2013, 03-13 Permit App: EGR-2013-0005ScOT"Fkarie
munity Development Department
rmit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter(cl�,spokaneval ley. org
(Staff Use Only)
PERMIT No.:
CHECKLIST?: DY ❑N INIT:
LAND DISTURBANCE PERMIT APPLICATION
STAFF USE :
0 ENGINEERED GRADING
0 REGULAR GRADING
0 GRUBBING & CLEARING
APPLICANT USE :
SITE ADDRESS:
122 N. FARR RD.
„ ,c - Z413,000g-
ASSESSORS PARCEL NO.: 45173.1017
APPLICANT NAME: CHRIS M. CLARK
PHONE: (208)665-9502
EMAIL: CCLARK@TRISTATEID.COM
SUB #
CONTACT NAME (Z SAME AS APPLICANT):
PHONE:
CELL: (208)290-7375
EMAIL:
CELL:
PROPERTY OWNER NAME: JUDY WERRE, SILVER FOX GROUP LLC
MAILING ADDRESS: 3465 S. WALKERS BAY RD.
CITY: COEUR D'ALENE
PHONE: (208)660-3850
0 CHECK IF APPLICANT
STATE: ID
zIP: 83814
EMAIL:
JUDY@JUDYWERRE.COM CELL: (208)660-3850
CONTRACTOR NAME: (0 TBD): BIG SKY DEVELOPMENT
MAILING ADDRESS: 10063 N. NAVION DR.
CITY: HAYDEN
0 CHECK IF APPLICANT
STATE: ID
ZIP: 83835
PHONE: (208) 772-9646
STATE LIC. NO.:
EMAIL:
CELL:
EXPIRES:
UBI:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
INSTALLATION OF 300LF OF 8" SANITARY SEWER WITH 4" SERVICES TO 8' LOTS, 310LF 8" WATER MAIN TO REPLACE
EXISTING 4" MAIN WITH 1" SERVICES TO 8 LOTS, AND A 577SF SWALE WITH A SINGLE DEPTH DRYWELL. ALSO, 140LF OF
FRONTAGE IMPROVEMENTS WITH CURB, SWALE, AND SIDEWALK.
ESTIMATED QUANTITIES (CUBIC YD): CUT:
IF CUT, PROVIDE DESTINATION OF SOIL:
START DATE: MARCH 2013
J ! v
Signature:
DE -02/ V-3/ 6-22-12
499 YDS FILL: 000 YDS
TO BE SPREAD OVER THE LOTS THAT USE THE PRIVATE ROAD FOR ACCESS
ESTIMATED COMPLETION DATE: AUGUST 2013
3 Dat) 3/) 013
/20
Page 2 of 2
•
..o•OVauey
LAND DISTURBANCE (LD)
ERMIT CHECKLIST
For Grading, Clearing and Grubbing work outside the Right -of -Way (ROW)
(Work within the ROW needs a ROW permit)
Permit Center o 11703 E Sprague Ave Suite B-3 0 Spokane Valley WA 99206
509.688.0197 • Fax: 509.688.0037 • permitcenter@spokanevalley.org
=umom:,.umg.
Project Address: 122 N. Farr Rd. Today's Date: 03/13/13
Project Description: 8 Lot Short Plat: Private road and turnaround with water, sewer, and storm water improvements
Signature:
Print Name: Chris M. Clark
The purpose of this checklist is to gather information about the proposed project so to determine what land disturbance
permit, if any, is required by the Spokane Valley Municipal Code.
Starting with Part 1 and working from top to bottom, please answer the following questions.
The first "Yes" identifies the type of land disturbance (LD) permit required.
PART 1— Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed.
❑ Yes ® No Does your project only have to do with emergency utility work; cemetery graves; eliminating septic
tanks; digging out a basement; building a wall less than 4 feet high; disposal of refuse that is covered
under other regulations; already permitted mining, quarrying, stockpiling of aggregate material (rock,
sand, gravel, aggregate, or clay) or exploratory excavations done under the direction of a licensed
engineer or engineering geologists? If yes, then project exempted from a LD permit.
