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HomeMy WebLinkAboutBLD2003-00474 • • MLA03-00425 BUILDING PERMIT APPLICATION ReviewType:l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00474 Received Date: 7/30/2003 SITE ADDRESS: 5871 OAK BAY RD PORT LUDLOW, 98365 OWNER: JOHN F SAUM PHONE: R MARIKO SAUM PO BOX 1168 PORT HADLOCK WA 98339 SUBDIVISION: (360)437-0274 Block: Lot: PARCEL NUMBER: 921321007 Section: 32 Township: 29 N Range: 01 E CONTRACTOR: THACKER&SON CONSTRUCTION / PHONE: (360)385-4149 80 W FITCHBURG AVE per ' PORT HADLOCK Wy8339 ' Contractor's License THACK2P fires 10/3/2001 REPRESENTATIVE: MIKE THACKER PHONE: (360) 385-4149 80 W FITCHBURG AVE POR -HADLOCK WA PROJECT DESCRIPT OP ACCESSORY DWELLING UNIT TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADU MAIN: 768 VALUATION 83,937.00 ADD'L: 432 HEAT TYPE: EEE CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: 5N GARAGE: 348 SHORELINE: CONST TYPE: DECK SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 2 Prop: 2 Seismic Streams Total: 2 8Total: 2 Flood Way Floodplain Routing Date: F&W Landslide — ..) I--aO03 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: J1 p�{�oved/Date Permit $881.75 MJA 07/30/03 58252 /"� °t/•�! v E Plan Check $573.14 MJA 07/30/03 58252 State Building Code $4.50 MJA 07/30/03 58252 ®Cr 2 2003 Potable Water Application $51.00 MJA 07/30/03 58252 Jefferson Count & Building D Y Planning Total: $1,510.39 partmt /�/ov��' F /24,/ie V V' , -'-- *- , 0 ,, sozv r Jefferson Coulepartm�t of Community Development ff,� o� 1 Sheridan Street,i t Townsend WA 88368(360)370-4450 �s �� tAppIc © JEFFER �� ON COUNTY DCD Project Description: Building Type: Project Type: Frame Type: ❑ Single Family . New lk Wood ❑ Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular ❑ Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial a(Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer ❑ Community System y[ Electricity 0 Oil Proposed: g. Proposed: a )4LIndividual System ❑ Woodstove ❑ Propane Total: a- Total: r)- If not sewer,fill out the following: ❑ Heat Pump ❑ Conventional V Alternative ❑ Other Permit# SEP Water Supply: eNt.. .54_, `e ,JcPrivate well ❑he? Party Well❑ Public:Name of water system: 1 Square Footage: For Office Use Only Main Floor 6 8 0Qt t�5. 1 Consistency Review 47.0, 2ND Floor ' ) �- v�k� . 0°*��" Base fee S g I 5 1 3 y 3rd Floor ._1 Plan Check fee—65% 4 1 � Htd Basement State Surcharge fee I �� Unhtd Basement Subtotal 16 0 I` ` C� 1.,� 6 �o Garage/ t 4E O • g Pot Water Review fee (a ...___ Decks 911/Rd Approach fee Commercial 0o TOTAL I 5 V� r 31 Industrial —� Ca rCj 73g. 0 Receipt# 52 aea--I Other Cash/Check# i a-g Total Valuation: I a00 -f--- S t°,,,-0 t1- Initials Or Date 13a/0003 Estimated Cost: If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark ft.Bank Height 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 plicant's pro erty or structure shall be requested and shall occur during regular business hours. Signature: - frit- Date: 7—/7-c-2,5 OV F R H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01 BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00474 SITE ADDRESS: 5871 OAK BAY RD Received Date 07/30/2003 Issue Date 10/20/2003 PORT LUDLOW, 98365 APPLICANT: JOHN F SAUM R MARIKO SAUM PHONE: (360)437-0274 PO BOX 1168 PORT HADLOCK WA 98339 SUBDIVISION: PARCEL NUMBER: 921321007 Block: Section: 32 Township: 29 N Range: 01 E Lot: CONTRACTOR: OWNER/BUILDER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION: ACCESSORY DWELLING UNIT REQUIRED INSPECTIONS: [ ] SETBACKS: 7e9_ [ ] UFFER: [ ] Footing: t I 24 b-22-o-1 G- c. i [ ] Foundation• /O27 •o ®a�-o C. [ ] Underground Plumbing: [ ] Underground Insulation: [ ] Shear Wall : ee [ ] Framing: ,e y z G f I Plumbing: ,0 /y 43 [ ] Propane Tank/Lines. [ ] Insulation: e i- /� jig f I Sheetrock: Ar [ ] Septic Sytem Final Approval: f 1 Zoning Final Approval: [ ] Final/Occupancy Approval: HEALTH DEPARTMENT APPR• AL 'E PTO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUSTIOR BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSP Office Hours 9:00 a.m. -4:30 p.m. ECTIONS. