Fill - Free fillable Erosion Control And Stormwater Management Permit Applications (Village of Brooklyn) PDF form

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1OF16UPDATED1/3/2018

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VillageofBrooklyn

ErosionControlandStormwaterManagement

PermitApplication

210CommercialStreet,P.O.Box189

Brooklyn,WI53521

608‐455‐4201/fax455‐1385

clerk@brooklynwi.gov&deputyclerk@brooklynwi.gov



Nolandownerorlandusermaycommencealanddisturbanceorlanddevelopmentactivity

subjecttothisordinancewithoutreceivingpriorapprovalofanerosioncontrolandstormwater

managementplanforthesiteandapermitfromtheVillageEngineer.Applicantshallsubmitthis

applicationalongwithacontrolplan

andpayanapplicationfeetothevillage.Within21daysof

receiptoftheapplication,controlplanstatement,andfeetheVillageEngineerwillreviewto

determineifallrequirementsoftheordinancearemet.(Ordinance107)



ALLNECESSARYINFORMATIONMUSTBEPROVIDEDONTHISFORM(Ordinance107‐36)



OwnerInformation

Name



ContactPerson

Workphone



HomeorCellPhone

Address



City,State,Zip

Email Fax



ContractorInformation

Name



ContactPerson

Workphone



Title

Address



City,State,Zip

Email Fax



ConstructionSiteInformation

SiteName:



LocationAddress:



MailingAddress:



ProjectStartDate: ProjectEndDate:

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2OF16UPDATED1/3/2018

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IfthesiteisnotwhollylocatedwithintheVillageofBrooklynorifthesiteisnotlocatedonaVillage

Street,completethefollowing:



QuarterQuarter_Quarter_____ Section_____Township______N.Range_______



Isthissitewhollycontainedontheabovequartersection?(YesorNo)______

*Usemore

spaceifneededtodescribesitelocation



TotalAreaofConstructionSite:_______AcresTotalEstimatedDisturbedArea:________Acres

SiteImperviousArea:(includingrooftops)BeforeConstruction:_________%

AfterConstruction:__________%

TypeofConstruction(checkallthatapply):

__Residential__Commercial__Industrial__Reconstruction__Demolition 



__Utility

__Transportation(ifapplicable,listWDOTProjectNumber)



__Other(Describe)



__Stormdrainsystem–infiltratestogroundwater

__Stormdrainsystem–dischargetosurfacewater

__Directlyorindirectlytowatersofthestate–enternameofstream,river,lakewetland

__Infiltrationtogroundwater

occurson‐site



Hasthestormwaterdischargeleavingthesitebeensampledandanalyzedforpollutants?(YesorNo)

Certification



“Icertifythatthisdocumentandattachmentswerepreparedundermydirectionorsupervisionin

accordancewithasystemdesignedtoassurethatqualifiedpersonnelproperlygatherandevaluate

theinformationsubmitted.Basedonmyinquiryoftheperson,orpersons,directlyresponsiblefor

gatheringtheinformation,theinformationsubmitted

is,tothebestofmyknowledgeandbelief,true,

accurate,andcomplete.Inaddition,Icertifythattheprovisionsofthepermit,includingdevelopment

andimplementationoftheConstructionSiteErosionControlandStormwaterManagementPlan,will

becompliedwith.IamawareoftheenforcementprovisioninOrdinance107

‐26ofthevillage

ordinance,andwherenoticeofnoncompliancehasbeengivenandinnotcorrectedwithinthetime

periodsspecifiedinOrdinance107‐26.Iauthorizethevillagetotakecorrectiveaction,asdescribedin

andconsenttoassessmentsbythevillageagainstmypropertyforthetotal

costsandexpensesofthis

action.”

OwnerPrintedName



Telephone#

OwnerSignature



DateSigned



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3OF16UPDATED1/3/2018

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Pleasecompleteifthispermitapplicationwaspreparedbyaconsultantorsomeoneotherthanand

employeeofthesiteOwner.



