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HomeMy WebLinkAboutBLD2002-00542 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD02-00542 SITE ADDRESS: 1253 GRIFFITHS POINT RD Issue Date: 10/16/2002 NORDLAND, 98358 Final Date: 5/30/2012 APPLICANT: ANDREA ROSE TRUSTEE PHONE: 619-417-8811 ANDREA ROSE TRUST 4346 HILL STREET SAN DIEGO CA 92107-4117 SUBDIVISION: Block: Lot: TX 52 PARCEL NUMBER: 021321028 Section: 32 Township: 30 N Range: 01 E PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE- (REVISION 8/12/09) WAS MLA02-492 SEE BLD02-543- SHOP MOVED TO HOUSE LOCATION TO BECOME SFR REVISION 2/12/12 -ADD MUDROOM & COVERED ENTRY THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes { no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON5/30/2012 I:\F_BLD_Occupancy.rpt 10/29/19 •)e, V / 1 • MLA09-00270 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00542 Received Date: 9/16/2002 SITE ADDRESS: 1253 GRIFFITHS POINT RD NORDLAND, 98358 OWNER: ANDREA ROSE TRUSItt PHONE: 619-417-8811 4346 HILL STREET SAN DIEGO CA 92107 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021321028 Section: 32 Township: 30 N Range: 01 E CONTRACTOR: SEAHOME SERVICES, INC PHONE: (360)765-3749 7425 THORNDYKE RD QUILCENE WA 98376 Contractor's License SEAHOSI077KS Expires 11/30/2009 REPRESENTATIVE: GREG BARRON PHONE: 360-765-3749 7425 THORNDYKE RD 360-765-4551 QUILCENE WA 98376 PROJECT DESCRIPTIOI SINGLE FAMILY RESIDENCE- (REVISION 8/12/09) WAS MLA02-492 SEE BLD02-543-SHOP MOVED TO HOUSE LOCATION TO BECOME SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 96,679.00 MAIN: 816 CODE EDITION: 1997 ADD'L: 337 HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: 410 SETBACK: 73 BANK HEIGHT: 30 SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 1 Prop: 0 Total: 1 Total: - 1-- Ro Date: ---I3 CQ Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,038.55 MAM 09/16/02 49645 Plan Check $675.06 MAM 09/16/02 49645 State Building Code $4.50 MAM 09/16/02 49645 Potable Water Application $50.00 MAM 09/16/02 49645 Renewal $153.00 AMS 09/17/07 93303 Renewal $157.00 LYK 09/09/08 102590 Permit $213 00 LYK 08/12/09 110722 Plan Check $632.29 LYK 08/12/09 110722 Total: $2,923.40 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD02-00542 Received Date: 9/16/2002 SITE ADDRESS: 1253 GRIFFITHS POINT RD Issue Date 10/16/2002 NORDLAND, 98358 Expiration Date 10/16/2003 OWNER: ANDREA ROSE TRUSTEE PHONE: 619-417-8811 4346 HILL STREET SAN DIEGO CA 92107 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021321028 Section: 32 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE- (REVISION 8/12/09) WAS MLA02-492 SEE BLD02-543- SHOP MOVED TO HOUSE LOCATION TO BECOME SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 816 VALUATION 96,679.00 ADD'L: 337 HEAT TYPE: EEE CODE EDITION: 1997 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: 410 SETBACK: 73 BANK HEIGHT: 30 SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,038.55 MAM 09/16/02 49645 Exist: Exist: Plan Check $675.06 MAM 09/16/02 49645 Prop: 1 Prop: 1 State Building Code $4.50 MAM 09/16/02 49645 Total: 1 Total: 1 Potable Water Application $50.00 MAM 09/16/02 49645 Renewal $153.00 AMS 09/17/07 93303 Renewal $157.00 LYK 09/09/08 102590 Plan Check $632.29 LYK 08/27/09 110840 Permit $212.00 LYK 08/27/09 110840 Total: $2,922.40 Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3 pm the day before inspection is needed. Monday Inspections must be received by 3 pm on Thursday before inspection is needed. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY 0111 ��.