HomeMy WebLinkAboutPermit File BLD-2020-0772 4115 Oakes Avenue (14)PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPAR ���a
° Mailing Address: P.O. Box 547, Anacortes, WA 98221 � �' !,Iry �-' � �� r'�\
ijFl��i
�niF... !�'h Office Location: 904 6u' Street Anacortes WA 98821 � � DEC o 9 iozD � �' i"
Phone: (360) 293-1901 {) `�
'':ITY OF ANACORTER
•• a
a � �
1. PROPERTY INFORMATION
Project Address (Street, Suite#):
Assessor Parcel Number:
it e cn es
31b79
Subdivision/Lot#:
Zoning Designation:
Lotarea(size):
�g69.� sq.ft.
2. TYPE OF PROJECT
❑ New SFR ❑ New Accessory Dwelling Unit: ❑ Deck porch (new/repair)
❑ New Duplex ❑Attached to
Primary Unit ❑ Interior remodel
❑ Detached from Primary Unit
❑ New Addition to SFR ❑ Garege, carport or
accessory building ❑ Fence or retaining wall
or duplex (new/repaid
Other: r",ga,,c � oc-Fwnui �._.+.. e
PI�roject Summary:YePla"'(�l"Or-"^"'
�°-"`- w,� nw 4.�c.. cciz., rca
Y �TT/1-4'C ON ¢Kig�FIN� coo �f-i y-F~
ProJectValuation: $ 15?7recro
3. PROPERTY OWNER INFORMATION
Name:
Phone:
Address (Street, City, State, Zip):
Email Address:
961 � W{.t�• d'z�y
O cr@ wcs ('C.o45'-�,.J c -: (c-[nw.
4. CONTRACTOR INFORMATION
Name:*
es Cum ��,�
Phone:
36o-b1a-b'3 3
Contractor's Business Licenses
State Ucense #:
City Ucense #:
All Contracrors & Subrontractorsmusthove o vaBdaty
ofAnacortes businesslicenseprlorro doing work in the
Expiration Date:
Ezpiration Date:
City.
Addres 5(Street ty St te, ip
:
9�L7
Email Ad s:
�,[o.
er cs co s�,:d✓ .1- ll
S. CONTACT PERSON
Select one person the city will contact for anything
16LApplicant � Property Owner contractor
related to this project:
❑ Other list below
Name: � f , /s
Phone: 36p_�/D _61i1
cf G.
Ad/dress (Bt et, City State, Zip):
Email Address:
eN>Y 1�.[o
�b l? S ID`1' S-F
�("tr�t1'�Wt_5{�C-oc.5'l•r+�uGS�%u
R>; zyy
Res. Building Permit Application Submittal Checklirt
Updated October 10, 2019
Page 5 of 18
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ANACORTES, lYA 9BRZ1 2B0—B80A�
�i7.t�
EXIST.
HOUSE
PURT PRUPERTYI
GRAPHIC SCALE
i5 0 95 3a _ q0
.:—r,
( IFi FEET) .
1 inoh = 3U .E.
Topography Survey
4115 pAKES AVENUE, Anacor�tes
Completed Aprll 11, 2017
PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98121
( �^ �"' Office Location: 904 Bd' Street Anacortes WA 98821
�'� Phone: (360J 293-1901
6. LENDER INFORMATION
RG1V 19.27.095 requires Me Cftyta obtain irdormadon with regard to lenders If there are no lenders lnvoNed whh your profecF,
write "no lenders" on the Name Line below.
Name:JC
GaN v,1c55 ea7d.
Phone:�bb -"f S7--Z ya Z
Z' J:
Address (Street, Ciry'',�
Email Address:
��Ca��te,
IZO yeo�f fVry F<,.
� �b'L33
Je�� �>`N�
/.?�
d\�✓`,-�'< Nc`I'
7. ACKNOWLEDGEMENTS &SIGNATURE
Read and Initial each of the following statements prior to signing this application:
I understand that when a building permit application is taken in overthe counter it does not mean
V�'
the application has been deemed technically complete and sufficient for staff review.
9 r
I understand that if I submit incomplete, inaccurate, and/or erroneous information it will take the
1.Y
Gty longer to process my permits.
<
I understand and acknowledge that I could be responsible for providing as -bulk drawings (on paper
or electronically) as part of the project's certificate of occupancy process.
1.
I understand and acknowledge that Special Inspections could be required as part of my project, and
Y
if needed I will be required to pay forthe wst of these inspections.
I understand and acknowledge that financial securities could be required as part of the work I am
•
wmpleting and I agree to provide the items needed for the City to calculate these securities and to
nil
provide the securities themselves.
I understand that if permits are reviewed concurrently such as design review, site plan, traffic
•
concurrenty, etc., any required revisions to one permiT may affect the entire plan set and could
��
add costs and time to the project.
I hereby declare that I am either the owner of the property listed on this application or the owner of
this property has authorized me to be their representative to act for them. I also declare under
penalty of perjury underthe laws of the State of Washington that all of the statements and answers
contained herein, and the information submitted with this application form is in all respects, true,
correct, and complete to the best of knowledge and belief.
1�-�L.J.�I.�— 6 - Zn _ z o
Signature Date
CJ:IIs
_%Z�s=�
Printed ame
Res Building Permit Application Submittal Checklist
Updated Oc[o6er 30, 2019
Page 6 of 18
,q y „` PLANNING, COMMUNIN, &ECONOMIC DEVELOPMENT DEPARTMENT
C� Mailing Address: P.O. Box 547, Anacortes, WA 98221
`c^-� "- Office Location: 904 6tb Street, Anacortes WA 98821
�.
� Phone: (360J 293-1901
•' a •' •
1. PROPERTY WHERE WORK IS OCCIURRING
DDRE55:
C (S' ��. k � ago ,e ,/•� N2co✓`� s
PARCEL
UMBER
— 31 b'7
2. DETAILED PROPOSED STRUCTURE INFORMATION
Complete the following information as it relates to your project. Mark Items that
are not applicable with
Structure height: I ,T +
AREA
SQUARE FOOTAGE
OCCUPANCYGROUP
CONSTRUCDON TYPE
OCCUPANT LOAD
1" Floor:
(tr 5 � S �
fw �.,.l....k 4,c u
2"a Floor:
3'a Floor:
Basement:
Garage:
b.�
Total deck:
Total porch:
�D S �-
Other:
Other:
Other:
3. QUESTIONS ABOUT THE PROPOSED STRUCTURE
Is a fire sprinkler system being installed?
❑YES NO
Is a monitored fire alarm being installed?
❑YES NO
Are retaining walls) being built?
❑YES NO
Are structural plans required?
❑YE5 ❑ NO
4. PROJECT SITE INFORMATION
A. Is work within the City's right-of-way proposed? If yes, you will be required
to submit aright -of -way permit application.
If you have already submitted a ROW permit, list the permit number here:
YES ❑ NO
B. Is the property located in a flood zone?
If yes, list thefloodznne designation:
❑YES � NO
C. Are there slopes in excess of 15°6 on or abutting the site? If yes, a
geotechnical report will likely need to be submitted.
❑YE5 �NO
Rez Building Permit Application Submittal Checklist
Updated October 10, 2019
Page 7 of 18
„_iTg„ PLANNING,COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT
�e Maijing Address: P.O. Box 547, Anacortes, WA 98221
�^ �” Office Location: 904 6t^ Street, Anacortes WA 98821
'�� Phone: (360)293-1901
D. Are there critical areas or buffers on or abutting (within 300-feet of) the
❑YES
NO
project site? If yes, a critical areas report will likely need to be submitted.
