Fill - Free fillable Land Disturbance Permit Packet PDF form

City of Chamblee | Development Department

5576 Peachtree Rd, Ste 102 | Chamblee, GA 30341

770-986-5010 | Fax: 770-986-5014| www.chambleega.gov

Land Disturbance Permit

Application Packet

Pre-Application Submittal

Pre-Application Meeting

Application Submittal

Plan Review

Resubmittal, if necessary

Plan Approval

Construction &

Inspections

Project Closeout or Other

Applications

City of Chamblee | Development Department

5576 Peachtree Rd, Ste 102 | Chamblee, GA 30341

770-986-5010 | Fax: 770-986-5014| www.chambleega.gov

The Following Information is Included in this Packet:

Pre-Application Instructions and Form

2. Instructions for Obtaining a Land Disturbance Permit

3. Land Disturbance Permit Process Flowchart

4. Land Disturbance Permit Application

5. Land Disturbance Permit Route Sheet

6. Redevelopment Assessment Form

7. Site Plan Review Checklist

8. Tree Removal Permit Application

9. Retaining Wall Permit Application

10. ROW Encroachment Form

11. Sewer Capacity Evaluation Form

12. Erosion Control Bond Form

13. DeKalb County GIS Review Checklist

Rev 1/20/17

City of Chamblee Development Department

3506 Broad St. • Chamblee, GA 30341 • 770-986-5024• chambleega.gov

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

INSTRUCTIONS FOR REQUESTING A PREAPPLICATION MEETING

Note: All new construction, major renovation, change of use and building expansions must comply with zoning and

building requirements. The City’s Code of Ordinances may be viewed online through Municode at:

www2.municode.com/library/ga/chamblee/codes/code_of_ordinances. Zoning regulations are located within the Unified

Development Ordinance section of the City Code.

Application Submittal and Review Process:

A. Complete a Pre-Application Information Form that contains a detailed description of the request.

B. Prepare Concept Plans and a Submit a PDF digital version that conveys the proposed project. These plans

may be conceptual in nature and do not need to be developed by a design professional. (Note: Individual PDF

files may not exceed 25 MB. Large files should be separated into individual PDF files not exceeding 25 MB.)

C. Submit the Pre-Application Instruction Form and Concept Plans to the Development Department in person

or via email to chambleedevdept@chambleega.gov. The application and forms will be reviewed within (2) two

business days. Once the plans are reviewed, the Development Department will notify the applicant if an in-

person Pre-Application meeting is required. Note: If an in-person meeting is not necessary, then the Pre-

Application Meeting will take place during Building Permit submittal.

D. Attend a Pre-Application Meeting with the Development Department. The Development Department will

contact the applicant to schedule a Pre-Application Meeting. Feedback about the proposal along with an

overview of the application/review process will be provided during this meeting. The applicant should bring a

hard copy of the concept plans to the meeting.

E. Submit a Signed Copy of the Pre-Application Information Form with the formal application. When the

applicant is prepared to submit the full, complete application for the development activity or zoning process a

copy of this form is required to be submitted.

PRE-APPLICATION INFORMATION FORM SUBMITTAL CHECKLIST:

 Complete Pre-Application Information Form

 One PDF digital version of Concept Plans (Note: Individual PDF files may not exceed 25 MB. Large files should

be separated into individual PDF files not exceeding 25 MB.)

PRE-APPLICATION INFORMATION FORM

This page must be completed by the Applicant.

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

APPLICANT

_______________________________________________________________________________

Name

_______________________________________________________________________________

Company

_______________________________________________________________________________

Mailing Address Suite/Apt. # City, State Zip Code

_________________ _________________ _________________

Primary Phone # Alternate Phone # E-mail

PROJECT SUMMARY

_______________________________________________________________________________

Address of Project

_______________________________________________________________________________

Name of Project

_______________________________________________________________________________

Application Type (Rezoning, Building Permit, Land Disturbance, Variance, etc.)

______________________

Total Project Acreage

Detailed Description (Include Proposed Use(s) and Square Footage of Floor Area for each use):

_______________________________________________________________________________

________________________________________________________ Date: ______ / ______ / ___________

Applicant Signature

NOTE: This form must be signed by the Development Department and submitted with your application.

For Internal Use Only:

Pre-Application Meeting Date: _______________________

Staff Printed Name: _________________________ Signed: _________________________________

click to sign

signature

click to edit

Rev 2/26/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

INSTRUCTIONS FOR OBTAINING A LAND DISTURBANCE PERMIT

All new construction, major renovation, and building expansions must comply with zoning and land development

requirements. The City’s Code of Ordinances may be viewed online through Municode

at: www2.municode.com/library/ga/chamblee/codes/code_of_ordinances

. Zoning regulations are located within the

Unified Development Ordinance section of the City Code.

Note: Any land or vegetation change, including, but not limited to, clearing, grubbing, stripping, removal of vegetation,

dredging, grading, excavating, transporting and filling of land and/or any land development or redevelopment requires

the obtainment of a Land Disturbance Permit.

Plan Submittal and Review Process (see attached flowchart for additional details):

A. Prepare digital PDF engineered plans as required for the construction of all new buildings, additions, or other grading

and land disturbing activities. (Note: Individual PDF files may not exceed 25 MB. Large files should be separated into

individual PDF files not exceeding 25 MB.) All plans should be clearly drawn to scale (feet/inches) and include the

details below. Clearly indicate the scope of work on the cover page of the plans. Refer to Article 6 of the UDO

for Specifications of Standard Development Documents.

B. DeKalb County Fire Marshal’s Office Review: A route sheet will be provided by the City along with a completed

original Chamblee Land Disturbance Permit application form with permit number at time of submittal. Two (2) sets of

plans will be routed by the applicant to the Fire Marshal’s Office for review. The office is at 330 W. Ponce de Leon

Dr., Decatur GA 30030. For intake fees, processes and hours, call 404-371-9256. See other Fire Marshal

requirements, forms, fee schedules and instructions at https://www.dekalbfirerescue.org

C. Fees. Land Development fees are listed on the fee schedule adopted by City Council. (See Fee Schedule) Payment

of the Land Disturbance Plan Review fee is required with the first submittal.

D. Plan Revision and Resubmittal Process. Code compliance comments from the Fire Marshal and Development

Department will be sent jointly via email to the contact person listed on the application. All resubmittals must be

submitted electronically along with a separate document that includes detailed responses to any comments

provided. The applicant must work directly with any other outside review agencies (see attached flowchart).

E. Plan Approval. When the plans are approved, an approval letter will be emailed to the contact person listed on the

application. This letter will notify the applicant of any outstanding items necessary to issue a permit. The applicant

will be asked to submit at least one (1) electronic final version of all plans. The applicant must also provide all

required outstanding, supporting documentation appropriate to the project (i.e. bonds, Board of Health, DeKalb

Watershed, etc.) outlined in the approval letter. Once the plans are digitally signed, they will be returned

electronically to the applicant. Once the permit is approved the City will contact you about arranging an on-site Pre-

construction meeting with the Land Development Inspector and/or the Building Official. A permit card will be

distributed at that time. The applicant must bring a printed set of the plans to the Pre-Construction Meeting. These

plans will remain onsite during construction. (Note: Individual PDF files may not exceed 25 MB. Large files should be

separated into individual PDF files not exceeding 25 MB.)