�,SON 0 Jefferson County ;lartment of Community Development x� °�� 6213heridan Strut,Port Town WA 88368[360)318-4450 ,.. ,., .., ,, Permict lel `iri - - - t- fi sxrzN�`�° App10-� co Pt' SAP 1s 20027E) Project Description: 4 H o/u E I Bt3ilding Type: Project Type: 6 F r e Type: ^ gif Single Family New Wood O Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular 0 Alteration/Remodel 0 Concrete 0 Commercial 0 Repair 0 Masonry 0 Multi-family/#of Units 0 Demolition 0 Other: ❑ Industrial ❑ Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer 0 Community System NI/Electricity ❑ Oil Proposed: )-. Proposed: .1^ WIndividual System Total: __ 'Total; �,, ❑ Woodstove C�Propane If not sewer,fill out the following: 0 Heat Pump ❑ Conventional G "Alternative 0 Other Permit# SEP O) — 000 75 W5ter Supply:l'i /] Private well ❑ Two Party Well 0 Public:Name of water system: . JtSuSl- Square Footage: agii For Office Use Only Lz; Main Floor (-4-4113 Consistency Review 47.00 Ai 2"o Floor .. (r 1' 40 2711.1{C/ Base fee (O38.S 13 `'' 3rd Floor " ` Plan Check fee—G :C 3Z= i. �S-0 (c Htd Basement State Surcharge fee C{ e St) Unhtd Basement Subtotal (7(r,5• ( Garage/Carport t jot. Pot Water Review fee gl -00 44ess PO ge g ''1 - - ' 4 SC Al- 911/Rd Approach fee95 Commercial TOTAL Industrial / i` ► Receipt# �4 q� . ,i:L.c...":".' Other Cash/Check# 1 O l o i Total Valuation: 4-1-4 9(t) ' Initials Pri.� Or Date Rl( f:,/DZ-� Estimated Cost: ":,t,n n^.� ( �-(1-1 If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark 7.3 ft. Bank Height 3o ft. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the ap ' nt's proper or struc re shall be requested and shall occur during regular business hours. Signature: Date: �J - /3- 0 Y H:HOME\P NTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01 ip APPLICATION FOR PERMIT* Jefferson County Department of Community Development l 621 Sheridan StreetfEj-.6 ti Port Townsend,WA 98368Affik„ " ; (360) 379-4450 or 1-800-831-2678 ' APPLICANT PLEASE PRINT OR TYPE ALL INFORMATION - C CK BOXES THAT APPLY ❑ Road Approach ❑ Road Approach Permit&Address ❑ General Permit Fee: $141.00 Fee: $141.00+ • t; SEP 1 6 2002 Fee: $141.00 ❑ Utility Class A ❑ Utility Class B 1❑' Yearly Class A Fee: 20%of Class B Fee: $141.00 Fee: $141.00 County Road Name: 499GC P-P 1 TH5 f d r//V T /e-D fi D - Intended use of County Right-of-Way is to constructiopberate and maintain a: )g/(JEl,014 - EFf=,�Ey/ / . d- MC L(RJO4 8 . ( 07—� I hereby designate �D r ��� T Applicant (Owner, Utility, or Authorized Representative.) to act as my agent In matters related to this application for permit(s). 3 o 0 D 'see)vER y k.Q . l(/ q-16—o 2--. Mailing Address Ap I ant Signature Date PO tr To wNs5/JA, u)4} 7 6936 1-- 6/ V o �) 3, ) a a.t? City-State-Zip Code Parcel Number (360) 379 - 16FE Telephone o. Flagging Color&Date ACKNOWLE DGEM ENS By signing the application form,the applicant attests that the Information provided herein Is true and correct to the best of their knowledge and agrees to al conditions on the permit. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. Any material falsehood or any omission of material fact made by the applicant/owner with respect to this application packet may result in this pem it being null and void. I further agree to save,indemnify and hold hamiless Jefferson County against all liabilities,judgment,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and Its employees,representatives or agents for the sole purpose of application review and any required later inspection. This right of entry shall expire when the County concludes the application has complied with all applicable laws and regulations. Access and right of entry to applicant's property shall be requested and shall occur only during regular business hours. The action or actions Applicant will undertake as a result of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the"Endangered Species Act"or"ESA." Jefferson County makes no assurances to the appicant that the actions that will be undertaken because this permit has been Issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County Development Code The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Appica has read is disclaimer and signs and dates it below. (APP OR AU ORIZED REPRESENTATIVE SIGNATURE) (DATE) MAKE CHECK PAYABLE TO JEFFERSON COUNTY Updated 12/19/01 o r-- ;r) I p_7 1580 S.F. TOTAL I ‹ ( 1 SEE 16 2002 ' 28'6 , ,„ 11' 3'6 -7'1 