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City of Whitewater (City of Whitewater)

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BROWSE CITY OF WHITEWATER (WI) FORMS

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City of Whitewater
Construction Site Erosion
Control
And
Stormwater Management
Permitting
Table of Contents
1.) Process Diagram: Construction Site Erosion
Stormwater Management
2.) City of Whitewater Permit Application
3.) DNR Permit Application:
a. Instructions
b. Water Resource Application/NOI
c. Stormwater Runoff Application Checklist
4.) City of Whitewater Tables
5.) City of Whitewater Erosion Control Permit
6.) City of Whitewater Stormwater Management
Permit
7.) City of Whitewater Maintenance Agreement
8.) City of Whitewater Financial guarantee
9.) City of Whitewater General Permit fees
10.) Construction Site Inspection Report
11.) DNR / NOT (Notice of Termination)
12.) City of Whitewater Final Occupancy Certificate
State of Wisconsin Water Resources Application for Project Permits
Department of Natural Resources Form 3500-053 (R 8/14) Page 1 of 2
dnr.wi.gov
St
orm Water Construction Site Notice of Intent Instructions
These instructions are for completing the Water Resources Application for Project Permits (WRAPP) form to serve as the Notice of
Intent (NOI) application for state coverage under the WPDES Construction Site Storm Water Runoff General Permit (Permit No. WI-
S067831) for land disturbing construction activities or for the renewal of permit coverage for a construction site project where permit
coverage has expired after 3 years and the applicant must reapply. For a renewal, the original Facility Identification Number (FIN) must
be provided.
Answers all questions and provide all information requested. An incomplete NOI application will be returned for completion. A
complete NOI application for a new project includes the WRAPP form (Form 3500-053), the WPDES Construction Site Storm Water
Runoff General Permit Notice of Intent Application Checklist (Form 3500-053C), and all required attachments and the appropriate
application fee. A complete NOI application for a renewal includes the WRAPP form (Form 3500-053) and the appropriate application
fee. Please follow the mailing and fee directions at the end of these instructions. Note that the WRAPP form is also used by the DNR’s
waterway and wetland program as the application for various permits. Information on applying for these other permits is available from
the DNR’s “Water permit applications” webpage at dnr.wi.gov/permits/water/. If multiple types of permits are required for the project,
the WRAPP form and fees will need to be mailed separately as identified by each permit program.
Section 1: Landowner Information
Provide the legal name of the individual, owner, operator, corporation, partnership, association, municipality, interstate agency, state
agency or federal agency that holds fee title, an easement or other interest in property that allows the person to undertake land
disturbing construction activity on the property. If the landowner is a corporation or unit of government, a duly authorized representative
and related contact information may be provided in Section 1. The NOI application shall be signed as follows:
1. For a corporation, by a principal executive officer of at least the level of vice president or by the officer's authorized
representative having overall responsibility for the operation covered by this permit.
2. For a limited liability company, by a member or manager.
3. For a partnership, by a general partner.
4. For a sole proprietorship, by the proprietor.
5. For a unit of government, by a principle executive officer, ranking elected official, or other duly authorized representative.
Section 2: Applicant Information
For a storm water construction site NOI application, the applicant must be the same and the landowner. This section may be used to
provide information on an additional contact person associated with the landowner other than the authorized representative indicated in
Section1 above.
Section 3: Primary Project Contact
