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Home My WebLink AboutGRD97-0015 - GRD Permit / Conditions - 7/30/1997 • GRD4��I� MASON COUNTY LAND MODIFICATION PERMIT Grading,Excavation,Fill, Slopes,Drainage Departent of General Services 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner Mery Settle Phone# 360-426-9763 Fire District # Site Address_W 1401 Deegan Road E. City_Shelton State WA Zip_98584_ Owner Address same as above City State Zip Describe Work Remove fill from wetland areas and restore with native vegetation. #2 Contractor Name Mery Settle Contractor Reg# Address see above Expiration Date City State Zip Phone #3 Engineer Name Phone Address City State Zip #4 Parcel No. 42024 - 43 -_00100_ Legal Description see attached site plan #5 Number of cubic yards to be excavated_approximately 200 Number of cubic yards to be filled none Number of cubic yards to be graded #6 Will this be a balanced cut and fill entirely within the site? 0 Yes 0 No If no: Will fill be brought on-site? O Yes O No Where does imported fill orginate from? purchased from supplier(topsoil=Nutramulch® Does fill contain any potentially hazardous materials? 0 Yes O No _Existin fig 11 ma�have some hazardous materials: nature unknown. #7 Will excavated materials be taken off-site? 13 Yes 0 No If yes: Where will excavated materials be taken? 8271perm 1 #8 Briefly describe existing terrain, vegetation, and improvements on subject site? Moderately steep slopes from east to west, steepest in the east becoming gentler toward the west. #9 Total size of area to be cleared N/A acres/square feet. Size of area to be cleared on slopes over 10% acres/square feet #10 Has a soils report been completed on the subject site? O Yes 0 No If yes, include copy with application. #11 Is the subject site within 200 feet of a designated shoreline? O Yes 0 No #12 Does the subject site contain any of the following features? O River O Lake 0 Wetlands O Saltwater O Slopes greater than 15% O Soft compressible soils 0 Seasonal runoff 0 None #13 Will the proposed land surface modification change the points where storm water or ground water enters or exits the site? 0 Yes O No Springs will be collected and directed into wetland (currently springs are directed into wetlandl. #14 Will the proposed land surface modification change the quality, quantity, or velocity of storm water or groundwater? 0 Yes O No Storm water runoff will be increased when RV Park is developed. #15 What methods, if any, will be utilized to minimize erosion and possible sedimentation into nearby waters during and after construction? —BMPs to prevent sediments from entering,wetland during construction, detention and biofiltration will be used to process runoff from roads and parking areas. #16 Will this land modification result in the redirection of any surface water runoff onto adjacent properties? O Yes 0 No #17 Will surface or subsurface runoff be collected or controlled by interceptors, curtain drains, or other water collection devices once this land modification has been completed? _Existing collection/control devices in place. #18 Will the land be replanted upon completion? 0 Yes O No If yes, with what types of plants? Restoration with native shrubs and trees proposed. #19 Will this modification result in slopes steeper than those currently on the site? O Yes 0 No If so, how steep? 8271perm 2 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON RCW 18.27, AND AM AWARE OF THE MASON COUNTY AND I AM AWARE OF ORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS FOR WHICH THIS PER- REGULATING THE WORK FOR WHICH THE PERMIT MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM BE MADE WITHOUT FIRST OBTAINING APPROVAL THE BUILDING DEPARTMENT. FROM THE BUILDING DEPARTMENT. X OWNER X BY DATE DATE PROGRESS INSPECTION. FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW Planning APP COND APP HOLD Building Environmental Other Special Conditions FEES Grading Permit $ Plan Review Site Inspection Violation Fee Other TOTAL FEES $ 8271perm 4 lShow following on the site plan Lot Dimensions Flood Zones Existing Structures Fences NDXT-f Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street APPLICANT TO DRAW SITE PLAN BELOW 1 Nor,i wEzN WHL`iZE kV UNITS waticc �, i r� � � NOl' TD ScAc.E.,- 'A T i � ST—t- 1 ff— C -T— X, Q / -7- �_ o _7r_ ,__ , l- APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW � J,l o f '7 V S G R L C--,YF �- .UEE GA N IW 4 I o Ex�ST1N6 HOSE � iYD &X�STIh((y�1 1Zo W E'n A N l7 1 %o 1 Hw`( Jo l NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED ` WITHIN 180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS IN- SPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANC� REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE FOR OFFICIAL USE ONLY:Accepted by: Date: DEPARTMENTAL REVIEW Planning APP COND APP HOLD Building Environmental Other Special Conditions FEES Grading Permit $ Plan Review Site Inspection Violation Fee Other TOTAL FEES $