Application # ___________
Page 1 of 5
TOWN OF SMITHTOWN FLOODPLAIN DEVELOPMENT PERMIT
APPLICATION
SECTION 1: General Provisions (APPLICANT to read)
1. No work of any kind will start until a permit is issued.
2. The permit may be revoked if any false statements are made herein.
3. If revoked, all work shall cease until permit is reissued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local, state, and federal
regulatory requirements.
7. By submitting this application, the applicant gives consent to the Town Planning Director or his/her
representative to make reasonable inspections required to verify compliance.
8. The Town Planning Director may require additional information to be submitted before the permit
application is processed (See Section 4).
SECTION 2: Proposed Development (To be completed by APPLICANT)
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER OR ARCHITECT
Applicant is the: Owner Contract Vendee Lessee Contract Lessee
PROJECT LOCATION:
Provide the street address, lot number or legal description (attach) and, the distance to the nearest
intersecting road.
Suffolk County Tax Map #
Continued on p. 2
August 2012
Application # ___________
Page 2 of 5
SECTION 2: Proposed Development (continued from page 1)
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
New Structure Residential (1-4 Family)
Addition Residential (More than 4 Family)
Alteration Non-residential (Floodproofing? Yes)
Relocation Combined Use (Residential & Commercial)
Demolition Manufactured (Mobile) Home
Replacement (In Manufactured Home Park? Yes)
ESTIMATED COST OF PROJECT $ ______________
B. OTHER DEVELOPMENT ACTIVITIES
Clearing Fill Mining Drilling Grading
Excavation (Except for structural development checked above)
Watercourse alteration (Including dredging and channel modifications)
Drainage improvements (Including culvert work)
Road, street or bridge construction
Subdivision
Private water or sewer system
Other (Please specify)
After completing SECTION 2 and signing the affidavits at the end of the application packet, APPLICANT
should submit the form to the Town Planning Director for review.
SECTION 3: Floodplain Determination (To be completed by TOWN PLANNING DIRECTOR)
The proposed development is located on FIRM Panel No. _________________, Dated _______________
The Proposed Development:
Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOOD PERMIT IS REQUIRED).
Is partially located in the SFHA, but building/development is not.
Is located in a Special Flood Hazard Area
FIRM zone designation is ___________________.
"100-Year" flood elevation at the site is: _____________ ft. NAVD88
Unavailable
See Section 4 for additional instructions.
SIGNED DATE
August 2012
Application # ___________
Page 3 of 5
SECTION 4: Additional Information (To be completed by TOWN PLANNING DIRECTOR)
The APPLICANT must submit the documents checked below before the application can be processed:
A site plan showing the location of all existing structures, water bodies, adjacent roads, lot
dimensions, and proposed development.
Development plans, drawn to scale, and specifications, including where applicable: details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant
materials used below the first floor, details of floodproofing of utilities located below the first floor,
and details of enclosures below the first floor.
Also,
Subdivision or other development plans. (If the subdivision or other development exceeds 50 lots or
5 acres, whichever is the lesser, the applicant must provide "100-year" flood elevations if they are not
otherwise available).
Plans showing the extent of watercourse relocation and/or landform alterations.
Change in water elevation (in feet) ________
Meets ordinance limits on elevation increases YES NO
Top of new compacted fill elevation ________ ft. NAVD88.
Floodproofing protection level (non-residential only) ________ ft. NAVD88. For floodproofed
structures, applicant must attach certification form registered engineer or architect.
Certification from a registered engineer that the proposed activity in a regulatory floodway will not
result in any increase in the height of the "100-year" flood. A copy of all data and
hydraulic/hydrologic calculations supporting this finding must also be submitted.
Other:
SECTION 5: Determination (To be completed by TOWN PLANNING DIRECTOR)
I have determined that the proposed activity: A. Is B. Is not
in conformance with provisions of §168 of the Code of the Town of Smithtown. The permit is issued
subject to the conditions attached to and made part of this permit.
