
1~. A (tlllln9" In no dlyt.'r-:.l1y of ~r.~d.,... ur n..IIl~lJrt c.f .l"y !".rl"'r.I,,~ of flout, Inl"ludl"g
tn'~'. "~:",",b!i, ur~,,!., U"O,I'.l. mkn)"oru. ,t,J ft'lu"t Ie rd'-1nfo;.?
1", ,., rnduetlnn 0' ttln nl.mh.lr!". of nny unll'fJl!P, rolrf~, or (lIId"naorf'lJ ~ro(.'cln1i of Ilr.,,,1
0 0 J4.
n @ 0
0 0
0 0
0 0
0 0
0 0
@ 0 0
n
n (e)
n €;
o
.
..
10. An ,lnlrljoJur:1l('lrJ of nuw :>J'Ulclos ot fll'"'' Into tJn ~rcla. OJ' Ilia t,,)rrlnr to Iho normal
ruplunl'iI""f.n1 of uxl~tln!) specllJs?
::'1. A rll:Sucthm In tlcrOf1HO of tiny ~9r1cuI1tJrul crop?
F:'PlANATI(JN:
'-!ITIGATlVE" MEASURECS):
COUNTY CO'.'J.lENT (S) :
FAUNA
WI lithe proposal result In:
22. Changes, In thedlvl3rslty of sreclos or numbcr~ of any species of fauna (birds; land
. Ztn Im.:a Is. Including roptlles; fish and shellfish; benthic: organisms; Insects; or
mlcrohuna)? ' ,
23. ~.'reductlon of the nu:nbors of Clny unlqut'i, rare.,or endnn:Jored spoclos'of .fauna?
24. An Introduction of new' specIes of (nunn Into an ar03, or result In a barrier to tho
mlQratlcin or 1l.o\.'(lIt1ent of fbunll?
25. A dotorlordtlao of.oxlstlng fIsh or wlldllfu hald1at?
DCPLAtlATIOII:
MITIOATlVE MEASURE(SI:
mnrrv 'CD'IolEUT( S) I
,
)'1"'; tlAYhr' lie
'.
11 C1 @
0 0 @
o
o
o
o
o
o
o
,0
.
.
HU,'IAN HEALTH
::"4. ",WIII,1t.~ pn.'I".o!:.~1 rtl~uJ1 In ill!) crcoJ11on uf ~n'l hoalth il<1/tSl'u 'Jr IICJfuntlol hunllh
. haz3rd, p:..:cludln(] ment.)1 f,l)ilI1h?
fiPLAHATIOH:
HITlGATlVE f-lEA5UnEfSl:
COuNTY CCM'olENl'fS):
AESTHET I CS
Will tho proposal rO!;ult In the obstruct Ion "of any scenic vIsta or view open to the
publIc or will the prC'po5~1 reslJlt In tho croat Ion of an aosthetlcally offensIve
S~TB ~pen to public vIew?
EXPlmATIO,.:
loll TlGAT IVE MrASUnE{~);
COONTY CO""EtlHSI:
RECREAT I ON
~G. "'III . fl.. prorlu~bl r..,~.uft In Illn Itllp.u;t !.II'?" thn tfunllty or qUlln' I ty af nxlt.t InO
roeroIl110n,,' opportunltlos?
rXr'I.M.ATIOtl:
YL5 l-l/\ynt. II.'
[J 0 G
o
@
o
o
oct
.
.
r.~f"lI(.~^TIV[ 1.1I:-r,.~LJUr(S):
rourlTY CQt.7.lENT(S):
WATER
or thn cour:;c of or dlrtlct Ion of wlIfor rnovcmf.:nts, In affllCtr
ChlJn~os,ln tho .,bsorptlon rIJtp.!:, dr"lml!Jo pnttorr.!>. Clr 1ho n,to imd ",muunt r)f ~ur'jJr.l)
\olator run-off?
Alteratlons"ln -the COLirse or flow,of flool1 wa.ters?
A change .10 the'lImount of surfi'lce w~ter In Dny water body?
A discharge Into sorf,z,ce w310rs, or In .:IIIY al'teratlLtn of !'iur(,)r.e w6tor quality, Includ-
Ing but not limIted to tti:1parllfuro, di!>sc.l..,t'd o.....y!lnn. Clr turLdlflt,? .
A chan!]o In thequnntlty of oround waters, either t"rough dtrqct addItions orwlth~
drawats. or through InterceptIon of an aqIJI for by cu1s or exc"vatlons?
A deterioration In ground water qualIty, flltllor through dlroct Injection br through
the seepage of leacha1"es. ptlosrlhlJtcs, detergents, .....'\1crborue virus or bllc1crla'. or
other substances I,.to thQ grou"nd ....a'ff.:rs.?
A reduction of the lHl,ount of w.'lter othor....ls.) aval lallle for public wilter supplIes?
EXFlAllATIOtJ:
17) Public water will be used
I-IITlfiATIVE ,,'EASUf<E(S);
rooNTY C'l.lI<EIlTC S I :
FLORA
HilI tho propo!'ol rot-t,lt In:
H!~ It. ch,mgo In tI.n dlv/lr!;lty 01 !.r,(,t:lt'f. ~r "umbur!:: c.' "n'~ qflJdd~ 0' flora. Inrludlrl9
Irf'!fJ', fohrubs, grl'l:i!., (:rOI.:1. /nlcrofforD. '.r,J lqu.,tlc pl.',nl!"?
p'. ^ rotlucl'nn of tho "t"nht'lr~ of n"y IInll'JJ8, r.lrr~. or fll."MOOroj !;r'('c'll~ of 'Ic.rel?
rr': I},AYhC 'JiJ
0 0 0
0 @ 0
0 0 c.@
0 0 @
0 0 @'
0 G <e)'
0 0 @
@ 0
n Q@
n n e)
.
.
='0. An fnlr'~dt,ldl{lll of n"w,~;pIlCr(J5 01 flll/',I Into an .ll"ua. (JI" In II thHTlflr 'e) Iho normo'Jl
ruplunl!iLIIl{tnt of (j)cl~tln~ r.pC'cltJs?
:.'1. A rt.:Jl'Ct I,," In ucrOi1!IU of /::In)' lHJrlcullur<J1 C,.op.!
F:'f'l MIA T I i!N:
,-lITJCATIVE MEASUHCfS);
COUNTY CC/"'J>tnIT (S) :
FAUNA
II the proposal result'ln:
Changes In the diversity of speclasor numbor=- of any spades of fauna (birds; land
t1nlm~ls; -'ncludlngreptlleSi' fIsh and shellfish; benthic organisms; Insocts; ,or
mIcrofauna)?
r. reductfon oitha number~ of bny ,un ique. rare. or end~n:Jnrcd species of ,fauna?
An Introdudlonof new'spedes of fnuni'l Into an area. or result In a barrier to tho
migratIon or n.i:l\'tJlllent of taunCt?
A doterloratlon of oxlstlng fish or wlldllft) IHltJliot?
MllIOhllVE I'EhSUnEISI:
C'OOrtTy an~E"HSl:
Yf'~: , rJC '.
''''^YI1f
n Cl @
0 [] c..r:v
o
o
o
o
o
o
o
o
(::~
Will tllD profl,:,,,,i)/ r05ult In: ~ \
~ ,
3<1. f. gunor':ltto,. f)f i!fJdftln(J~1 vf'lhlcul.-\r rUlVCfflunl? --.____""_
35. EHoefs 1)(1 Cl>ro:I:",'IIIl~1 p",.l:llh] 'dcll J11lJS 0'" d dUIl;.md 'CJr tlf'~ pm"klng?
36. An Inlp~ci (10 oJol.lstlng IrrUlfoportetlon hy:dt:ln~l
37. Altorattcms to rro!jont ft~ttorns of c.rrclIfu-tfon or flIOYf.lm,ttnt 0' Pll'lflle and !lunch.?
.~!J. !,I1Dr,rtlnno; I" wottfrlmrnu, rlll'. or air In.,, le1
"s? M Incrodsti In traffic hultwds 10:> notor vehlcla~, brcycll:.h. or padu51rlan~1
EXPLAtIATlON: .40) PiFS f1I"a'tcc:tiSR u.ill 'be [reM.. ai~rQ1=lt giE~ p.,i,....ot
~.3~) Vehicles will be transporting children to and from school.
35) 1here will be need for teacher and visitor Parking. 36) There ~ili be an Rdditinal
traffic on Kenedy Road during daytime hours. 37) This traffic will be on Kenedy Road
ins"ead of roads Rround nordland.
.
.
nr. t.IAYnr 110 '.
@ n 0
C!Jj n 0
@) n n
@} n n
n n d
[l 0) (9
than eur pFElGCnt
MITlCATIVE flEASURECS): 34)This flow of traffic will be only between 8
J$1 A PRrking SPace will be provided neRr the,school building.
:]';;';;'7 . .
; ~;;z...Jic2;.. ';e.".:&
~?a..bt"'.de--
. /-cUrc.~./4,('"d.~
: . p,.q:-c./ & /t;/
!P;'R/'a,t!,6.
PUBlI C SERV ICES
It/III the proposal havo an af'ect ui,on or
tho fel lowing lIreas:
40. Fire protoc'f Ion?
41. Po'lceprotectlon?
r~~ult In a nOed for n8l't" or eltE;:rod gO'''ernmon1l1l servlces"'n llny of
~O)
1he school will be 10cRted in a different fire district
@ 0
@ 0
o n
o 0
o 0
o 0
"f'lllOL-
-f:if~",r1I-l'
from where,>> i s L-oc~e:".
o
o
@
@
dj)
o
42.
43.
44.
45.
SChepis 7
r..,rks or oth~ rocro~troMI '~clllf'cs?
f{olnronanct.o.;..1 pub' Ie fl\cllltlr:s, Including rOdds?
OthO,. C 'di!nt I fy !Our-vice):
(:fPLM'AT JON:
Itl) I'h"" pnlii"p. pl'"ntp./"'t1..o.o.Jh..at ; ~ Mvp.n ...t the or-esent
'~IT'GATlVC ~E^SUflCCS),
40) 'lhere will be Bdeq~Fublic w.ter supply with R fire hydrant within the
required di stRnc.'L.2L-l,lLU.1!lliin f
CCoIUlTY CO."nlTfSI:
.
.
HU;'IAN IIIJ.Lf'fl
!J4., WIll tI,l-' rrcr.o~~1 r05ulf In thlJ croclth.ltl of ~n'l hual1h h<1!/1l'tJ ")r I,r:.tuntlnl hllnllh
h"l~nl, p:,<cludln!) mCn1i.ll t,oalth?
f/PLANATION:
Yl5 w\Yn~ ''''-;1:1
0 D G
. --..--.----,------------..--.--...--
IHTlGATlVE i'lEA5URECS):
COUNTY C(MoiENTC$):
AESTHET J CS
55. Will the propo:;al rosult In the obstructIon of eny scenic vista or view opc;n to the
pub I Ie or ....11 J the prc>posZlI r05U It tn tho cro~t Ion of an bcsthct Icelly of fens Ivo
sltft open to pub! Ie vIew?
MITIGATIVE MC.astIREC$);
CCWITY CO"'j.\EttT (s) :
RECREATIO:>;
'5". 1'1111 tli., pf Of,cl':o:' I '''',ult In on li'l'f'J(t ur,,,:,n thn qUi'lllf" (J' qu..,ntlty nf md,.tln!J
rocrnnt Ion" I opportun liles?
rXr'IMi.\TIOtI:
D
@
D
D
DC;
.
\'.I101t i.s the steepest ~l'llJo on .....~hO....5...b:1 IdanHfy tho nppI"'o)o;lmal-o
percent of tho sLope: ~k
3. \'.hat gcncl"'ul typc~ of saLLs arc found on tho si-to (...,0. Dand.