PreparePrintedName



Firm

MailingAddress



Title

City,State,ZipCode



Telephone#

SignatureofPrepare DateSigned

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4OF16UPDATED1/3/2018



VillageofBrooklyn

ErosionControlApplicationChecklist

Ordinance107.28



Date:___________



Project_________________________________________Permit#_____________________



Pleasechecktheappropriatebox:I=Included;NA=Non‐Applicable(if“NA”ischecked,and

explanationmustbeentered)



Applicant Reviewer

PlanRequirement I NA Explanation/LocationinPlan I NA

Crosssectionsandprofilesofroadditches    

Culvertsizes  

Directionofrunoffflow(contoursorrunoff

arrows)

   

Watershedsizeforeachcontributing

drainagearea

   

Designdischargeforditchesandstructural

measures(flowcalculations)

   

Runoffvelocitiesinchannels(feet/second,

meters/second)

   

Fertilizerandseedingrates(seed,fertilizer,

andmulch)

   

Timescheduleforstabilizingexposedsoil   

Preventgullyandbankerosionandapply

minimumstandardsforsheetandrill

erosion:7.5ton/acre/yr(soilloss

calculation)

   

Descriptionofhowthesiteistobe

developed(writtendescription)

   

Provisionsforsequentialstepsmitigating

theerosiveeffectoflanddisturbing

activities(listoferosioncontroldevices)

   

Provisionstopreventmud‐trackingoff‐site

ontopublicthoroughfaresduring

construction(stonetrackingpad)

   

Anyotherinformationnecessaryto

reasonablydeterminethelocation,nature,

andconditionofanyphysicalor

environmentalfeaturesofthesite

   

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5OF16UPDATED1/3/2018



Anyproposedchangestotheerosion

controlplanmustbesubmittedand

approved

   



ApplicationRequirement



I



NA



Explanation/LocationinPlan



I



NA

CopyofPreliminaryReviewLetter,if

applicable

   

Copiesofpermitsorapprovalsbyother

agencies

   

Proposedscheduleforcompletionand

installationofallelementsoftheerosion

controlplan

   

Estimatedcostofcompletionand

installationofallelementsoftheerosion

controlplan.

   



Ifstormwatermanagementrequirementsareapplicable,thestormwaterchecklistmustbeattached.

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6OF16UPDATED1/3/2018



VillageofBrooklyn

Stormwate r ManagementApplicationChecklist

Ordinance107.29,107.36



Date:___________



Project_________________________________________Permit#_____________________

Landowner:____________________________Applicant:______________________________

Address:_______________________________Address:_______________________________

___________________________________________________________________________

LandownerPhone#:______________________Applicant’sPhone#:______________________



FeeCalculation:



Notes:

1. Besuretoindicatethelimitsofdisturbedandimperviousareaonyourplan.

2. Allrequirementsonthischecklistcorrespondtotherequirementssetforthinchapter44

oftheVillageofBrooklynOrdinance.

3. Bysubmittingthisapplication,permitteeandlandownerpermittheLocalApproval

Authoritytoentertheprojectpropertyforpurposesofinspection.



LandownerorApplicant’sSignature:______________________________________



Date:___________________________



(Ifapplicantisnotthelandowner,attachanotarizedstatementauthorizingapplicantto

actaslandowner’sagent.)



Receivedby:_____________________________Date:________________________



Reviewedby:_____________________________Date:________________________



PermitIssuedby:__________________________Date:________________________

TotalNewImperviousArea(includesgravel)(squarefeet)_________X________$/sq.ft.‐$

TotalRedevelopmentImperviousArea(includesgravel)(squarefeet)_________X_______ _$/sq.ft.‐$

BaseFee=$________________

TotalPermitFee=$______________

click to sign

signature

click to edit

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7OF16UPDATED1/3/2018



Stormwate r ManagementApplicationChecklistContinued



Pleasechecktheappropriatebox:I=Included;NA=Non‐Applicable(if“NA”ischecked,and

explanationmustbeentered)



Applicant Reviewer

PlanRequirement I NA Explanation/LocationinPlan I NA

Narrativedescribingtheproposedproject,

includingimplementationscheduleof

designedpractices

   

Identificationoftheentityresponsiblefor

long‐termmaintenanceoftheproject

   

Mapshowingdrainageareasforeach

watershedarea

   

Noincreaseinpeakdischargefor2and10‐

year24‐hourstormeventsandsafelypass

the100‐year24‐hourstorm,including

summarytable.(runoffratesincubicfeet

persecond)*

   