PART 2 — Engineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer)
® Yes ❑ No Will this grading be for a short plat, subdivision or binding site plan?
❑ Yes ® No Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife habitat
conservation area or geologically hazardous area?
❑ Yes ® No Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes then a
SEPA environmental checklist will need to be submitted for review)
❑ Yes ® No Will the grading create a base or support for a permanent structure?
❑ Yes ® No Will the grading be for a driveway that is longer than 150 feet?
❑ Yes ® No Will any grading occur in a drainage channel or be for a water feature (like a perennial or intermittent
pond) with a surface area greater than 500 square feet?
❑ Yes ® No Will this grading result in the addition or replacement (excluding pavement maintenance) of 5,000
square feet or more of impervious surfaces or the disturbance of 1 acre or more land or the
construction of new drywells or other underground injection control (UIC) facilities?
❑ Yes ® No Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2 %2 feet?
❑ Yes ® No Will any excavations or fills have slopes at 10:1 (H:V) or steeper and heights greater than 4 feet?
PART 3 — Regular Grading Permit needed? (SVMC 24.50.040; 1 set of plans showing grading and temporary
erosion and sediment control; does not require engineering)
® Yes ❑ No Will the volume of excavation or fill be over 50 cubic yards on any one lot?
❑ Yes ® No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet?
❑ Yes ® No Will any fills have slopes at 2:1 (H:V) or steeper or heights greater than 2 feet?
PART 4 — Grubbing and Clearing (G&C) Permit needed? (SVMC 24.50.050; 1 set of plans showing G&C and
temporary erosion and sediment control; does not require engineering)
® Yes ❑ No Will the G&C work disturb 5,000 or more square feet of area or remove 7 or more trees? (Note that
forest practices overseen by DNR or commercial agriculture are exempt)
n Yes ® No Will there be any clearing on slopes or near/in FEMA floodplains, wetlands, wetland buffers, Fish
and Wildlife habitat conservation areas, geologically hazardous areas or erodible soils?
If the answers to all of the questions above are "No" then a permit is not required for the proposed work
Page 1 of 2
DE -02/ V-3/ 6-22-12
*Wane
Valleyk
ommunity Development Department
ermit Center
11703 East Sprague Avenue. Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter@snokanevallev.org
rill
(Staff Use Only)
PERMIT NO.:
HECKLIST?: Dv ❑ N INIT:
LAND DISTURBANCE PERMIT APPLICATION
1
STAFF USE :
❑ ENGINEERED GRADING
0 REGULAR GRADING ❑ GRUBBING & CLEARING
APPLICANT USE :
SITE ADDRESS:
122 N. FARR RD.
ASSESSORS PARCEL NO.: 45173.1017
APPLICANT NAME: CHRIS M. CLARK
PHONE: (208)665-9502 EMAIL: CCLARK@TRISTATEID.COM CELL: (208)290-7375
CONTACT NAME (® SAME AS APPLICANT):
PHONE: EMAIL:
CELL:
PROPERTY OWNER NAME: JUDY WERRE, SILVER FOX GROUP LLC ❑ CHECK IF APPLICANT
MAILING ADDRESS: 3465 S. WALKERS BAY RD.
CITY: COEUR D'ALENE STATE: ID zrP: 83814
PHONE: (208)660-3850 EMAIL: JUDY@JUDYWERRE.COM CELL: (208)660-3850
CONTRACTOR NAME: (® TBD): 0 CHECK IF APPLICANT
MAILING ADDRESS:
CITY:
C -zD!3-ODDS'
STATE: ZIP:
PHONE:
EMAIL: CELL:
STATE LIC. NO.:
EXPIRES: UBI:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
INSTALLATION OF 300LF OF 8" SANITARY SEWER WITH 4" SERVICES TO 8 LOTS, 310LF 8" WATER MAIN TO REPLACE
EXISTING 4" MAIN WITH 1" SERVICES TO 8 LOTS, AND A 577SF SWALE WITH A SINGLE DEPTH DRYWELL. ALSO, 140LF OF
FRONTAGE IMPROVEMENTS WITH CURB, SWALE, AND SIDEWALK.