E. Is the lot less than 5,000 sq. ft. in area?
❑YES
NO
If yes, your site and building will need to comply with the standards in AMC
19.43.O10.C.
F. Is your project involving an accessory dwelling unit?
❑ yE5
rryy
Icu NO
If yes, your site and building will need to comply with the standards in AMC
19.47.
G. Will more than 2-acres be cleared and/or more than 5,000 board feet
❑ y�
jyl NO
(about 1 log truck load) of timber be harvested? If so you may need to
obtain a forest practices permit from DNR.
H. Is this project subject to the SEPA process? If yes, you will be required to
❑YES
� NO
submiT a SEPA checklist
If you have already completed the SEPA process, list the permit number
here:
5. REQUIRED SIGNATURE
I hereby declare that I am either the owner of the property listed on this application or the owner of
this property has authorized me to be their representative to act forthem. I also declare under
penalty
of perjury under the laws of the State of Washington that all of the statements and answers contained
herein, and the information submitted with this application form is in all respects, true, correct,
and
complete to the best of knowledge and belief.
Signature Date
�o� ey- I,,.I �11>
Printed Name
Res. Building Permit Application Submittal Checklist
Updated October 30, 2019
Page 8 of 18
�.,gp „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
C��' Mailing Address: P.O. Box 547, Anacortes, WA 98221
"� �' � Office Location: 904 bth Street, Anacortes WA 98821
�d.: Phone: (360) 293-1901
MECHANICAL
Equipment Type:
Appliance/Equipment Information (new and relocated):
Total#:
Furnace:
Gas#:
Elec#: K BTU: Other#:
{
Wall Heater:
Gas#:
Elec#: Other:#: Location(s):
Gas Water
#:
Lowtion(s):
Heat Pump:
Elec#:
Other#: Ca city:
Air Cond#inning:
Elec #:
Oth pacity:
Radiant /Hydronic
Gas #:
EI
#: Other: #: Location(s):
Exhaust Fans:
Bath#:
La dry# Other:
Z
Range Hood:
#:
oca (s):
{L :�c�.�,.> �
)
Fireplace:
s #:
#: Other: #: Location(s):
Clothes Dryer&Duct:
a
EI #: Other.#: Location(s):
Stove/Range/Oven:
G s
Elec � Other: #: Location(s):
Gas Piping/ Outlet(s):
#:
Location(s):
Boiler
Gas
Elec#: BTUs: Location(s):
Other:
#:
Location(s):
TOTAL MECHANICAL OUTLETS
PLUMBING
Fixture Type (new and
relocated):
Total #:
Fixture Type (new and relocated):
Total #:
Water Closet (Toilet):
Z
Refrigeratorwater supply (for water/ice
)
Kitchen Sink:
)
Pressure Reduction Valve Pressure Re ulator:
Util' Sink:
Water Service Une:
)
Tub:
L
Water Piping:
f
Hand Sink:
Clothes Washer:
t
Shower:
%.
Electric Water Heater: Tank -less? Yes ❑
(
Dishwasher:
�
Backflow Prevention Assembly:
l
Hose Bib:
2s
Other:
TOTAL PLUMBING FIXTURES:
Res. Building Permit Application Submittal Checklist
Updated October S0, 2019
Page 9 of 18
.,.,T y „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
' e�e Mailing Address: P.O. Box 547, Anacortes, WA 98221
}'ry>" y Office Location: 9046d'Street Anacortes WA 98821
Phone: (360J 293-1901
Land disturbance
Description Total
SF
Total Area of Land disturbing aetivity
21 ao s•�
Total area converted from vegetation to
lawn or landscaped areas
Hard surface area calculation
Existing Removed Proposed Proposed
Description (sF) (sF) Replaced New
(sFl (sFl
Non Pollution Generating Hard
Surface Area � �
(Sidewalks, paths, patios, etc.)
Pollution Generating Hard Surface
Area �1Zg� �,
(Driveways, parking areas, etc.) g
Total Hard Surface
Site size 6gbq,bs�F
Existing impervious surfa[e
coverage %-7.6�L%
(s .R. hard surface/sbe size)
Use the information in the above table to navigate the flow charts) on the next page and
determine the applicable stormwater management minimum requirements for your
project. Then complete the applicable Stormwater Minimum Requirements Form on the
Public Works- Enaineerine Department Forms website and provide required submittal
items/plans.
R
u
f18
Check applicable box
Minimum
Requirements Determination
�
Minimum
Requirements#1-9.
�
Minimum
Requirements#1-5.
. BUIIdIng Pe Application Subml
dated Octob ,2019
IChedclisr
Minimum
Requirement#2.
,z y „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
Mailing Address: P.O. Box 547, Anacortes, WA 98221
7~ Office Location: 904 6d' Street, Anacortes WA 98821
�� Phone: (360) 293-1901
FLOW CHART FOR DETERMINING REQUIREMENTS FOR NEW DEVELOPMENT
Start Here
Ooea the site have 35% Yef See Redevelopment Minimum
re of existing Requiremenk and Flow Chart
Impervious coverage? (Figure I-2.4.2).
No
Does the project cpnven
............. vegetation to
Does the project result in lawn or landscaped areas, or
5,000 square feet, or NO anvert 2.5 acres ar more of
greeter, of new plus native vegetation to pasture?
replaced hard surface
No
Yes
Yes Does the protect result In 2,000
square fees, or greater, of new plus
replaced hard surface area?
Yes No
Does the project have land
disturbing activities of ],000
Yet square feel or grea[er7
O
M i um RegWrem tKt
applies.
ra Figure I-2.4.1
Flow Chart for Determining Requirements for
New Development
DEPARTMENT OF Revised June 2015
ECOLOGY please see a9p/Avww.ery.wa.gp �yrpht.Mm/f0lcopynAM mtice inclWinA Permissions,
Since of Weahin9icn Ilmilntian of liedAty, end tlistlaimer.
All Mlnlmum Requirements
apply to the new and replaced
hard surtaces and converted
vegeration are s.
Mlnlmum Requirements Mt
through t15 appy to the new
anatlnreplaced hard aurlacea
tl the land disturbed.
Res. Building Permit Application Submittal Checklist
Updated October 10, 2019
Page 14 of 18
�T o PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
� �' Mailing Address: P.O. Box 547, Anacortes, WA 98211
I Office Location: 904 6m Street, Anacortes WA 98821
19_- 4_y
��' Phone: (360) 293-1901
FLOW CHART FOR DETERMINING REQUIREMENTS FOR REDEVELOPMENT
Does the project result in 2,000 square feet, or more, of new plus replaced hard surface area?
OR
Does the land tlleturbing adMly tola17,000 square feet or greaten
Yes
Minimum Requirements #t through #5
apply to the new entl replaced hard Mini m Requir ent#2 applks.
surfaces and the IarM Olatumetl.
Ne# Question
Does the project add 5,000 square feet or more of new hartl surfacesT
OR
Convert � acres or mare of vegetation to lawn or lantlscaped areas?
OR
Convert 2.5 acres or mare of native vegetation to pasture?
Yes No
All Minimum Requirements apply Neal Questigs Is this a road
to the new hard surtaces entl the related project? NO
converted vegetation areas.
Ves
Does the project adtl 5,000 square kef or more of new hard surfaces?