}.;,....Ivet. pOolt-, 'or muck)? If yOU know the clnssLfi.caHon of agrt-
cultural soLls. spoclfy them anu noto .:any prLmo furmLnnd:
.::',>I')\<i<1. 4- (.4~'j;\usi
~. Are thcresurfocc"tndi.caHons or a hi.stor-y of unstable solls 1.n
the tlMledtate vtci..ntty? I f so, descrtbe them:
!--iN";,,"
.
EVALUATION
Agree Di.sugroo Mi. ttgatu
o
a
o
a
o
a
5. Oeser-Lbo the purpose, the ,type, and opproxLmat'; quanti.tLos of any a a a
fLLLLng or grodi.ng propos'7d. Identtfy tha source of tha fLLL,
\'Y)i'''U'L heud Ii-'i::' ~'''''_I'l 8l\,lc!,'",S:;'
r7 .'.
~l",d, t'..~" \;t \~ S ,,\-0 i>\:;
6. Could erosi.on occur as a resuL t of clear-tng. construct-ton, a a a
use? If 50, generaLLy descrtbe tt-: ~ ~(__.".J I.'..
7. "About lA.hat,percent of the si.to wouLd be covered wLth Lmparvl.ous
5urf'03ccS after construcHon of the project (i. .0. nsphaLt or
uutldtngs)? C' t3.C~CX, "J
Ooscrtbe 'proposod monsur-es to reduce or controL crosLon or other
t"llacts to tho eorth. i.f any:
l0::. ~ f
AIR
9. ~.;hnt types of emt,!HIo1.ons to the nt..... tf' any. wouLd rosuLt from tho
proposaL. (t .e. dust. DutomobtLe odOrS" Or lndustrLoL wood smoke)
d..".t,ng con~tructLon and ,,,hen tho prOJoct to compLatad7 ConoraLly
dltlocrtbe and gtvlII opproxtmato quonHtt,05. Lf known I
\~L\'-\~..l'\'-\Ol\-{ c:::cl,',,::", (<'1"11',-\1'1\,:,:> LI,(,I,I\7J(.:,L'J
'"
10. .\ro thrrco any off-aLto !lourcn!lo of amt.!IosLon!lo or odor a that mroy
..rrect yovr rropo!loal? If 60, gcnerllLly delScrlbb them:
'" (", ",,";
!i
11. Oe"crlLuo "rOFtO,utd,me..vroG to reduce or control OmLIIoGton5 or
olh.,.. l"'PA~ls to ttll11 ot,., 1.( unYl i....y'~_. f
a a
~~
a a a
TIel.( weu.. u~ /l"
N~~o
o
o
a
a
o
o
0"
a
o
a
a
a
a
o
.
.
^srClCl
:!~. ,".I...t ktnd and wnounf: of vC,Gotal;t.cn wouLd be removed or altered1 0
'(,:,:,,; 'j~'S~ ,,:\l{..j~ ~\r(. .-h:.c.(:":~
25. Ltst threatened Dr endangered ~pcci.cs known to be on or noar th~ 0
si. te: I.... '1(': ~'.J "7
26. Oeser-Lbe proposed LnndscnpLng. use of nature pLants, or other 0
measures to preserve or enhnnce voget-otton on tho slto. If any:
c:; ->: \ h: -1 ~L' C V \'~ -{ ItJ if. 1;:'( e \ ill<' .,\.<-...;.\,
ANIMALS
27. Check any bLrds and anLmats that-have obeen observed on 'or' noo.r tho 0
slto or are known' to be on or near tho'slote:
o Bi.,..ds: 0 ha\4k C heron 0 eagLe 0 songbtrds 0 ot~cr-i.dcntLfy:
[\]0"" "
o l\1anwnaLs:O deer 0 bear 0 elk 0 beaver 0 other-ldenHfy:
V0~~~ ('
o Fi.sh: 0 bliSS 0 salmon 0 trout 0 hcr,.~ng D,sheLlfi.sh
o othcr-ldenti.fy: ,\jO~'-lo ~~
28. Llst anythrcatcned or endangered specLes to be"ot'l'~;" ~e~r tho
!loL,te:
~UC..'..3L
29. Is the ISLte ptlrt of a. mtgrntLon route'? If so, ,o)lpLaln how:
\I.J~
30. De5crLbe proposod moasures to prunervo or onhanco wLldlLfe. tf
any:
IL.>C '^-' t
E""ncv AND NA TURN. RESOURCES
31. '";hAt ki.nds of anergy (l.e. aloctl"lc, naturAL gas, oLL, wood stov.,. 0
"nd solar) would be used' to maet the completod proJect'D onorgy
nl'eds? Deserlbe ",het-har It would be uaC!ld foro hOAt-Lng, monuf'aotur..
lng. .eto." (";F \.;~, .t'll'. .-/;" "t:"j C) '\
J.." "> 1-,-\-1.... ~. ~i \\~ ,,4; \\-; ,~
t,) "-'
32. '':ouLd the proj"ct _,'oc t tho pohntl ol u.... of aolor ane,.gy by
oSdJocent' properHos. I r so, Gencl'Ally daaerLbo tho affect:
\'L'e:
,
:3. ~'h3t Sel"dw. or onercy cons~,.v"tlon ronh..."" nro lncludad In tho
"loS'" or HI'.... proposal? Ll.t oth"r ,..rl)po~od rne"Slras to reduce or
controL eo"~r&.,. llllpocts. Lf any'
\~k~,'\J ~
6VALUATlo."
0l.5Dgrce 'riii. \ ~lg;\ l<e
0. re
0. re
0. re
0.
re
0.,
re
0.
0.
0.
re
0.
0.
re
o
re
o
[;J
~
o
o
leJ
.
.
EVALUATlO,'l
AgreD Dtsns,.o'o Me. ttgato
ENVtPI1~'\!ENT^L HE^LTII
3~. Aro thoro any cnvLronlllcnt3l health hu:eurds, LncLudLnl; l1>;po5ure to 0
toli,;i.c chcl1llcals, ri.sk of Fi.re and cxploston, spi..LL, or hazorCl"-.
o
o
l~aste. th...tcouLd occur as a result of thLs propotial? If 50.
doser-tbo the hazards:
f-.J C \,-!'?
/'
35. Oeser-tbe spa'claL emergency se,..",tcos that mLght be requlred:
o
o
o
t-.J 0.'-3 7
36. Deser-Lbe proposed mensuros to reduce or controL cnvtronmentnL
o
o
o
health hazords, Lf.. .nny:,
.. \'Ve- \\J?
NOISE
37 ..,l',hat typos of noi..secxi.sl: tn tho aroo that: may affect your prC)jcct 0
o
o
-,.(t.e. traffLc. 'equi.pment. nnd operQ~i..ons)?
\\Je"'-l t
38. \';h"lt types'a.nd LeveLs of naLse would be created by orassoi..cated
"tth tho project on Q short-term or D long-term b05tS (t .B. CDn-
structton. trafftc. and operatton)? Indtcote \'IIhat hours noL5e
\\ouldcome from the stto: -ta....+-~-~ \'<... ...~" .\"5. i
'1 (~V'r\, 1 -\' "-' 'I '-.f'.'Y\)
o
o
o
39. easerLbe proposed measures to reduce or controL nOL58 tmpacts, Lf
o
o
o
any. \~C.:.J'7
LAND M:D SIIO~EL I NE USE
-a.
''.h.,t t~ tho eu,.rrnl: UGd of tho
, rC-P. .. 2. l~"v. ~> y l-
.j~u.*)1 .u.,:! ~ .)
5t to nnd ndJnccnl: p,:oportte51
C()!1''\I''Y\ t'ji.~ ~ I ," \
o 0 0
C. VIltzeN'T ()~ ($IF srrlZ 15
l)1..meve.l-DP6O
-.. H.II\ th., .sUe bffen used fo" n~,..L cut h".o? Ir ao, dOllcrtuQ tho UIHII 0 0 0
'i\.J C
.a~. Oesc,..lb" any .truct"reu on tho ~Llol 0 0 0
\\.;J t\,..., '(
.
-13. l';tL't nn)' :>lruclurcHi be delllulished? If so. whn~ structuros?
\l)c,,-, C
..a-l. t'.hat' L5 tlu! current' comprCllCJlULVC pLan or communtty devolopment
pL an dcsi..gnatLon of the st to?
LC'\,>VY\ e e (; I, l
Idcnttfy the pLnn:
('?:'ll.-;"j;", '" ,,<,
45. IF .appLicable. v.hot &.5 tho curront shoreli..no mastor prosram
'desLgnatlon of the st te?
\)..Jc,'-....i~'
-Sti. H.1S' any part of the sito been cLasstftod .as
sensitive" oreal If so. speclfy i:ho part:
"envi..ronmontaLLy
,I..:. c.:.
-17. Appro)(i.matcLy how many people wou.Ld reslde or work tn the
completed project? ,(, '2. b "'+' ) -, ,--
..a8. ApproxtmatcLy now many people ",ould tho completed project
di.sploce? ~
..a9~ Oeser-Lbo proposed meaS....es to Bvoi..d or reduce dt,spLacement
tmpdcts. 'If nny:
\\.:)0,...; ~
SO,. Descri.be proposed measures to ensure the proposal to compotLble
~Lthe)ll5t,lng and projected land uses nnd plons~ tf any:
1.L)c,.......' "
HOUSINC
51. Appl""oJCtmutoly how many unLh wouLd be provlded, Lf any? Indtcoto 0
~\hether thn houstng &.5 htgh, IIlLddLo. 01"" Low Lncome:
j'-...)(,) ,\..3 t;
5:!. ApproJClm.Jtoly how many unL tis, If any, ~uld be ollmlnat-od1
Iootcate \\hethtlr tho houstne La htgh, mlddLe. or Low Lncomo?
I\.)()"',.J '{II'
53. Oescrlbe proposed "",usuraa to ,.eductl Or" controL hDusl..ng I..mpncta,
L' any: f~'c~~ ~
,Ii
AESTltETICS
Sol, "J",t ls th. t'alle~t hal,;,ht or .ny proposed atructuro{,.,. not
lncLudLng "nl..nnaa? ~',h;\t La the prlncL'J"l od.,.LOt' butLdlnc.
.....t.,.laL(... "ropoacod? ( i 9.> I.:!:.')
l.t.)C':~,cl ~~ .!-t(~I.\:\Ult
.
EV,~LU^T'ON
AgroQ Dt :::,ugruo Ml ttgato
0 0 0
0 0 0
C) 0 0
0 0 0
0 0 0
0 0 0
0 0 0
o
o
o
o
o
o
o
o
o
0'"
o
o
o
o
,.,
e,
GENERAL PROVISIONS
1. THIS PERMIT IS SUBJECT TO RC'A 36.75.130. .IQO ANa ,150 AND AMENDMENTS THERETO.
2. ntE GRANTEE" ITS SUCCESSORS AND ASSIGNS.. AGREES TO PROTECT JEFFERSON COUNTY AND SAVE IT HARMLESS FROM ALL
CLAIMS, ACTIONS OR DAMAGES OF EVERY KIND AND oeSCRIPTlON WHICH MAY ACCRUE TO OR BE SUFFERED BY ANY PERSotl..
PERSONS, OR PROPERTY BY REASON OF THE PERFORMANCE OF ANY SUCH WORK.. CHARACTER OF HATER IALS USED OR HANNER
OF INSTALl.ATlON; IN CASE ANY SUIT OR ACTION IS BROUGHT AGAINST TIlE COUNTY FOR DAMAGES ARISING OUT OF OR BY
REASON OF ANY OF THE ABove CAUSES.. THE PETITIONER, ITS SUCCESSORS OR ASSIGNS WILLI~ OPON NOTICE OF COMMENCE-
MENT OF SUCH ACTION" DEFEND THE SAME AT ITS SOLE EXPENSE AND SATISFY ANY JUDGEMENT ARISING THEREFROM IF
DETERMINED ADVERSE TO JEFFERSON COuNTY.
