TC 2013102611 10900 Bald Hills Rd SE SECOND SUBMITTAL 03132015 ,• , y� ; � � � ,�r««s;�aw�, �,,���;:�,cA s�y k
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r - r 2000 Lakeridge Dr. SW,Olympia,WA 98502
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MASTER APPLICATION
STAFF USE ONI.Y DATE STAMP
13 107483 BS TNt��STON COUNT`�
Permit Type: Site Application R��,�.����
Sub Type: Residential Lot:B M�Y �A �n��
site: 10900 BALD HILL RD SE YELM WA 98597 �
I Assessor Property ID: 22729310700
Applicant: BALD HILL ROAD LLC ���{��� �1�5�����'�C� �+��►���
Owner: BALD HILL ROAD LLC
'�_:� �. ._`'.� I l'��� � ( �
Intake by: '�Z
The Master Application is required for all projects and shall accompany a project-specific supplemental
application(s). The Master Application may not be submitted alone. Check the appropriate box for each
supplemental application being submitted with this Master Application.
T e of Pro�eCt(check all that apply):
BUILDING PLANNING
❑Residential(�orm SA001) ❑Administrative Variance(form SA021)
❑Non-Residential(�orm SA002) �Binding Site Plan(�orm SA022)
❑Non-Residential Hood&Duct(�orm SA003) ❑Boundary Line Adjustment/Lot Consolidation (form SA023)
❑Non-Residential Sign(�orm SAOO4) ❑Critical Area Review(�orm SAO24)
❑Manufactured Home Placement(}'orm SA0o5) ❑Design Review(form SAO25)
(�I Minor Permit (form S,4006) (�Division of L,and(form SA026)
(Mechanical/Plumbing/Fire/Re-roof/Re-siding/Demo) �Division of Land Final Map({orm SAO26a)
❑Adult Family Home Inspection (}'orn�S,4007) ❑Environmental Checklist(SEPA)(�orm SA027)
❑Fire Code Permit(form SA008-SA012) ❑Forest Practice Activities(form 5,9028)
�Innocent Purchaser(}'orm SA029)
ROADS ❑Joint Aquatic Resources Permit Application(Jt�RPA)
0 Encroachment Permit(jo.m SA013) (�orm SA030)
❑Construction Permit(jorm SAOZa) ❑Legal Lot Detemunation (�orm SAO31)
❑Variance(�orm SAOIS) ❑Other Administrative Actions (�orm SA032)
❑Scoping Review Request(form SAO15a) ❑Presubmission Conference({orra SAO33)
❑Access Permit(�orm sAO156) ❑Reasonable Use Exception(�orm SAO34)
❑Release of Moratorium(�orm SA035)
ENVIRONMENTAL HEALTH ❑Rezone, Comp Plan Amendment, Open Space(�ormsAO36)
�On-Site Sewage System(�orm SAOI6) ❑Shoreline Administrative Variance(jorm SAO3�)
❑On-Site Sewage System Abandonment(�orra SAO17) ❑Site Plan Review(�orm SAO38) �CEIV
❑On-Site Sewage Evaluation (�orm SAO18) ❑Special Use Permit(�orm SA039)
❑Water System Design(Group B or 2 Party)(�orm �Variance—Hearing Examiner(�orm SAO o) J U N 21 2013
SAOl9) SC A N I V E D
�Well Site(form SA020)
R����d 3-» JUN 2 4 2013 Form No. MA001
T'hurston County Permit Assistance Center
Master Application
Page 2 of 3
Property Tax Parcel Number(s): 22729310700 '
Zoning: RR1/5 Acreage: 10.5
Subdivision Name(if applicable): BLA04104565TC Lot#: B
Property Address: 10900 BALD HILL RD SE City: YELM State: WA Zip Code: 98597
Directions to the Property:
GOING SOUTH ON HWY 507 THROUGH YELM TO RIGHT AT TRAFFIC LIGHT ONTO BALD HILL RD SE TO SITE ON
LEFT.