Yes No
Is the total of new plus replaced irerd surfaces
Do the new hard 5,000 square feet or more,
surtaces adtl 50%or Np No additional NO AND
ore to the existing does the value of the proposetl improvements
hartl surfaces wghln remrements, including interior improvements -exceed
the project limits? 50% of the aseeasetl value (or replacement
value) of the ¢xisting age Improvements?
All Minimum Requirements apply tome new and replaced
hard surfaces entl converted vegetaton areas.
0 Figure I-2.4.2
Flow Chart for Determining Requirements for
Redevelopment
,RTM ENT OF RevSed June2015
OLOGY Please see h(fp/Nnwu.ecy wa.gov/wpynghthtmlrorcopydpht notice includlig pelmissicns
of Washina[an limitation of lieblliry, entl dlstlaimer.
Res. Building Permit Application Submittal Checklist
Updated October 30, 2019
Page 15 of 18
Storm
DEC 092M ICI;
L�J
+iCY OF ANACORTES
Water Minimum Requirements #2
ENGINEERING DEPARTMENT
904 6'b Street Anacortes, WA 98221
Official Use Only: (Information to Inspectors)
Required Storm Water Facility and other related requirements:
Project Address: A,Je
Parcel Number: f7 - -3
Permit Number:
FRONT OF REPORT
Submittal Checklist:
w-w-w anacorteswa.g09
Submittal Date: fog F Y o2U
Revision Number:
Acceptance Date (COA):
Reviewer;
o TAB 1 - Drainage Analysis — Minimum Requirement #2
o APPENDIX 1 - Survey performed by a Professional Land Surveyor
o APPENDIX 2 - Model Soil Management Plan for BMP T5.13
a APPENDIX 3 - Determining Construction Site Sediment Damage Potential (Appendix 7)
o APPENDIX 4 - Site Plan with all applicable information (Minimum Size 11x17 — 30 scale)
o APPENDIX 5 - Documented Site Photos (North, South, East and West)
Proiect Description: (What is it you are looking to do? Provide details regarding, but not limited to, Lot SF,
HQme SF, New and Replaced Hard Surface) ! }
DCk%4 Jqs C� 1C i 5—k ci �(f i c �` /i UJ C�c e �' . Pu P_ �� u"� it f _ V- rJ �'+�+ Al eC�hL c- C4
Existing Site Conditions Summary-
(Additionally, provide information on previous permits, if any, like Grade and Fill, Clear and Grade, topography,
vegetation, drainage, Critical Areas adjacent to the site and how it may affect this project if soils are disturbed,
Soils Type (included in Soils Analysis Report), Erosion Problem Areas, Construction PhasinglSequence)
COL
Version Date: December 19, 2018
TAB 5 (MINIMUM REQUIREMENT #5)
• Minimum Requirement #5— On -site Stormwater Management
All sites are required to utilize BMP T5.13 —Post Construction Soil Quality and Depth.
For each surface, consider the BMP's in the order listed for that type of surface. Use the first BMP that
is considered feasible. No other on -site Stormwater Management BMP is necessary for that surface.
Feasiblity shall be determined by evaluation against:
1. Design criteria, limitations and infeasiblity criteria identified for each BMP in this manual, and;
2. Competing needs criteria listed in Chapter V-5 — On -site Stormwater Management.
Lawn and Landscaped Area:
• BMP T5.13: Post -Construction Soil Quality and Depth. (Attach Detail in Report)
Refer to this site for requirements and specifications. All projects are required to utilize this BMP.
http�//wwwsoilsforsalmon.orolpdf/Soil BMP Manual.pdf
See below for the "Model Soil Management Plan for BMP T5.13" to be submitted with Drainage
Report and Application Material.
Version Date: December 19, 2018
control BMPs are bio-degradable and designed to remain in place following construction such as
compost socks.
❑ Provide protection to all BMPs installed for the permanent control of stormwater from sediment and
compaction. All BMPs that are to remain in place following completion of construction shall be
examined and placed in full operating conditions. If sediment enters the BMPs during construction, it
shall be removed and the facility shall be returned to the conditions specified in the consVuction
documents.
❑ Remove or stabilize trapped sediment on site. Permanently stabilize disturbed soil resulting from
removal of BMPs or vegetation.
ELEMENT 12: Manage the Project —Projects subject to Minimum Requirements 1-9 must have a Certified
Erosion and Sediment Control Lead (CESCL) for site inspections. Projects subject to Minimum Requirements
1-5 do not require the inspector to be certified. By the initiation of consVuction, the SWPPP must identify the
CESCL or inspector, who shall be present on -site or on -call at all times.
❑ Phase development projects to the maximum degree practicable and take into account seasonal work
limits to prevent soil erosion and prevent transporting sediment from the site during construction.
❑ Inspection and monitoring —Inspect, maintain, and repair all BMPs as needed to assure continued
pertormance of (heir intended function.
❑ Maintain, update, and implement the SWPPP.
❑ Clearing and grading activities for developments shall be permitted only 'rf conducted using an approved
site development plan (e.g., subdivision approval).
❑ From Oct 1 through Apr 30, clearing, grading, and other soil disturbing activities is permitted only H
shown that the site operator will prevent silt -laden runoff from leaving the site through a combination of
the following:
1. Site conditions including existing vegetative coverage, slope, soil type, and proximity to
receiving waters.
2. Limit activities and the extent of disturbed areas.
3. Proposed erosion and sediment centrol measures.
Weather conditions can influence the seasonal limitation on site disturbance. The City of Anacortes has
the authority to take enforcement action per AMC 19.76 Stormwater.
❑ The following activities are exempt from the seasonal clearing and grading limitations:
1. Routine maintenance and necessary repair of erosion and sediment control BMPs;
2. Routine maintenance of public facilities or existing utility structures that do not expose the soil or
result in the removal of the vegetative cover to soil
3. Activities where there is 100 % infilVation of surface water runoff within the site in approved and
installed erosion and sediment control facilities.
Version Date: December 19, 2018
ELEMENT 13: Protect Low Impact Development BMPS
❑ If implementing any bioretention facilities or rain gardens, refer to the applicable BMP sections of the
Manual for requirements.
Applicant Signature Date
Version Date: December 19, 2018
PROJECT INFORMATION "Model Soil Management Plan for BMP T5.13" age#_of_pagea
...ho. nAAN:..nnl n
Site Address /Lot No.:
Permit Permit Number:
Permit Holder: Phone:
Mailing Address:
CoataM Perron: Phone:
Plan Pre aredB
ATTACfP1IENT3 REQIIHIED (Check offregvired items that are anoched to this plan)
_Site Plan showing, to scale: _ Areas of undishubed native vegetation (no amendment required) I
_New planting beds and tw-f seas (amendment required)
Tune of soil improvement proposed for each area
Soil teat roaWta (re aired if ro sin custom amendment rates)
ProdaM teat results for ro osed amendments
AREA# (should mvmhAreafk oa Site Plan)
PLANTING TYPE _ Tmf _Undisturbed native vegetation
_Planting Beds Other:
SQUABE FOOTAGE OF THIS AREA: square feet
SCARIPICATION
_inches (depth) of scarification needed to achieve Finished tota112" loosened depth.