3. IF THE GRANTEE ENTERS INTO A CONTRACT. OR AGREEMENT ',UTH A THIRD PARTY TO PERFORM THE WORK AUTHORIZED
BY THIS PERMIT,"THE THIRD PARTY.. AS'A 'PART OF THE CONSIDERATION FOR ITS CONT,RACT WITH GRANTEE, AGREES TO
INDEMNIFY, HOLD HARMLESS. AND DEFEND THE COUNTY IN ACCORDANCE WITH THE PROVISI,ONS OF PARAGRAPH 2, ABOVE.
~. ~~Y T~~~A~~R~fTA~~ ~~NI~~ ~g~~{~~~~~O~N~O~~Q~~~~~~~~~ ~i~~:~ ~8D~Ay~RS~:ltU~~B~~C~HiH~~R~E~~I~Hio G~:~~~~..
LATlON AS HEREIN PROVIDED.
5. DURING THE CONSTRUCTION OF THE FACILITY.. THE GRANTEE SHALL COMPLY WlTH THE MANUAl ON UNIFORM TRAFFfC CONTROl
DEVICES FOR STREETS AND HH~HWAVS PUBLISHED BY THE U.S, DEPARTMENT OF TRANSPORTATION.
6. ON COMPLETION OF SAID WORK HEREIN CONTEMPLATED, ALL RUBBISH AND DEBRIS SHALL BE IMMEDIATELY REMOVED AND
THE ROADWAY AND ROADSIDE SHALL BE LEFT NEAT AND PRESENTABLE -AND SATISFACTORY TO THE COUNTY.
7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATION OR THE REMOVAL OF ANY STRUCTURE OR STRUCTURES
AUTHORIZED BY THIS PERMIT AT ANY TIME, SAID CHANGE OR REMOVAL TO BE MADE AT SOLE EXPENSE OF THE PARTY OR
PARTIES, TO WHOM THIS PERMIT IS ISSUED, OR THEIR SUCCESSORS AND ASSIGNS.
8. ~~~ E~~~T c~~~~~~ER:~~~N~r~~Cr~~N o~n T~~L~~t~i~~ S 8~0~~EA~~A~n~E~~~~L C~5N~~N;Hl~L SY~H N~ ~~~E:E A~E~~Ltl~~~~E
FOR ANY DAMAGE TO THE GRANTEE BY REASON OF ANY SUCH WORK BY JEFFERSON COUNTY.. lTS AGENTS OR REPRESENTATIVES..
OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, STREETS, PUBLIC PLACES OR STRUCTURES IN QUESTlON.
9. THE GRANTEE SHALL NOTlFY THE COUNTY'S REPRESENTATIVE UPON COMPLETION OF THE WORK UNDER THIS PERHIT SO THAT
A FINAL INSPECTlON CAN BY MADE.
0 1.
~ 2.
~3.
~q.
0 5.
0 6.
0 7.
o 8.
SPECIAL PROVIS IONS~("(::"r;}j'l n
APPLICABLE PROVISIONS ARE DENOTED BY AN eX) , '_ ;'::':~:."~i '~1!/~~\
A COPY OF THE PERMIT SHALL BE ON THE JOB SITE, AND PROTE~TED FROM THE ELEMENTS, AT'AL~<rIl1ES; Du~iN'G~':THE
CONSTRUCTlON AUTHORIZED BV SAID PERMIT WITHIN THE COUNT't S RIGHT-OF-WAY,
THE APPROACH SHALL BE CONSTRUCTED IN ACCORDANCE HITH THE ATTACHED DESIGN PLATE TYPE ~
APPROACH.... ~ Fr. LENGTH OF .a.. INCH DIAMETER CULVERT PIPE SHALliE PLACE~
DITCH AND LAID TO A TRUE LINE AND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWN ON
O~~E~~:~G A~~ ~~~F~~~D~A ~~R T~~oAP~:~e~~E S~~~~E=~Y I~N:gcg~e~~~E R ~ ~~~_~~~w:~O~: tE ~g~T:~L P~:MI~~Eh~AN.
TUE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO
PREVENT ANY MUD TRACKING ONTO THE COUNTY ROAD. ANY MUD TRACKED ONTO THE COUNTY ROAD SHALL BE IMMEDIATELY
CLEANED UP BY THE GRANTEE OR HIS AGENT.
IF NECESSARY TO INCREASE SIGHT DISTANCE.. STUMPS Arm BRUSH SHALL BE REMOVED FROM BOTH SIDES OF THE
e:ra~A~~ALl T~~T I:~J ~~=~ 7 ~~~~Eo~U~~~~~y 0~o~5R~7~~~~g~~wl~~8ER OR 01 SF I GUR ING OF ANY FEATURE OF SCEN IC
WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:00A.M. AND ~:OOP.M. UNLESS OTHERWISE AUTHORIZED BY THE
ENGINEER.
A SURETy BOND I N THE ^MOUNT OF $ , WR I TTEN BY A SURETY COMPANY AUT!IOR I ZED TO
DO BUSINESS IN ntE STATE OF WASHINGTON, SHALL BE FURNISHED TO INSURE COMPLIANCE WITH ANY AND ALL OF THE
TERMS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIN IN FORCE UNTIL ALL WORK UNDER THIS PERMIT HAS
BEEN COMPLETED AND APPROVED BY THE COUNTy.
BEFORE ANY LOG IlAULING OPERATIONS BEGIN, A SURETY BOND IN THE AMOUNT OF t .. SHALL
BE FURNISHED BY THE GRANTEE TO PROfECT THE COUNTY AGAINST ANY DAMAGE TO THE COUNTY ROAD AND TO INSURE
COMPLETE REMOVAL OF THE APPROACH AND CLEANING UP OF THE RIGHT.OF.WAY TO THE SATISFACTION OF THE COUNTY.
APPROVAL OF ALL CLEAN UP WORIC SI1ALL BE SECURED BEFORE THE BOND WilL BE RELEASED.
SPECIAL CONSIDERATIONS
Form 113 tl
~!;>
TYPE C.,
. COMMERCIAL ROAD APPROACH
1---50'~
J
,
- ---------:~~~f:;;~~
12"010 mln.cu:yvert E.lstino ditch
Edge of . Shoulde r
_-=0::'-===-_:::'" _ _ _ _ L~S~~d~:~~~ may be required)
Count)' Roo~
Varies
l\,
---------------------------.----------.---
e of Count)' Road
EdQe O'.'hOUider I
120m,",
At.!!.e,g!!ir.!.d___ I ",2'li ~
--- ---~.:::::"~ ~
Min.4" ballast '
Mln, i' top course Min,li'CUI,,5
PLAN
SIGHT DISTANCE REQUIREMENTS
POSTED SIGHT DISTANCE
SPEED LIMIT MINIMUM DESIREABLE
.!!!9.E!!:.!.
25 160 FT. 200 FT.
30 200 FT. 240 FT.
35 240 FT. 275 FT.
40 275 FT. 350 FT.
45 315 FT. 410 FT.
50 350 FT. 475 FT.
NOTES:
1.)
Culvert shall meet
for IIS-20 loading.
1) concrete
2) corrugated metal
mlnlmum specifications
Approved types include:
2.) County road shoulder shall be left at
existing profile.
APPROVALS:
County Engineer
Date
Chairman, Board of
County Commissioners
Date
F m I .d
.
.
FLOOD RfGIONS
VALUES OF Ct (Min, 1Ft.)
Average Na tu ra I
Annua I Drainage Overl and Sewe red
Runoff Basins Flow Areas
- 0.5 1.00 0.30 0.25
0.5 - 1.0 0.60 0.20 0.15
/.0 - 10 + O. ~O O. is 0./0
10 - 30 C:.!..:~-) 0.30 0.25
30 - 50 0.80 0.20 0.15
50 - 70 0.50 0.10 0.10
70 - 100 + 0.30 0.05 0.05
(c.S.W.S. Paper 1687. 88. 89
Put 12. 13. 14 and Aldridge-
Blodgett Rcpods)
Regions
8 - C
Wc~tcrn Wash i ogton
and Regi or; ^
TABLE 1-1
Tc = Ct(L n /JS )0.6
Tc Ttme of consentratton, Ln mLn.
Ct = CoeffLcLent for ave. annuaL runoff and basLn type.
L = Length of draLnage basLn.
n R Frtctton factor
5 = Slope of prLncLpLe channeL Ln ft/ft.
TYPE OF AREA
"n" VALUE
Average N.:ttL,roll Chllnnels. overall
Pol\tca Channc I s
Overland Flow .Jnd Improved Channels:
Smooth p,J,vi ng
BMC' polCkt'd soi 1
Poot gras!, cover
A_tlrolQt' qraH CO'/(:r
Dcn!>!: gro1s~ cover
. 'Storm S(.'l,cr:.
(--, Il. OS"'"
0.014 to 0.040
0.016
0.100
0.300
O. ~OO
0.500
0.012 to 0.025
If .,ld./ tl"'" ,If .ilt'rlllllJ ;lOil' (Inlet Lime) for small (lrI.'O.'i kf"~re It IS a :denibcant
}..Ichlr.
TABLE 1-2
.
I',h.lt L!. the $tcc~cst. slopo on the si-to? Idcntlfy the upproxtmatc
percent of the slope: ~/ /?./'~/= /'"v ?'t::)~'/
3. I'.hat general type:;. of 501.ls ore found on the si-to (t.e. foand.
,;r,:wcL. poat. or muck)? If you knoM. the clossi.ftcatton of as,..t.
cut tural sOL l5, spocLfy them and note any pri..mc farmLand:
SANr/...., C/"I}' /J1;X
-I. Are thore s...."..face tndtcattons or D hi.stor-y of unstable sells i..n
the l.nvnedi.,ate vtct,;i..ty? If 50. descri.be them: N,....,
5. Oeser-Lbo the purpose. the type, and appr-oxl.matc quanti. ttes of uny
ftlLlng 0'" gradi.ng proposed. Identi.f.,. the source of the ftLL:
f.1?4,1)~7 ~?J/i' ",!/?A/';v/"vt/ <;01'<,,::: h'//
cJ'AI . <;"/7/..-;> .7,,( 11 t'
6. Could eroston occur as B resuLt of clear"i..ng. constructton.
use? If so, generalLy descrj.bc tt: No
About \O.h3t percent of the stte would be covered wtth tmpcrvtous
surfaces after cOnstruction of the project .Ct .c. asphalt or
butldtn&s)? ?aj
8. Descrtbe propoSoed measures to reduce or control croston or other
t"tHlcts to the earth, tf any:
AJO/oI 94A~!>.
LJ/A"";r;~,,r -MI."-/;!S
, '/ '
AIR
9. I'.hat type~ of c:mtsstons to the nlr. tf nny. would rc:tiult from the
propc$OIl (t.e. dust, automoblle odors. or lndustrtal wood smoke)
du,.tnC ccn~truc.tlon and ",hen the project t.!Io completed? Gonerally
de\\ocrtba "nd glye opproxlmate qUo/lntL tl(l5, l( known:
r,'t1N\~ t.-il ",7"/ ')/'14,11-: r- C'.A-"1p'~...r/J")
10. ,\,.e the,... any off.!Iolte 50.....COtt. of cmi.sslons 0"- odors that mny
affect yOIl" ",.opos;.Bl? If so. gnn8,...lLy descrtbe them: /J/J
11. Oe.cr, be propo."d mr,uu..rretlo to r.,duce or cont,.ol emlaatonli
nth",. ,"'pact. to the atr. tf Any:
..../>U'.L_d/'/:J /....C A h'/ 4'
.