*****

***********************************************************************************************************************

Notes to Contractors:

The street address and/or suite numbers must be clearly posted at all project locations. Construction dumpsters may

not be placed in the street. The inspection card and an approved set of the plans must remain on the site at all times

during construction. Permits are not transferable nor are they refundable. Permits expire if work is not begun within 6

months (Section 340-69) or completed within two years of issuance (Section 300-45).

Rev 1/10/20

City of Chamblee Planning & Development Department

5576

Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

LAND DISTURBANCE PERMIT SUBMITTAL CHECKLIST:

Initial Submittal:



Completed Land Disturbance Permit Application



Completed LDP Route Sheet



Pre-Application Information Form (signed by staff)



Completed Tree Removal Application, if applicable – submitted as separate permit



Completed Retaining Wall Application, if applicable – submitted as separate permit



ROW Encroachment Form, if applicable



Redevelopment Assessment Form (for additions only)



One (1) digital copy of survey, site plan, and civil drawings (Note: Individual PDF files may not exceed 25 MB. Large files

should be separated into individual PDF files not exceeding 25 MB.)



Utility location plan for gas and electric (townhomes)



Hydrology report, if applicable



Completed Erosion, Sedimentation & Pollution Control (ESPC) Plan Checklist



LEED or Green Globes Checklist and Project Registration



Federal Aviation Administration FAA Form 7460-1 and any and all responses received from FAA (projects in the Runway

Protection Zone Overlay District)



Plan Review Fees paid



NPDES fees paid ($80/ disturbed acre) (all sites >1 acre): $40/acre to Chamblee; $40/acre to EPD (submit receipt).



Erosion Control Bond ($3,000 per acre or fraction thereof).

Plan Revisions:



PDF Digital Version of Plans (Note: Individual PDF files may not exceed 25 MB. Large files should be separated into

individual PDF files not exceeding 25 MB.)



Document including detailed responses to any plan comments



Any other requested supporting documents from Reviewers

Prior to Issuance of Permit:



At least one (1) final electronic set of final engineered/architectural plans (Note: Individual PDF files may not exceed 25 MB.

Large files should be separated into individual PDF files not exceeding 25 MB.)

Prior to Project Closeout (stand-alone LDPs only; all others will be closed-out at CO):



Inspections:

a. DeKalb Fire/Water & Sewer (all projects)

b. County/State DOT (work within County/State ROW)

c. Federal Aviation Administration (in Runway Protection Zone Overlay District)



Remaining Required Documents (recorded bonds, agreements, easements, and as-builts).

a. Performance Bond (incomplete roads, sidewalks, landscape)—150%.

b. Maintenance Bond (detention ponds)-- $5.00/cubic foot of storage.

c. Maintenance Bond (roads, sidewalks, landscape)—60%

d. Stormwater Maintenance Agreement executed and recorded (detention

ponds).

e. Stormwater As-builts, in .pdf file format, reviewed and approved by Engineer

(detention ponds).

f. Stormwater As-builts, in .dwg file format, for our MS4 inventory (detention

ponds).

g. Confirmation of recorded easements.

 Digital version of plans

Land Disturbance Permit Process

Official Submittal

1. Completed Land Disturbance Permit Application

2. Completed LDP Route Sheet

3. Pre-Application Information Form (signed by staff)

4. Completed Tree Removal Application, if applicable

5. Completed Retaining Wall Application, if applicable

6. ROW Encroachment Form, if applicable

7. Redevelopment Assessment Form

8. One (1) digital copy of survey, site plan, and civil drawings (files not to exceed 25 MB)

a. Utility location plan for gas and electric (townhomes)

9. Hydrology report, if applicable

10. Erosion, Sedimentation & Pollution Control (ESPC) Plan Checklist

11. LEED or Green Globes Checklist and Project Registration

12. Federal Aviation Administration FAA Form 7460-1 and any and all responses received from FAA (projects

in the Runway Protection Zone Overlay District).

13. Plan Review Fees paid.

14. NPDES fees paid ($80/ disturbed acre) (all sites >1 acre)

a. $40/acre to Chamblee.

b. $40/acre to EPD (submit receipt).

15. Erosion Control Bond ($3,000 per acre or fraction thereof).

Internal Plan Review

1. Planning & Zoning – arussell@chambleega.gov

2. Engineering – jmueller@chambleega.gov

3. Arborist– acorr@chambleega.gov

4. Public Works – mbaker@chambleega.gov

5. Public Works ROW Encroachment– jthomson@chambleega.gov

6. DeKalb Fire – pgspieks@dekalbcountyga.gov

7. Each submittal review takes up to 10 business days.

8. Comments are sent to applicant by Planning Coordinator on the Code Compliance

Letter. Fire Marshal comments will be included in the Code Compliance Letter.

9. Each City resubmittal requires that the applicant submit one digital PDF.

External Plan Review

1. Applicant routes plans to external agencies using LDP Route Sheet;

2. Based on scope of project, applicant should take the following number

of plans to the following agencies:

a. DeKalb Fire/Water & Sewer – two (2) sets (all plans). Sewer

Capacity Letter or Sewer Action plan required.

b. DeKalb County GIS – electronic copy (most plans).

c. GDOT District 7 – electronic copy (all sites affecting

access/ROW along State roads) – Buford Highway and

Peachtree Boulevard.

d. DeKalb County Board of Health – one set (swimming pools)

3. All other external reviews run concurrently with internal reviews.

4. Permits are not issued until approvals are received by all the required

agencies. Applicant is responsible for ensuring all approvals are

submitted electronically to the Development Department.

Questions?

Just ask. Contact Gabrielle,

our Planning Coordinator, at

770-986-5010 or

gcazeau@chambleega.gov

Plan Approval

1. Submit one final PDF version for digital

signatures, if required. Plans will be signed

electronically and returned to the applicant

electronically.

2. Print a full set of stamped plans to remain

on-site during construction.

3. Applicant will set-up Pre-Construction

meeting on-site with Land Development

Inspector and/or CBO.

4. Permit card will be issued at the Pre-

Construction meeting.

5. No work until initial site inspection

conducted by the Erosion Control Inspector.

Inspections

Email for inspections at

inspections@chambleega.gov

, or call

the inspection hotline at 404-450-

0012, or go online to City of

Chamblee’s Contractor Portal

Inspection requests submitted by 4

p.m. will be scheduled for the next

business day.

For Fire Inspections call

404-371-9256. For immediate

assistance contact 404-371-2470.

Fire Inspections requests submitted

by 3 p.m. will be scheduled for the

next business day.