Property Access Issues(locked gate,code required,dogs or other animals): �No OX Yes
If yes,Describe: LOCKED GATE-LOCK BOX ON LEFT SIDE OF GATE,CODE:3-6-0
OWiti�R 1S t2ESP�i�SI$I.�F`�I'�,�'_,E���l\TS��I1_�LQ�,S BEFORE SITE VISIT.
Type or Print: Additional property owner sheet can be obtained onli�ze at www.co.thurston.wa.uslnermittine or copy obtained
from the Permit Assistant Center.
Property Owner(s): BALD HILL ROAD LLC CHAD HALTERMAN
Mailing Address: 15705 92ND CRT SE
City: YELM State: WA Zip Code: 98597
Phone#: (253)380-2954 Ext. Fax#:
Cell#: E-mail:
Signature:* Date:
AppliCant(if different than owner):
Mailing Address:
City: State: Zip Code:
Phone#: Ext. Fax#:
Cell#: E-mail:
Signature:* Date:
Point of Contact: JIM HENRY DESIGN SERVICES INC
Mailing Address: PO BOX 14531
City: TUMWATER State: WA Zip Code: 98511
Phone#: 956-7242 Ext. Fax#: 956-7242
Cell#: 507-1267 E-mail: HENRYJIM@COMCAST.NET
�
Signature:* ` � Date: �5 —,Z —
Revised 7-71 Form No. MA001
.�`�� Thurston County Environmental Health
� _ 2000 Lalceridge Dr. SW�lympia,WA 98502
F_� �� (360)867-2b73/(360)867-2660(Fax)
__� � TDD Line(360)754-2933
7�i-I! IZ�`l�t'� t.��i:�,;-t-,- , �.
�� �s- <<��-d�_��
�rr��cei�x�.� — -
Supplemental Application
ONSITE SEWAGE SYSTEM
STAFF USE ONLY DATE STAMP
13 107484 HD
Permit Type: On Site Sewage Systems ".��""��T�� �,.Q�f[�''��(
��������
Sub Type: On Site Sewage 5ystem Lot:B
site: �QgpO BALD HILL RD SE YELM WA 98597 MAY 2 9 2013
Assessor PropertylD: 22729310700
Applicant: BALL�HILL ROAD LLC ����E�QSS��j'�l,��� ����.���
Owner: BALD HILL ROAD LLC i5^` ` '
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This application cannot be submitted alone.In addition to this form,a complete package includes:
Ap U C�ant SUBNIITTAL CHECKLIST S Onl se
Q Master Application_ ❑
� For new septic systems requiring a design: �
a. Site plan(5 copies—11"X 17"maximum size), 1"=20'or 1"=30' scale.(See attached checklist)
b. On-site sew e se tic stem desi 3 co ies
� For replacement of existing septic systems requiring a design:On-site sewage(septic)system design �
3 co ies .
� For submittals not requiring a design: (�amples: sand filter and/or mound rebuild using existing �
design,septic tank or pump chamber replacement,septic tank placement):Site plan(3 copies—11"X
17"m�imum size ,
� For onsite sewage system proj ects within a city jurisdiction,the application must be taken to the city �
for review and comment prior to submitting an application with Thurston County. If unable to obtain
comments rrom the city,Environmental Heaitii wili route the appucation to the city. The project will
be laced on hold unril comments from the ci have been received.
� Applicable processing fees.Refer to current fee schedules. Depending on the adopted fee �
structure, additional ees m occur i base hours/ees at intake are exhausted.