EVAl.UA T I or-;
Agree Di.~ag,..ee toli. ttsnte
0 0 0
tj.' JIV.>c tIV 400)
0 0 0
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
.
EVALUATlO:--.:
Ag,..ur.' Dt~aB,..cn Mi..ttsate
ENV I RON~13NT AL.. HIZAl.. TH
34. Are there any envtronmcntal heal th hazards, lncL udi..ng exposure to 0
o
o
tOJo.;LC chcmL caLs., ,-i.Gk of. fi.re Bnd expLoslon. spi. L L. 0,.. hazar-dous
...."stC.tholt could occur'" LIS a result of thi..s proposaL? If so,
de~cri.bc the. hazards:
/)Ir')
35. Oeser-Lbe speci.al orner-geney sC,..""Lce5 that mlght b. required: 0 0 0
l/ II' /( ,/)I" cd AI
36. DC5cdbe propo50ed measu,..es to ,..educe or controL envi..ronmental 0 0 0
health hazards, tf any: lilt:! N I::'
NOISE
",hat types of naLse exi.st tn the area that may arfoct you!"' pr-ojcct 0 0
It .e. b-affi.c. equi.pment. and aparat,lans)? ~'-'A/~ -r~FIC. P~f\-1
o
Ho-# ,e.D.
\'.hat.types and levels of nolsc wouLd be created by or.us5ol.cated
\,i.th the pl"'oject on a short-tcr-mO'" a tong-ter-m basts Ct.e. co,1-
~t"uctton. trafftc. LInd operat:i..on)? Indtcate what hour!> notS-:l
"ould come from tho stle: --L}LdA/t;
o 0 0
INC,ee;A-~e: IN N()-fSC
-nIfT ~{;AJt:>r-A(" VIChVrrr-
Wlr..t ,eeS-<J't..T FICffi'-f
P~POSAl......
39. Ccs.crtbf" propol'-cd measures to ,.oduce or control nOLSo tmpl'lcts. tf
o
o
o
"ny:
,11,,/1/5
LM'O AND SHOREL I NE USE
-10. I'.t'-'lt La tht' currl'!'nt use or tho fiLte And adjacont p,:"opl'!rtloa?
./?.E..ildr. AI 7/.A.L~cI~Uv~ r. ,L ,f/,.vr!
o
o
o
., . Ii.. the .t te been u!Iood (0' nr;rtcut h,e? If ... deficrLbe the use: 0 0 0
"p-Adt-'r!E
-I~, Dflac:,.tb" any .truct\l'OW on tho .lto; N",II/r 0 0 0
.. . '.
.."~---,--_.-.,,---,,,
.
.
EVALUA T I ON
ACree OL5o_Cree ML Hgat.
".hut is the steepest slopo on the sLte1 Identi..fy the approxLmate
percent of the slope: O%-old RR qrade LS + 2-3' tvo;callv
o
o
o
3. ~'.hat general types of saLLs ere found on the si.te (L.e. sand,
Itr,a\leL. pOOlt. or muck)? If you kno"," the ctosstftcatton of agrL.-
o
o
o
cultural soLLs. spectfy them and note any pri.me farmLand:
Genera11v Ou1cene Rock (gravP1s)
~ppt;r pp~k tp~t rppnrt
~. Are there surface Lndi..caHons or a hi.story of unstebte sotLs i..n
the i..nwnedi..ate vtct.,;i..ty? If 50, descrt,be them: No
Spp sni'~ log frnm
o
o
o
s. Descrtbe the purpose.. the type. end appro-.i..mate quanti.. ti. es of eny 0 0 0
fi.lli..ng or gradLng p,..oposed. I dent:i. fy the source of the fLU:
Grarling nnly 'fnl"'.rn;llnc: ~nri f'nllnrbi-; nn (m;n;m~l )
6. Could. e,..osi..on occur as a re5ul t of cLeortng. constructton, 0 0 0
use? If so. generally de5cri. be It: No
7. About ...hat percent of the si.te would be covered wLth trnpervtous 0 0 0
surf aces after construction of the prO ject (i. .e. Bspna L t or
butldLngs)1 Approx;mate1Y 1/2 Ac. or Approx;mate1v 7%.
8. Deserlbe proposed measures to reduce or controL eroston o~ other 0 0 '0
L""acts to the eal"'th. tf any: Nnnp
^IR
9. ",hat types of emi.sslons to the atl"', Lf any. would result from the
propos.at (L.e. dust. automoblLe odors. or Lndustrlal wood smoke)
duri.ng con.tructi.on and when the project La eompLetlldl CaneralLy
dncrlbe and Elva appro)CLmete quanttHell. if known I None
o
o
o
10, Are th.,.... any off-aLt. .ou-cas of em".stons 0" OdD,... that may
o
o
o
a"ect yo.... propo.al? I f so, general Ly de.crlba thoml
No
'1. O.se,.l b. p,.opo..d mft..Uf"'.. to reduce
oth.,. l"'P"ct. to the ."ro. If anYI
controL .mL.slons Or
o
o
o
Not Aonlkahl..
.
...
JEFFERSON COllNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
1. Project Name. ;:5,q.;/l) Co,"",el2c;4'. t;>p,J{!)oom ANt
I
2. Project Proponent Knp.eR-r {:. <;,411<;
Address '3o~o c.eNl"eF<. 1>.'=> .
Rep.
S<h-n S-
Phone No. (:--' 732. - <1678
3. Date received mf'f'r' q, I~B?3
4. Preliminary review completed
_I
Date Response Due /(J.4-<j I !:?, 19B{J
by
5. Conditions of Approval sent by
6. Prel1minary desi~n reviewed bY
Final desi~n approved bY
7. Pre I im. draina~e p 11m .rl!v1i!\;,.ed . bY
Final draina~e plan approved bY
8. Construction approval~
Sub~rade approved bY
Finish ~rade approved bY
Drainaee approved by
Surfaci~ approved bY
9. Final review tor all cDndi lions:
Conditions have been met on bY
CDllIIlents
EVALUATION
Agreo Olsngrco Mt Hgatc
" ~';hut i.s the s t:ocpes t sLope on Lho st tol IdenHfy tho opproxLl1Ioto 0 0 0
percent: of tho slopo: /10- F.fhT 6"R.oV"vO
3. l~hQt: gonorllt. I:)'POS of salls oro found on tho ~ll:o (l.e. sund, 0 0 0
gr':lVol, flcuL..o/" lItuc!<}1 If yOU I<now Lho closnlflcal:ton of ngrl-
culturaL solls. spcclfy thelll und noto ony prtmo farmLand:
{/WOMIRY S'/'lk,oy .L..(:1/l~ /lA'O L);CI< jp/1MY ,J'/9~P
Are there surfllco.lndLcntlol1s or II hlol:ory of unsl:obLo f1olLo tn
tho llllll1cdtal:c vlclrill:y1 If 90, doserLbo thorn: /YO
o
o
o
OoscrLbo t:ho PUl"PO!JO. tho type, and npproxll1lol:o (Iullntltlos of any
o
o
o
fllllng Or grndLng proposod. Idcnl:tfy 1:1\0 sour"CQ.of tho fllL:
A0A/E FyPr/'""",er.o
6. CoulcJ eroslon.occur.Qs u resuLt of clearlng. eonstrllcHon. or
use? I f so, gCl1crully uoscrLbo L b /Vb
o
o
o
.\bout:.,"hal: porccnl.of tho. sLtc would be covored wlt:h lmporvLous
o
o
o
!5urfilcos nfl-or construcHon of tho projoct (L .0, t1sphnlt or
lJulldll1gs)?
/JPRt' Y. /'0/:1
n, Doscrlbo proJlo~r.d. III005ur09 l'o ,"oduco 01' conlt"oL cl'u!llon or othol"
o
o
o
lnl1ocbs. to lho nllrt:h, tf nny:
vh,vc- C',( p1~t!' re"/J
AIR
"..
9. 1~1wl: t)POS of cmi.tJ!Jlons 1'0 tho Ill..... Lf nllY. would r08ult: frOln tho
propo~lIIl Il,o. uu!St. nulOlnobllo odol"o. or ll1duslrLnl wood tllllol<o)
durlng con!lh"ucHon ond ,~hol1 tho proJoct ll'l comllLolod? Conorally
dnscrlbo UflU glvl! npP,"oMlmilto lllll1llllllcu, If Ilnownl
o
o
o
10. ,\,.e tht'f'e Qny off'-nl to !lOur-OOR of crnlnslon9 Dr odorts that nlllY
arfoct )0,.' prollO'llll? If !'ID. gOllorall.... doscr-lbo lllolll: "Y"O
o
o
o
11, O.scr-lbe J)rOI'O..!II) manll\K'oa La roduCQ Dr cOntrol amlaalonft 'or
o
o
o
other l"'flOlCts to tll" olr. If IInyl
ENV I RONfrENT ^L IIE^L TII
~.'re thoro uny envlronmontul huuUh hozords. lncludlng e'posuro te
L/ ~o,..lc chcmlcoLs. rlsl<. of ftre and tlxpLoslon. splLL, or hazardous
~m5~C. HlUt couLd occur 05 a rCGul~ of thls proposuL1 If so,
dl!scrtbo ~he hmo:urd:i: ;/tJ
35. Oescrlbt: spectaL emorgoncy scrvlcc5 that IlItght bo rcqulrcd:
, . ~)/...
o Dosedho "ro"osod mousuros to roduce or conb-ol envlronmontol
hc...Uh 11Ilzard~. tf any: 1f(1/l
,NOISE
37. ~\hat typos of nol!llQ QloCtSt: \on tho area that may uffoct your proJaot: 0
(L .e.~"'Dfftc, cqulpmcl1l:, ond opcrnl:,lons)1 A~K'€
e ",hot ty"os ond lovol. ef nolse would hn crootod by or o..olcohd
. . ..Uh tho "rojoct un 0 .hurt.'orm or 0 long.'o,-m bu.ln (L.o, con.
strucHon, trnfflc, and opcral:lol1)1 Indtcnl:o \Vhot: hourlJ nolso
"ould como from tho alto:
". r" ,.. LJ.1Y5
39. C05crltUJ pr.opo5ctl nUUHsur05 to roduce or. oonlrol notuo tmpnota, tf 0
';r,'YI;~1!'
LNlO MID 5110REL I NE L/'.3E
6 Ill....' l. Iho ou,-ronl u.o ef 11'0 .l'o ""I ..Ijecen' p~0"orHoe7
-L:1J!. 0 ,..<.r. //AM~.f'-=-.i?..P.d.tli,v /-va
~Pl.'O:!7Y - .J'.<!'fi: ~~;rA'T/~h' .-P#P, G"~
.K I.S' P,1hf:.
EVALU^ T I ON
^C'.OO OlaOlWUQ Mt Hgol:o
o 0 0
:5'e~VI~ I--<"'i '0";15
-rz,X.I~ Df2. FU'r1-ir-iA6lJS""
5()~T"'N~' 'S'tOgf"i2t'S
#J"D 'Pt~Po~,",- ~
'fO!i6 tlAZM=n
o
o
o
o 0 0
$ae- CoND, * 13 rz.. >;;;" q
t ) t I
o
o
ODD
NOc;oe; L$Jeu; ('()Il.-L.
tt.J~5 iN A~.
o
o
o 0 0
C-OH l'-\E.~CJ.tt-L
~, . II.,. the all ft tnum ".sou ror ftl:,.tclllluro1 I r so, dnncrLlle lho ueo I 0 0 0
-6~
..a:!. Oeser l h. "fly IIl_ UelUf"Otl un tho fill"", ~fi'. 0 0 0
..,' .~
JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
1. Project Name ,~,;- ~-?7AC/f~,[<"J
2. PrDJ ect Proponent. Rep .tf A .d.n{~~
Address .R/.,1jJc,Yb: <? JU;dkh
Phone No. _> C2f2L> 3flS'~ 0'1 S(('.,...-
3. Date received -3-;'/6-t":/ Date Response Due S~.-2-/-F"c
4. Preliminary review completed by
5. Conditions of Approval sent bY
6. Preliminary desi~n reviewed by
Final desi~n approved bY
7. Prelim.. draina~e plil~',rev1i!~'ed" by
Final draina~e plan approved bY
8. Construction approval:
Sub~rade approved bY
Finish ~rade approved bY
Draina~e aDPrDved bY
Surfacin~ approved bY
9. Final review for a II' cDnd itions:
Condi tions have been met on bY
CDnvnents
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ARtA tC~t NUMBEII UTUISION
TelephonedQ}Please Call@--
Called to See YouO Will Call AgainO
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Message
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I (Name) _6f!:::..