Project Closeout

1. Once a final inspection has been conducted, a letter w

ith the

following project closeout documents will be sent to the applicant

(Refer to the Project Closeout Packet):

a. In addition to inspections required by the City of

Chamblee,

the following agencies must provide a final

inspection based on use type:

i. DeKalb Fire/Water & Sewer (all projects).

ii. County/State DOT (work within County/State

ROW).

iii. Federal Aviation Administration (in Runway

Protection Zone Overlay District).

b. Performance Bond (incomplete roads, sidewalks,

landscape)—150%.

c. Maintenance Bond (roads, sidewalks, landscape)—60%

d. Stormwater Maintenance Agreement executed and

recorded (detention ponds).

i. Maintenance Bond (detention ponds)--

$5.00/cubic foot of storage.

e. Stormwater As-builts, in .pdf file format, reviewed and

approved by City Engineer (detention ponds) - 10

business day review process.

f. Stormwater As-builts, in .dwg file format, for our MS4

inventory (detention ponds).

g. Confirmation of recorded easements and other

dedications.

2. Once all required project closeout documents are submitted and

verified, the LDP will be closed-out.

Will your project

also require a

Final Plat?

Pre-Application Meeting

Meeting required for all DCI,

Rezoning, and Variance

appli

cations and may be

required for LDP applications

at the discretion of Staff prior

to accepting the application.

Proceed to the Plat

Review Process.

Yes

Will your project

also require a

Building Permit?

Yes

Proceed to the Building

Permit Review Process.

Page 1 of 2

City of Chamblee Planning and Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Revised 6/16/20

Redevelopment Assessment Form

(Applies to all existing structures except for Single-Family Detached Residential structures,

per Chamblee UDO Section 270-9)

PROPERTY ADDRESS: ______________________________________________________________

APPLICANT NAME: _______________________________ DATE: ____________________________

PROJECT TYPE: (Check all that apply)

 Renovation

 Alteration

 Addition

 Repair

 Other ______________________________________

THRESHOLD ASSESSMENT:

Total construction cost post renovation/improvement, cumulative: TCC = ___________________

(Attach documentation for all improvements made over the last 3 years. See UDO Section 270-9. Interior-only

renovations are 50% of the cost valuation based on the ICC Building Valuation Data Construction Cost Table)

Fair Market Value of existing structure(s): FMV = ___________________

(Attach DeKalb County Tax Assessor documentation for all buildings on the site. The information can be obtained

from the following website: https://propertyappraisal.dekalbcountyga.gov/search/

Percent calculation: TCC/FMV = ________________

ASSESSMENT: (Check one)

 Improvements not required because less than 30% improvement

 ≥ 30%  ≥ 60%  ≥ 70%

Mandatory compliance is not intended to result in total improvement costs greater than or equal to

125% of FMV value but applicant shall meet items in order of priority listed in Section 270-9 of the UDO

until the 125% cap is met.

See Page 2 of this form for Redevelopment Thresholds Summary Table.

Page 2 of 2

City of Chamblee Planning and Development Department

5576 Peachtree Rd, Ste 102. • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Redevelopment Thresholds Summary Table

Code to be applied

Redevelopment costs as a percentage of the

fair market value of the structure

Less than

30%

30% or

60% or

70% or

Section 230-26 (Streetscape design)

Not

mandatory

Mandatory Mandatory Mandatory

Section 250-7 (Parking)

Not

mandatory

Not

mandatory

Not

mandatory

Mandatory

Section 230-27 Building architecture)

Not

mandatory

Not

mandatory

Mandatory

Section 230-29 (Storefront Streets)

Not

mandatory

Not

mandatory

Mandatory

Remaining provisions of Chapter 230, Article 2

(Civic Design) not listed above

Not

mandatory

Not

mandatory

Not

mandatory

Mandatory

Section 250-21 (Dumpsters)

Not

mandatory

Not

mandatory

Mandatory Mandatory

Remaining provisions of Chapter 250 (Off-Street

Parking and Loading Standards) not listed above

Not

mandatory

Not

mandatory

Not

mandatory

Mandatory

Section 320-21 (Off-street surface parking lot planting

requirements)

Not

mandatory

Not

mandatory

Mandatory

Remaining provisions of Chapter 320, Article 2 (Buffers)

not listed above

Not

mandatory

Not

mandatory

Not

mandatory

Mandatory

Subsection 350-2(a)(1)(b) (Sidewalks crossing

driveways)

Not

mandatory

Not

mandatory

Mandatory

Remainder of UDO

Not

mandatory

Not

mandatory

Not

mandatory

Mandatory

Rev 01/22/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

LAND DISTURBANCE PERMIT CHECKLIST

CHECKLIST OVERVIEW

This checklist will assist applicants seeking a Land Disturbance Permit (LDP) for a commercial project to prepare and submit

complete and compliant Construction Plans for review. Your Development Permit will be valid for two (2) years from the date of

issue. Permits for grading only will expire if work is not commenced within 60 days of issuance of permit or if work is abandoned

for 30 consecutive days. All work must be in conformance with an approved site plan and applicable City ordinances, codes, and

policies.

Submittal Requirements for Plan Review:

PLANNING:

General Requirements for Construction Drawings, as per UDO Section 300-62

All Constructions Drawings should include the following:

a. Project name

b. Developer’s name, address and phone number

c. Owner’s name, address and phone number

d. Date of plan and any revision

e. Name and telephone number of 24-hour local erosion and sediment control contact

f. Name and telephone number of emergency 24-hour contact person

g. Location/vicinity map

h. Land lot and district

i. Area of property and area to be disturbed in acres

j. Location sketch (scale no less than 1" = 2,000')

l. Subdivision Plats must be signed and sealed by a Registered Land Surveyor or a Registered Engineer

m. Civil Drawings must be signed and sealed by the appropriate professional(s)

n. Landscape Plan must be signed and sealed by a Landscape Architect

Provide a to scale Certified Boundary Survey showing Existing Site Conditions including:

k. Boundary and Topographical Map to be signed and sealed by a State of Georgia Registered Land Surveyor

a. Property boundaries;

b. All streams, rivers, lakes, wetlands and other hydrologic features;

c. Stream buffer requirements of Chapter 310, Article 2 of Title 3;

d. Topographic contours of no less than ten-foot intervals;

e. All primary and secondary conservation areas labeled by type, as described in Subsection 300-14(d)(2) of this article;

f. General vegetation characteristics;

g. General soil types;

h. Existing roads and structures.

j. State acreage of site, and disturbed acreage; and existing ground cover (wooded, grassed, pavement, etc.)

k. Show adjacent property information including subdivision name, lot numbers, block letters, property owners, zoning, land

uses, etc.

l. Indicate existing conditions, including but not limited to structures, pavements widths, easements, fences, walls, walks,

signs and buildings and approximate locations of all public utilities

m. Show adjoining roadways, with names, pavement widths, lengths of streets and right-of-way width

n. State or show land lot lines and district on the plans. If it is not possible to show land lot lines on the plans, please provide

a legal tie down for the property; e.g., intersection of two right-of-ways distance and bearing from property to land lot line

intersection or right-of-way intersection

o. Show existing trees

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

p. Show ten-foot no access easement along the rear of all double frontage lots

q. Show location exact dimensions boundary of any existing cemetery and ownership information