If different from the landowner, provide the contact information of the person that will be the primary project contact. The contact person
should be the person completely familiar with the construction project activity and/or charged with implementation of the permit
requirements.
Section 4: Project or Site Location
Enter the official or legal name of the construction site and its complete address or location description. Enter the county, type of
municipality, and municipality name.
Enter the township, range, section, quarter, and quarter-quarter information for the project. If the project is not wholly contained in the
quarter-quarter, provide more description. Enter the latitude and longitude in decimal degrees for the center of the area of land
disturbance.
Section 5: Pre-Application Resource Screening
Waterways: Provide the name(s) of the closest waterbodies to the project location. Identify the waterbodies that are on-site, nearby,
and downstream of the project site, including the first waterbody off-site if storm water runoff from the project site will enter a storm
sewer system that drains to that waterbody. The DNR’s surface water data viewer is available at
dnr.wi.gov/topic/surfacewater/SWDV/.
Wetlands: Indicate whether the project site has been assessed for the presence of wetlands. Indicate the sources of the information
used to assess for the presence of wetlands and attach the supporting report or documentation. The DNR’s wetland locating
information is available at dnr.wi.gov/topic/wetlands/locating.html
. Information on the DNR’s wetland identification program is available
at dnr.wi.gov/topic/wetlands/identification.html. Indicate whether the wetlands will be filled, excavated, or disturbed during construction
or as part of the project.
Endangered or Threatened Resources: All projects are required to comply with endangered and threatened resources laws. An
evaluation may be done prior to the submittal of the NOI application using the protocols developed by the DNR Bureau of Natural
Heritage Conservation at dnr.wi.gov/topic/ErReview/. If a review is completed prior to submittal of the NOI application, attach the
supporting report or documentation. Please note that an evaluation prior to the submittal of the NOI application may shorten the DNR’s
application review time.
The presence of wetlands, endangered/threatened resources, or historical/archaeological resources can delay projects, and
may require design changes to reduce impacts. Evaluation of potential impacts prior to NOI application submittal may reduce
or eliminate project delays or design changes.
Section 6: Project Information
Duration: Provide the anticipated start and end dates for the project. Land disturbing construction activities cannot begin until permit
coverage has been granted by the DNR. The anticipated project start date may not be less that 14-working days prior to the date that
the DNR receives a complete NOI application.
Photos: Provide clear ground level photos of the project site in its existing condition. Enter the date the photos were taken. Be aware
that snow cover or vegetation may obscure important details. The photos should show the area of proposed land disturbance sufficient
State of Wisconsin Water Resources Application for Project Permits
Department of Natural Resources Form 3500-053 (R 8/14) Page 2 of 2
dnr.wi.gov
to identify the existing land use and topography. Digital copies of the photos on a CD are encouraged.
Project Purpose and Need: Provide a brief description of the project, intended use of the project, and any land and water alterations.
Attach additional sheets as necessary to complete this section.
Section 7: Certification and Permission
Certification: Wisconsin law provides for civil and criminal remedies for submitting false information on the NOI application.
Permission: Signing the NOI application also certifies that the landowner gives permission for DNR staff to enter and inspect the site
for the purpose of determining compliance with storm water regulations and permit requirements.