SIGNED DATE
If Box B is checked, the Town Planning Director will provide a written summary of deficiencies.
Applicant may revise and resubmit an application to the Town Planning Director or may request a variance
from the Board of Zoning Appeals.
APPEALS: Hearing date:
Decision: Approved Denied Approved w/ conditions
Conditions:
August 2012
Application # ___________
Page 4 of 5
SECTION 6: As-Built Elevations (To be submitted by APPLICANT before Certification of
Compliance is issued)
The following information must be provided for structures that are part of this application. This section
must be completed by a registered professional engineer or a licensed land surveyor (or attach a
certification to this application). Complete 1 and 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High
Hazard Areas, bottom of lowest horizontal structural member of the lowest floor, excluding
piling(s) and columns) is: ft. NAVD88.
2. Actual (As-Built) Elevation of floodproofing protection is ft. NAVD88.
SECTION 7: Compliance Action (To be completed by TOWN PLANNING DIRECTOR)
The TOWN PLANNING DIRECTOR will complete this section as applicable based on inspection of the
project to ensure compliance with the community's local law for flood damage prevention.
Inspections Date: By In Compliance? Yes No
Date: By In Compliance? Yes No
Date: By In Compliance? Yes No
Certificate of Compliance issued: Date By
August 2012
Application # ___________
Page 5 of 5
OWNER’S ENDORSEMENT
STATE OF NEW YORK
COUNTY OF SUFFOLK
_________________________________ being duly sworn, deposes and says he/she resides at
(Name)
_______________________________________________ in the County of ________________________
(Street address, City, State)
and that he/she is owner in fee or __________________________ of ______________________________,
(Title/Position) (Corporation)
which is the owner in fee of the premises described in the foregoing application and that he/she has
authorized _____________________________________ to make the foregoing application.
(Name of applicant)
Sworn to before me this
_____ day of _____________ 20____ ____________________________________
Signature
_______________________________ ____________________________________
Notary Public, Suffolk County Print or Type Name
APPLICANT’S AFFIDAVIT
STATE OF NEW YORK
COUNTY OF SUFFOLK
_________________________________ being duly sworn, deposes and says he/she is the owner, attorney
for owner, contract vendee, lessee, or contract lessee of the property above described, and that all
statements made in this application are true to the best of his/her knowledge and belief, except as to the
matters therein stated to be alleged on information and belief and as to the matters he/she believes the same
to be true.
Sworn to before me this
_____ day of _____________ 20____ ____________________________________
Signature
_______________________________ ____________________________________
Notary Public, Suffolk County Print or Type Name
August 2012
Stormwater
Construction Permit
Regulations
NEW YORK STATE
DEPARTMENT OF ENVIRONMENTAL
CONSERVATION
SPDES General Permit for Stormwater Discharges
from Construction Activity
July 2008
If your project will impact, disturb or expose
one or more acres of soil, including:
Clearing and Grubbing
Filling or Stockpiling
Building Construction
. . . you are required to have a permit for
stormwater discharges from the site.
Grading
Excavating
Demolition
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Building Something?
Building Something?
The Problem with Stormwater
Stormwater is water from rain or melting snow that
doesn't soak into the ground but runs off into
waterways. As stormwater flows from rooftops, over
paved areas and lawns it picks up debris, chemicals,
motor oil, animal waste and other pollutants.
Stormwater can flow into a storm sewer system or
directly into a lake, stream, river or wetland,
potentially contaminating the water we use for
drinking, swimming and fishing. Polluted runoff is the
nation’s greatest threat to clean water.
Stormwater carries the residue of urban living. Toxic
chemicals from automobiles, sediment from
construction activities, bacteria from animal wastes
and careless application of pesticides and fertilizers
threaten the health of the waterway and can kill fish
and other aquatic life.