Provide a Site Plan to scale with:

a. Building footprints and dimension to the property lines

b. Show locations of all doors of any type

c. Show all setbacks applicable to the zoning on plans

d. State the use of the buildings and square footage, height and if sprinkled, or not, on the plans

e. For residential or multi-family developments, state the house or unit size on the plans

f. Show parking spaces calculations, including number existing (if any), and proposed, number of handicapped spaces and

percentage of compact and full size

g. Show Curb cuts and internal circulation

h. Show loading area and dumpster locations

i. Show location of lighting fixtures

j. Provide calculations of existing and proposed pervious and impervious areas

k. Show on the plans exact boundary of any cemetery, disposal site, or area of potential ground contamination

l. The location of signage shall be shown on the plans

Provide information to verify the following Zoning requirements are met:

a. Maximum Impervious Surface (% of lot area) - Section 230-2

b. Minimum Open Space (% of lot area) - Section 230-2

c. Lot Size, minimum - Section 230-2

d. Lot width, minimum - Section 230-2

e. Front yard - Sections 230-2, 230-6

f. Side yard, min - Section 230-2

g. Rear yard, min - Section 230-2

h. Meets Accessory Use Provisions (if applicable) - Chapter 240, Article 2 under use code

i. Meets Supplemental Use Provisions (if applicable) - Chapter 240, Article 3 under use code

j. Meets Location, Design and Construction of Parking Areas Requirement - Section 250-7

k. Meets Stacking Spaces for Drive-Through Service Windows - Section 250-8

l. Meets parking area surfacing and lighting requirements - Section 250-10

m. Meets Off-street Loading Space Construction Requirements (if applicable) - Section 250-21

n. Meets Dumpster requirements - Section 250-22

o. Meets LEED requirement (if applicable) - Section 300-47

p. Meets landscaping in parking areas requirements - Section 320-21

Special Conditions based on zoning history of the site (if applicable). If applicable, attach conditions in table format,

indicating required and provided provisions.

Provide information to verify the following Tree requirements are met:

For minor development on existing sites ONLY, the following should be submitted:

a. If site contains 2” DBH and greater that will be affected or removed, submit Detailed sketch showing proposed changes.

b. Include a Tree Survey Plan and Inventory that includes:

c. To scale map or site plan prepared and sealed by registered surveyor, certified engineer or landscape architect.

d. Note the location of all specimen trees or stands of trees plus all other trees which will be preserved and counted

toward meeting site density requirements

e. Include specimen trees and their critical root zones with labels/inventory of size and species. Include trees to remain

and those proposed for removal.

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Provide information to verify the following Tree requirements are met:

f. Include all other trees to be counted toward meeting density requirements, with labels/inventory of size and species.

(Existing trees less than two (2) inches DBH do not need to be shown and cannot be included toward Existing Density

Factor).

g. For forested areas over two (2) acres, sampling methods may be used to determine tree densities.

h. Show all tree protection zones, tree save areas, and buffers with existing trees.

i. Tree Replacement Plan

j. If site cannot bear replanting of required density, submit alternative as required under Minimum Density Requirements

k. Pay $150 Fee to City of Chamblee

For all other development types:

A. Provide a Tree Survey and Inventory Plan that meets the requirements of the City of Chamblee UDO, and includes:

a. Plan has been prepared and stamped by a state-licensed landscape architect, or an architect or engineer knowledgeable

in landscape architectural design and/or tree protection plan preparation.

b. Location, size and species as measured at the diameter breast height (DBH) of the tree(s) to be removed and to be

protected;

c. All tree protection zones, natural areas, landscaped areas, buffers and areas of re-vegetation including active and passive

tree protection methods

d. Limits of clearing, land disturbance and staging areas where disturbance may affect tree protection zones;

e. Location of all existing and proposed structures, phase lines, utility lines or easements or boring sites for underground

utilities are shown.

f. Tree save areas where trees have been inventoried for density calculations have been delineated

g. Calculations showing compliance with Site Density Factor

B. Provide a Tree Protection Plan and Tree Replacement Plan (the two plans can be combined or drawn separately)

that meets the requirements of the UDO and includes:

a. Plan has been prepared and stamped by a state-licensed landscape architect, or an architect or engineer

knowledgeable in landscape architectural design and/or tree protection plan preparation.

b. Statement that the development conforms to the adopted typical streetscape designs standards, or if not, how it

various from the typical and an explanation of why (See UDO Section 230-27, Streetscape Design).

c. Provide the dimensions and location the Sidewalk and Landscape Zones in relation to the street rights-of-way.

d. Indicate the location of remaining existing trees and proposed street trees, as well as their caliper and species and

proximity to street lighting.

e. Provide interior landscaping for parking lots designed for 20 or more spaces (UDO Section 320-21)

f. Provide the following note on the Tree Replacement Plan or detailed sketch.

“All debris from trees cut or substantially damaged should be removed from the site in a timely fashion including the

removal of any portion of the tree stump above the original natural grade or elevation unless accepted by the city

tree consultant for a specific reason.”

g. Provide the following note on the Tree Replacement Plan or detailed sketch (UDO Section 320-20(c)(5)):

“All trees and landscape materials will be planted at the proper planting times, preferably in the fall, winter or spring

and maintained in perpetuity. The city may require performance bonds be posted if planting is delayed due to

seasonality.”

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

h. Provide the following note on the Tree Replacement Plan or detailed sketch (UDO Section 320-27):

“Prior to issuance of a certificate of occupancy, the developer or owner shall post a performance bond or cash

escrow guaranteeing all landscaping materials and work for a period of two years after approval or acceptance

thereof by the city in a sum established by the city arborist. The bond will be in the amount of 100 percent of the

estimated cost of replacing all of the landscaping required by these specifications. At the end of two years, the city

manager shall make an inspection and notify the owner or developer and the bond company of any corrections to be

made.”

C. Meet the requirements of UDO Chapter 320, including:

a. Projects are compatible with the guidelines provided in the Addendum 2.0 - Section 320-3(a)

b. Mixture of proposed tree species meets standards - Section 320-3(c)

c. Invasive species are not used - Section 320-3(d)

d. Artificial plant materials are not used - Section 320-3(e)

e. Water efficient design considerations with regard to approved species in Bio-retention Area provided in Addendum

2.0 are utilized - Section 320-4

f. Location and width of required buffers meets standards - Section 320-11 and 320-12

g. Landscape strip planting requirements are met - Section 320-20

h. Off-street surface parking lot planting requirements are met - Section 320-21

i. If applicable, screening requirements for “No Access” are met - Section 320-22

j. Tree Preservation and Replacement Requirements are met - Section 320-38

k. Tree Density Requirements are met - Section 320-39

Minimum Grading and Drainage Plan Requirements

a. Provide a Grading & Drainage Plan showing: Existing and proposed ground contours/elevations, indicating cut and/or

fill operations; may include stockpiling.

b. Provide location (horizontally & vertically), size, direction of flow, and length of existing and proposed drainage features

with drainage areas.

c. All drainage structure outlets to be erosion proof and must be a distance of at least six times the diameter of the outlet

pipe from the property line. Outlet protection shall be designed in accordance with the Georgia Manual for Erosion and

Sedimentation Control, latest edition.