_Subsoil will be scarified
PRE -APPROVED
inches of compost or imported topsoil applied
AMENDMENT METHOD:
X 3.1 (conversion factor, inches to cubic yarxis)
PRODUCT:
_Topsoil import
- cu. yards per 1,000 sq. ft.
with compost
X ,000s sq.ft. w this area
_Amend
end amend
cubic yards of amendment -. -. -. -. -+
QUANTITY: CU. YDS.
_Stockpile
u. ds. stoc filed)
(needed to cover this area to deli aced de th
CUSTOM AMENDMENT
Attuh test reaWts and calculations.
Topsoil import
_inches organic matta� or topsoil import
PRODUCT:
_Topsoil &compost lift
X 3 1
_Amend
= at. yards / 1,000 sq. ft.
Stockpile end amend
X ,000s sq.ft. in this azea
_
(_ cu. yds. stockpiled)
_
cubic yards of amendment -. -. -+-� -�
QUANTITY: CU. YDS.
MULCH
,000 sq.ft.
PRODUCT:
X 6_2 (conversion, ro give 2 inch mulch depth)
= wbie yards of mulch -� � -� � -� -�
QUANTITY: CU. YDS.
TOTAL AMENDMENT/TOPSOII/MULCH FOR ALL AREAS com fete on a e 1 an , tatalin al! areas/ a es in this Plan
❑ Product#1: ❑Quantk : cu. da.
Version Date: December 19, 2018
APPENDIX 2 -Model Soil Management Plan for BMP T5.13
Note: Document is provided under Minimum Requirement 5 in this document
Version Date: December 19, 2018
APPENDIX 3 -Determining Construction Site Sediment Damage Potential (Appendix 7 - NPDES Phase
II Permit)
Note: See attached
Version Date: December 19, 201 S
❑ Teat ResWta: % or anic matter C:N ratio <25:1 (exce t mulch, or <35:1 fornative lams) "stable^ es/no
❑ Product #2: ❑ Quantity: cu. yds.
❑ Test Results: % o snit matter C:N raflo <25:1 exce t mulch, or 65:1 for native lants "stabld' s/no
❑ Product #3: ❑Quantity: co. yds.
❑ Teat Results: % o soic matter C:N ratio <25:1 exce t mulch, or <35:1 fornative hots) "stable^ es/no
Date:
InepeMor:
Approved:
Revisions Required:
Date:
Inspector:
Approved:
Revisions RegWred:
APPENDIX 1 —Survey pertormed by a Professional Land Surveyor
Version Date: December 19, 2018
Westerrs Washington Phase77 Starmwater Permit
APPENDIX 7 -Determining Construction Site
Sediment Damage Potential
The following rating system allows objective evaluation of a particular development site's potential to
discharge sediment. Permittees may use the rating system below or develop alternative process
designed to identify site-spec'rfic features which indicate that the site must be inspected prior to clearing
and construction. Any alternative evaluation process must be documented and provide for equivalent
environmental review.
Step one is to determine if there is a sedimenUerosion sensitive feature downstream of the development
site. If there is such a site downstream complete step two, assessment of hydraulic nearness. If there is
a sedimenUerosion sensitive feature and it is hydraulically near the site then go to step three to
determine the construction site sediment transport potential.
STEP 1 — SedimenUErosion Sensitive Feature IdentiPcation
sedimenUerosion sensitive features are areas subject to significant degradation due to the effect of
sediment deposition or erosion. Special protection must be provided to protect them.
sedimenUerosion sensitive features include but are not limded to:
i. Salmonid bearing fresh water streams and their tributaries or freshwater streams that
would be Salmonid bearing if not for anthropogenic barriers;
ii. Lakes;
iii. Category I, II, and III wetlands;
iv. Marine near -shore habitat;
v. Sites containing contaminated soils where erosion could cause dispersal of
contaminants; and
vi. Steep slopes (25% or greater) associated with one of the above features.
Identify any sedimenUerosion sensitive features, and proceed to step two. If there are none the assessment
is complete.
STEP 2 — Hydraulic Nearness Assessment
Version Date: December 19, 2018
Sites are hydraulically near a feature if the pollutant load and peak quantity of runoff from the site will not
be naturally attenuated before entering the feature. The conditions that render a site hydraulically near
to a feature include, but are not limited to, the following:
i. The feature or a buffer to protect the feature is within 200 feet downstream of the site.
ii. Runoff from the site is tight -lined to the feature or flows to the feature through a channel
or ditch.
Flupe s�'!, 20i3 flcd�f�ea Ja�uery'i o, 2C� _ _' � _. _-
Potam`iai Pap.=. 'i of 3
Version Date: December 19, 2018
A site is not hydraulically near a feature if one of the following takes place to provide attenuation
before runoff from the site enters the feature:
iv. Sheet flow through a vegetated area with dense ground cover
v. Flow through a wetland not included as a sensitive feature
vi. Flow through a significam shallow or adverse slope, not in a conveyance
channel, between the site and the sensitive feature.
Identify any of the sediment/erosion sensitive features from step one that are hydreulically near
the site, and proceed to step three. If none of the sedimenUerosion sensitive features are
hydraulically near the site, the assessment is complete.
yij. CTFo 3 —Construction Site Sediment TransooH Potential
Using the worksheet below, determine the total points for each development site. Assign points
based on the most critical condition that affects 10`y or more of the site.
If soil testing has been performed on site, the results should be used to determine the
predominant soil type on the site. Otherwise, soil information should be obtained from the
county soil survey to determine Hydrologic Soil Group (Table of Engineering Index Propefies
for step 1.D) and Erosion Potential (Table of Water Features for step 1.E)
When using the county soil survey, the dominant soil type may be in question, particularly when
the site falls on a boundary between two soil types or when one of two soil types may be present
on a site. In this case, the soil type resulting in the most points on the rating system will be
assumed unless site soil tests indicate that another soil type dominates the site.
Use the point score from Step 3 to determine whether the development site has a high potential
for sediment transport off of the site.
Total Score Trans Ratin
<100
❑100 High
A high transport rating indicates a higher risk that the site will generate sediment contaminated
runoff.
Construction Site Sediment Transport Potential Worksheet
A. Existing slope of site (average, weighted by aerial extent):
Points 2%
or less
>2-5%............................................................................................
>5-10%..........................................................................................15
>10-15%........................................................................................30
>15%.............................................................................................
50
S. Site Area to be cleared and/or railed:
<5,000 sq. ft...................................................................................0
5,000 sq. ft. — 1 acre.....................................................................30
> 1 acres.......................................................................................
50
C. Quantity of cut and/or fill on site:
<500 cubic yards............................................................................0
500 — 5,000 cubic yards...................................................................
5
*5,000—10,000 cubic yards.........................................................10
*10,000 — 20,000 cubic yards.......................................................25
>20,000 cubic yards.....................................................................40
D. Runoff potential of predominant sails Natural Resources Conservation Service):
Hydrologic soil group A..................................................................0
Hydrologic soil group B...................................... .............. .............
1❑
Hydrologic soil group C.................................................................20
Hydrologic soil group D.. ...................................................... ........
40
E. Erosion Potential of predominant soils Unified Classification System): GW,
GP, SW, SP soils............................................................................0
Dual classifications (GW-GM, GP -GM, GW-GC,
GP -GC, SW-SM, SW -SC, SP-SM, SP-SC) ..........................10
GM, GC, SM, SC soils..................................................................20
ML, CL, MH, CH soils.......................................................1..........40
F. Surface or Groundwater entering site identified and intercepted
Yes.................................................................................................
0
No................................................................................................25
G. De th of cut or height of fill >10 feet:
Yes...............................................................................................