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY -SEE REVERSE SPECIAL CONDITIONS FORCASE S E # BLD03-00474 0 1.) The application was reviewed by the Jefferson County Department of Development staff on August 13, 2003 for the Sensitive Areas (ESAs) under the provisions of the Unified Development CodeCommunityU potential presence of Environmentally After an initial Geographic Information Systems ma inspection, the following ESAs were confirmed to be present on the subject Code (UDC). Aping review and an investigative Typete 5 stream, Man-made pond. 2.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identifiedthe subjectpropety: property. The stream will require a setback of 50-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM on the shall also have Buffers BuildingtAreas 3.) Buffers are areas that shall be maintained in their natural Fish and Wildlife Habitat Areas Setbacks established. wever, minor pruning r alterationares hv station may of the buffer are not diminished. y be permitted as oing asf tlhe function on and character 4.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorts), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may Big-Leaf Maple which m y be used includes: Vine Maple (Acer Circinatum), BigMe Le f Maple (Acer Aspen (Populus Red Alder(Alnus Rubra), Pacific Madrone Bitter Cherry ( pulus Tremula), Black Cottonwood (Populus Trichocarpa), (Prunus Emarginata , gon (Arbutus ), Cascara (Rhamnus Purshiana), Pacific Willow(Saliz LaWhsiand ate k (Quercus Garr ana (Rhamriana). ) and Scouler's Willow(Saliz Among the native shrub species which may Among , be used are: Sevice-Berry Red Osier Dogwood (Cornus Stolonifera)Salal (Gaultheria ShallonSpray ), (Holodiscus Discolor), Indian Plum ( y(Amalanchier (Holodiscus cu Capitus), Oemlaria Cerasiformis), Pacific n). Ocean (Physoa p ) Red Flowering Currant(Ribes Sanguineum Wild Rine (R ), Swamp Rose (Rosa Pisocar a (Sambucus wamp Rose , p ), Willows (Salix ss ) Rose (Rosa (Sambucu Ovaem ) Snowberry(Symphoricarpos Albus P )' Red Elderuckle 5•) All construction activities shall ed cnot encroach uponkleberry nthearvifolium�Evergreen Huckleberry preparation of materials. buffer. This includes the storage or 6.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), buffer setback of 50-feet. The setback shall be measured horizontally High Water Mark (OHWM) shall maintain a vegetative 7.) An additional setback of five (5)feet ie s squired from from the Ordinary proposed Accessoryl of in Accessory Dwelling the Unit. 8.) A permanent physical separation'along tthe boundary o e edge of the buffer area to the and permanently maintained. Such separation can include inns alllin logs,shall be installed hedgerow, or any other prominent physical markingapproved 9•) Buffer perimeters shall be marked with temporary signs at an i g trees, a atan by the UDC every one hundred (100)feet, whichever is less. Signs shall be in place priorAdmiantrator. during construction activities. The signs shall contain the followingerval of one per parcel or Not Remove or Alter Existing Vegetation." to and 10.) Aerial photographs of the parcel taken in 1994 and again in 2000 statement: "Buffer- Do determination that the pond located onsite is man-made. are consistent s t shall apply.wh a 11.) The applicant is proposing to create or add 2,918 squareStream impervioussurface 1,750 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that feet of surtace and for a medium project. your proposal submit a stormwater plan 12.) A Stormwater Plan has beeubmitted and approved Development. Once the subject permit has been issue by the Department of Community implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule d the applicant shall fully plan compliance. A Certificate of Occupancy will gnot be ssued until the Departmentr for verifies plan compliance. No clearing for roadways or utilities shall occur on the r site until clearing necessary for the installation of temporary sedimentation and control measures have been completed. project 13.) Jefferson County determined that this proposal is categorically exempt fromreviewerosion the State Environmental Policy Act(SEPA)A minimum of four(4) pursuant to WAC 197-11 800 under accessory dwelling parking spaces are required for the single family residence and ry unit(ADU). 