Talked w;th ~f 1J6-P1I:>~'I-- 01 ;s>>'I7TyLdI9!:l/px!r2k~-
;Ii::. 1 c.lled [J Party called T'Ole ..--7..::..2.0 ~ Date .._t?,,4?_,.....'''....--
Sublect __J2I$:J/~J!!.6'g-.L~/1z7:i~~
What I sa;d. _"'/-1~-P'~.iL-f;<i2dli..J)..#.E:=...-A.-Zl(;.!,,_4y_70-
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What party sa,d: _...W.44..7.'~..-..-?J!---kl!!.('}<</-A-~-~I.~-6-~S~.l2E.6'".AI-L
t/PAtJr.."To. .,D17..1J:...,NO&<J. j3.1A7:__"tJ/.I.../.....---lJP---./. r._.,vt!!:K.-r::.-/MIt.....I----
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Hr. I1.AYh[' WJ
WATER
1oI111:tllo proposal, r05ult In:
10. Ch~n9os ,In the curronts, or tho cour::c of or dIrectIon of w~tor mOVfJnltnts, In t'lthflr
/r.nrlno or Hosh watp.rs?
ChunlJes ,In the ..,b~orrtlon rbtos, dralnllao pot1crr.!>. or thu rate i'lnd &mounl of !;UrfilCP.
"at CJr run-of f?
Alterlltlons In the course or (low of flood waters?
A chango In the amount. cf surf.,ce ....ater In ony woter body?
A discharge Into surface waters, or In .HIY alteration of surfnce ...01ur quality, Includ-
Ing but not ,limited to1E:1:lpero1urc, di!>sohll::do......,9nn. (lr 1urldi11ty1
A ctlbnge .In' the qu;)nt Ity ,of around waters, either through dl reet ~ddll Ions or wlth-
drawflls, or through I ntercoptlon or bn bQU I for by cuts or f:!iCcbva11or.s1
A-deterlora11on Ir. ground water_quality, fllther through dlrec1- -Injection or 1hrough
1 ho seepage of I eachates. r.t1osphutcc. dot ergents. wil1 crl.lorno v I rus ("lr b"ct or lb. or
other substances Into the ground Ioo'"fers?
A reduction of tt.e bn.ount of "llte..r otl,of'"wlsc avat (tilde.. for llubllc \<.'ater ~upplles?
DPlArlAT ION:
MITIGATiVe MEA$URECS);
couuTY o:n~EfITCS):
FLORA
Will thlt f.ropo~1I1 re!'.ult In:
.e. ,., chbllge-In tI", dlvl.r~lt.,. nr spbC".I(.!o cr r'Il""~lJn: c.f an', !.I,celt!~ Cl 11erl:l. Inr.ludlng
tt(!O\. !ihrub!.. or.\~~, crcr.::., IIIlcrofl:)r",. :u.J ltjuotlc pl;:,lIts?
,~. "rnductlnn 01 1hn nlill'tliU"::" c.f lIl"', ",'lIq..o, rlln, or Nlct..'n~or6.:J cr.;c1.,<;. (.;f flc.rl)?
0 0 l1!
@ n iii
0 0 l'l!
0 0 'fl'
0 0 \t
0 D
@ 0
0 0
n
n fiJ
n ~
o
.
.
THMlSPOllT ^ T ION
Will tltr' I" op....:..iJl rc:!.uI1 In:
34, A Oflnordt 1011 of nJJIt IOrliJl Yflhlc;ul.J( u...P"It....IlIHl.7
~5. rffllC15 on r,~ld III!I l.drUun fdClllt Ic!. or il dlVluJnd for IW.( pilrklng7
:'t6.An IplplSct un ol<.I!'i1Ing 1rnnr.j.or1n1Ion !>Y!i11:rn!l7
37. Al1orl'lIICJrls 10 pra::iont 'Jtsttorf/5 of c JrcuJ.,tlon or, nlovumt:lnt of pllopl fl and good..1
,U. Al1orll'llnrl':. to looa1urt..urnlJ. fDII, or air 1rnfflt;?
}~. PI> Incro.'" .In trof~l,c h,":ord' 10 ",010r vohlclo., bl.cyclI,ts. or pn,ust::,'oJ"1
EXPLAIlATlml: 21!. ,.Q . 1.J) ~f'.t.. j Ur LL
^ ~ ~_' 1),-:' 0- ,~.~-..,...Y [/),'1"'-- Tf;"
~. " ,r II
l'I~<:f?"^" ~ '
MIT IGATlVE flEASUREISI:
courITY COoltENTl 5 I:
PUBLIC SERV ICES
yr~, r~^Ynr 110
J4 1'1
~~
n n
'-"- cry Cl
j /nA' rz..(nA.3--
, ---, ..J--
fL'l II i.J L'I /" /7\/
Cl
l'l
r;(
t'I
9J
<<
Will the proposlIl hove on offect upon or re::.ult In 8 neadfar new or llltered governmental
tho following llreos:
40. f'Ire protection?
41. police protection?
42. 5chopls1
4:J. Porks or other recro&tlonol facll11les?
44. JI.aln1onance of publIc faclll11if:os. lncludlng roads?
-45. other (Identify service):
scrv Ices In any of
0 0 16
0 0 l!l.
0 C1 !If
Cl 0 vi
0 0 ~
0 0 ~
E:.XPLt.I'AT 1011:
MITIGATIVE MEASURClSI:
COOflTV co."rllT(SI:
.
.
1. Project Name
JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
au.u ~~A {lxk
/
./' '
(~
Phone No.
~~.LA..J
pia /-30 A' .,p~3
c.b~t..
<_l
Rep.
2. Project Proponent
Address
<-'
3. Date received
..;2. - d.17 - :? _C:- Date Response Due
4. Pre I iminary review completed "5 -I -85 by SK
5. Conditions of Approval sent by
6. Preliminary desi~n reviewed bY
Final desi!!n approved by
7. Prelim, draina!!e plan,rev'lewed' bY
Final draina!!e plan approved bY
8. Construction approval:
Sub~rade approved by
Finish ~rade app roved bY
Draina~e approved by
Surfacin~ approved by
9. Final review for all conditions:
Conditions have been met on
bY
Comments
",
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..,
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.' " " ~
::t. \I) c..j-
'~ ~,
~ 0.. <b
~ ~ ,~
~ (),. '8
~ 't 0
\J) "" .
I
5'hla
:l..o..B..:,...__
ft/D..JI.! r;:' .c~f-_
'!:.
'.'
"\,.. "I
r4..' ,,"
::..
.
,
t'.
,I
9.-..:
{' :; ..;-;, '.
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1'-'4r '" .-
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. "....
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.
.
EVALUATION
Asr'co Dtsogrco MlHgoto
" I'.lml: ls I:hc 5 taepes t: sLopa 0", lha st L07 JdenHf'y tho opproxtlllot:o 0 0 0
percen t: of l:ho 5lopo: HIPr
3, ~'.ho 1:' general t)'PCS of saLLs arafoun~ on tho 9th (La. sond, 0 0 0
l:r.\vcL. pout. or lIIuclc)? If you know lho' cLosstftcuHon of oGr.t-
cuLtural soLLs. speclfy them untl no ~e uny Jwlmo furmland:
-S"'r-J.nj
4 , Are thero sllrfuco lndlcnHoml or u "l~l:ory of uns I:obl 0 salls In 0 0 0
t:he tlllrnedlot:o vlclnll:y? If so, descrlbe them: N (~
S, Ocscrlbe tho purpOse, tho type, and .upproxlmal:o qunnl:ltlcs of ony 0 0 0
rUllng :or ,;rndlng proposed. ~d(:mHfy tho, SOUI"CO of t:ho (lll:
c.. \U'>- D I t-H, ""To ""LLD~ r-Oe. (:..0e..~~
~N.~(~6- \
6 ~ Caul d. crO:Jl on occur" es n resllll: of clearlng, construcf:loll, 0 0 0
use? If '0, l;enerully ucscrlbe it:: N.I,
'. ,\bout: ",hutpcrccril: of I:ho slte would be covered wlth lmporvious
surf.u:es aFl'er consf:rucllOIl of the, project: (i. .0. n!lphalt: or
~ulldl"g.ll ~",Z-., toOK f?o.f-r
.f:,1I1 LJi)'N &
o
o
o
11. Doscrlbo proposed mansures to'reduce or control oroslon or othor
In,,ncts to tllO ourtl" Lf uny: ~~~~
A(1E,,\- 'A-ND L~P,"'b '
o
o
o
AIR
9. l~h,"lt l)P09 of emlssLons to tho ntr, If na,y, wouLd ronult: from tho
o
\P
\
o
prop0911l (L.o. dust, nulOlnohllo edoa"n, or lndustrLnl wood 5mol(0)
uurlng con91,'uatl,0I1 and ,~ho" tho proJoot: ls oompleted? CnnarnLly
dcruc:rlbo nud r,lvo npproKlmal'o quunt-L llOIl, Lf leno""", ~~r
_~~LU.ci..c. F"l2.... ~I~I J ('>1 Nb,
~O.t:i.eL~.CU:~..tL~D.l.lGZ.....l2uOe&...-l:tltlhW~ (,
10, ,\r" tllI:re IIn)' off-sUa &ourOQ!I or "ml!UJl.ons or odo~~ Lhal: mny 0
,,(foct )0'" P"OtlO!idl1 I r 90. gcnornllydo9crlbo lhOtn, _~
o
o
11. De'Sc,'l bl't profJu!lftd ",,,,,,,uros Lo rcuuen
conlroL omlll!lLons or
o
o
o
other It'')8cls lo lha at.., lr ully'
r-l/Pr
/
.
.
EVALUi\TJON
ACroQ DL5USI~DO MLHgnt:o
ENV I RON~ENT AL IlEAL TII
hool th hazards, lncLudlng exposure to 0
toxlc chcmlcuLs. rtsk of ftro and QxplosLot\, spLLt, or hazardous
o
o
'''(IS to. H1I1t: could occur
a r05uL t of thts propo~uL 1 If 50,
descrLbc tho Imzards: N {}
Describe spocLaL emergency scrvtcos that: mLghl:. be roqutrcd:
o
o
o
....In N IE
Oe5Cf~Lbo proposed meusuros to reduce or controL onvtronmcnl:ul
o
o
o
heuLth hazards. If ony:
NOise
l';hat: I:ypos.or noLso Qxtst: tn I:ho.oroo that: may affoct: your proJoct: 0
o
o
(Le. truffle. oqutpm.mt,und aparat,Lons)?
Nf1NF,
G
\'/h,,1: . typos and levels of t1oLso would be crollt:od by or oS9otcotod
I\l th tho project: ana short- torm Or n LOI\g-t:crm boslB (l. o. oon-
strucHon, trufrtc. and opornlLo~)l Indlonh ~hnt: hourei nalso
I\auld coma from tho tllle: J:le.dY~-~
C~t.'Tl!..uL5fl",..j' 1.0r.C'\1)I~l'IPVIN(, NAU+IN~
~ca-~~~.u.bl.l.-,lt, bUbIN~"'"
-\:Io.u.e...s.. . 'is'v''I-H - ~ (2 W--
39, COllcrllut,pr'ofJosed man sur all lo rodvoCl or cOlllr'ol,noloCl lmpnct.o, tr 0
o
o
o
o
o
nny:
"VI/...LI:;;-
LJ\NO /\NO SIIOR[!L I NE WI!