25
No..........................................................................................................0
H. Clearinq and grading will occur in the wet season October 1 — May
1): Yes 50
No...........................................................................................................0
TOTALPOINTS.............................................................................................
,
1 If no surface or groundwater enters site, give 0 points.
,qp „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
CtiiP<+e Mailing Address: P.O. Box 547, Anocortes, WA 98221
��/• �'t*' Office Location: 9046th Street, Anacor[es WA 98821
\4� Phone: (360J 293-1901
�• •
1. PROPERTY WHERE WORK IS OCCURRING
DDRE55:
�� �c L9 gcor'�"�5
PARCEL
UMBER(5)
n 316 �
P- �1
2. GENERAL INFORMATION
This form is intended to assist applicants in creating wmplete, code compliant site plans. Please check
the plans you wish to submit to make sure they contain each of the listed items. To the right of the
Requirements column is space for you to list the sheet number of the plan set where the listed
information is shown.
• Minimum Plan Size: 11" x 17" and drawn in an engineering or architectural scale.
3. INFORMATION REQUIRED ON ALL SITE PLANS
PAGE q ON
COMPLETE?
REQUIREMENTS
YOUR PLANS
Cover sheet must contain all of the following:
• Vicinity Map
• Name of the project
• Name, address, and telephone number of owner and agents)
• Name, address, and telephone number of Applicant (if different from
the owner)
• Zoning designation of the site
Area, in square feet and acreage, of the project site
• Reference to the Building Code used
• Proposed use
• Occupancy group
• Construction type
• Square footage and height of each individual building
• Percent lot coverage
• Percentimpervious surfaces
Style and North Arrow
Propertyfeatures:
Location, identification, and dimensions of all property lines and
easements. All easements shown on the title report, Record of
Survey, or plat must be dimensioned and shown.
Location and dimensions of existing critical areas (wetlands, streams,
steep slopes) and their associated buffers.
Location of Ordinary High Water Mark and shorelinejurisdiction IimRs
('rf adjacent to a shoreline).
Existing and proposed contours and site elevations (i.e. finished
grades) at 5-foot minimum increments. The horizontal and vertical
control datum must be clearly shown.
Res. Building Permit Application Submittal Checklist
Updated October S0, 2019
Page 16 of 18
,Ty „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
� c�a Mailing Address: P.O. Box 547, Anacorces, WA 98221
v� �"" Office Location: 904 b'rh Street Anacortes WA 98821
Phone: (360) 293-1901
Structures:
Location, identification, dimensions. and size of all existing and
proposed buildings and other structures.
Location of existing and proposed retaining walls, rockeries, and
Location, identification, and dimensions of all setbacks.
Show proposed projections into required setbacks, including
dimensions (see AMC 19.44.140)
Utilities &Easements:
Location and dimensions of existing and proposed stonnwater,
sanitary sewer, potable water, and fiber lines/facilities. All wells and
septic systems located on or nearthe project site must also be
identified.
Location of all existing and proposed fire hydrants within 300 feet of
the boundary ofthe project site.
Location and dimensions of existing and proposed freestanding
lighting fixtures, utilityjundion boxes, public utility transformers.
Stormwater
Proposed Temporary Erosion and Sediment Control Measures, if not
located on other Ions.
Proposed permanent Stormwater management BMPs.
Access, Circulation &Parking
Location, identification, and dimensions of all existing and proposed
on -site and adjacent streets and alleys, including the location and
dimensions of all existing and proposed curbs, gutters, sidewalks,
median islands, and streettrees.
Show existing and proposed vehicular access to the site, includingthe
size and location of driveways and curb cuts.
Show existing and proposed parking spaces, including surface material
and dimensions of spaces.
Open space (ADUs, Small Lots, and Duplexes)
Show calculations, location, dimensions and provided square footage
of required open space area per AMC 19.43.O10.C, E, orAMC 19.47,
as applicable.
Landscaping
Show the location and design of landscape areas to be preserved and
planted, and a plant list to include the location, number, size and type
of plant material by botanical and common name.
Location of irrigation system if a permanent or temporary system is
ro osed.
Show the location of existing trees to be retained in conformance
with AMC 16.60, and tree protection measures to be implemented,
when applicable.
Fes. Building Permit Appllwtion Submittal Checklist
Updated October 10, 2019
Page 17 of 18
,q y „ PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
t�C.o Mailing Address: P.O. Box 547, Anacortes, WA 98221
�I"c`__"' Office Location: 904 6''t' Street Anacortes WA 98811
�'.g Phone: (360f 193-1901
'� O . '
Provide a maintenance plan for any infihration-based stormwater
best management practices (BMPs) built as part of the landscaping
design, including the specifications and maintenance procedures of
any soil amendments.
Show new trees to be planted and tree unit credit calculations, in
wnformance with AMC 16.60 Tree preservation, when applicable
The following table, with project specific information filled in, must be placed
on the site plan:
Required Landscaping
For Example
Calculations
She Area
7 600 s . ft.
%of she area to be landsoped (per
20%- R2A zone
AMC Tables 19.42.020-.030)
1,600 sq. k. required
1860s .k. rovided
Compliance with AMC Ch. 16.60
Tree unh credits required:
Tree Preservation.
8 tree units required
Tree unit credits retained:
2 trees 6" dbh = 4 tree
unk
credits retained
Tree unh credits provided:
2 new dedduous trees
(min. 2"
caliper @ 6"above ground)
e 2 new evergreen trees
(8' in
hei ht
Number of required street trees
1per 30'of frontage
60 lineal feet of frontage =
3 street
trees
Res. Building Permit Appllwtion submittal Checklist
Updated October 10, 2019
Page 18 of 18
Developed Conditions Summary:
(Additionally, to be shown on the site playa. Identify cut and fill areas, proposed slopes of all hard
surfaces, proposed contours)
Site Sediment Transport Score: ��F-�-dotal Points (High\Low) (See Determining Construction Site
Sediment Damage Potential (Appen Id x 7}
Complete the Applicability Requirements - Flaw Chart (Figure 1-2.4.1 Attached, Figure 1-2.4.2 Attached
and Figure 1-2.5.1 Attache
- Highlight the path and attach
DOE Stormwater Management Manual Minimum Requirements: (MR#1 to MR#5 only).
Refer to the 2012 Department of Ecology Manual, as amended in 2014 for further required information.
Version Date: December 19, 2018
S.tart Here
Does the site have 35%
or more of existing
impervious coverage?
No
Does the project re}sull in
55.000 square feet, or
greater. of new plus
replaced hard surface
area?
Yes
All Minimum Requirements
apply to the new and replaced
hard surfaces and c.orivetled
vegetation areas.
Vos a edevelopment Minims
R iretnents and Flow
C art
(Figure 1-2A.2)-
Does the project convert 3
acres or more of vegetation to
lawn or landscaped areas. or
No cwwe f 2.5 acres or more of
native vegetation to pasture?
Minimum Re-quirements # 1
ihrough #5 apply to thenew Yes
and replaced hard surfaces
and the land disturbed -
No
Does the praiect resu13 iln 2 DOG
sQuare feet, or greater. of new plus
replaced hard su'fac* area?
No
Does the projeci have lard
atsturb ng ac iviuies of 7,000
slzuate flow or
No
Minimum Require3nent #2
,applies.