15.) Outdoor residential storage shall be maintained in an orderly manner and fire, safety, health or sanitary hazard. 16.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on ll create no than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. n any lot less y Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. with Outdoor storage of thirteen (13)or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile yard or junk (or salvage)yard and allowed as a Permitted Use in Table 3-1 of the and such storage shall meet the requirements of UDC Section 4.10. In no case, shallhacking suchS unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive AreaDC, (ESA). any 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as impervious surface which includes rooftops, driveways, concrete, etc. 18.) The building height is not to exceed 35 feet. amount of 19•) Minimum setback from Oak Bay Rd is 20 feet. located along the northern parcel boundary is 20 feet. Minimum side and rear are 5 feet. Environmentally Sensitive Areas furtherMlnimum setback from the easement 20.) Oak Bay Rd (C569908) is a county minor collector road. The setbacks.approach setbacks and an address of 5871 Oak Bay Rd has been assigned to the parcel. 21.) A septic permit(SEP84-00006)for the primary residence was finaled March is1986 existing, 2 bedroom system. A septic permit(SEP03-00154)was approved system with capacity of 240 gallons per day to serve the accessory dwelling unit 1986 for a June 25, 2003 for a 22.) A building permit(BLD96-00097)was finaled August 26, 1996 for an addition family residence. A building (ADU). g eeamit (BLD96-00484)was finaled September 30�1996 for the gle an addition/deck for the single family residence. 23.) An Accessory Dwelling Unit shall have a maximum size of 1,250 square area. 24.) To obtain an Accessory Dwelling Unit(ADU)designation, the owner of a feet j gross floor property shall reside on the premises, either in the main or accessory dwelling. 25.) The site plan as submitted with the buildingapplicationthe subject reviewed for consistency under the UDC, and hasbeen oa Julyroe0,by Jefferson has been Department of Community Development. Any approved County the stamped, approved site plan dated October 16, 2003 shall be resubmiodifications, changes, tted additions rreview to and approval by Jefferson County Department of Community Development. 26.) This approval is for a Accessory Dwelling Unit(ADU) only. or review are subject to review for consistency with applicable codes and ordinances and does preclude review and conditions which mayy Any future permits on this site be placed on future permits. not 1:1F BLD PermitBuildng.rpt 10/29/19 r \. / i," tr,• JEFFERSON COUNTY , �, } tOct r DEPARTMENT OF COMMUNITY DEVELOPMENT 1-- t� 2003 ,/ I lip �,A. 621 Sheridan Street • Port Townsend •Washington 98368 ` ' 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# j.-""f 3- 4 2`r PROJECT/APPLICANT NAME: efts 14L4, -1 k-cO S A-Va. Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. / IA; 1 I 2 at .--/_ t4-I/ < Slz, ri htl 0+ `-e-,.(v t a 1-j-pt Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. - w� k-��,.�� ��.1�44) St per_ L./i., -o (9dr-, I. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. CO 4-e- / l-,..1 ra , 13-d -Fir -�' k c� 110 6_e_ e j � t-t 1\.-.S' / t,) CA- S r`1-e�t V-fek Q U)-- r l . c,'"-J( 4. Describe the existing soils. Indicate soil type on the site map. li.,5 r m , i- ID rx. 