Completesiteplanandspecifications*  

Engineereddesignsforallstructural

managementpractices

   

Fornewdevelopment,trap5micronsoil

particle980%reductioninTSS)forthe1‐

year,24‐hourstormevent

   

Forredevelopment,trap20micronsoil

particle(40%reductioninTSS)forthe1‐

year,24‐hourstormevent

   

Treatfirst0.5inchesofrunoffforcontrol

ofoilandgreasefromcommercialor

industrialareas.(seeordinance107‐29

(b)(2))

   

Proofofstableoutletcapableofcarrying

thedesignflowatanon‐erosivevelocity

   

Alldownspouts,driveways,andother

imperviousareasshallbedirectedto

previoussurfaces,wherefeasible

   

Provisionsandpracticestoreducethe

temperatureofrunoffforsitesthatdrain

toacold‐waterresourceasidentifiesinthe

ordinance(seeordinance107‐29(b)(3&

7))(seeThermalLocatorat

   



8OF16UPDATED1/3/2018



www.co.dane.wi.us/landconservation/hom

ebnd.htm)

Maintenanceplanandscheduleforall

permanentStormwatermanagement

practices

   



ApplicationRequirement



I



NA



Explanation/LocationinPlan



I



NA

CopyofPreliminaryReviewLetter,if

applicable

   

Proposedscheduleforcompletionand

installationofallelementsofthestorm

watermanagementplan

   

Estimatedcostofcompletionand

installationofallelementsofthe

stormwatermanagementplan

   

Evidenceoffinancialresponsibilityto

completeworkproposedinplan

   

Copyofaffidavitrequiredbys.14.49(3)(d)

forprivatelyownedstormwaterpractices

   



Seenotesonnextpage



9OF16UPDATED1/3/2018



VillageofBrooklyn

Stormwate r ManagementPlanNotes



Thesummarytableinplanrequirement4mustincludethefollowing:



 Pre‐existingpeakflowrates

 Postconstructionpeakflowrateswithnodetention

 Postconstructionpeakflowrateswithdetention

 Assumedrunoffcurvenumbers

 Timeofconcentrationusedincalculations



Completesiteplanandspecificationsinplanrequirement5mustincludethefollowing:



 Propertylinesandlotdimensions

 Allbuildingsandoutdooruses,existingandproposed,includingalldimensions

andsetbacks,allpublicandprivateroads,interiorroads,drivewaysandparking

lots,showingtrafficpatterns

 Andtypeofpavingandsurfacingmaterial

 Allnaturalandartificialwaterfeatures

 Depthtobedrock

 Depthtoseasonalhigh‐watertable

 TheextentandlocationofallsoiltypesasdescribedintheDaneCountySoil

Survey,slopesexceeding12%,andareasofnaturalwoodlandandprairie

 Existingandproposedelevations,sections,profilesanddetailsasneededto

describeallnaturalandartificialfeaturesof

 Theprojectsoilerosioncontrolandoverlandrunoffcontrolmeasures,including

runoffcalculationsasappropriate

 Detailedconstructionschedule

 Copiesofpermitsorpermitapplicationsrequiredbyanyothergovernmental

entitiesoragenciesanyotherinformationnecessarytoreasonablydeterminethe

location,natureandconditionofany

 Physicalorenvironmentalfeatures

 Allexistingandproposeddrainagefeatures

 Thelocationandareaofallproposedimpervioussurfaces

 Thelimitsandareaofthedisturbedarea



10OF16UPDATED1/3/2018



VillageofBrooklyn

ErosionControlSimplifiedPlanChecklist



THISFORMMAYBEUSEDONLYFORLANDDISTURBINGACTIVITIESADMINISTEREDUNDERTHE

VILLAGEOFBROOKLYN’SEROSIONCONTROLANDSTORMWATERMANAGEMENTORDINANCE

WHENEVERALLTHREEOFTHEFOLLOWINGCONDITIONSEXIST*(Ordinance107ArticleII):



 Thelanddisturbanceisnotmorethan20,000squarefeetinarea

 Thelanddisturbanceisnotadjacenttoanddoesnotdraindirectlyintoanysensitive

areasnearby,suchasstreams,lakesorwetlands

 Theslopethroughthelanddisturbanceisnotmorethan6%(6ftverticalto100ft

horizontal)



(*Note:Aspecificerosioncontrolplanisrequirediftheaboveconditionsdonotexist.Referto

ordinance107‐27Brooklyn’sErosionControlOrdinance.)