6'11 1'11 '4 Y 4 1 k---5'1"4 �, � 3'4 - 3'7 � � 4E-0 !ArNl ' e-SirCttSS i� Exhaust Fan 4 0,I b'L 3068 2640 2 CLOSET HALL Il(4/r0 1C/I41 / ,0 " 3'5x6'3 ''' LAUNDRY zo : , 3'9 1 6'3;x 6'3 N BEDROOM co r 10'4 x 11'7 Se' A_ 2768 i Electric Heater A iP Exhaust Fan i m Propane Hot Water He- er 1 , o N 1 j ' CD >> KITCHEN 'I N ATI 41 v I - '" u rZ- 10' x 15'5 '� o � i op 4it‘31 10'4x8' 1 N HALL CO V _' 2 4 _ 5568 E CD (`') ram: ...1 51168 Zero Clearance Propane Fireplace coh cc LIVING 17'2 x 14'9 DINING �'�, c pJ� 11('S` 10' x 12'8 M I S ; 51- c, O`10p- c 3040 3040 3040 3040 M li ✓ 1. ,. - F..s. ,,3 3068 -- 3'3 i 4' 7' 3'7 3'5 H-. 4' 3'3 17'1 10'8 PORC 28'6 27'6 x 7'6 GLAZING SHALL 03Z COMPLY WITH CHAPTER 24, 1997 UBC All Windows Single Hung Except Where Noted AS AMENDED BY S /4.1.1,1 -12 8a?./4 WASHINGTON STATE MAIN FLOOR BUILDING CODE COUNCIL 963 S.F. ♦ n 28'6 7'6 13'6 . lca (P.) ' It? 11 --_, 5'2 3'2 5'2 i .�rl i SEP62640 284 `�, 1 'Yw „,,,r4S77'"lauggarag' 447: ''',4 " - 1 Iff,,,,--iff, 1,, ,,' Am qv, - ,ngh,t,,,,, -...1m,,,, 4 HALL ' M43 pry 3'x3' --Op IENT DN tl co EM- co ri 3 Z- Exhaust Fan a OPEN BELOW 6'2 x 13'7-7_6 2450 "V c % I in E MASTER BATH / ° l x 6'11x16'9 v Electric Heat v CT)' Egress Window Z+Edi3'S I c, / N Casement Type s M `1eNIrm♦eD CV M 1 N o / ' A r o \ MASTER BDRM 1 I 20'3x22'10 / !y Freestanding Propane iSt9ve zy T6 / 2430 2430 2430 --- ----- 7'6 --- c5 M M co LI its ALL GLASS AND GLAZIN9 SHALL Dr COMPLY WITH CHAPTER 24; 1997 UBC AS AMENDED BY 28'6 sOE" it../4 id Es-72 J ATTIC FLOOR 617 S.F. 17'-6 3/4" / / 8'-9 3/8" 8'-9 3/8" / /1/ / ro r BEDR❑❑M I .-8 \ 6068 irk \ AUG 1 2 2009 2 X 10 PT J❑IST 16 ❑/C W/WATER TIGHT C❑VERING o 2ND FLOOR SCALE: 1 19'-0" II • • i JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 1„..-A 1 621 Sheridan Street•Port Townsend•Washington 98368 \\ti‘z, iticaD,.' c6...") 360/3.c:o.9-4450jeftar . 36 son.wa.0/37%4451 Fax pment AUG 1 2 2009 www uslcanrrhdevekf Master Permit Application MIA: V I—a--10 P"ersaic0,,,) -'-ii 1> L.X Pet t..2 -rvetCii__,j3-tferr‘_ct lion(include separate sheets as necessaryr): • Tax Parcel Number:Ca,i 3 a.jff Property Size: t(of f Ai i'& (fie feet) Site Address and/or Directions to Property PropertyAl ,,,, Owners)of Record:�rY� (� I ci ,t r, Telephone: (019 Li17-VI1 Fax: email: r ta51Qjn1,k)GEr1P�E Mailing Address: t(34to wit 5t-( O "f Ci3 g21a Applicant/Agent Of different from owner) t to, 13f11(T 0,4 Telephone: 36 o•- 765-3'1`t 9 Fax: 3 d,® 7 6S- 14S5/ email: MtdlingAddress: `74ra5 hgC,✓,yke.- R ;Ir. -K,... a vlt `hi3'74. What kind of Perot?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 VA=4:**,,C0(Minor,Major or Reasonable Economic Use) ?Single Family ❑Garage Attached l Detached .,:i ., _ . I Use[C(a),C(d),or C)" ❑ Manufactured Home 0 Modular Li f.'.,•,-1, "r-my'D"or Unnamed Use Classification ❑ Commercial* C, Vet(Essential Public Fealties)" ❑ Change of Use t. l., Adjust:nerd ❑ Address 0 Road Approach 0 -?. : ❑Home Business 0 Cottage Industry 0 ceding`i tf ❑Propane 0 Long Plat.. O Sign Signed'Yes'Use Consistency0 Planned Rural _ *1 Development(PRRD)/Arnendments" Analysis 0 Plat Van atioh/Akeration ❑Stormwater Management ❑Shoreline Master Program Exemption/Pen n*Revisions" ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development*' ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunkcatton* 0 Comprehensive PtanlUDCA.,and Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment May Pre-Application Confaonsaee 0 Tree Vegetation Request **Requires a Ph -Aplpifeadon Conhrnaca Please identify any other local,state or federal permits required for this proposal,if known: • DESIGNATION OF AGENT I hereby designate Cflij'j}-�r to a act as my agent in matters relating to this applicatt"ton far potato).OWNER SIGN SIGNATURE A/fAAA, (), 1 . Date: _7_/j__91__ _______ BY signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or la knowledge. Any material falsehood or any omission of a meanie tad made by the cwnerr agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,Judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit I further agree to provide access and right of entry to Jefferson County and is employees,representatives or agents for the safe purpose of application review and any required later inspections. Staffs access and right of entry wit be assured unless the applicant informs the County in writing at the time of the agpl=he or u vd�ts prior notice. Signature: tit.. i (`Vt l'YJ.