SEPTIC DESIGNER:
Name: JIM HENRY Company Name: JIM HENBY DESIGN SERVICES INC
Mailing Address: PO BOX 14531 City: TUMWATER State: WA Zip: 98511
Phone#: 956-7242 Ext. Cell Phone# 507-1267 Fax#: 956-7242
E-mail Address: HENRYJIM@COMCAST.NET
Revised 5-9-II Form No. SA016
Thurston County Environmentai Health
Supplemental Application for Onsite Sewage System
Page 2 of 3
JURISDICTION: �����' �
� Thurston County ❑City of Select City from List
CITY JURISDICTION REVIEW AND COMMENT: ❑Approved ❑Disapproved
� �
,
Comments: � � � �° � � �..��"�C.� t� �' � .��c. �C( �
� , " _..�
- -Tit1e. �., ` � =z�
�r'
Signature: % >% ' � ���1:�<<a� ���Cs_r�"t.� ��' Date: > � �i
TYPE OF PROJECT:
0 Onsite Sewage System with Residential Site Plan Review
(Project includes a new structure or addition/remodel to e�sting structure)
�Qnsite Se�xr�.ge System only(I�) (no claange to structure that septic will serve)
0 Residential Single Family ❑ Residential-Multifvnily #Units �Ton-Residential
TYPE OF PERMIT:
�On Site Sewage System ❑Tank Only ❑Sand Filter and/or Mound Rebuild or Replace
❑Community Drainfield
WORK TYPE:
ONew ❑Repair of a Failure ❑Modification Upgrade Number of Bedrooms: 6
WATER SUPPLY: ❑E�sting �Proposed
0 Single Family well ❑Two Party well ❑Group A ❑Group B
System
Name of Communiry system ID#
ACCESS:
x❑Existing Access ❑Proposed Access ❑X Private Driveway ❑Shared Driveway
❑Private Road (list name of road,if applicable)
Ox Public Road BALD HILL RD (list name of road,if applicablel
PROPERTY INFO:
Water on or within 300' of property: ❑None ❑Salt �River/Creek/Flood Zone ❑Lake/Pond ❑Wetland�Ditch
Name of body of water: FLOOD ZONE ACROSS ROAD WITHIN 200 FT OF SW PROP CORNER
Has the property ever flooded? ❑No ODo not know ❑Yes,when?
/Tl rc'ti. S'Itu�r ur�a t�n �t1�i'i;t�z�
Slopes greater than 20%? ❑No ❑Yes
APPEAL: Any person aggrieved by a decision,an inspection,or notice made by the Health Officer sball have the right to appeal
the matter as specified in Article 1 of the Thurston County Sanitary Code.
EXPIRATION•
Sewage System applications eapire one year from date of application per Thurston County's Sanitary Cod,Article IV, Section
9. This period may be extended for a single one-year period without charge,if specifically requested by the applicant prior to
the eapiration date.
Revised 5-9-11
Form No. SA016
Thurston County Permit Assistance Center
Master Application
Page 3 of 3
BRIEF DESCRIPTION OF PROJECT PROPOSAL
NEW CONSTRUCTION FOR PRIMARY MOBILE HOME AND FUTURE FMU
BILLING INVOICES
The base application fee charged at the time of application covers base hours listed on the fee schedule. When the base
hours by a Department are used,a monthly billing invoice will be generated for additional hours at the hourly rate listed
on the fee schedule. Should review of the project exceed the base hours allotted,billing invoices shall be mailed to:
❑X Owner ❑Applicant ❑Point of Contact
*Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar
with the information contained in the application and that to the best of my knowledge and belief,such information is true,
complete,and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby b ant to the
agencies to which this application is made or forwarded,the right to enter the above-described location to inspect the proposed,
in-progress or completed work. I ab ee to start work only after all necessary permits/approvals have been received.
Revised 3-11 Form No. MA001
Thurston County Environmental Health Division
�"°�-�� 2000 Lakeridge Dr. SW,Olympia,WA 98502
°� � - (360)867-2673/(360)867-2660(Fax)
��g� ,�„ ,: TDD Line(360)867-2603
THL'ItS�t'�.��'�i C;(JUI�TTY http://www.co.thurstou.wa.us/health/ehadm
����a�,� �
WATER SYSTEM PRIORITY OF SERVICE
❑ Owner/Applicant '�Applicant Only Date Received --
� � L L� � � �-fi � Phone#� J 3 ���'!� _� % S��
Name ���,a L � -��I l l�
r �� . . �� 1L'Tf,P "`'�' \�.