Instructions:

 Completethisplanbyfillingintherequestedinformationonthesitediagramonthenext

page

 Submitthisplanatthetimeofpermitapplication

 Incompletingthisform,giveconsiderationtominimizingthedisturbedarea,prompt

seeding,andproperplanningofwaterrunoffpatternsthroughallstagesofdevelopment







11OF16UPDATED1/3/2018



SITEDIAGRAM 

(UseErosionControlPlanLegen d frompreviouspage)



12OF16UPDATED1/3/2018



Representativesoiltypeofthedisturbedareaonthesite:_______________________________



ProjectLocation(address,city):____________________________________________________



Builder:___________________________________PhoneNumber:______________________



Owner:____________________________________PhoneNumber:______________________



WorksheetCompletedby:_____________________Date:_________________



ErosionControl–SimplifiedChecklist



Completethesitediagramwiththefollowinginformation:



SITECHARACTERISTICS



Northarrowandsiteboundary.Indicateandnameadjacentstreetsorroadways.



Locationofexistingdrainagewayswithinandnearbythesite.



Locationofexistingandplannedstormsewerinletsandculvertscrossingnearsite.



Locationofexistingandproposedbuildingsandpavedareas.



Locationandapproximate

dimensionsofthedisturbedareaonthesite.



Approximategradientanddirectionof:1)existingandplannedslopes;and2)existingand

planneddrainagewaysonthesite.



Locationandapproximatewatershedareasofoverlandrunoff(sheetflow)anddrainageway

runoff(concentratedflow)comingontothesitefromadjacentareas.



Representativesoiltypeofthedisturbedareaonthesire(i.e.sandy,loam,siltloam,clay)



13OF16UPDATED1/3/2018



ErosionControlPractices



Locationoftemporarysoilstoragepiles.

 Soilstoragepileswillbecontainedbyadownslopesedimentfenceorbecoveredwitha

tarp.Itisrecommendedthattheybelocatedmorethan25feetfromanydownslope

roadordrainageway.

 Itisrecommendedthattheybetemporaryseededandmulched.



Locationoftemporarygravelaccessdrive(s).

 Graveldrivewillhavetwotothree‐inchaggregatestonelaidatleastsevenfeetwideand

sixinchesthick.

 Driveswillextendfromtheroadway50feetortothebuilding(whicheverisless).



Locationofsedimentcontrols(filterfabricfence,strawbalefence,rocksedimenttrap,orother

plannedpractices)thatminimizetheamountoferodedsoilleavingthesite.

 Sedimentcontrolswillbeinstalledalongthedownslopesidesofthedisturbedareas

unlessitisplannedthatpermanentseedingandmulchingwillbecompletedwithin30

daysofthestartofgrading.

 Sedimentcontrolswillbeinstalledaroundsoilstoragepiles,inlets,atoutletsofdrainage

ways,andalongadjacentwayswhichreceiverunofffromthesite.



Locationofsedimentbarriersaroundstormsewerinlets.

Locationofdiversions.

 Itisrecommendedthatareasofconcentratedflowbeproperlydivertedaround

disturbedareas.Overlandrunoff(sheetflow)fromadjacentareasgreaterthan10,000sq.

ft.isalsorecommendedtobedivertedarounddisturbedareasinamannerthatwillnot

adverselyimpactadjacentlandowners.

 Diversionswillbestabilizedwithseedingandmulchingwithin24hoursofdiversion

completion.



Locationofpracticesthatwillcontrolerosioninareasofconcentratedflow.

 Drainagewayswillbestabilizedwithseeding,mulching,andotherappropriatemeasures

within24hoursofdrainagewayscompletion.

 Sedimentcontrolswillbeinstalledattheoutletendsofdrainageways.



14OF16UPDATED1/3/2018



ManagementofErosionControl



Temporarystabilizationofdisturbedareas.