ESTIMATED QUANTITIES (CUBIC YD): CUT: 485 YDS FILL: 000 YDS
IF CUT, PROVIDE DESTINATION OF SOIL: TO BE SPREAD OVER THE LOTS THAT USE THE PRIVATE ROAD FOR ACCESS
START DATE: MARCH 2013] ESTIMATED COMPLETION DATE: AUGUST 2013
/ /d /20/3
Signature: Date
DE -02/ V-3/ 6-22-12 Page 2 of 2
Spokane
Valley
•
✓u5r. (3 • 05
LAND DISTURBANCE (L PERMIT CHECKLIST
For Grading, Clearing and Grubbing work outside the Right -of -Way (ROW)
(Work within the ROW needs a ROW permit)
Permit Center 0 11703 E Sprague Ave Suite B-3 0 Spokane Valley WA 99206
509.688.0197 ♦ Fax: 509.688.0037 ♦ permitcenter@spokanevalley.org
Project Address: 122 N. Farr Rd.
Today's Date: 02/11/13
Project Description: � 8 Lot Shgrt Plat: Private road and turnaround with water, sewer, and storm water improvements ,
Signature: /1"1
`
Print Name: Chris M. Clark
The purpose of this checklist is to gather information about the proposed project so to determine what land disturbance
permit, if any, is required by the Spokane Valley Municipal Code.
Starting with Part 1 and working from top to bottom, please answer the following questions.
The first "Yes" identifies the type of land disturbance (LD) permit required.
PART 1 — Is LD work exempted or already covered? (SVMC 24.50.020) If so then LD permit not needed.
❑ Yes ® No Does your project only have to do with emergency utility work; cemetery graves; eliminating septic
tanks; digging out a basement; building a wall less than 4 feet high; disposal of refuse that is covered
under other regulations; already permitted mining, quarrying, stockpiling of aggregate material (rock,
sand, gravel, aggregate, or clay) or exploratory excavations done under the direction of a licensed
engineer or engineering geologists? If yes, then project exempted from a LD permit.
PART 2 — Engineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer)
® Yes ❑ No Will this grading be for a short plat, subdivision or binding site plan?
❑ Yes ® No Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife habitat
conservation area or geologically hazardous area?
❑ Yes ® No Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes then a
SEPA environmental checklist will need to be submitted for review)
❑ Yes ® No Will the grading create a base or support for a permanent structure?
❑ Yes ® No Will the grading be for a driveway that is longer than 150 feet?
❑ Yes ® No Will any grading occur in a drainage channel or be for a water feature (like a perennial or intermittent
pond) with a surface area greater than 500 square feet?
❑ Yes ® No Will this grading result in the addition or replacement (excluding pavement maintenance) of 5,000
square feet or more of impervious surfaces or the disturbance of 1 acre or more land or the
construction of new drywells or other underground injection control (UIC) facilities?
❑ Yes ® No Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 2 '/2 feet?
❑ Yes ® No Will any excavations or fills have slopes at 10:1 (H:V) or steeper and heights greater than 4 feet?
PART 3 — Regular Grading Permit needed? (SVMC 24.50.040; 1 set of plans showing grading and temporary
erosion and sediment control; does not require engineering)
® Yes ❑ No Will the volume of excavation or fill be over 50 cubic yards on any one lot?
❑ Yes ® No Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet?
❑ Yes ® No Will any fills have slopes at 2:1 (H:V) or steeper or heights greater than 2 feet?
PART 4 — Grubbing and Clearing (G&C) Permit needed? (SVMC 24.50.050; 1 set of plans showing G&C and
temporary erosion and sediment control; does not require engineering)
Z Yes ❑ No Will the G&C work disturb 5,000 or more square feet of area or remove 7 or more trees? (Note that
forest practices overseen by DNR or commercial agriculture are exempt)
❑ Yes ® No Will there be any clearing on slopes or near/in FEMA floodplains, wetlands, wetland buffers, Fish
and Wildlife habitat conservation areas, geologically hazardous areas or erodible soils?
If the answers to all of the questions above are "No" then a permit is not required for the proposed work
DE -02/ V-3/ 6-22-12 Page 1 of 2