Stormwater Management
Stormwater management, especially in urban areas,
is becoming a necessary step in seeking reductions in
pollutants in our waterways and presents new
challenges. More often than not, end-of-pipe controls
are not the best answer for removing pollutants from
stormwater runoff. Pollutants in runoff enter our
waterways in numerous ways and the best method of
control is usually at the pollutant's source.
The US Environmental Protection Agency and the New
York State Department of Environmental Conservation
are addressing stormwater management in several
ways. A federal regulation, commonly known as
Stormwater Phase II, requires permits for stormwater
discharges from Municipal Separate Storm Sewer
Systems (MS4s) in urbanized areas and from
construction activities disturbing one or more acres.
To implement the law, the NYSDEC has issued two
general permits, one for MS4s in urbanized areas and
one for construction activities. The permits are part of
the State Pollutant Discharge Elimination System
(SPDES).
Construction Permit Notice of Intent
Section 402 of the Federal Clean Water Act requires
permits for stormwater discharges from construction
activities that disturb one or more acres of land. To
obtain coverage under the SPDES General Permit for
Stormwater Discharges from Construction Activity, you
must prepare a Stormwater Pollution Prevention Plan
(SWPPP) and submit a Notice of Intent (NOI) before
beginning construction.
Mail your Notice of Intent to:
NYS DEC “Notice of Intent”
Bureau of Water Permits
625 Broadway, 4th Floor
Albany NY 12233-3505
Note: A Stormwater Pollution Prevention Plan must
be prepared before submitting the NOI.
If your project is in a regulated MS4, you must
submit your NOI and SWPPP to the municipality.
For More Information:
Visit the DEC website at:
http://www.dec.ny.gov/chemical/8468.html
If you don’t have web access, you can obtain written
material by calling your Regional DEC office below or
your County Soil & Water Conservation District office.
Region 1: (631) 444-0409 Region 6: (315) 785-2524
Region 2: (718) 482-4933 Region 7: (315) 426-7500
Region 3: (914) 332-1835 Region 8: (585) 226-5452
Region 4: (518) 357-2045 Region 9: (716) 851-7070
Region 5: (518) 623-1200
For a listing of Soil and Water Conservation Districts in
New York State visit:
www.nyacd.org/districts.html
Tools available from the DEC website:
SPDES General Permit for Stormwater Discharges
from Construction Activity
Permit Forms for download —
Notice of Intent (application for permit coverage)
Notice of Termination
MS4 SWPPP Acceptance Form
Instruction Manual for Stormwater Construction
Permit (for preparing SWPPP and NOI)
New York State Standards and Specifications for
Erosion and Sediment Control (2005 )
New York State Stormwater Management Design
Manual (2003)
NEW — Chapter 9: Redevelopment Projects
NEW — Chapter 10: Enhanced Phosphorus Removal
Stormwater Interactive Mapping Tool
Technical guidance documents
Stormwater Pollution Prevention Plan
The owner/operator must prepare a SWPPP - a plan
for controlling runoff and pollutants from a site during
and after construction activities. The principal
objective of a SWPPP is to comply with the NY SPDES
Stormwater Permit for construction activities by
planning and implementing the following practices:
Reduction or elimination of erosion and sediment
loading to waterways during construction
Control of the impacts of stormwater runoff on
the water quality of the receiving waters
Control of the increased volume and peak rate of
runoff during and after construction
Maintenance of stormwater controls during and
after completion of construction
Stormwater Impacts from the
Construction Industry
The construction industry is a critical participant in the
nation’s efforts to protect streams, rivers, lakes,
wetlands and oceans. Through the use of proper
erosion and sediment control and stormwater
management practices, construction site operators
are the key defenders against stormwater impacts.
Construction and development increase the amount of
impervious surfaces in our watersheds, thus
increasing runoff to waterways. The additional runoff
results in increased erosion and sedimentation, and
destroys aquatic habitat. Preventing soil erosion and
sedimentation is an important responsibility at all
construction sites.