Signature: The person who must sign and date the NOI application is indicated in Section 1 above. Provide the printed name and title
of the person signing the NOI application.
Attachments and Permit Access
A complete NOI application for a new project includes the WRAPP form (Form 3500-053), the WPDES Construction Site Storm
Water Runoff General Permit Notice of Intent Application Checklist (Form 3500-053C), and all required attachments and the
appropriate application fee. A complete NOI application for a renewal includes the WRAPP form (Form 3500-053) and the
appropriate application fee.
A copy of the WPDES storm water runoff general permit is available at:
dnr.wi.gov/topic/Stormwater/documents/ConstructionPermitS067831-4.pdf
Mailing
Unless otherwise directed, mail the complete NOI application and attachments with the application fee to the Wisconsin DNR (WDNR)
office associated with the county in which the construction site is located as follows:
Northern Region (NOR)
Ashland
Barron
Bayfield
Burnett
Douglas
Florence
Forest
Iron
Langlade
Lincoln
Oneida
Polk
Price
Sawyer
Taylor
Vilas
WDNR Baldwin Service Center
890 Spruce St
Baldwin, WI 54002
715-684-2914 ext. 109
Northeast Region (NER)
Brown
Calumet
Door
Fond du Lac
Green Lake
Kewanee
Manitowoc
Marinette
Marquette
Menominee
Oconto
Oneida
Reservation
Shawano
Waupaca
Waushara
WDNR Northeast Regional Headquarters
2984 Shawano Ave
Green Bay WI 54313-6727
920-662-5100
West Central Region (WCR)
Adams
Buffalo
Chippewa
Clark
Crawford
Dunn
Eau Claire
Jackson
Juneau
La Crosse
Marathon
Monroe
Pepin
Pierce
St. Croix
Trempealeau
Vernon
WDNR Baldwin Service Center
890 Spruce St
Baldwin, WI 54002
715-684-2914 ext.109
South Central Region (SCR)
Columbia
Dane
Dodge
Grant
Green
Iowa
Jefferson
Lafayette
Richland
Sauk
WDNR South Central Regional
Headquarters
3911 Fish Hatchery Rd
Fitchburg WI 53711
608-275-3266
Southeast Region (SER)
Kenosha
Milwaukee
Ozaukee
Racine
Sheboygan
Walworth
Waukesha
WDNR Waukesha Service Center
141 NW Barstow St, Room 180
Waukesha WI 53188
262-574-2100
Fee Schedule
A non-refundable fee is required with the submittal of an NOI application. Remit a check or money order payable to the Wisconsin DNR
(do not send cash). The fee is:
Land Disturbance
Application Fee
Less than 5 Acres
$140
5-25 Acres
$235
25 or greater Acres
$350
An NOI application submitted without the required fee will be considered incomplete.
Washington
UN
UN
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Washington
WPDES Construction Site Storm Water Runoff
General Permit Notice
of
Intent Application Checklist
Form
3500-053C
(R 7/14)
Project Name:
--------------------------------
County:
D Erosion control map shall include the following:
Existing topography and drainage patterns, roads and surface waters.
Boundaries of the project site.
Drainage patterns and approximate
slopes anticipated after major grading activities.
Areas
of
soil disturbance.
Location of major
structural and non-structural controls identified
in
the erosion control plan.
Location of areas where stabilization practices will be employed.
Areas that will be vegetated following land disturbing construction activities.
Page
3
of
4
Area and
location of wetland acreage on the construction site and locations where storm water is discharged
to
a surface water
or
wetland within one-quarter mile downstream of the construction site.
Areas used for
infiltration of post-construction storm water runoff.
An
alphanumeric or equivalent grid overlying the entire construction site.
D Storm water management plan shall include the following:
Storm water management plan meets all
of
the applicable performance standards
in
either
s.
NR 151.121
to
151.128 or
s.
NR 151.241
to
NR 151.249Wis. Adm. Code.
An
explanation
of
the technical basis used to select storm water best management practices. A description
of
the management
practices that
will be installed during the construction process
to
control total suspended solids and peak flow, enhance
infiltration, maintain
or
restore protective areas and to reduce petroleum
in
runoff that will occur after construction operations