-xn-� Data: 7/(�f&r The action tr actions Applicant MI undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential lake'of an endangered species as those tarns are defined in the federal law known as the 'Endangered Species Ace or ESA.'Jefferson County makes no assurances to the applicant that the actions that wit be undertaken because this permit has been issued we not viorate the ESA. Any Individual,group or agency can file a lawsuit on behaff of an endangered species regaining your actions)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable reeporm r • to and complying with the ESA. The Applicant hes read this peer+ 1 signs and dates t below. Signature:� ,( t.. ,, 'q. Date: (/t`(/0 G:\Pemeitctsu \#cr ##FORMS###WRD PORMS\Mrster Permit Ap cation 5.29Jar 1 III • , BUILDER STATEMENT The signer of this statement does hereby certify that they are the Demers of the parcel referenced herein,that they are no licensed contractors and that they will be assuming the respond:Ay of the General Contractor for the proposed project, Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED Hose INSTALLER: PHONE: FAx: 1 ,Aribiryi e. . .e.cr.i ra.-11S 7.."-t-i L. (364 7 os--?,7 it 1 (sto) 76 5-11M5) MAILING ADDRESS: 7/lac 'AA nva y it... /241 EMML: CONTRACTOR'S LICENSE WAINS NUMBER: 6r-A tit>S4 17) tc- MAILER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: - EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sevrage Disposal: U New A'Wood Existing: 0 Sewer O Addition CI Steel Proposed: ----"1— Bank 0 Community System 0 Alteration/Remodel o Concrete Total: "2- Height (individual System O Repair 0 Masonry EP Pen** O Demolition 0 Other: Bedrooms: Water Supply: Existing: Sietback: 0 Private wed 0 Two Party Type,of Heat Proposed: • l(Public gi_i:atirrr-c.... Total: 2_____ Nettle of System:114-46"144F-- .„ —, . .. If thhh Is a Conwnerclal Protect Vgy must answer the follourina: - -- Number of Parking Spaces: Cunene Propo'sed: Number of 612,6 Pivichig Spaces: Number of occupseits(includes owners,tenants,employees.etc) Current IBC Occupancy. IBC Type of construction: WM you have Food es tNi- ff this Is a Pitmen*Tank warlior Apothem,Installation oennit mark all Items below that apple I Underground Tank 1 Above ground Tank Size of Propane Tank I Heat Stove I Cook Stove I Woodstove I Firepiece Insert I Hot Water Tank I Pellet Stove I Other Is this socilance being Installed In a klanufictured/Mobile Home? Yes ! No When applying fora permit to install a propane tank you must also submit a site plan showing ail of the buildings,all property lines,tank location and size,distances from the propane tank to at property lines,buildings and septicleystem components, Including the reserve area. Main Floor Heated EH Bid App Review: f*110 LID 232 Floor Heated Consistency Review: 3 i5 - 339 Other Heated Base fee: Cgl 5 - i )I,‘.._ .. - Mezzanine Acid6O+rjam-- , 4c1-7 , . ,.,,,, Heated Basement -_ _ Plan Check fee: -"- State Strcharge fee: , ' Sri Lc, Unheated Basement . , . Other Unheated Wm D el:0-1 •- =L., 7!-:-,1„ Pot Water Review fee: -.--- Garage/Carport - SUBTOTAL I-10 U2C1 i 5LE 3 Decks ''---7 1 0 - ' 811/Rd Approach fee: _______, Other TOTAL $ 1101,ael 3Ltg.c›13 ReoelPt Number I (07ZZ 1- )1(423 ---- -' cash/check Number 21000 ESTIMATED COST(REQUIRtD) --- --- Date: s ?'-'labor (Zg 'Fair metket value Xell and latenals foundation to Nis h 4(9 (e7 I Initials: ' GAPernatCentei\###FORMS$O#ADRD FORMS\Masts=Permat Applicason 5 25-08.doc • • Hi Z- ''' ,� _ I ,—.Lz tui . r Yrr1 5 d . ,, � (-4-5.,---,,,\_4.se , mtJEFFERSON COUNTY ‹)1. I "�kir" . DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend . Washington 98368 SQ 360/379-4450w . 