d. Provide pipe chart and additional design calculations as needed to fully evaluate or describe storm system or culvert

performance (including channel/swales)

e. Maximum allowable velocity for storm sewer exit pipe is ten feet per second when flowing full or half full based on

Manning's Formula. Energy dissipater is required for exit velocity in excess of five feet per second. All outfall pipes shall be

held to a slope not to exceed 1.00%.

f. Define limits and elevation of 100-year high water elevation of adjacent watercourse, existing and/or proposed

stormwater drainage features including detention ponds, inlet headwalls/culverts and locate on the grading plan and on

all plats.

g. Design cross-drain culverts to pass at least the 25-year storm with 100-year storm evaluated for flood hazard. Show on

grading plan and on all plats the 100-year high water elevation. 100-year flood elevation shall not adversely affect

adjoining properties.

h. Design storm water pipe collection systems and channels for the 25-year storm.

i. Check the performance of all storm water drainage systems including detention facilities using the 100-year storm

(developed condition) for evaluation of local flooding, and possible flood hazards to adjacent structures and/or property.

j. Provide Storm Plan & Profiles on a scale of no less than 1" = 100' horizontally and 1" = 10’ vertically. Show 25-year

hydraulic grade line for all pipes and the 100-year HGL for and pipes within road right of way.

k. Match crowns of different size pipes at structures.

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Minimum Grading and Drainage Plan Requirements

l. Specify gage for metal pipe determined based on depth of cover and loading conditions, but not less than 16 gage.

Provide fully bituminous coating for steel pipe. No steel pipe shall be placed in a detention facility, a water quality system,

or in any road right of way. Reinforced concrete pipe is required in perennial streams.

m. Provide a detailed maintenance schedule for detention/sediment pond(s) on plans.

n. Locate detention ponds such that they can be accessed easily for maintenance. Show access easements and 10’

easement around pond at 100 year elevation.

o. Identify regulated and/or documented analysis for localized 100-year flood plain. Provide FIRM panel number and

date.

p. Locate the limits of the floodway if applicable. No fill material shall be placed within flood plain in such a way to

decrease existing flood plain area/ volume on the site.

q. Delineate wetlands or certify there are no wetlands on the site. Notify the Army Corps of Engineers and provide copy of

permit as required. Add note to plans: Acceptance of these plans does not constitute approval by the City of Chamblee of

any land disturbing activities within wetland areas. It is the owner’s responsibility to contact the appropriate regulatory

agency for approval of any wetland area disturbance.

8. Hydrology Study Requirements

The following is the minimum information required in a standard hydrology study submitted to the City of Chamblee. It should be

noted that most residential development does not require a hydrology study. Hydrology studies are required if the project

involved the creation, addition and/or replacement of 5,000 square feet or more of impervious cover, or involves other land

development activity of 10,000 square feet or more. They may also be required if it is determined by the City Civil Engineer that

special drainage conditions exist that may impact the safety or structural integrity of structures on the site, such determination is

made on a case by case basis.

The following is the minimum information required in a standard hydrology study submitted to the City of Chamblee. Additional

information may be required for site specific conditions. It shall be at all times the responsibility of the engineer of record to

accurately model and report the conditions on the site. The City of Chamblee accepts no responsibility for errors or omissions from

this report.

Hydrology Study Requirements

Cover

Cover sheet signed and sealed by a professional engineer licensed in the state of Georgia and qualified in the field of

hydrology and water resources

II.

Introduction

Provide a brief description of the project that includes:

a. Location

b. Size of project

c. Scope of project

d. Existing land use

e. Proposed land use

f. Project methodology, including water quality measures proposed

Provide a summary table for each discharge point

a. 2, 10, 25, 50 and 100-year storm events

b. Channel Protection Volume

c. Water Quality Volume

d. Allowable flow rate (cfs)

e. Developed flow rate (cfs)

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Hydrology Study Requirements

f. Peak elevation in the stormwater facility

g. Allowable velocity (fps)

h. Developed velocity (fps)

III.

Pre-developed Conditions Hydrology

1. Provide Drainage Basin Map with topography. Identify all drainage basins both onsite and offsite.

2. Provide weighted curve number calculations (based on GSMM Table 2.1.5-1) or for basins under 5 acres weighted

runoff coefficients (based on GSMM Table 2.1.4-2).

3. Provide time of concentration calculations - Time of concentration shall be calculated as provided in Section 2.1.5.6 of

the Georgia Stormwater Management Manual.

IV.

Post-developed Conditions Hydrology

1. Provide developed site map with topography. Identify all drainage basins both on-site and off-site as well as the

location of all stormwater management facilities.

2. All new developments and re-developments (defined as removal and replacement of buildings, parking or other

impervious surfaces over more than 40% of the site) must meet a pre-development runoff coefficient of 0.3 (Rational

Method) or a Curve Number of 60 (SCS Method), which corresponds to that coefficient normally used for a site in a

wooded condition, in addition to a 10% reduction in runoff.

3. Show drainage areas that bypass detention in a developed state. Demonstrate how these flows are managed to a

predevelopment state.

4. Provide weighted curve number calculations.

5. Provide time of concentration calculations.

6. Provide Water Quality and Channel Protection Volume calculations.

7. Provide details of all control structures.

8. Show trash rack details.

9. Provide details of all water quality facilities (including planting plans).

10. Provide design data for each water quality measures as indicated on the Design Procedure Forms provided in the

Georgia Stormwater Management Manual.

11. Provide downstream analysis to the point at which the site area is equal to or less than 10% of the overall drainage

basin.

12. Provide detailed analysis of the capacity of structure downstream.

13. Clearly indicate the adequacy of the receiving waters for rate and velocity of flows.

14. Provide the drawdown time of all stormwater facilities.

15. Provide stage-storage relationship for all stormwater facilities.

16. Provide TSS removal rate spreadsheet, available at www.northgeorgiawater.org.

Supplemental Information

1. Provide detailed pre-developed hydrographs or routings.

2. Provide detailed developed conditions hydrographs and routings.

3. Provide storm pipe/ culvert calculations with an exhibit that clearly identifies all storm structure identification numbers

and locations.

4. Provide all headwater elevations at culvert crossings.

5. Provide maintenance schedule for all stormwater facilities.

Transportation Requirements

a. A Georgia Department of Transportation Access Permit will be required prior to the issuance of a development or

grading permit.

b. All curb cuts on state highways must be approved by GDOT; all others must be approved by the DeKalb County

Department of Transportation.

c. Provide road plan and profiles of all subdivision streets on a scale of no smaller than 1" = 100' horizontally and 1" = 10'

vertically.