have been
completed.
Wherever permanent infiltration devices will be employed or were evaluated, the depth
to
the nearest seasonal high
groundwater
elevation or top
of
bedrock shall be identified. Appropriate
on-site
testing shall be conducted
to
determine if
seasonal high groundwater elevation
or
top of bedrock is within 5 feet
of
the bottom of the proposed infiltration system.
Storm water management practices are
adequately separated from wells
to
prevent contamination
of
drinking water such that
the
following minimum separation distances shall be met:
- Storm water
infiltration systems and ponds shall be located at least
400
feet from a well serving a community water system
unless the department concurs that a lesser separation distance would provide adequate protection of a well from
contamination.
- Storm water management practices
shall be located with a minimum separation distance from any well serving a non-
community
or
private water system as listed within
s.
NR 812.08.
D Site-specific erosion control plan: The site specific erosion control plan is attached.
Is the project exempt from the post-construction performance standards
ins.
NR 151.121(2)
ors.
NR 151.241(2), Wis. Adm. Code?
Where
applicable, include the following:
0 Yes 0 No
D Storm water management plan: The storm water management plan
is
attached.
D Site evaluation
for
storm water infiltration: A summary of the results of the site evaluation, similar to Step
Din
Technical Standard 1002,
is
attached.
D Modeling
sum
mary: Modeling was used
to
estimate compliance with the percent total suspended solids reduction, peak
flow, and/or infiltration requirements and a summary
of
input, output and model version is attached.
D Long-term maintenance agreement: For any permanent structures, provisions have been made for long-term
maintenance with the municipality or other responsible party. The long-term
maintenance agreement is attached.
D Non-refundable
NOI
Application Fee (make checks payable to "Wisconsin DNR")
Acres
of
Land Disturbance
Less than 5
5 or more and
less than 25
25 or greater
Application Fee
$140
$235
$350
Washington
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State of Wisconsin CONSTRUCTION SITE INSPECTION REPORT
Department of Natural Resources Form 3400-187 (rev. 9/04) Page 1 of 2
dnr.wi.gov
Notice: Use of this specific form is voluntary, but the information contained on this form must be collected and kept by the permittee under s. NR
216.48(4), Wis. Adm. Code, for a construction site covered under the General WPDES Construction Site Storm Water Discharge Permit, Permit
No. WI-0067831-2. This form is provided for the convenience of the permittee to meet the requirements of s. NR 216.48(4), Wis. Adm. Code.
Multiple copies of this form may be made to compile the inspection report.
Inspections of implemented erosion and sediment control best management practices must be performed weekly and within 24 hours after a
precipitation event 0.5 inches or greater which results in runoff.
Weekly written reports of all inspections conducted by or for the permittee must be maintained throughout the period of general permit coverage.
The information maintained in accordance with s. NR 216.48 (4) must be submitted to the Department upon request.
Name of Permittee:
Construction Site Name (Project): Construction Site ID No.:
Location: County:
Contractor: Field Office Phone:
Note: Weekly inspection reports, along with erosion control and stormwater management plans, are required to be
maintained on site and made available upon request.
Date of inspection (mm/dd/yy):
________________
Time of inspection: Start: a.m./p.m.
End: a.m./p.m.
Type of inspection: Weekly Precipitation Event
Other (specify) ____________________________________
Name(s) of individual(s) performing inspection:
Weather:
Description of present phase of construction:
Modifications Required Yes No
Not
Applicable
Comments/Recommendations about the overall effectiveness of the erosion
and sediment control measures.
Note: For each item checked "Yes", complete the follow-up information on
page 2.
Ditch Checks