360/379-4451 Fax NO http://ww.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE rMLA# ! '4440' `Z 1G PROJECT/APPLICANT NAME: ' '.r: • [1 1 iippil Il Please answer all of the following questions to the best of your ability. Where the quest, callssfo .r1►al Litt., .- applicant may choose to either incorporate the elements into the general plot plan for the aster Lan.' 4:. ;.• r l4 r ..�, separate stormwater site plan map. + . t A Project Overview .I,,i, 1. Describe the proposed developed conditions of the site. Indicate position and -1agwep�Q - • . - -. r n the site ma.. ( R a IPA .I0 - °,11i ' `_ _S,� �. Ai -'----vi � 1741F 4 116 Existing Cpnditlons Summary j`"�+_ 1 2. Describe the existln. to.o.ra.h . Indicate contours on the site ma.. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map, o 4. Describe thie existing soils_ Indicate soli type on the site map. t'tc e?-r • i et° rv�'G -tb. t L--O Pre.-. 4 , u 5. Describe the existing site hydrology(i.e.,drainage; behavior of water on the site—above,below,and on the ground R I ndicate existing starmwater drainage to and from the site on the site map. Depict separate drainage basins on the si GI�map, if applicable and Indicate acreage of each. 0 - ,`b _ Lam-r�- t ( v,-s '7-t, - �Y-r-.l.t, ct I. '■' l I II 6. Describe ari+excess levels of noise generated by the proposed use or activity: 11 If IIII - - ' - it erarmweter see plan iemplat%—rev.10/21/2008 ,J I 5 800/L00 0 ONI S30I1183S 3i90HV]S 1.99P9 L09E XVJ 79:61. 600;/EL/80 13. Describe the water quality system. ill 14. Describe the conveyance system analysis and design. M� A.t /04 - ill _ Il 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excesjs material. ray . .- - - 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter y; i of the Uniform Building Code. 17. Describe the proposed surfacing material. 7i 18. Describe methods for restoration of the site. l _ Ill — 11 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [this is normally requi =` for large"projdcts only and only those for which facilities are required to control flow or treat runoff.]' If included,list the .:�i uals here. 20, List here and include any special reports or studies conducted to prepare the Stomtwater Site Plan / AUGG 1 7 LU c / } 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals in l 'e conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those con !ins or restrictions here_ ! . ! 7 alorinwatar site plan amplecq—rev.10V2112009 900/300 3NI 339II183S 3IOHV3S L99I 9 09C ?;b'3 Cy.CL 600 .;'CL/80 • • • i I 1 12 Required Elements Construction SWPPP(continued) 8. Stgbiliae Channels and Outlets. . ilk . /CI /fr _ _ . 9. Control Pollutants. t • l , ill , I r 10. Co m " ntrol De-Watering(the act of pumping groundwater or storwater away from an active construction site). 4 _ A) /k ; 1 . _ • ,II 11. Mslfntain Best Management Practices(BMPs). j T II iiil 01 if—F'r ...,-C(L i -c.t 4 f.. II 1Il VII 12. Manage the Project. r I 1 I ri eivrtr t,� _c 1 it-: /= elute 1''11 - II 2. Adjacent Allies. j a Description of the adjacent areas that may be affected by site disturbance (e.g„ streams, lakes, wetlands, !..idential areas,roads). h p4ss74..„,--zr_f3 star.-4 1Ill I b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum dist-:Iil= of 400 yards).; _ ll -- I ,Ill 3. Environmentally Sensitive Areas. I a. Description of environmentally sensitive areas that are on or adjacent to the site. , i ; PLUG 1 / ZU3 II tom. iL-r k7 j "60 t --ter-- h I ater nwafer elle plan lamplele-raV.1 0/2 112 00e 9 800/800 ll 3NI S33If183S 3NOHb'3S 1.99tr99?098 HH3 89:6t 600Z/01780 • • di 11 II SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a gtormwater site plant' ,d/or a separate Construction SWPPP Site plan- This is a checklist to ensure that the following are depicted on a site plan: F 1. General. I r a. Vicinity Map , b. Jefferson County Approval Block c. En lon and Sediment Control Notes 11 il 2. Site Plan. ! b 1 , a. Legal description of subject property. b. North arrow. f c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. 