 Itisrecommendedthatroughgradeddisturbedareas(plannedtobeleftinactivefor

morethan30days)andtemporarysoilstockpiles(plannedtobeleftinactiveformore

thansevendays)bestabilizedbytemporaryseeding(betweenApril1andOctober15)or

byothercover,suchascoveringwithatarpormulching.

 TemporaryseedingofoatsorsudangrassarenormallysownbetweenMay15andJuly

15.RyegrassorwinterwheatarenormallysownbetweenJuly15andSeptember15.



Permanentstabilizationofsitebyre‐vegetationorothermeans.

 PermanentseedingwillbecompletedbySeptember15 orsoddingplacedbyNovember

15

 Straworgrassyhaymulchingisrecommendedonalldisturbedareasthatareplannedto

beseeded.



PERMANENT SEE DINGTY PE RATEOFAPPLICATION





 Useofdownspoutand/orsumppumpoutletextensiontostabilizedareas.

 Trappingsedimentduringsitedewateringoperations.

 Sedimentladendischargeshouldbetemporarilypondedbehindasediment

barrieruntilmostofthesedimentsettlesout

 Properdisposalofbuildingmaterialwastesothatpollutantsanddebrisarenotcarried

offsitebywindorwater.

 Maintenanceoferosioncontrolpractices.

 Allerosioncontrolpracticeswillbeinspecteddailyandmaintainedinworking

condition.

 Accumulatedsedimentwillberemovedfrombehindsedimentfencesand

barriersbeforeitreachesadepththatisequaltohalfthebarrierheights.

 Allsedimentthatmovesoff‐siteduetoconstructionactivitieswillbecleanedup

bytheendoftheworkday.

 Allsedimentthatmovesoff‐siteduetostormeventswillbecleanedupassoonas

possible,butatleastbytheendofthenextday.

 Temporarygravelacrossdriveswillbemaintainedthroughoutconstructionin

workingcondition.

 Allerosioncontrolpracticeswillbemaintaineduntilthedisturbedareasthey

protectarepermanentlystabilizedandestablished,thetemporarycontrol

practiceswillberemoved.



15OF16UPDATED1/3/2018



 Scheduleoferosioncontrolpracticesinstallationandsitegrading

 Necessaryerosioncontrolpracticeswillbeinstalledpriortothebeginningof

grading.

ACTIVITY DATE

InstallErosionControlPractices

StartGrading

ApplyTemporaryStabilization

ApplyPermanentStavilization



Permanentseedingresponsibilityof:

Name___________________________

Phone#:_________________________



Installationandmaintenanceoferosioncontrolpracticesresponsibilityof:

Name___________________________

Phone#:_________________________



FORADDITIONALASSISTANCEWITHPLANPREPARTION,refertotheVillage’sErosionControl

andStormwaterManagementOrdinance107,WDNRWisconsinConstructionSiteBest

ManagementHandbook,theDaneCountyErosionControlandStormwaterManagement

Manual,andtheUW‐Extensionpublication,ErosionControlforHomeBuilders.



TheWisconsinConstructionSiteBestManagementHandbookisavailablethroughStateof

WisconsinDocumentSalesat(608)266‐3558.



TheDaneCountyErosionControlandStormwaterManagementManualisavailablethrough

theDaneCountyLandConservationDepartmentat(608)224‐3730



ErosionControlforHomeBuilders(GWQ001)canbeorderedthroughCooperativeExtension

Publications,(608)262‐3346



ContactDaneCountyPlanningandDevelopment–ZoningDivisionat(608)266‐4266orthe

DaneCountyLandConservationDepartmentat(608)224‐3730forfurtherassistance.



Village

ofBrooklynOrdinance107‐36



16OF16UPDATED1/3/2018



OFFICE USE ONLY

Date Received: By: Parcel #:

Referred To: Fee: $ Check#

Paid

OFFICE USE ONLY – MATERIALS SENT TO:

Date Sent: Return By:

Response:

Zoning Administrator

Building Inspector

Public Works

Police Department

Fire Inspector

EMS

Village Engineer

Village Attorney (as needed)

APPROVALS

Plan Commission Meeting Date:

Your Request has been:

Approved Not Approved Approved with conditions

Village Board Meeting Date:

Your Request has been:

Approved Not Approved Approved with conditions



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Erosion Control And Stormwater Management Permit Applications (Village of Brooklyn)

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