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. a 1 1 .,S7 t)f--1' b OL-J- l) p 11 i,,zO -hi-,,, ot-z, ,,,% __________ APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER �1,/v,.� R PLAN L16 81131-1. JEFFER •N COUNTY DEPT.OF COM I ITY DE E.. ip stormwater site plan template—rev.1CV1/2003 SIONATUR•• � 5 ra,_ 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on'the site. Indicate location on the site lv -- Play. - pdykd 8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (streams,wetlands,lakes,steep slopes,etc.). i S f r1�y 1 7J "---e A S , Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30 in the Manual)or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] L) 11. Describe the perform ce goals and standards applicable to the project. )x r 12. Describe the flow oontrot s�etFr`i:'"`Y""""`1 Fi._ ,r e,.e to , i Z itp:141t Ise tit VW 11111 storrtiwatersite pan template—rev 10/1/2003 /x 'sllP 6 • 13. Describe the water quality system. Ste' L.' �—/ 14. Describe the conveyance system analysis and design. —' F S 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. r) r' _ss r: l/ 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. POD Lj, 17. Describe the proposed surfacing material. 1U0 - g 18. Describe methods for i storation of the site. / 9LU t - p �=5+C� L C� 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. stormwater site plan template—rev.10/1/2003 7 CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits., CI -QAf i v-z3 2. Establish Construction Access. ej - • 3. Control Flow Rates. 4. Install Sediment Controls. T, I - �- 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. 8 stormwater site plan template—rev.10/1/2003 • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. it.,)0 1WW4.- 9. Control Pollutants. 10. Control De-Wateringa (the act of pumping groundwater or stormwater away from an active construction site). l PD Y`-(— 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). p 0)-cam b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). FAN t Y< f f v cjcc ‘ r uc l--, --fp ,4 0,--d- 3. Environmentally Sensitive Areas. a. Description of a vironmentally sensitive areas that are on or adjacent to the site. 7\.) stormwater site plan template—rev.10/1/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. ij Ys-C- 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. I i �h, S' Pi-- Ii. Wet Season Construction Activities. a. Proposed wet season construction activities. R HT L b. Proposed wet season construction activities for environmentally sensitive areas. !Lk V - 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. RAAN.--( 8. Engineering Calculations. Provide Design Calculations on a separate sheet r the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. 4 ( c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev.10/1/2003 SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan,a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes •2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches,or ditches. b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. 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/inlet. g. Detail controVrestrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate 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 and 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 than 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 quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/1/2003 11 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. /1slo3 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template—rev.10/1/2003 D W el 1.. ‘,4 4:t t. a 1 & • 2 ko: it 6 g 1,:, i 41 ..tea WZ fl Cae: j a ; i i r 8 N . i -tt t if aL l'N e:. I ig ,.. .riA ... ,4 „,- . ?..), t , ,, .c. tiStPf ' c. rn ..t . . Ret,24. SV°e a c o cos l(;:7 t'tn°!iY,:1 Azi," N\\ I „:„::,, a sd,,,, e ,.., ,„ \ , ,,,,L/ ,,, , l ' 1. , ..,6 /ii\ ,s. ,,,, c 0r2 (1 , \ 0 sl N\ s-...f_y . v.1 ask .3- Qn. cp I— •2 I li 2 1 20 0 0 v it j o N. / ( k , .zy t \ 7O / I ,n 0 T PA, g 5Y7/ OAK Bp; RIl urn �, Nl�� su�s� N -