.0, l'itll\t l!l tho curr.,nt- UIIO or tlld III tn nll(~ ndJncent: pr:oporHnn? 0 0 0
--V~...q-.
~1. 11.,.1110 .l tc baen uaad ror n,;rlcuLturc? I r ao. dncr'lb. lha uaa I 0 0 0
!::IeO
.aJ. De,er-lb. "ny .t"och....,,, Oil tll" slln: -----DLo...hJ~ 0 0 0
.
,';tLL on)' 51'r~,chjrQs bo domoLished? I F so, what: structuros?
No
tho clII-ront: cOHlprchcl\l:lotvo pLan or . communlt:y devolopment:
the st l:e1 Identify tho pLan:
IN Do5"Tr?-.f 11'TL-
IfoppLlclIbLc. I~hat: is tho current: shoroltno nluster program
dllstgnal:lon of the sito? kJ/~
I
11.15 ,loy part of tho site beon cLasslfied 05 un "envlronmontally
scnslttvo" Lwea? If 50, spo:!clfy tho port: N IJ
@APpro"m."OLY how m.nypoopLo wouLd ros,do or worl. ,n tho
compLol"odprojucI:1. -, (_.
'\ppro>o;lmoltol')" how m.my people wouLd ,tho compLel:od proJact:
displace?
HOH e.-
Oescrlbe, proposcid 1IlIJusI.ires to avotd nr rDduc~ dlpplllcomonl:
tnlp.Jct:s. Lf any: HItor'.
/
DoscrtUa 'propo5lld mOLHU..rca to ensuro t,ho proposaL Ls c,ompul:lbLo
\~lth ,C>ril5Hng und proJoctad lund U!:105 nnd pLons. If anyl
<:..014 PU"N <<EO-' l-'" I-n+- i'-/liI-,'5llSe.. {lJ<t-N ~lJ frl-/
~e...t...~-n"lJN (,..)1.,."H- -me:... f}Y.rNNIH (,
~q:Hef'l,-r
II0U5ING
:il. ^prr()~lm"tuly hOl_ ninny "'I,ll'lI wouLd bo pro\lldod, If on'y? Inr.llcul:o 0
nho.1tllor thu hll\.Julng ls hlgh. mlddLo, or Low lncomo: "I/~
52. '\ppro"llft.lloly how nlllny \Iolla. If ony. wouLd ho oLlmLniltod? 0
Indlcal'Q \\hutlu'" tho hOut.l,,~ to hlUh, middlo. 0'. low lncomo?
HfA-
51. O"lIcl'lbo propdtlcnl nWiIUU,'ot, to rOthlr.a or control housLng lmpnct:a.
II ,,",yo _--L1jP-t
Al!STlll!T I en
S~. ,',h.lt tWo t!lv I..lt.,r.l hol~ht of ony prOI)ollad atructllro(a), oat:
lno:l~...HnR .."t"I\I'\,..l !'ih..l- l. tho prlncl"nl Gxhl"lo,. bull.cllnn
",..tll,.l~,l(.) pr'olHUOlI1 __,;l.J:l Fr.
, VJ..r.J,'iJ---
~c)ll~_t:ie.qJ9;,l.-....-
.
EVALUATION
AGroo Dlsagroo 1.1t Hgot:o
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0" 0 0
~ MtA~ ee.:rol~.
o
o
o
o
o
o
o
o
o
o
.
.
EVALUATION
Agreo Dlsugroo M1.tlgato
HISTORIC AND CLl.TWAL pp.eSEr,VATrDN
6.J. Are thero any placos or objects Llsl:cd on or proposed for mlHonoi., 0
state, or Local proscrvotlon roglstcrs I<nown to be on or nexe to
tho 51. to? If 50, genorally doscrlbo i.'hom: N In..
t
o
o
GeneraLly duscrlbo ony landlllDrks. or ovldcnco .of hlst:orlc. culturnl, 0
Or 5clontlflc Lmportanco I<nown to be O"lor naxt to
NIp,.
I
o
o
6li . Describo proposodmcosurcs to reduce or control lmpacts. 1. f ony:
N Iq
I
o
o
o
TRANSPORT A T ION
Idonttfy pllbLLc streets ond hlghwoys sorvtng thcslto and dcscrLbo 0
the proposod acceSs to tho cxlsHngsh'ooc system. Show on tho
o
o
sUcplan: '5~';""1 ~
-.J-
*' lA:> -I d-PJ
68. Is Lho 5th currontly sorvad by. pLlhLlc tronsLt:1 If no, what 1.s tho 0
.'ppro),;lmal'odl5l'nnco 1:0 lho naarosl: transLt 5topl 41FE..-5
I bey- 'f;>'S
o
o
H~\~ tllilny 'IoIrl,tng spacoa wouLd tho complotod project ho"01 lIow many 0 0
,..ouLd thollrojoct ellmtnllto1 ff_c?CSf!:. I 0 fA~1 ~ JQ ~~t:::S
-:;5 PA<-. E:.- S
o
~e:PrN3U:;
70. ltlLl th... flrllpo:Hll.roquLro llny now rouda or !itr'ool'D, or l",-lrO"011l0n1:6 0
too-.;lsHnn ro"ds or stroots. not lnoludLng drLvowoY51 r r 60.
gonoraLly deucrlho them, LndLcal;lng l\hoUler they IIro puhllc or
o
o
prLvlltol
~o
71, l-:tll tho projoot UISO ,,,at'or. ruLL. 00- ",r tronlSporl'utlon. Or oocur 0 0 0
In IholllWflodtOlh vlolnll:y of th050 fnoLLlHonl If .0, gonoraLly
d,Jacrlbo tho In.1) I /'J.O
73. Ikllw """my ....ohlc"lar trlp" pcr day \would bo gonora loci by tho COnl- 0 0 0
plotod pro Joct? 11' I,nolm, lndlcolll'a "rUin pOlloi, VOhlfnotl woul.d occur I
,~~~ - $hH ~~eN
G. O.ncrLhll prOf)Olliod motlsurnlS to reduco or control l'rnnsflortnllon
,",'.0", " ""y' /'I,l:).NI!E-
[100
A~~~ ~l".'''\(-rs F'~
fvJC> '
+
~
<l
ill
':>
.u
13
'2
::)
< q::}
0, '"
Cl u'l
N 93
. vi
~, -.
~.
~~~
r ...
/
SETON RD. t
~ J I
\
8.
t I
()Pe.y
5'1/0;0 .;
o;irol<?4cx:.
J'
~ GRtI<A: c.. J(
J4 ~
-_. .r.J...... ....' ,..:
"Z~..z.ll'
Nea.o"Z.'/O"W
fmJ@f1JJfi'iJOflJlfJfffJW
, f' oudltcr'. f8e
certl Icate: nl.mber
ec:ordthll_day of .198....:.~ at
m. In book_of .urvey. at palle
qu..t 01 AL.AN S CARMAN.
30.001 .-......-
;?a'\)'
t
I
N C,
~ ~I
~~
~
I
I
~
"
I
""
o
,
\
~
~y'or's certificate:
,this map correctly repre..nts a survey mad
under my direction In conformance with ti
o1.the URVEY RECOROlNG ACT at the rc
'Su~ '" o~13
j;'';--' R. .190.!L-.
"':
5 i~ 8
iltiITo 12
, ' ,
,. -r,
. , ,
-@
. T.
, , , , 11
;""-1- -~
++++ 10
9
8
$Ii 7
o
12
11 'M
....-r-~-
.
.
EVALUATlo.'l
Auree otsagrce Mi.tLgol:o
Ef'oV J R0~~ENT AL HEAL TII
3"'. Are there any cnvtronmcntaL health hazards; LnclL..Jtng DXposure 1:0 0
to",tc chemicals, ,..Lsk of flro and cxploslon. spt.Lt. or htt.....rdou$
o
0"
~d5I:e. that could occur as : IDrosu~t of th,s proposoL 1
descrtbe the ha:.eords; N.
If 50,
3S;
Oescrtbo spoc~'lL ~m:::onoy sorvtcos that ;,,'ght be requ,red:
l' l\\ I r-;
o
o
o
36,
Descri.bc proposed mCBsure5 to rCDdUCOjJJicontroL envtronmentaL
health hazards. tf any: ~_ _ts:
o
o
o
NOISE
exist
tn the ore a that m;:x..af~,YOUr project
and op,e,..a~i.ons)? l f)d; ,L. I (0\:()
/'L
o
o
o
\":h31: types and Levels of nolso would be created by or assoleated
",i.th'the project on B,short-term or a Long-tc....m basts (t.o. con-
strucHon. trafftc. and operoHon)? Indlcatc whal: hours noLso
.0uLd oom. from the .tt.: g'''- SF"" (p1lA-t{ <; AuJ(;'(K
o
o
o
39. CC5crt.be proposed measures to reduCe 01"' control nollia tmpacts, i.f
any: D\~ If\; -
o 0 0
NC;l(t,C Pbf-'\ Tt1e' ~q
f^pf-( /Jor O~ ~AGIE
,?Oo..b L-IM rr:
LAND M'O SIlOREL I NE lJ5E
o
o
o
.0,
, for IIgrlcul h...el If' "0, deGer-Lbo the utUl1 0
." u.,. the .t to ber" used 0 0
~ lCJ
.tJ. OOGer-Lbe An)' .truch....Cs on the nUO I 0 0 0
~ ()\Jc-
.
~1~ \',tll ."\n}' '!Otruch"..c~ bo domuLl~hcd1 I f so. "hat utructurcs?
t--(D
~.,
:'.hat La tho current comprch",u.tvo pLun or community dovolopment
pLan dcsi..gnaHon Qf I:he 'slto1 IclonHfy tho plan: ~..f CX:,.
~~y (7rM) -:COO'> '(1e.)v1-L
If appltcriblo.
.&s:
~hat i.s tho cur,.cn.t ,!ih~\eLj;Pc master program
doslgnaH.onof the, si.tc1' \\JDtJ6. PfJ~
H~s any part of tho s,to boon cLassLflod 'as an :erv,ronmonhLly
sensi..ti.ve" oreo? If 50. spoclf)' tho part:: . ~ ()
.6,
.7,
Approxi.mateLy how'many people would reslde Dr work tn the
completed project?
"/__ M.J~ 1L
46. Appro.l<l;i.rno:ttcLy how many people ,~ould the completed project
di.sptace? ~
..s9. OoscrLbe proposod mansur-os to avoi..d or reduce displacement
~mpdctS. tiony:
()J B-. .
.