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Transportation Requirements

d. Show and state all names and rights-of-way (existing & proposed), distance from centerline, and pavement widths of all

roads that appear on plans. Show all existing conditions along the property frontage on both sides of the road, i.e.

driveways, streets, utilities, and so on.

e. Provide traffic signage and striping plans. All traffic control devices, signs, signals, and markings (striping) to be used

must conform to the requirements of the Manual on Uniform Traffic Control Devices for Streets and Highways (MUTCD).

f. Provide minimum pavement width of 24 feet. Provide minimum turnaround diameter of 100 feet on cul-de-sacs.

g. Show all streets to intersect with other streets as a 90-degree angle.

h. Provide minimum curb or pavement radii at intersection of 25 feet or at a minimum radius as required by the County

Fire Marshal for adequate emergency vehicular access.

i. Provide street grades not less than 1.5 per cent grade nor more than 15 percent grade. No grade shall be greater than or

equal to 14% for more than 1000 feet.

j. Provide 24-inch vertical face curb and gutter on local streets and 30-inch curb and gutter on state routes.

k. Provide street grades such that drainage flows away from intersecting streets. Provide low points at a minimum of 12

feet from the edge of paving on intersecting streets and a minimum of 6 inches below the edge of pavement.

l. Provide grades of 3:1 or flatter adjacent to road right-of-ways. In locations where grades do not permit 3:1 side slopes

provide Type W/T guardrail as approved by the Transportation Department.

m. Provide 5’ wide concrete sidewalks with 5’ wide beauty strip along all property frontage adjacent to roadway right-of-

way as required by the City of Chamblee Zoning Ordinance, latest edition. Right-of-way dedication may be required. Right-

of-way should be measured from the back of sidewalk plus one-foot.

n. Execute and return right-of-way deeds to City of Chamblee.

o. If the site is along GDOT rights-of-way, show location of any billboards or outdoor advertising on or within 500 feet of

the subject property.

Site plan design requirements

300-12(d)

a. Provide 10’ no access easement for double frontage lots along boulevard, primary, and secondary streets.

300-12(e)

b. Unbuildable lot only permitted for project entrance sign or stormwater management facility.

300-14(c)(1)

c. The planned location of protected open space;

300-14(c)(1)

d. Potential connections with existing greenspace and trails.

300-14(c)(2)

e. Open space management plan per Section 300-14(d).

350-3

f. Streets designed according to standards in code.

g. Location/vicinity map

h. Land lot and district

i. Area of property and area to be disturbed in acres

j. Location sketch (scale no less than 1" = 2,000')

k. Boundary and Topographical Map to be signed and sealed by a State of Georgia Registered Land Surveyor

l. Subdivision Plats must be signed and sealed by a Registered Land Surveyor or a Registered Engineer

m. Civil Drawings must be signed and sealed by the appropriate professional(s)

n. Landscape Plan must be signed and sealed by a Landscape Architect

New street design

350-3(a)(2)

a. Proposed street layouts shall interconnect within a development and with adjoining development as often as

possible

350-3(a)(3)

b. Public or private streets longer than 150 feet must be connected to a continuous street network or else must

end in a cul-de-sac.

350-3(a)(3)

c. Maximum cul-de-sac length is 250 feet in length from the nearest intersection with a street providing through

access (not a cul-de-sac). Minimum radius for culs-de-sac shall be 40 feet

350-3(a)(4)

d. Minimum ROW and pavement widths based on street types and according to table in code.

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

350-3(b)(1)

e. Private streets are prohibited except where necessary and subject to approval by the City Manager

350-3(b)(2)(e)

f. Private streets require mandatory property owners association, with bylaws and/or covenants (required by

final plat).

350-3(b)(3)(b)

Private street shall install street signs with the street name and designation "private.”

350-3(b)(4)

g. Easements for private streets shall be designated on final plat. 40’ for SFR and according to street type for

rest.

350-3(b)(4)(b)

h. Easements for private streets shall not be included in any calculation of minimum lot size or density limitations

350-3(b)(4)(c)

i. Private street shall be drawn as its own discrete parcel to be dedicated to a mandatory private homeowners

association

350-3(b)(5)(c)

j. A private maintenance covenant recorded with the Clerk of the Superior Court shall be required for any private

street and other improvements. Requirements in code.

300-50(b)

k. Public streets to be dedicated.

350-2(a)

l. Curb cuts and access management in accordance with spacing requirements

m. Civil Drawings must be signed and sealed by the appropriate professional(s)

n. Landscape Plan must be signed and sealed by a Landscape Architect

Private streets on final plats

350-3(b)(6)(a)

a. Deed book and page reference to the recorded covenant required in Subsection 350-3(b)(5).

350-3(b)(6)(b)

b. The following statement shall be provided: "The City of Chamblee has no responsibility to build, improve,

maintain, or otherwise service the private streets, drainage improvements, and other appurtenances contained

within the general public purpose access and utility easement or easements for private streets shown on this

plat."

350-3(b)(6)(c)

c. "Grant of Easement. The general purpose public access and utility easement(s) shown on this plat for private

street(s) is hereby granted and said grant of rights shall be liberally construed to provide all necessary authority

to the City, County, and to public or private utility companies serving the subdivision, for the installation and

maintenance of utilities, including, but not limited to, electric lines, gas lines, telephone lines, water lines, sewer

lines, cable television lines, and fiber optic cables, together with the right to trim interfering trees and brush,

together with a perpetual right of ingress and egress for installation, maintenance, and replacement of such

lines.

________________________________________

Signature of Property Owner Date"

350-3(b)(6)(d)

d. "Certificate of Dedication. All water and sewer lines installed within the general purpose public access and

utility easement(s) shown on this plat for private street(s) are hereby dedicated to DeKalb County."

350-3(b)(1)

e. Private streets are prohibited except where necessary and subject to approval by the City Manager

350-3(b)(2)(e)

f. Private streets require mandatory property owners association, with bylaws and/or covenants (required by

final plat).

350-3(b)(3)(b)

Private street shall install street signs with the street name and designation "private.”

350-3(b)(4)

g. Easements for private streets shall be designated on final plat. 40’ for SFR and according to street type for

rest.

350-3(b)(4)(b)

h. Easements for private streets shall not be included in any calculation of minimum lot size or density limitations

350-3(b)(4)(c)

i. Private street shall be drawn as its own discrete parcel to be dedicated to a mandatory private homeowners

association

350-3(b)(5)(c)

j. A private maintenance covenant recorded with the Clerk of the Superior Court shall be required for any private

street and other improvements. Requirements in code.

Access management

350-2(a)(1)(a)

a. Interior driveways shall be a minimum of 22 feet in width with 90 degree parking.

350-2(a)(1)(b)

b. Sidewalk paving materials shall be continued across any intervening driveway at the same prevailing grade and

Development Review Checklist

Rev 01/23/17

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

cross slope as on the adjacent sidewalk clear zone. Corresponding interior sign or painted bar on the driveway

shall be provided adjacent to the sidewalk paving as it intersects the driveway

350-2(a)(1)(c)

c. Driveway widths shall be a maximum of 24 feet for two-way entrances or shared driveways, and 20 feet for

one-way entrances

350-2(a)(1)(d)

d. Curb cuts shall not be permitted on any street that is classified as a boulevard, primary, secondary or feeder

street when access may be provided from a side or rear local street

350-2(a)(1)(e)

e. Driveways are not permitted between the sidewalk and a building, and shall be perpendicular to any adjacent

street.

350-3(b)(2)(f)

f. No more than one curb cut shall be permitted for each development, provided that properties with more than

one street frontage may have one curb cut located on each street frontage. Properties with more than 400’ of

frontage may have two curb cuts.

