2015, 04-10 Permit App, Checklist RGR-2015-0004 Paving to ShopMAILING ADDRESS. /(/
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Spokne
�-'Valley.
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@spokanevallev.orq
(Staff Use Only)
PERMIT No.:
CHECKLIST?: ❑Y ON INIT:
LAND DISTURBANCE PERMIT APPLICATION
-
STAFF USE :
❑ ENGINEERED GRADING
EGULAR GRADING
❑ GRUBBING & CLEARINEENTEL
APPLICANT USE :
SITE ADDRESS:
ASSESSORS PARCEL NO.:
APPLICANT NAME:
PHONE: Qg g79-7i67'/ EMAIL:
CONTACT NAME SAME AS APPLICANT):
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E`aa ,pi!
project #, f -GW
�Name
�uhmit a( :
CELL:
PHONE:
EMAIL:
CELL:
PROPERTY OWNER NAME: ,% G7/ R
17
PHONE: EMAIL:
STATE:
CELL:
❑ CHECK IF APPLICANT
ZIP:
CONTRACTOR NAME: (0 TBD): .L, //j_- (
MAILING ADDRESS: / n 54- 4— // _3
5y
CITY:
STATE: vV `T
PHONE: — 3/,MAIL: CELL:
STATE LIC. NO.: J/U'L-//I/,ff 95�-�),
EXPIRES:
91- / ? /Z
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
U BI :
c CHECK IF APPLICANT
ZIP: /6 ///
ID/I) 011/49 - Yd,/11>i}3'
ESTIMATED QUANTITIES (CUBIC YD): CUT:
IF CUT, PROVIDE DESTINATION OF SOIL:
START DATE: /c)/ 4./
77 � f FILL: /4Q
1
ZI/w
tor-- )7/1 (C/7/6-)-LAA/6// Ov7e-
ESTIMATED COMPLETION DATE:
—/ / /l) /20/c
Signature: Date
Updated March 2011
C:1Users\pbarclay\Desktop\Customer Information\Grading Permit\Land Disturbance Permit Application.doc
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
-77
Project Address: 502 3 A. , Today's Date: %
Irie\'`
jUalley
Project Description:
Signature:
Print Name: 4;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 Lpiivork 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
❑ Yes
❑ Yes
then a SEPA environmental checklist will need to be submitted for review) + %‘) �R
❑ Yes 'Rlo Will the grading create a base or support for a permanent structure? /3',� c
❑ Yes 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 perlantp
or
intermittent pond) with a surface area greater than 500 square feet?
❑ Yes - �P<lo Will this grading result in the addition or replacement (excluding paver hit maintennce) 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 o Will any excavations or fills have slopes at 2:1 (H:V) or steeper and heights greater than 21/
feet?
❑ Yes slo 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)
's ❑ No Will the volume of excavation or fill be over 50 cubic yards on any one lot?
❑ Yes .09fo Will any excavations have slopes at 2:1 (H:V) or steeper or heights greater than 3 feet?
❑ Yes J140 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 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 Flo 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?
Will this grading be for a short plat, subdivision or binding site plan?
Will any grading occur in a FEMA floodplain, wetland, wetland buffer, Fish and Wildlife
habitat conservation area or geologically hazardous area?
Will the volume of excavation or fill for the project be over 500 cubic yards? (If checked Yes
If the answers to all of the questions above are "No" then a permit is not required for the proposed work.
00111N...„
kane
.0001rValley'
For requirements, see
Spokane Valley Municipal Code
Chapter 24.50
LAND DISTURBING ACTIVITIES
Permit Number_
Parcel Number:
`-i Nr 3 4 ago/
Today's Date:
4/(cal / s—
Street Address:
3 7- 3 /V f fora
Property owner:
Applicant:
Plan Prepares
Onsite Contact:
1) Far Regular Grading or Grubbing and Clearing:
of existing and new
and structures
A) Show on the site plan:
Cidjacent or nearest streets Q Footprints
l"roperty boundaries buildings
0 Boundary of work area 0 Known utilities
El Arrows pointing downslope before work begins
B) Temporary erosion and sediment control (TESC) — show on site plan:
Q Silt fence at downs lope portions of project (see detail)
❑ Protection of drainage structures onsite or in the street to keep dirt
from getting in (see detail example)
Locations where concrete trucks will get washed out
2) For Regular Grading only - additionally, provide:
❑ Show arrows painting
In Delineate which areas
CI What is the vertical height
Cut slope:
to what will
are cut and
of maximum:
feet, Fill
new paving
be downslope after work is done
which are fill
slope: feet
ID Delineate existing and
areas with dimensions.
Note:
and sediment control measures shall be
or grubbing and clearing begins and these
ma intained for the extent of the project,
and repair as needed. The appl itant is
all soil on the project site and adding other
to accommodate changing or unexpected site
Stabilize bare soils in autumn with seeding.
adjacent to the construction access route(s) at
If sediment has been tracked off site then
dra image structures) is required_
protect adjacent properties, control dust arkd
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.
cleaning (streets and
The Contractor shall
remove all construction
site.
CALL 2 BUS1N SS DAYS BEFORE YOU DIG
811 OR 1-800-424-5555
Dra DYE
No
Regular Grading or Grubbing and Clearing - Site Plan
1E N FLORA,
1
1114
Circle Scale used:
1' 1Q' 1" 20' 1"=30' 1"=4O 1' 50' 1"=6U' 1"se 100`
City Use Only -
1" x 1" Grid Reviewed for completeness by:
Date:
Silt Fence Detail
Inlet Protection Example
Joints in liter fabric shal be spl oed at
posts. Use staples, wire rings or
equivalent to attach fabric to posts
6' max
Past spacing may be Increased
to 91 iiwire backing is used
F!gure 7.3.20— Slit Fence
2'x2" by 14 Ga. wire or
equivalent if standard
strength fabric used
Fitter fabric
T'137.. 111inirrwm 4"x4" trench -`
Backtill trench with native Soil
or 34-1.5ewashed gravel
2'x2" wood posts, steel fence
postsror equivalent
E
kg
•
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 vtructure (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.
Plan View
Darin
Grate
(_
4
°Vs ea
r
.010
Sector A -
A
a c +
plc
Concrete Block
Gravel Backfill overflow
___„_
Water
rti Water
drnp Intel
1
68 Concrete
„0 Block
:0
OCA
Gravel
o Backlill
110
Wire Screen or
Filter Fabric
Ponding HT,
77)-N/) V/\
Figure 7.3.15 Block and Gravel Filter