1, e, Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). F. Show existing and proposed contours. I i g. Indiate drainage basins and direction of flow for individual drainage areas. h. Lablel final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show ail cut.and sill slopes indicating top and bottom of slope catch lines. I 3, Conveyaned Systems. a. Designate locations for swales,interceptor trenches,or ditches. 1 b. Shdw all temporary and permanent drainage pipes,ditches,or cut-off trenches required fbr erosion&sedimertt�.•ntrol. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. i III d. Sho(ws grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes- ` e. Provide details for bypassing off-site runoff around disturbed areas, I f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 11 5, Erosion andi Sediment Control Facilities. I a. Show the locations of sediment trap(8), pond(s),pipes and structures_ f b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions, d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe,and/or other filtering devices. f. Detail stabilization techniques for outlet/iinlet. g. Detail control/restrlctor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i, Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. A i!�; 1 % 2009 k. Provide front and side sections of typical rock check dams. I. lndieate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained [11[I• illustrated with detailed drawings. 7, Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other th it sediment(e.g.,concrete wash water). 8, Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water • 1:,lity on the construction site. Sampling stations should be located upstream and downstream of the projct site. I I i I 9Wrtnweler Pile plan lemplata-rev 10/21/200B 800/1700ZI 3N3 S33II183S 3WOHV3S 1.991793L09C HV3 c9 8t 800C./61./80 } • • ., ;II iI • I. 7. Descal'ibe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetly I• l steepislope3, on the site. Indicate location on the site map. � treams, - c II l{! ,II ITi 8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities, roads,and sensitive ri 1-I areas streams wetlands lakes stee slo es,etc.). j �' 1 ID III Iiil,. Permanent Stormwater Control Plan I This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater i and facilities to remain in place after construction of the project is completed. tpl BMPs "Medium",size projects are required to have the totals calculated of all Impervious surfaces, pollution-generatin, I,It . surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and ervr°us facilitles,are not exceeded. { control 9. Describe the developed site hydrology, it D sc Manual) if not, what y gy, as proposed. Indicate whether stormwater will be fully dispersed (i.e., pe' 'tP T5.30 within the Site. Locate these facilities on the site plan and differentiaof stormwater flow control will te prooposed facilitilized for the es from existing facilities.e or specific threshold dis• I 'I, e areas I a CAG • fM6 7-6 7 --�- !I Oil' lalithe project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilitie l rroposed for use ori,the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facihti:i- l [This is normally for"large"projects or projects that involve the potential for dispersion of contaminants.] i - • �y ii�ii1 ki Fly 'aII 11 11. Describe the pegW rformance goals and standards applicable to the project. ,/ _ iW.'Irpp�p I 12- Describe the flow control system. .111 itif +r c ri ?003 III , I 11 11 11 ctwmwaler eit, en l plan emplale 4rov.10121/2008 dlI� B 800I GOB OMI 333I1183S 31+101035 1.591793L03S: XVd E :6t 600 •%ci s • • III CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the appli,�: ll'L In the d1', template that follot�s must be�Installed on the ground during all construction phases of the project. The proponent is resp.t,�liii ble for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction S'� water Pollution Prevention (SWAP) Best Management Practices (BMPs) Packet for guidance, particularly with rural Ir, •entlol development. SECTION I-CQNSTRUCTION SWPPP NARRATING 1. Construction Stomiwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has ' or will be addressed. Identify the type and location of BMPs used to satisfy the required element. if an element is not ap.,I'.