Figure 1-2.4.1
go Flw-*hart for Determining Requirements for
New Development
DEPARTMENT OF R*vISO JLr.a ; .`:
ECOLOGY Pleas-2 see ftprIwww_ec}-4a.go► topyngnrArm +or eopy1ghtnotice ,ncluing persnsssons.
:'.ate of Washington r^s�3t'or al11ao114. and ClIsclalper.
version uate: uecemoer -s u, zw o
TAB 2 (MINIMUM REQUIREMENT #2)
• 1-2.5.2 Minimum Requirement #2—Construction Stormwater Pollution Prevention Plan (SWPP)
- All projects are required to complete Minimum Requirement 2.
- Refer to the 13 Elements of the SWPP (See document below, complete and attach)
- See attached Table 4.1.1, Table 4.2.1 and Table
- Provide Engineering Calculations as an attachment for Sediment Ponds\Traps, Diversions,
Waterways and Runoff/Stormwater Detention Calculations.
Version Date: December 19, 2018
Tahle a.1_1. Source Control BMP's by SWPPP Element
BMPor Element Name
Element Nt
Preserve
Vegem[bMAarR
L a
✓
Elemem%2
Establisb
Cons[runion
Yccexs
Element YS
6mbilhe
bogs
Element R6
Pmtec[
Bbpas
Ekmenlg9
Conttol
Pollutants
Eknknl Mit
Malnuun
BMPa
Element gl3
Manage the
Projen
Element Ml3
Prokct Law
Impact
BMP C101: Preserving Natural VegetMion
BMP C302: BUFkr Zones
✓
✓
BFIP L'103: Hlgb Nsibirity Plm[k or MaW
Fence
✓
✓
BMP C105: 3mbghed Consvuctlon
Envance lEds
✓
BMP C106: VuheelWssh
✓
BM1IP C302: CanatmUbn HaatllPukkg
Area Stabilization
✓
BMP C120:Temporary entl Pernenent
Beeding
BMP C121: Mukhing
✓
✓
✓
✓
BMP C122: Ilek entl Blankets
✓
✓
BLIP C123: pksgc Covaring
✓
BRIP CIN: Sodding
✓
BAIP CI)5: Topaoilbg/Compw[ing
✓
BMP C126: Polyacrylvrttle for Soil Erasbn
Pmteclion
✓
BMP C130: Burtece goughening
✓
✓
BRIP C1N: Gmdien[Terrecas
✓
✓
BMP L1do: Oust Conval
✓
BMP C160: MakrkH On Hand
✓
✓
BMP C151: Concrete Handing
✓
B hIP C152: SmxulOag entl 6urtacing
Pogulion Prevengon
✓
BMP C153: Maerial Delivery, Storage and
Containment
✓
BMP C156: Concrete Nhshoutdrea
✓
Bb1P Cifi0: Candied Erosion entl
Sediment Control Leatl
✓
✓
BMP C162:6chetluling
✓
Version Date: December 19, 2018
Table 4.2.1 Runoff Conveyance and Treatment BMP's by SWPPP Element
1+3r17e•'rtllkS
Eipmonl 04
Fleu*ni Ai5
el�Itt�ntF Clemt AtttLr
Eiew nl i1KJ
Flormnt#irY
rlemnnt rc�s
13M14 or CA rrontttastr
G4ndroE
lnsLsll
Ptuiurt jj
F�rtrtar' � StaUiEiau
Channals {
Contra{
Contra{ De-
Prolcrt Lc rr
Irrpacf
Icrrr "alas
5�tlirYtent
t:cntrnls
Slopes
I D.ain Inlets +
` land Outiala I
po"Arttx
Wmtrlitrp
]eYnb areal
WFr C700' Irlt*"ptgw [like and SvAle
V,
OOP CM: GrawLtned Channrl,
13+ P CBDT: Channel L1tkrtg
WIAiP C243: Water aar„
V
91i{P C7174: PiF>tr Slope Drains
-
•-
- - -- —�
------- - -
tstHP 1376d: Sulaxurrfsco ixairrs
` �
PirM1i'C20dt 1,@vtr9prr�3c.lcr T— •--
ve
EtrdP C2117. Chock Aar
1
_.___�
_...___-_ .-
_ •- -
PIMP t24#1: 7rlarngularStTl Vifiw (Gparaxiup
L"awd Cheait Dorn)
13MP C209: Out[* It Prntxctian
Ri=its C,2M Sturm Mah, Inlet Protodion
rI
UMP C231: 13ruair Barrier
�
Yf
OOP C232: Crowd f-llWr Fteltn
+�
WOP C233: Silt Fencra
.{
Bh3P C23d: V#gelrt'ad ?iNp
r`
l3FAP c235: Watllus
MAP C236: Ve4itnth-fe Ftltratltan
F3FAPC2IG: 5cdWant Trap
-V
✓
_
13FdP C2lt: TPm{wrary zctirt+en! f}entt
_
_._ f _
--
BFAP C2W Conxlrudian Slnmmater--
C I a it IC k1 Tia Ab lie lit
Stnf C251: CanetzrucU 7n Sttn imutur
NVAion
_
-- —_-_._
_ ._.. __...
_---•
_
131AP C252: Hklh pH NetAratizalfan tHirtp
ry
CO'
$r4P CM, PH Crrrtr0 Far tllgtl pit Vortor
Version Date: December 19, 2018
13 Elements of SWPPP
(Construction Stormwater Pollution Prevention Plan)
Please check off boxes to show that each element has been read and understood. Provide details where
applicable and if certain aspects are unnecessary or exempt, clearly justify. Details of the 13 Elements and the
correlating BMPs are listed Above from the 2014 Stormwater Management Manual for Western Washington
(SWMMWW). A link is provided on the City of Anacortes website, under Planning, Community, & Economic
Development Department, as well as under Stormwater on the Engineering Division of Public Work's page.
r-
Owner Name:
Site Address:
Prepared By: I
The Stormwater checklist or building permit determined that:
The 13 elements must be addressed
for construction activity adding under
2,000 sq. ft. of hard surface area.
❑ These elements must be addressed
for construction activity adding 2,000
sq. ft. or more of hard surface area.
This means that an attached narrative
and site plan are required with this
document.
Under each element, explain the best management practices (BMPs) used or mustify reasonincl for
those that will not be used If needed, please attach a narrative to further explain plans or justification.
ELEMENT 1: Preserve Vegetation/Mark Clearing Limits
Before beginning land disturbing activities, including clearing and grading, clearly mark all clearing
limits, sensitive areas and their buffers, and trees that are to be preserved within the construction area.
'- Retain the duff layer, native top soil, and natural vegetation in an undisturbed state to the maximum
degree practical.
ti `f4 QJC'__ S G I J � i" f_' yLl cc r 1N [_ + C 'e •—
Version Date: December 19, 2018
ELEMENT 2: Establish Construction Access
Z Limit construction vehicle access and exit to one route, if possible.
I- Stabilize access points with a pad of quarry spalls, crushed rock, or other equivalent BMPs, to minimize
tracking onto roads.
Locate wheel wash or tire baths on site, if the stabilized construction entrance is not effective in
preventing tracking sediment onto roads.
If sediment is tracked off site, clean the affected roadway thoroughly at the end of each day, or more
frequently as necessary (ex: wet weather). Remove sediment from roads by shoveling, sweeping, or
pick up and transport the sediment to a controlled sediment disposal area.
Z Conduct street washing only after sediment is removed in accordance with the above bullet.