350-3(b)(3)(b)

Private street shall install street signs with the street name and designation "private.”

350-3(b)(4)

g. Easements for private streets shall be designated on final plat. 40’ for SFR and according to street type for

rest.

350-3(b)(4)(b)

h. Easements for private streets shall not be included in any calculation of minimum lot size or density limitations

350-3(b)(4)(c)

i. Private street shall be drawn as its own discrete parcel to be dedicated to a mandatory private homeowners

association

350-3(b)(5)(c)

j. A private maintenance covenant recorded with the Clerk of the Superior Court shall be required for any private

street and other improvements. Requirements in code.

300-50(b)

k. Public streets to be dedicated.

350-2(a)

l. Curb cuts and access management in accordance with spacing requirements

m. Civil Drawings must be signed and sealed by the appropriate professional(s)

n. Landscape Plan must be signed and sealed by a Landscape Architect

Rev 8/1/19

City of Chamblee Development Department

3506 Broad St. • Chamblee, GA 30341 • 770-986-5024• chambleega.gov

TREE REMOVAL PERMIT APPLICATION

Job Address:_________________________________________________ Application Date:______________

Type of Application: Type 1 – Major ($75) ___ Type 2 – Minor ($50) ___ Type 3 – Hazardous ($50)___

See UDO for definitions of Types 1, 2, & 3. Any commercial development is considered Type 1.

Number of Trees to be Removed:__________ # Specimen Trees*_______ # Non-specimen Trees______

*Specimen Trees include Hardwood Trees 24-inches DBH or larger, Softwood Trees 30-inches DBH or larger,

and Understory Trees 4-inches DBH or larger (Sec. 320-35). Homeowners can remove up to 5 NON-SPECIMEN

trees WITHOUT a permit.

Provide with this application photos of trees to be removed along with a detailed sketch of property showing the

location of all existing trees 2-inches DBH or larger. Clearly indicate which trees are to be removed and their

DBH.

Property Owner (of Job Address)_________________________________________________________

Address:___________________________________________________________________________

City:________________________________________________State:____________Zip:___________

Phone/Cell:_________________________________________________________________________

Contractor:______________________________________________________________________________

Address:___________________________________________________________________________

City:___________________________________________State:___________Zip:_________________

Phone/Cell:_________________________________________________________________________

Copy of Business License and Liability Insurance to be provided prior to permitting.

Primary Contact Name: __________________ Phone:__________________ Email:___________________

The Applicant shall be responsible from the date of this permit, or from the time of the beginning of the first work, whichever shall be the earlier, for all

injury or damage of any kind resulting from this work, whether for basic services or additional services, to persons or property. The Applicant shall

exonerate, indemnify and save harmless the City from and against all claims or actions, and all expenses incidental to the defense of any such claims,

litigation, and actions, based upon or arising out of damage or injury (including death) to persons or property caused by or sustained in connection with

the performance of this permit or by conditions created thereby or arising out of or in any way connected with work performed under the permit or for any

and all claims for damages under the laws of the United States or of Georgia, arising out of or in any way connected with the acquisition of and

construction under the permit and shall assume and pay for, without cost to the City, the defense of any and all claims, litigations and actions suffered

through any act or omission of the Applicant or any subcontractor, or anyone directly or indirectly employed under the supervision of any of them.

I HEREBY CERTIFY THAT I HAVE EXAMINED AND UNDERSTAND ALL INFORMATION ON THIS APPLICATION AND THAT THE ABOVE

STATEMENTS AND INFORMATION SUPPLIED BY ME ARE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES

GOVERNING WORK TO BE PERFORMED SHALL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT.

**Note: Only the Property Owner or Contractor should sign this application as an applicant.**

Signature of Applicant: ________________________________________________ Date:_______________

Signature of Property Owner: ___________________________________________Date:_______________

DOCUMENTATION AS SPECIFIED IN THE CITY OF CHAMBLEE UNIFIED DEVELOPMENT ORDINANCE,

SECTION 320-34 MUST BE PRESENTED WITH THIS APPLICATION.

City of Chamblee Planning & Development Department

5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleega.gov

Retaining

Wall

Permit

Application

□ Concrete

□ Masonry

□ Wood

Date: / / Permit No.

ESTIMATED VALUE (Labor and Materials): $

JOB SITE ADDRESS: PROJECT NAME: SUITE #:

Property Use: P.I.N.: Zoning Class.:

Job

Description:

___________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

____________

Property Owner

Name:

Address: Zip: Phone:

Contractor

Name: Bus. License No.:

Address: Zip: Phone:

Total Length of Wall:

Total Height of Wall:

Wall Thickness:

Contact Person:

_________________

Phone/ Fax: _________________

Email:___________________________

Design Professional: _____________________

Phone/ Fax: ______________________

Email:________________________________

Notice: No changes shall be made from that which is stated in this application, or in attached plans and specifications, except by submitting a revised application,

plans and/or specifications and receiving approval of the Chief Building Official for such change. Granting of a permit shall not be construed as a permit for or an

approval of any violation of the Building Code or any other state or local law regulating construction, erosion control or the performance of the same. I hereby certify

that I have read and examined this application and the information provided herein is true and correct. I further certify that all construction will comply with the

Minimum Building Codes.

Signature of Permitee: Date:

FOR OFFICE USE

ONLY Application Accepted by:

Wall Material: Setback Required:

Linear Footage Valuation Multiplier Valuation $

Wall #1

Wall #2

TOTAL

Administrative Fee:

Date Paid:

Plan Review Fee:

Date Paid:

Permit Fee: $

Date Paid:

Total Fee:$

Date Paid:

APPLICATION AND PERMIT FOR RIGHT OF WAY / UTILITY FACILITY ENCROACHMENT

To: City of Chamblee Utility Project Reference #:

3210 Cumberland Drive

Chamblee, GA 30341 City Reference #:

Phone: (770) 986-5019

Fax: (770) 986-1027

Application is hereby made by:

Mailing Address:

for permission to construct, operate, and maintain the following described utility facility installation within the

public rights of way for (road):

in the City of Chamblee, at the following described location(s):

in accordance with the attached plan and subject to the rules, regulations, and any special requirements set

forth herein. All general and special provisions noted on the plans shall be observed during the

installation, operation, and maintenance of said facilities. Descriptions of utility facility to be installed (attach

sketch):

Permit requested this day of ________________, 20

Signature:

Print/Type Name:

Print/Type Title:

24 Hour Emergency Contact and Phone Number:

Permission is granted to make the above described Utility Facility Encroachment in accordance with the plans and

provisions hereof. This permit is to be strictly construed and no work other than that specifically described above is hereby

authorized – subsequent normal maintenance excepted.