Erosion Control Plan

Erosion Mat

Grading Practices

Inlet Protection

Mulch

Offsite Sediment

Permanent Seeding

Schedule / Phasing

Silt Fence

Silt Screen

Sod

Stabilized Outlet

Temp. Diversion Channel

Temp. Settling Basin

Temporary Seeding

Tracking Pads

Turbidity Barrier

Other (specify) __________

CONSTRUCTION SITE INSPECTION REPORT
Form 3400-187 (rev. 9/04) Page 2 of 2
Name of Permittee:
Construction Site Name (Project): Construction Site ID No.:
Use the space below for detailed follow-up action items.
Exact place of erosion/sediment
control inspected
Type of erosion/sediment control and its
observed condition
Description of any necessary maintenance or repair
to erosion/sediment control, including anticipated
date of completion
Ashland
AQ
AQ
Section
1:
Landowner Information
Notice
of
Termination - Storm Water Discharges Associated
With Land Disturbing Construction Activities
General Permit
Form
3400-162
(R
5/14)
Page
2 of 2
Instructions
Provide the legal
name
of
the person, firm, public organization,
or
any
other entity
that
owns
the
construction site described
in
Section
Ill
of
this application and holds or qualifies
for
an applicable general
or
individual constructions site
storm
water
discharge permit.
The
mailing
address
and phone
number
given should be
for
the
authorized representative.
Section
II:
Contractor Information
Provide the legal
name
of
the person, firm,
or
any
other
entity
that
acted
as
the
major contractor
in
charge
or
operating the construction
site described in Section
Ill
of
this application.
The
mailing address and
phone
number given should be for the contact person.
Section Ill: Construction Site Information
Enter
the
construction site's official or legal name and complete address, including county, city, state and zip code. Be
sure
to include
the quarter-quarter, quarter, section, township and range (the nearest quarter section)
of
the site.
If
the site
is
on more than one
quarter, enter
the
quarter
that
best describes the location
of
the site. Use additional
space
if needed to describe
the
site location.
The
WDNR
Site
Number
can be found
in
the upper right corner
of
the original letter conferring coverage under
the
general permit
from
the
WDNR.
Section
IV:
Certification
State Statutes provide
for
severe penalties for submitting false information on this NOT form. State regulations require this
NOT
to be
signed as
follows:
1.
For a corporation, by a responsible corporate officer including president, secretary, treasurer, vice president, manager,
or
a duly authorized representative having overall responsibility for
the
operation covered
by
this permit.
2.
For a
unit
of
government, by a ranking elected official or
other
duly authorized representative.
3. For a partnership, by a
general partner; and for a sole proprietorship,
by
the proprietor.
4. For a limited liability company, by a manager.
Sign
the
form
and print the
name
of
the
individual signing the NOT and
date
of
signature. If
the
form
was prepared by a consultant or
someone
other than an
employee
of
the
site landowner, provide
the
name and address
of
the preparer.
If
you need additional information
about
the
NOT
for construction activities, please
contact
the Department
at
(608) 267-7694.
Mailing Address
Unless otherwise directed, mail this completed
NOT
Form to the
WDNR
office associated with
the
county
of
the
site location:
Ashland
Barron
Bayfield
Burnett
Brown
Calumet
Door
Fond
du
Lac
Adams
Buffalo
Chippewa
Clark
Columbia
Dane
Dodge
Kenosha
Milwaukee
Douglas
Florence
Forest
Iron
Green
Lake
Kewaunee
Manitowoc
Marinette
Crawford
Dunn
Eau
Claire
Jackson
Juneau
Grant
Green
Iowa
Ozaukee
Racine
Langlade
Lincoln
Oneida
Polk
Price
Marquette
Menominee
Oconto
NORTHERN REGION (NOR)
Rusk
Sawyer
Taylor
Vilas
Washburn
NORTHEAST REGION (NER)
Oneida
Reservation
Outagamie
Shawano
Waupaca
Waushara
Winnebago
La
Crosse
Marathon
Monroe
Pepin
Pierce
Jefferson
LaFayette
Richland
Sheboygan
Walworth
WEST CENTRAL REGION (WCR)
Portage
St.
Croix
Trempealeau
Vernon
Wood
SOUTH CENTRAL REGION (SCR)
Rock
Sauk
SOUTHEAST REGION (SER)
Washington
Waukesha
WDNR
Baldwin Service Center
890
Spruce Street
Baldwin,
WI
54002
715-684-2914 ext. 109
WDNR
Northeast Regional Headquarters
2984
Shawano
Avenue
Green
Bay,
WI
54313-6727
920-662-51
00
WDNR
Baldwin Service Center
890
Spruce Street
Baldwin,
WI
54002
715-684-2914 ext. 109
WDNR
South Central Regional Headquarters
3911 Fish Hatchery Road
Fitchburg,
WI 53711
608-27 5-3266
WDNR
Waukesha
Service
Center
141
N.
W.
Barstow
Street,
Room
180
Waukesha, WI
53188
262-57 4-21
00
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