[Y Control street wash wastewater by pumping back on site or otherwise preventing it from discharging
into systems tributary to waters of the State.
r_,1 S f 1✓� '41C �+ `> �t nI �; � f' 1 l.� -C t,�-.f S' � E�"f-- ,ItiJ' t] "�►�e C � r� `i rF7 —Y �✓ C' O! + •lr.,, c'ri� �'
ELEMENT 3: Control Flow Rates
Protect properties and waterways downstream of development sites from erosion and the associated
discharge of turbid waters due to increases in the velocity and peak volumetric flow rate of stormwater
runoff from the project site.
2( Where necessary to comply with the bullet above, construct stormwater retention or detention facilities
as one of the first steps in grading. Assure that detention facilities function properly before constructing
site improvement (e.g. impervious surfaces).
If permanent infiltration ponds are used for flow control during construction, protect these facilities from
siltation during the construction phase.
p
r t 5 rG AJst
Version Date: December 19, 2018
ELEMENT 4: Install Sediment Controls
Design, install, and maintain effective erosion controls and sediment controls to minimize the discharge
of pollutants.
Construct sediment control BMPs (sediment ponds, traps, filters, etc.) as one of the first steps in
grading. These BMPs shall be functional before other land disturbing activities take place.
0 Minimize sediment discharges from the site. The design, installation and maintenance of erosion and
sediment controls must address factors such as the amount, Frequency, intensity and duration of
precipitation, the nature of resulting stormwater runoff, and soil characteristics, including the range of
soil particle sizes expected to be present on the site.
A Direct stormwater runoff from disturbed areas through a sediment pond or other appropriate sediment
removal BMP, before the runoff leaves a construction site or before discharge to an infiltration facility.
Runoff from fully stabilized areas may be discharged without a sediment removal BMP, but must meet
the flow control performance standard in Element #3, bullet #1.
Locate BMPs. intended to trap sediment on -site in a manner to avoid interference with the movement of
juvenile salmonids attempting to enter off -channel areas or drainages.
Provide and maintain natural buffers around surface waters, direct stormwater to vegetated areas to
increase sediment removal, and maximize stormwater infiltration.
}' Where feasible, design outlet structures that withdraw impounded stormwater from the surface to avoid
discharging sediment that is still suspended lower in the water column.
AJ
ELEMENT 5: Stabilize Soils
�1 Stabilize exposed and unworked soils by application of effective BMPs that prevent erosion. Applicable
BMPs include, but are not limited to: temporary and permanent seeding, sodding, mulching, plastic
covering, erosion control fabrics and matting, soil application of polyacrylamide (PAM), the early
application of gravel base early on areas to be paved, and dust control.
Z' Control stormwater volume and velocity within the site to minimize soil erosion.
Control stormwater discharges, including both peak flow rates and total stormwater volume, to minimize
erosion at outlets and to minimize downstream channel and stream bank erosion.
Soils must not remain exposed and unworked for more than the time periods set forth below to prevent
erosion.
a During the dry season (May 1 — Sept 30); 7 days
o During the wet season (Oct 1 —Apr 30): 2 days
J7 Stabilize soils at the end of the shift before a holiday or weekend if needed based on the weather
forecast.
Stabilize soil stockpiles from erosion, protect with sediment trapping measures, and where possible, be
Version Date: December 19, 2018
located away from storm drain inlets, waterways, and drainage channels.
Minimize the amount of soil exposed during construction activity.
/r] Minimize the disturbance of steep slopes.
X Minimize soil compaction and, unless infeasible, preserve topsoil.
ELEMENT 6: Protect Slopes
,21- Design and construct cut -and -fill slopes in a manner to minimize erosion. Applicable practices include,
but are not limited to, reducing continuous length of slope with terracing and diversions, reducing slope
steepness, and roughening slope surfaces (Ex: track walking).
Divert off -site stormwater (run-on) or ground water away from slopes and disturbed areas with
interceptor dikes, pipes, and/or swal es. Off -site stormwater should be managed separately from
stormwater generated on the site.
11' At the top of slopes, collect drainage in pipe slop drains or protected channels to prevent erosion.
o *Temporary pipe slope drains must handle the peak volumetric flow rate calculated using a 10-
minute time step from a Type 'IA, 10-year, 24-hour frequency storm for the developed condition.
Alternatively, the 10-year, 1-hour flaw rate predicted/indicated by an approved continuous runoff
model, increased by a factor of 1.6, may be used. The hydrologic analysis must use the existing
land cover condition for predicting flow rates from tributary areas outside the project limits. For
tributary areas on the project site, the analysis must use the temporary or permanent project
land cover condition, whichever will produce the highest flow rates. If using the Western
Washington Hydrology Model (VWVHM) to predict flows, bare soil areas should be modeled as
"landscaped" area.
o Where 15-minute time steps are available in an approved continuous runoff model, they may be
used directly without a correction factor.
Place excavated material on the uphill side of trenches, consistent with safety and space
considerations.
j Place check dams at regular intervals within constructed channels that are cut down a slope.
Consider soil types and its potential for erosion.
f� Stabilize soils on slopes, as specified in Element 5.
BMP combinations are the most effective method of protecting slopes with disturbed soils. Ex: Use both
mulching and straw erosion !control blankets.
I0 41 e cry +7..5 I A - --
Version Date: December 19, 2018
ELEMENT 7: Protect Drain Inlets
2� Protect all storm drain inlets made operable during construction so that stormwater runoff does not
enter the conveyance system without first being filtered or treated to remove sediment.
Clean or remove and replace inlet protection devices when sediment has filled one-third of the available
storage (unless a different standard is specified by the product manufacturer).
Where possible, protect all existing storm drain inlets so that stormwater runoff does not enter the
conveyance system without first being filtered or treated to remove sediment.
,7 Keep all approach roads clean. Do not allow sediment and street wash water to enter storm drains
without prior and adequate treatment unless treatment is provided before the storm drain discharges to
waters of the State.
J Inlets should be inspected weekly at a minimum and daily during storm events.
ELEMENT 8: Stabilize Channels and Outlets
Design, construct, and stabilize all on -site conveyance channels to prevent erosion from the following
expected peak flows:
o *Channels must handle same peak volumetric flow rate as temporary pipe slope drains listed in
Element 6, above.
ez Provide stabilization, including armoring material, adequate to prevent erosion of outlets, adjacent
streambanks, slopes, and downstream reaches at the outlets of all conveyance systems.
Yl The best method for stabilizing channels is to completely line the channel with a blanket product first,
then add check dams as necessary to function as an anchor and to slow the flow of water.
" ,-J a (
Version Date: December 19, 2018
ELEMENT 9: Control Pollutants
Design, install, implement, and maintain effective pollution prevention measures to minimize the
discharge of pollutants.
Handle and dispose of all pollutants, including waste materials and demolition debris that occur on -site
in a manner that does not cause contamination of stormwater.
Provide cover, containment, and protection from vandalism for all chemicals, liquid products, petroleum
products, and other materials that have the potential to pose a threat to human health or the
environment. On -site fueling tanks must include secondary containment. Secondary containment
means placing tanks or containers within an impervious structure capable of containing 110 % of the
volume contained in the largest tank within the containment structure. Double -walled tanks do not
require additional secondary containment.
�1 Conduct maintenance, fueling, and repair of heavy equipment and vehicles using spill prevention and
control measures. Clean contaminated surfaces immediately following any spill incident.