In addition to the environmental impacts, uncontrolled
erosion can have a significant financial impact on a
construction project. It costs money and time to
repair gullies, replace vegetation, clean sediment-
clogged storm drains, replace poorly installed
practices and mitigate damage to other people’s
property or to natural resources.
Rain could easily
wash this loose
soil into the
storm sewer and
into a nearby
stream, causing
a water quality
standards
violation that
could cost the
site operator up
to $37,500 each
day it occurs.
* Consult Appendix B of the General Permit for a
complete listing of SWPPP requirements by project type
** Check the MS4 Stormwater General Permit for
maps of regulated MS4 boundaries, TMDL watersheds
and impaired waterbody listings
SWPPP and General Permit Sequence
If your project will disturb or impact 1 or more acres of
land and you are constructing a commercial, industrial
or institutional building, apartments, duplexes, a
roadway, a single-family residential development with
more than 25% impervious surfaces, a single-family
development impacting 5 or more acres of land
(including home construction); creating recreation areas,
fill areas or linear utilities disturbing 5 acres or more*:
Develop a Stormwater Pollution Prevention Plan
(SWPPP) with stormwater management practices in
conformance with the New York State Stormwater
Management Design Manual and erosion and
sediment controls in accordance with the New York
State Standards and Specifications for Erosion and
Sediment Control
If your construction project is single-family residential
with 25% or less impervious cover, a linear utility,
recreation fields or fill area, and will impact between 1
and 5 acres of land (and the site is not
located in a
TMDL Watershed, or directly discharging to an
impaired 303(d) waterbody**):
Develop a SWPPP with erosion and sediment controls in
accordance with the New York State Standards and
Specifications for Erosion and Sediment Control
If your project is located within a regulated MS4**
1. Submit the SWPPP and Notice of Intent (NOI) to the
municipality
for review and acceptance
2. Submit the NOI and signed MS4 SWPPP
Acceptance form to DEC in Albany
3. Begin construction 5 business days after
notification from DEC of acceptance of NOI
If your project is not located within a regulated MS4**
1. Submit a Notice of Intent (NOI) to the DEC in Albany
2. Begin construction 5 business days after
notification from DEC of acceptance of NOI
However… If the SWPPP deviates from the DEC technical
design standards:
1. Submit a NOI to the DEC in Albany
2. Submit SWPPP to DEC Regional Office for review
and acceptance prior to beginning construction
When all construction has been completed and the
site has been stabilized and fully vegetated:
File a Notice of Termination (NOT) with the DEC
Stormwater retention ponds provide effective water
quality control by using forebays for sediment settling,
and have controlled-discharge outlets for flood control.
Important Terms
Owner/Operator: The person or legal entity which owns or
leases the property where construction will occur.
Qualified Professionals: Professional Engineers,
Landscape Architects and Certified Professionals in
Erosion and Sediment Control are qualified to develop
and certify SWPPPs and inspect construction sites.
TMDL and 303(d) Waterbodies: Section 303(d) of the
Clean Water Act requires states to identify Impaired
Waters where specific designated uses are not fully
supported. In order to restore and protect these
Impaired Waters, Total Maximum Daily Loads (TMDLs) or
other strategies have been developed to reduce the input
of pollutants that restrict waterbody uses.
Basic Components of a Stormwater
Pollution Prevention Plan
*
Narrative Report describing pre-development
conditions and details of the planned project
Maps illustrating site location, topography, drainage
area, existing and proposed structures, erosion and
sediment control and stormwater control measures
Erosion and Sediment Control Plans
Water Quality and Water Quantity Control Plans
Construction Sequence Schedule
Contractor Certification Statements
Operations and Maintenance Schedule
Weekly Inspection Reports
* For a complete description of required SWPPP
components please refer to the SPDES General Permit
for Stormwater Discharges from Construction Activity.