2012, 06-05 Permit App: RGR-2012-0004 Land Disturbancei
Siiokane
j�alle3'.
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 720-5240
Fax: (509) 688-0037
permitcenter@sl okanevallev.orq
(Staff Use Only)
PERMIT No.:
CHECKLIST?: DV ON INIT:
LAND DISTURBANCE PERMIT APPLICATION
STAFF USE :
❑ ENGINEERI-sj? GRADING
i
❑ REGULARZGPADIPd3 j 1f (_ 7 : -1 ❑ GRUtiBINc3 A CLEARING
APPLICANT USE :
SITE ADDRESS: •
t r { (1
ASSESSORS PARCEL NO.:
lir cj. 1 r
APPLICANT NAME:
RECEIVED
JUN 0.5 2012
PHONE: EMAIL:
CONTACT NAME (0 SAME AS APPLICANT):
CELL: CSV PERMIT CENTER
SUB#I 1 i REV.#
PHONE: EMAIL:
CELL:
PROPERTY OWNER NAME: ax --c---) �j,- ✓1
MAILING ADDRESS: LI -3D S 20 ndir a r •
rnqo IG a e Vct 1 11✓�
PHONE: J�/ l t ''j 7 ) EMAIL:
CITY:
CONTRACTOR NAME: (0 TBD):
0 CHECK IF APPLICANT
STATE: WPI -
CELL:
ZIP: 6/9i (p^�
c01 L- l
0 CHECK IF APPLICANT
MAILING ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
EMAIL:
CELL:
STATE LIC. NO.:
EXPIRES:
UBI:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
ESTIMATED QUANTITIES (CUBIC YD): CUT: '2p . o G( FILL:
IF CUT, PROVIDE DESTINATION OF SOIL: 61-i77 - 5"
START DATE: _ z- /2___ ESTIMATED COMPLETION DATE:
/ /20
Updated March 2011
\\SV-FS2\Public Folders\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Land Disturbance Permit & Checklist 3-
29-11.doc
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LAND DISTURBANCE (LD) PERMIT CHECKLIST
For Grading, Clearing and Grubbing work outside the Right -of -Way (ROW)
(For work within ROW need a ROW permit)
Permit Center ♦ 11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206
509.688.0197 ♦ Fax: 509.688.0037 ♦ permitcenter®spokanevalley.org
Project Address: 143o4 S POAd V C% Pr Today's Date: .6- OS --12...
Project Description:
Signature: Print Name: \(y (j -h - and v/i
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 allo Does your project only have to do with emergency utility work; cemetery graves; eliminating
septic tanks; digging out a basement; building a wall Tess 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 — E aineered Grading Permit needed? (SVMC 24.50.030; 2 sets plans, calcs etc. from Engineer)
❑ Yes o 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 )Z( 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 ,Ero Will the grading create a base or support for a permanent structure?
❑ Yes is o Will the grading be for a driveway that is longer than 75 feet?
❑ Yes ri 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 FrNo 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'/
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)
❑ YesNo Will the volume of excavation or fill be over 50 cubic yards on any one lot?
El 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)
❑ Yes JNo 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.
S�Skane
jUalley.
For requirements, see
Spokane Valley Municipal Code
Chapter 24.50
LAND DISTURBING ACTIVITIES
Permit Number:
Parcel Number:
Today's Date:
Street Address:
Property owner:
Applicant:
Plan Preparer:
Onsite Contact:
1) For Regular Grading or Grubbing and Clearing:
of buildings and
diameter at breast
tree protection
— show on site plan:
detail)
street to keep dirt
out
A) Show on the site plan:
before
of all trees
and a description
during
sediment control
portions of
structures onsite
example)
trucks will
North:
A Adjacent or nearest streets
* Footprints
structures
■ Property boundaries
Boundary of work area
* Known utilities
work begins
8 -inches in
of the
construction.
(TESC)
project (see
or in the
get washed
• Arrows pointing downslope
■ The approximate location
height (dbh) and larger,
standards to be implemented
B) Temporary erosion and
• Silt fence at downslope
• Protection of drainage
from getting in (see detail
• Locations where concrete
2) For Regular Grading, additionally show an the site plan:
■ Arrows pointing to what
will be downslope
are cut and
of maximum:
feet
after work is done
which are fill
• Delineate which areas
■ What is the vertical height
• Cut slope
• Fill slope feet
Note:
and sediment control measures shall be
or grubbing and clearing begins and these
maintained for the extent of the project,
and repair as needed. The applicant is
all soil on the project site and adding other
to accommodate changing or unexpected site
adjacent to the construction access route(s) at
sediment has been tracked off site then
drainage structures) is required.
protect adjacent properties, control dust and
related debris to an approved waste disposal
• All erosion prevention
installed before grading
measures need to be
including replacement
responsible for confining
measures as necessary
and weather conditions.
• Inspect all roadways
the end of each day. If
cleaning (streets and
• The Contractor shall
remove all construction
site.
CALL 2 BUSINESS DAYS BEFORE YOU DIG
811 OR 1-800-424-5555
Regular Grading or Grubbing and Clearing - Site Plan
Arrow Pointing to
North:
OJT5)
Project
#
2
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RECEIVED
JUN
052012
SUB
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Circle Scale used:
T
City Use Only -
-,' —,5--/Z..____
1" x 1" Grid
Reviewed for completeness by: Date:
1"=10' 1"=20' 1"=30' 1"=40' 1"=50' 1"=60' 1"= 100'
,ii
Silt Fence Detail
Inlet Protection Example
Joints in filter fabric shall be spliced at
posts. Use staples, wire rings or
equivalent to attach fabric to posts
2"x2" by 14 Ga. wire or
equivalent, if standard
strength fabric used
Filter fabric
U
Post spacing may be increased
to 8' if wire backing is used
Backfill trench with native soil
or 3/4"-1.5" washed gravel
Figure 7.3.20 — Silt Fence
2"x2"
wood posts, steel fence
posts, or equivalent
(..
70cycnr
Ii - 0'34
'411 2
mac" 'f'°, (ravel
t Backfill
Block
Wire Screed or
Filter Fabric
Gravel Bacldill —;
Notes:
1. Drop inlet sediment barriers are to be used for small, nearly level drainage areas. (less than 5%)
2. Excavate a basin of sufficient size adjacent to the drop inlet.
3. The top of the structure (ponding height) must be well below the ground elevation downslope to prevent runoff from
bypassing the inlet. A temporary dike may be necessary on the downslope side of the structure.
Figure 7.3.15 - Block and Gravel Filter