Fillable Cold Spring Storm Water Management Application -September-30-2014-1 - Cold_Spring_Storm_Water_Management_Application_ Final 08_20_20141

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Cold Spring Storm Water Management Application -September-30-2014-1 - Cold_Spring_Storm_Water_Management_Application_ Final 08_20_20141

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Storm Water Management Program Application Rev 08/2014 Page 1
Storm Water Management Program Application
City of Cold Spring
5694 East Alexandria Pike
Cold Spring, KY 41076
Phone: (859) 441-9604
Fax:
(859) 441-4640
www.coldspringky.com
FOR CITY OF COLD SPRING USE ONLY: Application Number:
The enclosed The Storm Water Pollution Prevention Plan – SWPPP (Construction Erosion and Sediment Control Plan) and
supporting information for certification pursuant to the City of Cold Spring Construction Erosion and Sediment Control
Ordinance ______________.
Section A (To be completed by Responsible Agent during Construction)
1. Name of Project:
2. Project Address:
3. PIDN:
999-99-
4. Subdivision: Lot #:
5. Number of Units/Buildings/Dwellings:
6. Total Project Area: Acres
7. Total Area Being Disturbed: Acres Watershed Drainage Area
8. Property Owner Information:
Name:
Address:
City State Zip
Phone Number: Email:
9. Plans Preparer Information:
Name:
Address:
City State Zip
Phone Number: Email:
The Storm Water Pollution Prevention Plan – SWPPP (Construction Erosion and Sediment Control Plan) must be prepared by
or under the direction of and be sealed by a Professional Engineer licensed in the Commonwealth of Kentucky.
10. Responsible Agent During Construction Information:
Name:
Address:
City State Zip
Phone Number: Email:
11
.
SIGNATURE: I hereby certify that the information contained in this application and attachments is true and correct and
that any misrepresentations or misstatement of facts shall be grounds for denial or revocation of the permit.
Applicant’s Signature Date
Section B (To Be Completed By the Storm Water Management Agent)
Applicant Certification: Stage I D
evelopment Plan
Print Name: Certified Denied
Date:
Receipt of Fee, Plan and Supporting Documents: Stage II Development
Total Fee Charged: $ Certified Denied
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Storm Water Management Program Application Rev 08/2014 Page 2
Storm Water Management Program Application
City of Cold Spring
5694 East Alexandria Pike
Cold Spring, KY 41076
Phone: (859) 441-9604
Fax: (859) 441-4640
www.coldspringky.com
Application/Certification for Storm Water Management and
Construction Erosion and Sediment Control
By completing this form and signing the attached form, the applicant hereby certifies that all information
provided with the application will be in accordance with the current construction erosion and sediment control
measure standards and in accordance with the City of Cold Spring Storm Water Manuals and agrees to the
following:
1. To notify the City of Cold Spring in writing at least forty-eight (48) hours in advance of any land
disturbance activity. Failure to provide such notification may result in additional inspection fees and
fines.
2. To notify the City of Cold Spring upon completion of the Project. (NOTE: No certificate of occupancy
can be granted until a report of compliance is issued by the City of Cold Spring and/or their duly
authorized representative.)
3. To maintain a copy of the certified and approved plan on the project site during construction
4. To allow the City of Cold Spring and/or their duly authorized representative to access the project lands
for inspection.
5. That any conveyance of this project or portion thereof prior to its completion will transfer full
responsibility for compliance with the certified plan to any subsequent owners.
6. To comply with all terms and conditions of this application and certified plan including payment of all
fees prescribed by the district fee schedule hereby incorporated by reference.
The applicant hereby further acknowledges that structural measures contained in the Storm Water Pollution
Prevention Plan – SWPPP (Construction Soil Erosion and Sediment Control Plan) is reviewed for adequacy to
reduce offsite soil erosion and sedimentation and not for adequacy of structural design. The applicant shall
retain full responsibility for any damages which may result from any construction activity notwithstanding
district certification of the subject soil erosion and sediment control plan. It is understood that approval of the
plan submitted with this application shall be valid only for the duration of the initial project approval granted by
the City of Cold Spring and/or their duly authorized representative. All municipal renewals of the project will
require submission and approval by the City of Cold Spring and/or their duly authorized representative. In no
case shall the approval extend beyond three and one-half (3-½) years at which time resubmission and
certification will be required. Soil Erosion and Sediment Control Plan (SWPPP) certification is limited to the
controls specified in the plan.
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Completed 12 July 2020

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