Mailing Address � � 7� I ���� � �1 f � �"'� �/} r ��� �' ��
Property Address ��� 1 ��� ��'T- � � � � ��"�� �S �_ Parcel#�� �c��� ,� �0 7(� �
(attach location map)
�
Project Description (Plat, short plat, etc) : i1 L �r - -
Primary Source Area Utility_ �� I M ��t�� �� _
Priority I-Area Utility
Yes,the applicant will be provided with terms of service
Yes, via area utility satellite service
_No (Go to Priority Level II)
Signature of Utility Representative Date
Priority II-Neighboring Utility
Yes, the applicant will be provided with terms of service
Yes,via neighboring utility satellite service
_No (Go to Priority Level III)
Signature of Utility Representative Date
Priority III-Other Approved Satellite Service Company
Yes
_ No (Go to Priority Level IV)
Signature of Utility Representative Date
Priority IV-Water Supply Developed by Applicant
Date
Signature of Thurston County Environmental Health Representative
Approval of Service
Date
Signature of Thurston County Environmental Health Representative
To obtain a list of approved utilities, and the name of your primary area utility, contact the Thurston County Environmental
Health Representative.
UPDATED 12/29/09
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Exr�iarr A
RESOLUTION 541
SIX YEAR TRANSPORTATION IMPROVEMENT PRClGF2AM
PROJECT LIST
. ._._ ��_..
�...._......__. Proj+�ct Name Prvjecf
� � Number '�
__ __.......___�
Bald Hill to SFt 507 -tUew Connection Y2C
� � SR �10 Yeim �oop_� _ Y3
-- --��
Kdlion to Coates - New Connecfiion _ _ ; Y4A ',
. �._.........._....�...._� _.........._�.- -r----..................
�Burnett/93� (r�tersection -Realignment and Signal i Y5A '
__......_._
� Longmire lntersection - Siqnal � _ Y56
Central Business District between Culiens and 4 - Y5C
Reconstructian
_....._..__ ____.....__�.__
Cannect Prairie Line to Tacama Rail Y7A
__M. d_ _._..____._.___
, Rail Traif between, o�,._wer canal and Roy Y7B
�_..._.. -
� Extend Mosrnan from Lt�ngmire to Solberg (New Y8A ;
' connection} ......_.�_� —....._......�._a
__. �._._
____._ _._..---._. _.
Soiberg between Yeim Avenue and Masman - ; YSB �
( Reconstructian '
__. __.__........._.,_...,._
Masman between Sofbe�nd SR 507 - Reconstructian Y8C
' Mosrnan/SR 547 intersection - Reali�nment Y8Q
Mosman between SF2 507 and��- 4t�-Reconstruction W Y8E
- ---...._...�_._..., ----....�_..___
Mosman from 4 ta Clark-�lew Connection Y8F
B�Id Hill Road from City limits ta 5 corners - Y9
Reconstruction
�
x
CITY OF YELM
RESOLUTION NUMBER 546
AMENQING THE SIX YEAR TRANSPORTATION IMPRQVEMENT PRO�RAM
V1�NE�EAS, Section RCW 35.77.010 RCW requires the ad�ption of a six year
' transportation improvement program; and :
WHER�s, the adopted six year transpartation improvement program has been
updat�d annually by the City Council; and
WHER�AS, the Gity Council has determined that recommendations c�f the Yelm '
Transportation Gommifitee ta upc�at�: and amend the adopted six year transportation '
; improuement program are consistent with the C�mprehensive Plan and Transpartation
P{an; and
WHE��AS, the current Six Year 7ransportation Improvement Program was
adopted by the City Councif on July 9, 2013, by Resolution 561; and
WwE��,s, the Counc'sl wishes to clarify that project Y5C includes the constructian
of curb, gutter, and sidewalks on the north side of Yelm Avenue (SR 510) between
Solberg Street and Cullens Road;
NC}W, THEREFORE, BE IT RES�LVED by the City Cauncil af the City of Yelm
that the 2013 six year transpc�r�ation improvement program is amended by the addition
ofi project Y5C1 as at#ached to this r�solutian as Exhibit A and that a copy of this
resalution be fi(ed with the Director of the Washington State Department of
, Transportation.
APPR4VED this 14t`'day January, 2014.
��-� `
�,��,,.�
----__.�.�'..._........_.._..�.�_.......e........._._�_.._.______
Ron Harding, �� ayor '
�
ATTEST:
�
��L��i��-%�:�� ...�'��.�,,.�,,...
M anine Schnepf, City C! k
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