��h :eie to the propdsal.justify in writing. Descriptions of the 12 Elements are found at Volume II Section 3,2.3 of the Manual (b•?:nning on page 3-7) ,1 72 Required Elements--Construction SWPPP 1. Mark Clearing Limits. #19111 2. Establish Construction Access_ I 3- Control Flow Rates. • 1Il II I 4. Install Sediment Controls. _ !I'll r` �.. exe- �9 /�ate` cam. r''.i ill 5. Stabilize Soils. 1iI 6. Protect Slopes. _ I Lies r , !'I1 1 ._. il�'ll 7. Protect IDrain Inlets. aU 1 7 ,vq ill Ill ` Il 114R11Water she plan template—P1n/.1fl 11200h III 1 800/900 2 ONI S30I11a33 31OHV3S 19 1799L0SC x'd3 r9 61. 600Z/8l/80 • • II _ is b. Description of special requirements for working in or near environmentally sensitive areas. 4j l f 1 •-r e t I40,4s-.. ! II N4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of t' .n site soils(e.g.,etodlblllty,settleab[lity, permeability,depth, texture, soil structure). HI '0 ry _ At' 0 4..) 5, Construction Phasing. a. e.,dpstruotlon sequence ++ Z.—V1C eh; 'Tie(eud At'a 60 P. Dgic 'r Cd r r2 c 6,e_h r t I i' Il II b. Construction phasing(if proposed) 11 6. Construction Schedule, Wet season is October 1 through April 30(page 2-21 of the Manual). iProvide a proposed construction schedule_ /� _ II. Wet Season Construction Activities. Via, Proposed wet season construction activities._ _ 0 `v le, A r I .vtr '�:$ ri. i _ ''I II qb. Proposed wet season construction activities for environmentally sensitive areas. /-- - , Ifl ill 'hI�I 7. Flnanclal/0vy'nership Responsibilities. � a. Welty the property owner responsible or the initiation of bonds and/or other financial securities. A -f P APB '`1 1I b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedi II'I i tation impacts. A A- II ' Il 8. Engineering Sedimenta. Ponds/Traps. (t` _ Il /14 b. Diversions. `►i/ . c. Wate ways, .. 1V/k. ,U f 111 d. Runoff/Stormwater Detention Calculations � 11 I atormwater vita plan template-rev.10212009 1D 800/L00 tj 31NI S30If1933 3ItOHV33 1.95Vg8L09E XVJ 1:9:SI. 600,3/61780 • S i • • Stormwater SiteiPlan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,t e proposed revision;;,':hall be submitted to DCD;prior to construction. The submittal shall include substitute pages that include ;II proposed change Devised drawings showing any structural changes,and any other supporting information that explains and suppo Is the reason for thei yl� -nge, Final Corrected Plan Submittal ' I If the project included construction of conveyance systems,treatment facilities, flow control facilities, or -tructural source co n{ BMPs (not standard on-Site stormwater management BMPs), the applicant shall submit a final corrected plan(as-builts")when thelli',.ject is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accur=tety represent theji .Lect as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is'.till :' and correct to the best of my owledge. I also certify that this application is being made with the full k owledge and conse 1.f all owners of the a ed p rty. • (LANDOWNER AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) 1 • i THIS SPACE MAY SE USED FOR ADDITIONAL NOTES, IF NEEDED: • • 1 ,I I I I _ II e10mlweler site plan template—Sev.10d1l2Xa "' i 12 800/800 3NI 333I1183S 310HVIS L9St'c9L09E is'od b SL 600Vc 80 0 «0-,SZ / if ,�9-�Z I- / / / / 1110 0170E Ot'OE 9SOE , •♦ i♦ I ? G��1 ii.. 0 0 ~ — — ct 0 f _. O o_ IC) 0 l i A U I— c Z = w a_ _'lj LU U q 10 1 1 w x U ct 1— w `b H op o $ I 1/41) Ih ! 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