� Discharge wheel wash or fire bath wastewater to a separate on -site treatment system that prevents
discharge to surtace water, such as closed -loop recirculation or upland land application, or to the
sanitary sewer, with local sewer district approval. Wheel wash or fire bath wastewater should not
include wastewater from concrete washout areas.
Apply fertilizers and pesticides in a manner and at application rates that will not result in loss of
chemical to stormwater runoff. Follow manufacturers' label requirements for application rates and
procedures.
fX' Use BMPs to prevent contamination of stormwater runoff by pH -modifying sources. The sources for this
contamination include, but are not limited to: bulk cement, cement kiln dust, fly ash, new concrete
washing and curing waters, waste streams generated from concrete grinding and sawing, exposed
aggregate processes, dewatering concrete vaults, concrete pumping, and mixer washout waters. Adjust
the pH of stormwater if necessary to prevent violations of the water quality standards.
Assure that washout of concrete trucks is performed off-sde or in designated concrete washout areas
only. Do not wash out concrete trucks onto the ground, or into storm drains, open ditches, streets, or
streams. Do not dump excess concrete on site, except in designated concrete washout areas. Concrete
spillage or concrete discharge to surtace waters of the State is prohibited. Do not use upland land
applications for discharging wastewater from concrete washout areas.
Obtain written approval from Ecology and provide to the City before using chemical treatment other
than CO2 or dry ice to adjust pH.
,d�`' Woody debris may be chopped and spread on site.
PI Conduct oil changes, hydraulic system drain down, solvent and de -greasing cleaning operations, fuel
tank drain down and removal, and other activities which may result in discharge or spillage of pollutants
to the ground or into stormwater runoff using spill prevention measures, such as drip pans.
�l' Clean contaminated surfaces immediately following any discharge or spill incident. Emergency repairs
may be performed on -site using temporary plastic placed beneath and, if raining, over the vehicle.
Version Date: December 19, 2018
ELEMENT 10: Control De -Watering
PJ' Discharge foundation, vault, and Vench dewatering water, which have characteristics similar to
stormwater runoff at the site, into a conNolled conveyance system before discharge to a sediment Vap
or sediment pond.
.�'� Discharge clean, non -turbid de -watering water, such as well -point ground water, to systems Vibutary to,
or directly into surface waters of the State, as specified in Element 8, provided the de -watering flow
does not cause erosion or Flooding of receiving waters or interfere with the operation of the system. Do
not route clean dewatering water through stormwater sediment ponds. Note that "surface waters of the
State" may exist on a construction site as well as off site; for example, a creek running through a site.
Handle highly turbid or contaminated dewatering water separately from stormwater.
Other treatment or disposal options may include:
1. Infiltration
2. Transport off -site in a vehiGe, such as a vacuum flush Vuck, for legal disposal in a manner that
does not pollute state waters.
3. Ecology -approved on -site chemical treatment or other suitable treatment technologies.
4. Sanitary or combined sewer discharge with local sewer district approval, if there is no other
option.
5. Use of a sedimentation bag with outfall to a ditch or Swale for small volumes of localized
dewatering. -
7i Construction equipment operation, clamshell digging, concrete tremie pour, or work inside a cofferdam
can create highly turbid or contaminated dewatering water.
� Discharging sediment -laden (muddy) water into waters of the State likely constitutes a violation of water
quality standards for turbidity. The easiest way to avoid discharging muddy water is through infiltration
and preserving vegetation.
hJo dew4-f�r,;,a onJ S� �t
ELEMENT 11: Maintain BMPs
Maintain and repair all temporary and permanent erosion and sediment control BMPs as needed to
assure continued pertormance of their intended function in acwrdance with BMP specifications.
� Remove all temporary erosion and sediment control BMPs within 30 days after achieving final site
stabilization or after the temporary BMPs are no longer needed. Some temporary erosion and sediment
Version Date: December 19, 2018
GYT Y O.v /
City of AnacorEes Application for al q',�i
ENCROACHMENT TEMPORARY INTO
�'1�'�' PUBLIC RIGHT OF WAY OR PUBLIC EASEMENT q p -W p
Street Address of Proposed Encroachment �� (� t� k u � J < A� cor")'c s
Name of Property Owners) as they appear on the pr'o�perty deed. A1copy of the Property Deed
must be submitted with application. (Please print) I L�S e /' lJ 1 � S � B Q
Appltcant(s) Nnme��og cr I J,� 1 � S Phone 3 6D - 6 tD � 6 � �3
E-mail address �c��4.+a cc a..a,'Oz �4w+s�Y .e.o .a
(Please Prht) /
Mailing Address: �b13 S /��`' S7 Mop-c.-/�- �ef�oN r,.7A ��Z7�
Legal description of property, be specific and attach proper deed with complete description.
Include Parcel Number. L�I (S pc, kc s Ayr � 31 67 q
Please give a detailed crpoof the proposed encroachment. Include the
dimensions of the encroa'ET."
hment off of your property line and into the City right of way.
Use additional sheet if 1necessary. //
E4�II eP7'JI sNhfGSs�P�'S"r.�i i'u P_YL5 /'�"N>r—T� f
DIJ EXIsSTiNC tl1r,�tlf sJ51
Revised 6Yt6/2018
NOTII�'ICAfIONS: Please include names and mailing addresses of Property Owners in the
block adjacent to the encroachment. For ENCROACHMENTS INTO OPENED OR
UNOPENED ALLEYS. Please include names and mailing addresses of Property Owners in
the block abuttin('g the street or alley right-of-way to be encroached upon p
P,nr� Dt AwJ�icar'-}cs Kld Ccw,.r-,crc.��,l A�< Nnf4cov�Cs
Pc.�f•�cie. S�e�oL..eNs �i3oS ee,S�.�✓,'c..� e�• /�n�vc�ri-es
Reason for proposed encroachment:
'e CiS ,� qrr Sc P_45P rw e'uJT
PLEASE NOTE: It can take up to two months to complete the Encroachment Application
process. �7
Certification: I, C_ os rr L.) ,' I) s > as the applicant for this permit, do
hereby declare that I a the legal owner of the property adjoining the City right -of --way for
which I am requesting use. .I
Dated this Zy �'� day of A c, s -i- yeaz Z_� Z [.�
Signature ofApplicant(s)
� /..%,t..t- Date fS -Z `�-2 d
If you have any questions regarding the process of your application contact:
Steven Lange
Engineering Division
904 6th Street
Anacortes, WA 98221
Telephone (360) 299-198 Faa (360) 293-1938
Please submit complete application with payment to:
Anaeortes Ci[y Hall
Finance Dept.
PO Box 547
904 6`" Street
Anacortes, WA 98221
Telephone (360) 293-1919 Fax (360) 293-1938
Revised fi/26/2018
For Office Use Onlv
Anolication Submittal
� $100.00 Application Fee Paid. Receipt No. Date. �
Distributed [o Applicant and Abutting Property Owners Date
Notification of Proposed Encroachment and Tentative Decision Mailed
(15 calendar day appeal period to City Council)
End of Appeal Period Date
Decision: Encroachment Approved ❑
Encroachment Disapproved ❑
Date Decision is Final Date
(signature)
A eats:
Appellant Name Phone:
$50.00 Appeal Fee Paid: Receipt No. Date:
EncroachmentA eementProcess
Agreement to Applicant for Signature: Date:
Sent For Recording: Date:
Distributed To Finance, Engineering, Building, Operaflons Date
Rcised 6R62018