EVN.UA TI ON
ACroe Di.~.lsroc Ml Hgate
0 0 0
0 0 0
q 0 0
/
0, 0 0
0 0 0
0 0 0
0 0 0
o
so, Doser:\. be proposed measures to ensure tho proposa l Ls compaHblc 0 0
~"tth extsttng and projected Lund uses ond plDns~ if any:
l ^
.)~'k-
HOUSING
Sl, '\ppro,)(tma teL y how many untts would bo provtded~ Lf nny? Indi.cote 0 0
~~he ther the housi.ng ,s htgh, mlddlc, or Low t.ncome:
52. Approxtmatoly how mllny unlts, tf any, would bo oLtmtnalcd?
Indtca.te ~~hether
mtddle, or Low lncomol
53. Ocscrtbe proposed mrAtlourou to raduco 0,. controL houstng tmpacts,
It' Rny:
-OJi1t
"
AE5TIlET I CS
s..a, \',hat t.. the b.,\.la~t ht!lr.hl or ",ny P,.opO&Cld olruch,,.o(a), not
t nclud~nr. ..nt ClIln.n,? ~~h,'\l' l ~ tllO p,., nCllJnL oxlcrLor llul ldlnl;
....1..t.II.J prop....!1 '"2- -::J-' C, II
J.L6Ifib - C{)g ~.Min-=:.CfX.-~-ur.
o
o
o
o
o
o
o
o
o
o
JEFFERSON COUNTY
DEPARTMENI OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
1. Project Name ~; %)/ :7::J/d-l.c'..(./!/, .J].r."
2. Project Proponent Rep. &/t'''?':d'!@dt!&Cc'../
Address tf1?c;, ,&y _?.t:Z4t' ~A'htii
Phone No. , ,j',f's:- 4/.00
3. Date received
...s-:"'/G -,r-j/
Date Response Due 6-7-6/
by
by
bY
bY
bY
bY
by
bY
bY
bY
bY
4. Preliminary review completed
5. Conditions of Approval sent
6. Preliminary desi~n reviewed
Final desi!!n approved
, 7. Prelim,'draina~e pla'....'rev:!ew'ed"
Final draina~e plan approved
~. Construction approval,
Sub~rade approved
Finish ~rade approved
Draina~e approved
Surfacin!! approved
9. Final review for all conditions:
Conditions have been met on
Comments
.
'.
Minutes, Week of August 6, 1984
Page 5:
Public Works re:
Problems on Elkins Road at jail site: Two problems
on Elk!,ns Road were outlined by Br1an Shelton: 1)
A water line installation at the jail site has' torn
up an existing oiled road and 2) The access points
from the parking lot to the jail site need to be im-
proved, Paving of the Elkins Road is not in the
scope of work for the jail's paving contract.
Chairman Brown advised that when the paving contractor
is at I:he site ':he road should be paved as well os
the jail parking lot. Brian Shelton 101111 contact
David Johnston, Architect and Ralph Hall, Project
Manager, to discuss these problems,
State Liquor Control Board re; Two applications for special
occasion licenses: Pope ~ralbot's two app11cat10nsror spec1al occasion
ri"censes were approved on the motion of Commissioner Pitts, seconded
Chairman Brown,
The meeting was recessed on Monday evening and reconvened
Commissioner Pitts and the Chairman in attendance on Tuesday morning,
. 'BID OPENING. re: For pre-engtreered and prefabricated canopy
and reinfo1:'ced concrete s l,ib-'---tFlC"'fo oW1ng nIds were opened at: tne
aPP01nted t1me tor the cancipy and reinforced concrete slab 1:0 be located
at. the Jefferson County Sanital'Y Landfill:
Optional Total
Canopy/Slab Approach Slab incl. Tax
Amdall Construction, ~a2 . 027,00 $ 3,718,00 $16,973,11
Port Ludlow
Nordland Construction 23,165.14
Engineer~sEstimate 7,000,00 4,000,00 11,858,00
Commissioner Pitts moved to accept the bids and have the engl.neer check
them for possible errors and muke u recommendation, Commissioner Brown
seconded the motion,
Fred Hl.ll re: Proposed Threshold Determination for Gravel Pit
'project' onfHighway 20: RilcherNuthunson, Assistant Planner, revi.ewec\ the
Envrronmental Cll'CCKITSt Addendum for this proposed gravel productl.on pro-
ject to be located on Hlway 20 n"ar the Airport Cutoff Road,.for the
BOllrd and seven area resIdents, Only the items that we>:e changed on the
checklist were reviewed, In additlon to these comments Ruchel noted
the following:
Air: If complalnts w"re recelvcct from'sur>:oundIng property owners
about (illllng dust, the Olympic Air Pollution Control Agency
would monitor. the sl.tuiltloll and If ';he Sr.ate stllndu,."ds ftre not
being met the project could be fIned or possibly shur. down,
l~ater: The State Depo).tmen!; of ,"co logy would be responsIble for. complainl
made abollt posslhle r:l1l11l'orlng wi.th wl,r.er 1."I~hts and could requI,."o
that iI hydrologl':"1 ',;J:lIdy he don".
The suggested mlti.gotlve Ole"SU"(';; wc,,'{J J"evl.ewed und 11 lctl:c,." fr.om ~:r.s,
Jallet A. Daley, OJ y,npic C;"I'I.'n:'IlIW;U, \~"S r"lld into the reeOl"d,
Chnlrman Brown i1~il(cd thnsl" pn!SL'tl! for' COIIIIlH.Hl':S nnd/or qucsr:lons:
Mr, Daley, ownl,')' of Olympic' (;"I:l!III""'"l', lo..:ated IIcross 1:l1u st,"eel: fr.om
the project slr.u stotod LlI",. Ill: .""tld I J VI! wll:h the mlnlll)', operation
th"r. is prer"nlly condllC',,'.! III .:!II" sJ,.e, bul: I'"ols r.he fH'opo,;ed pr.o.!",,!;
Is lo direct vlollltLon elf i'hl,' .rl'II't..'I'~;UIl Count:y Compr(~hc'Hllvc Pl.nll, lie
listed concern" "hollt: I, \1,","-' /1 "1',.,,1'1'1,:, :II l'..:<.momlc "rrocl; 011 ad 101,11-
lug businesses dnel It) f)J'lll't,,'f.y V Illb'!;, lIu t10(Hi not. S('c rh,," I:~f.s pro:jocr:
ciln he consilk.rL.d unvll"lJlllltvlllillly I1IH)-~;lgnl,rLc'-lnt l.llltl.l ~,I'L1di,\1:-; iJ'~(~ do no
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JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PRELII1INARY PROJECT' REVIEW
1. Project name
'.::?~ '-d./ ~
>>d,!.,.j/~ ,Jjw..
Rep. /fflc.Lu.af d/d/tUV
2. Project proponent
3. Response due
6-7-.f'.y
4. Preliminary review:
-eoll~: :5 e. 2 C>
-Rd-No-o-
at M.P.
~ access ( l is ~ood. ( ) needs chan~in!!.
Existin~ traffic count is
~ On site improvements need to be submitted for review and approval.
C<5 A draina!!e plan needs to submitted for review and approval.
( , ,Off site improvements to county roads will be required.
(
(
(
Projected traffic for project
needs approval
7
Additional Ri!!ht of Way wil I need to be dedicated;
5. Comments: &"';G-=/UJ<9-0 7'J ,eo aT pAZ6sbJr U!cAr"o,.,; 0,<.- U/1J:) -
.54o?iI.J ;g~ R~ ~OcArcz..,iJ = #0 -1!.r" /r- ;>"" 5 S /6Jt:e M4J'
;11/ Vi! ~/~rlr 7)/9:r/9,VCe. 7J/~ i'3 ~ms- ~
Prepared t;,/'2-2-
by f#-- '
title tl\>
19 d1:.
Approved
19
bY
t1 tie
)(1~ ?6 8C-c..
q. oJ-/ -
~~
~7
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.
ovrnALl PLAN (do-:.r:rlb,. tiny rd.ln~ ror tufurl' wJdlll"n". n)((1iJn',lnn'i. or rr'lnlul! ;,,'llvll II.,!., fir ,:1.111" Ioy 1I11,'.r',
Ih.,l ma\'nffpcl tho p,.Clpnr,nl):
ENVIRONMENTAL IMPACTS
vr'i ,1.WIII 11'1
EAf<TH
WI'I till! prornc;n' f"(".ult.ln:
I, UnstablA on;1hcnndltlons 01" ch~mJI'!;; in tho 'l"'~ln.,lcal subr,trur:tllrr'i?
2. Disruption'" dl!"oplacf\mr'nls,.cr.ompodlC'ln, or n\t,'rruvorlng of 1h~ ~o111
3. A ChiHIIJ(Jln lop",o;raphy or yround rel10f fa1l1ut"t'~1
4. The dustructlon, covedn!'). ormodlflcatlnn of tiny unlquo gnolo!JICllI or phy~lcal lentur,':>?
~. Wind CJr wl.ltEfr nro~lon nf $1")11.., either on or (Iff thn site?
11(1posltl('ln or nrO".Ic,n n' t,(lnch sllnd..,or eh"'''I'':,., In ..II t&tloo, d'lposlllnn, nr orn,.lnn
whlch.mnyn1odl'y tho channel of b rlvor or s1rf".,rn or 1he.bfld.of 1h~ uco;m (Ir .1IIV l'oV,
I,nl!t1 ,or ll3kul
CXPtANA.TION: TTpnnl"'nmpl p-r.i nn n'f" ,...pmnv~l_aL.-T.np' ~::I,.,n~'nrl g,...~v~l ""~('O'aimati.an.:o..:r
the property will commence in accor~ance with the D.N,R. p~rmit ~egulatians
resulting in a change in the topog~hY. and possibly geological s1!illl:tr_ug1.ures~
n If:it 11
11 xx n
~ n C1
n n x~
n xx n
11 n XIll
MITIGATIVE MeASURECSI: A'n'Y P-T"o!=:i On wi 11 hp ,...p.-r.~inprl in w~::d:p""" npT.pn+.i nn pnn,;~ On-
thp. prop"rty
C.OUNTY (l'H.lE'NT('j):
AIR
1he,propno;nl rotoult tns
AIr f!ftllulon~,uf'" d,..trl"lol"ntllltl u' ..''',blonl .,Ir flUtlllty1
Thn crfl"t Inn of nbJnr.lln"~I.I,, n,I""".l
fl, TI,ft "ltllrn'Ino of I'll.. IIIOV"_",,,II, "I''''.turn, or l''l''llpr...,furo'. or nn)' chnn'll.. In cl "r~ll",
elfhol" IUC'lll'y or "",,lou,III.,1
n
l'
rI
n X~
11 xlC
11 XXl
l'<'.lAtlATIOU:
..I...
~
.
.
MlllC.f,lIV[ M[A;,UHr<~):
CXlUflTY COI<^EflTCSI,
WATER
wn I tho proposal rosult In:
10'. Chongos In the currents, or the cour!;o of or dlrtietlon of wator movemt:nts. In elthar
mor.l no or Hesh wtlters7
Changes I n tho obsorpt Ion rl:ltes, dra I nogo pott orr.s. or tha rote and bmount of surf ace
wat or,' run-of f?
AlteratIons In the course or f low of flood waters?
A change tn'the omount of surface water 1n any wllter body?
A d I schargo Into sur(oce wat ors, or I n any a I tarot Ion of surf ace water qua II ty. I ne I ud-
log tJut,not limited to tooperoturo. di!.sol...~d o:o\ygp.n. or 1urbldlty?
15. A change In the quantIty of ground waters, either through d1rect oddl11ons or wl1h-
drowals, ~r,throu9h InterceptIon of an aquifer by cuts or excavations?
16. "A det~r'oratlon In ground woter qualIty, either through dIrect Injection or'through
:the seepoge of leachates, phosrJ'atcs, detergents, waterborne v I rus or bacterta. or
-;other substances Into the ground wa1ers?
17. "A rcduct ton' of the lln.ount 'of water otherwise ova II all I e for pub lIe water suppll es?
yr~ ~\A"a,[ fl'-,
0 0 XX
JCJt 0 0
0 0 J8C
0 0 XX
0 0 XX
0 XI!( 0
0 0 X]{
0 0 Xk
EXPLANATION: The property will be cleared as the
absorptio~rates will change on the property,
perty and the water permit has been approved,
minin~ occurr~ ~o- +'h~~ +'he
There is a well on the uro
MITIGATIVE MEASUREISI: Any sur.face water will be retained in detention ponj~and
'the gravel was\water will be recycled
COUNTY ca"ENTISI:
FLOR^
WII' thn proposel result In;
,e. A change In HIe dl.,.."sltv o( $poclcs or "u""b(lr~ cd tln'( r;f'lt.tcle!\. of f lor", Ineludlng
1rt'lol. shrubS, 9ras~. crops; mlero,lorill, nnd aquotlc pll'lnl~?
