HomeMy WebLinkAboutGRD2016-00010 73.51 acres - GRD Application - 6/22/2016 pN Co
Aa ` MASON COUNTY PERMIT NO6CJ2aJL0OIC�
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING• FIRE MARSHAL
WWW.CO.MASON.WA.lJS (360)427-9670 Shelton ext.352
Mason County Bldg. III, 426 West Cedar Street (360)275-4467 Belfair ext.352
PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
LAND MODIFICATION PERMIT
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:NORTH MASON SCHOOL DISTRICT NO.403 NAME: TBD
MAILING ADDRESS:71 E CAMPUS DRIVE MAILING ADDRESS:
CITY:BELFAIR STATE:WA ZIP:98528 CITY: STATE: ZIP:
PHONE:(360) 277-2300 CELL: PHONE: CELL:
EMAIL:drosenbacht-northmasonschools.org EMAIL :
eric@hainline.net L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 1220 - OOOO, -360010 & -260000 FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATBD) SECTION 8.TOWNSHIP 2' W1 R1W. W.M. MASONZ:NTY
SITE ADDRESS 75 E. CAMPUS DRIVE CITY BELFAIR
DIRECTIONS TO SITE ADDRESS Near the intersection of State Route 3 and State Route 302
IS PROPERTY WITHIN 200 FT: NO
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YESR'NO❑
WILL TIMBER BE CUT AND SOLD IN PARCEL PREPARATION? YES [� NO❑
TYPE OF JOB: EXCAVATION M' FILLING V GRADING Q' CUTTING V OTHER ❑
TOTAL SIZE OF PARCEL 73.51 ACRES/SQ FT SIZE OF AREA TO BE EFFECTED 9.3 AC ACRES/SQ FT
ESTIMATED AMOUNTY OF CUBIC YARDS TOTAL CUT=23,700 CY*/TOTAL FILL=21,400**CY
*IMPORT FROM HIGH SCHOOL STOCKPILE: 9 700CY / **EXPORT OF ORGANIC RICH FILL: 12,000 CY
DOES THE SITE HAVE SLOPES 14%OR GREATER YESRr NO❑
DESCRIBE SCOPE OF WORK REDESIGN AND CONSTRUCTION OF SITE WORK INCLUDING STORM,WATER AND
DRY UTILITIES.A NEW HOME AND VISITOR GRANDSTAND, TRACK AND CONCESSION BUILDING.
WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS:Yes-From on-site stockpile near High School
WILL EXCAVATED MATERIAL BE TAKEN OFF SITE?IF YES,SITE ADDRESS:Yes-Organic Rich Fill (location
DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? undetermined) YES ❑ NO p'
HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES VNO ❑
WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER RUNOFF? YES&rNO❑
WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES❑ NO V
WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES❑ NO&r
WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES VNO ❑
WILL THE LAND BE REPLANTED UPON COMPLETION? YES VNO❑
WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES hir NO❑
IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES❑ NO vCf
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative,or contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection.This permittapplication becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x <;-�-LZ-I-Z=.
Sicj6atup4f Applicant Date
X Raym Mow OWNER/REPRESENTATIVE/CONTRACTOR
Print Rame (CIRCLE TO INDICATE)