1<'. "roductlnn of lho numborto 0' ftny unique, rllra, or (!nd/lngoro.:! !.f'lerclo'S of flore7
XX
o 0
o
o i\c
.
.
20. ,An InlmlJur:tlon of n01lo' ~pftc:16S 0' flc'll"''' Into en Or-Oll, or In" barrier to tho flormoJ
"rOll'''~I'5ti'ri''".1' n(ft.'sf Inn ,!:opIJC l~co1 ,
21. /~ reduct'ifl~ I;;'ocre.;qo'ol'any. ogrlculfuie' r:rop7
''!'h" prop"rtyh"'" be"n'loe:(l:ed and as the e:ravel is
w; 11 'be' r-e'claimed and. replanted wi th na ti ve' tree s
MIT,!O,",lIH Mf^.~l!R-((~f:
CO!JNTX, CCffiWHS'I,:,
FAUNA
Will 1hf:r propo:.s,:,l:rp.5ult lr'l:
n~ r..hIln~OS .'n .He d1~"r9Iiy nfsreclos ("Ii numhor::.of any species of IleuM (hlrds; lend
anlmal50, 'ndudl"!') raptllns; flf,h "n(j ShAIlflsh; t,t>lIthlcorl)onlstIlSi In,ocho or
mlcrllfl'lun.,)7
2.3. ^ rl)dudlon of 1hpnlllftlJUr~.. of onv un'I'll.tp,.ril!lrtJ, nr' AndDnge'rod SPAC'09 of hun.17
24. An Intrnf1u(tl"'1 (If nnw f'.p~('lf1s. of '"uM In10 all o"o",'or rMoult In a border fo tho
rnllJrtlflolJ or ;lIov'oMnnf of filUI'lft1
Yr~ MAmr NO
0 " n ., ZlX
0 n XIX:
removedJ.!lll
n
l5X
n
n
n
n
[J
lOX
/SX
/5X
". AtttrforIMIltlC\r,-ul.,,'dr.11ng fts'" or wllrtllh habl1ot1
txrIA~ATIOII: There will bea change in the habitat 01' the wildli1'e until,the
replantin~ ,i s 1'ini shed.
~ITIOATlvt ~rASunrl~11 _
("OINT'( (O.f.4lflT(:'b
n
n
.
.
TRANSPORTATION
Will tho propo5l11 r05ult In:
~4. A gl1noratlon.of ,u.ldltlonol vohlculnr movemont?
35. Effect:> on flxls11na porklnq fl.lcll111osor a dn'l1Ond for new pl'lrklny1
36. An Impocton exlr.1Ing'.tron!"iror"f15tlon syr.1t3ms7
:n. Altortltlons 10 pre~ont ptlt10rns of c:lrclJletlt')n or movoment 0' pnof:le nnel !100rl57
3e. Altoro'llnn'i to ,",ohrborno, rell, ur olr1rolflc;7
39. An IncrfJase In troff Ie hllzOrds to mut'or vehicle::;, bIcyclists, or pndClstrlllnsl
EXPLANATION, The proposed project will relocate the tra$,[ic
generated at our plant in Hadlock
~
~
n
rJ
~
currently
YES /fArm rm
XIK
n
lGX
x!x
II
n
o
l\X
n
n
XI<
If,-l<
t<lTlGATlV, MCASURf:(SI: The Department of Highways has been informed ....QL.gJl-Lin:t.ention
OOUf/TY C(M'ENTlSI:
PUBL I C SERV ICES
Will tho propos/! I htlve on tI' feet ullon or' re!>u I t r n a Ilued for nAW or e I terod !Jovornment ill scrv I Ci"S In eny of
1ho'followln!l are.!!s:
40. f! ro prated lonl n n :\(~
41, rolleo protocf lon7 [1 n lFJC
42, ~chopl!o7 0 n XX
43, ('ark, or other rer;rf,u,t Ion" I fecl/lilos? n n ltK
44, Mftlntnnllnce ot public fl\cllTtlf'os, Including ronds? n n Iflt
45. O1hcr (ldp.nt1'V sorvleol: n 0 XX
CXPLAN^TIOtl:
MITIG^TIVC MC^SUNClSl,
r.()..mTY COf~rm C S) :
.
.
~[~ MAH;[ riD
ENEI"3Y
WI" He propo!.~J rf:lsul1 In:
46. lhe use of suLs1entlbl i)'IIDUn1~ tJf fuul or enorgy? 0
47. A dUTIlSnd upon ox1stlng source!> of energy, or roqulre tho devolopmont of now S(.IUl"'cas of 0
Otlurgy 1
D
D
IIlX
sex
EXPLANATION: PUEP.t:: ~nnnn 'Pnwpr k Li en+. ;!=:: ~w~,...~ nT' n",... rower nl';;'edh an.c:J--:-
ha~ run ~ervicp. ~n ~hp. propert.y
'''ITIGATIVE MEASURE(S):
CQJNTY ca....ENT (S) :
UTI L1TI ES
Will tho propose I result In" need for the devolopment, olterotlon, or addition of llny of the following
utilities:
48. power or nature I gels?
49. CcmnunlcDtlon7
50. Witter?
51. SOlllor or soptlc tenk?
52. Storm weter dralnago?
'3. Solid WDsto dlsposel?
EXPLANATION:
D D XX
D D XX
D D ~
D D Ylf
D D XX
D D YSC '
MITIGATIVE MEASUREfSI,
CXlUllTY rol<EIITl S I :
Phone No.
JEFFERSON COUNTY
DEPARTMENT OF PUBLIC WORKS
PROJECT REVIEW CHECKLIST
7Yu_.,c. ~L& /'lu;tC/c./dv
Rep. t(?.../dA/( ;J)ULtJV
fllJ,/;.,yfn Ikl!.d~<J'tJ.1t) ;G:':;, ..&;,t'..'3;:<.t/ >l/t!dk.i.aJ,u
< o'ZOc,) 3J' .s _ sf; () 0
Y~Yr~
"I
1. Project Name
2. Project Proponent
Address
3. Date received
<i?!!.!z...l 71'1- '](" 9'.2
~,/""7q- (/.<13/
,r//CJ/fl Date Response Due
4. Preliminary review completed by
5. Conditions of Approval sent by
6. Prellminary desil!n reviewed by
Final desil!n approved bY
7. Pr'el im, drainal!e p I an ,rev'iew'ed ' by
Final draina~e plan approved by
8. Construction approval:
Sub~rade approved bY
Finish ~rade approved bY
Draina~e approved by
Surfacin~ approved by
9. Final review for a II conditions:
Condi tions have been met on bY
Comments
, "
,,'
.
.
ovrnAlL PLAN Cdn~r.rltm ""Y f11;w~ for tutu.." illldlllflnr, mlpi.n!.tnn'i, tlr rr..lnlllll ,v'flvlllt,!., "1" 1.1.11'" I.y 1111.,,1"",
t1"'~ :0\ .'fL:":""".I;., --~!:::.:-T~~-~~~E!-.-~
~ _170--' ~_~~d.,<-c>.!_~~U~~,::!'...7~-r~~
5' tv'...~ . r ______.______._________.......____. ....... ....
o /../. C. 0~~" tJ.-./'-~~
ENVIRONMENTAL IMPACTS
EARTH
~.
ihP p':orln..:'I'''(~;'lIlt In:
UAs1ebl~nilf1hcnndI1Ions or ('h~n~Ji;s in ii'A !l1"''';lnl'}lccll sub!>tructurC'..?
015rup110m., dlFordllcNTll?n1s. cr.ompoctlC\n. or f.lvr'r'C"ovnrlrlguf the $0111
A chi'lf,~lt In 1C'1p",~"arhy or ground relief fEu,.turl~!:>?
The dvslruc1lon~.eoYerrn!l. or moll 1 (Icctlnn of tiny unlqllo gnolo!JlcQI or physic."
Wind (Jr watarnro!>lon nf 50110;, al1her on'or off 1ho site?
fellturl'~? fl
n
Yr 'i ~1""Y111 11'1
., n
0Y
Xl'C
:If" 11
JCX n
n eJ'
11 XX
XX n
n X~
6. PI"posltlnn nr oro".leln nf t,('neh slInds, or ch.,rlll'.... In ..II t..,tltm, dnJJoslllnn, nr nrn'.lnn 11
whIch m1ty molllfy1hnch"nncl of a rlvor or sir..../'n or 1he.bAd of ihe uco,ln (If" ony t.ny.
,Inl~~, ..,or .Ieke?'
r~rt~N~T.,!OI'l:;!T!,nn f":nmp' P+:; on nf' y"pmnvR'_aLt:hta' ~Rnrl Rnn gY"Rv~l Y"Pt""l R;Tr).ati.DJ1..;o.f
the property will' commence in, accor.liance wi ththe D.N. R. permi'l:
resulting in a change in the topography and possiblygeol'ogical
MI~IGATI~~':trASUnF.(S): Any PT"o-':::; On' wi 1 1 -hp- .,..P+'R; npn ; n WR+'P.,.. np'+,pnt:i nn I'nnn~- 'on.;.
_.' r)
(:CONTY a>-f.4ENTI~I, ..JJ~Chanqe to "yes" with an exp lanation that reads, "The extraction
of materials wli I create disruption, displacement, and possible compaction to the soils,"
AiR
Will 1he ~ropnr:t11 re'5ult In:
1. -Air ~Iult)n\ (Jr d""...rlorntl,," III ,""'blnnt ...Ir fllmlltv1
l!. Tho crf'I'l1lnn 01 obJnr.llnlllll,I,/ n.,....,.!'.?
(I. 'II,. "li'lrntlnn of nlr ""'Yl(",'nt, rr,-,I",turn, nr l,omr"r.,turn, or nny c1ll'1n!l'" III c.lltr..dp,
8tHlor locellv or r...,lo""IIy1 '
l-':PlANI\T 10th
"
o
n XIO
11 xlC
11 XIO
n
.
..
'r~ MA'I!l[ "0
ENERGY
Will 'tlla propo!.", rttsul1 In:
46. lhe use of suLs10nthd ~lIoun1s tlf f!Jut or energy?
47. ^ dU'Tlond upor, 8..r51 109 sources of energy. or requIre the dellulopmont of new ~'HJ"'ces pf
energy?
.Q.
CO"
o
o
:\lX
sex
f.)(PlAHATION: Puge1:: !=:.nnnn PowAr ~ T,; gh+ ; Cl ~w~'t"'~ nf' nl1"" rn~~~d~ and--
b:=t~ rnn Rervice -to 'the property
M ITlGATIVEMEASURECS):
,---, .
COJNTY CO-t>lENTCSb ITEM 47: Chanqe to "ves" with an explanation that,reads, "The majority
'o'f facilities on the site shall operate 'by electricity."
UT I UTI ES
~~:;l~~:S~ropoS"1 result In II need for tho development. ,,110"'''1100. or 8ddltlon of llny of the following
48. Power or nntural gll$?
49. 'CoMluntclltlon?
'0. 'W"t~r1
51. Sewer or septIc tonk?
52. Storm ....,fer drlllno907
53. Solld,,"sto dlsp051111
0 0 XX
& 0 lCC
0 0 ,~
@ 0 Jt3C
0 (g lCC
.0 .0 "~.
EXPlAlIAT ION:
MITIGATIVE MEASURECS):
COlIIITY CO-l-4ENl'ISI: ITEMS 49 AND 51: Chanqo to "yes" with an explanation that roads,
~..aJ"Dhon" and on-site sewaqe disposal wi II be roqulred for Installation." ITEM 52:
Channe to "mavbo" with an oxplunatlon that roads, "On-slto dral nago may bo nocessary."