Permit approved this day of , 20

CITY OF CHAMBLEE PUBLIC WORKS DEPARTMENT

By:

(Director)

CALL CHAMBLEE PUBLIC WORKS DIRECTOR (770-986-5019) 24 HOURS PRIOR TO BEGINNING WORK

Date Completed: Signed by Utility Rep.:

(12-19-2011; Rev. 3-10-2016)

Trench in pavement: (L) x (W) Trench outside pavement: (L) x (W)

Number of bores under road: Total length of bores:

Number of poles (wood): Number of poles (steel):

Estimated date of completion: Size & specifications of pipe: x (L)

Special Requirements:

GENERAL PROVISIONS FOR UTILITY FACILITY ENCROACHMENT IN THE CITY OF CHAMBLEE

1. It is expressly stipulated that this permit is a license for permissive use only and the placing of facilities

upon public property pursuant to this permit shall not operate to create or vest any property rights in

holds.

2. Prior to the initiation of any work under this permit, the applicant shall determine the location of any

and all other installations for utilities upon, over or across the right–of–way and shall install, operate and

maintain the facilities in such a manner as not to damage or interfere with the operation of the existing

facilities.

3. Whenever necessary for the construction, repair, improvement, maintenance, safe and effective

operation, alteration or relocation of all or any portion of the roadway or other City/County facilities as

determined by the City of Chamblee, any of all said facilities and appurtenances authorized hereunder shall

be immediately removed from the right–of–way or reset or relocated thereon, as required by the City of

Chamblee, and at the sole expense of the Permittee unless reimbursement is authorized by separate

agreement. Should the Permittee fail to remove or relocate facilities, upon due notice from the

City/County, Permittee shall be liable for any extraordinary cost or damages incurred by the City of

Chamblee as result thereof.

4. Applicant agrees to indemnify and hold harmless the City of Chamblee and all officers, employees or

agents of the City of Chamblee or any political subdivision thereof, against any and all claims, damages,

demands, actions, causes of action, costs and expenses of whatsoever nature, which may result from any

injury to, or the death of any persons, or from the loss of or damage to, property of any kind or nature,

when such injury, death, loss or damage arises out of the construction operation, maintenance, repair,

removal or relocation of the facilities covered by this permit.

5. The City of Chamblee, its engineers, officers or employees shall not be held responsible or liable for

injury or damage that may occur to facilities covered by this permit, or to any connection or connections

thereto, by reason of City/County maintenance and construction activities or City/County contractor or

Permittee operations. The City of Chamblee’s contractor shall not be held liable for any damage that may

occur to utility facilities if the Permittee has been notified of a construction conflict and given reasonable

time to mark or relocate its facilities but has failed to do so. The facility owner shall be responsible for

interfacing with the Utilities Protection Center (UPC) to determine notification.

6. If the City of Chamblee undertakes to improve this roadway or other City/County owned facilities, it shall

be the responsibility of the Permittee to plan with the City of Chamblee and its contractor a schedule which

will clearly set forth at which state of operations the Permittee will be required to perform any adjustment

to its facilities necessary to accommodate the City/County improvements.

7. During the initial installation or construction of facilities authorized by this permit, or during any future

repair, removal or relocation thereof or any miscellaneous operations, the Permittee shall, at all times,

maintain flagman, signs, lights, flares, barricades, and other safety devices in accordance with the Manual

On Uniform Traffic Control Devices and as may be necessary to properly protect traffic upon the roadway

and to warn and safeguard the public against injury or damage.

8. It is expressly provided that with respect to any limited access highway, the Permittee shall not have or

gain direct access, whether ingress or egress, from the main traveled way of said highway or its on or off

ramps to any facilities authorized by the permit except upon specific approval by the City of Chamblee.

9. It is the applicant’s responsibility to verify the limits of public right-of-way and perform land surveying if

necessary for location of the utility facilities authorized hereby.

10. No inherent or retained right or privilege of any abutting property owner is affected by this permit nor

is the City of Chamblee responsible for any claim which may develop between the Permittee and any

property owner concerning the use of the right-of-way. Permittee is responsible for maintaining

reasonable access to private driveways during installation of its facilities and for restoration of driveways to

the owner’s satisfaction. The Permittee will be required to replace any disturbed area with “in kind”

materials throughout entire permit area unless a satisfactory replacement is approved by the City/County

and abutting property owners.

11. Approval of this permit does not constitute approval of design or construction details for the proposed

facilities. Applicant is responsible for compliance with all applicable governmental codes and regulations.

12. Use of explosives within the City/County right-of-way is prohibited unless approved by separate permit.

13. Applicant shall be responsible for obtaining approvals for the proposed installation which may be

required by any local government or agency on roads or streets under their jurisdiction.

14. Permittee shall give the City of Chamblee a minimum of 24 hours notice prior to beginning any work

under this permit.

15. This permit shall be void unless work hereunder is begun within ninety (90) days of the date of its

approval.

16. The provisions of this permit are regulatory and not contractual. No interest or right of an applicant

granted by this permit may be transferred to another except by written consent of the City of Chamblee.

17. This permit may be revoked at the discretion of the City of Chamblee upon thirty (30) days written

notice to the Permittee.

18. Any utility cut made within the roadbed of any City/County road shall be replaced as required by the

City of Chamblee/DeKalb County Standard Drawing #804. In addition, said cut shall be plated until such

time as the concrete has cured to design compressive stress and promptly asphalted.

19. Permittee shall be responsible for obtaining any other state and federal permits necessary for work

performed under this permit.

20. The Permittee’s attention is drawn to the requirements of the Georgia Sedimentation and Erosion

Control Act. If strict adherence to those requirements is not met, the City/County has the authority to

revoke this permit.

SPECIAL PROVISIONS FOR UTILITY FACILITY ENCROACHMENT:

(12-19-2011; Rev. 3-10-2016)

Project Information:

Developer's Information:

Engineering Firm's Information:

Please include the following items in your submittal package:

Existing Developments New Conditions

Proposed utility plan, if available

Name: Date:

Signed: Seal:

Received By:

Signed:

Geographical Information System (GIS) map clearly showing the proposed site (s) surrounds areas, and utilities

Internal Use Only

Capacity Evaluation Request will not be accepted until form is fully completed and all supplemental information is attached. Once Capacity Request

Package has been reviewed and accepted by our internal staff, a letter will be completed within 60 days.

Date Capacity Request

Reviewed and Accepted:

City, State, Zip Code:

Phone Number:

Email Address:

Phone Number:

Email Address:

Company's Name:

Address:

County District:

(Calculated Peak Flow - Existing Flow)

Total Peak Flow Requesting:

GPD

SEWER CAPACITY EVALUATION REQUEST

Department of Watershed Management

Project Address:

Project Name:

(City, State, Zip Code)

Type of Development:

(Private or Government)

Intended Tie-In Manhole:

Land Lot and Parcel ID:

Company's Name: Address:

Contact Name:

City, State, Zip Code:

Separate detailed calculation sheet signed by the owner or owner's representative for each project

(See Appendix B)

Proposed Peak Daily Flow Calculation based on attached guidelines

(See Appendix A)

Contact Name:

Estimate of anticipated peak hour flow and instantaneous peak hour flow for each industrial, commercial, and

mixed-use project, and for each residential project that is over four stories in height

330 W. Ponce de Leon Ave, 3

floor, Decatur, Georgia 30030

fklaguaite@dekalbcountyga.gov

Specifications:

1. Size

Where:

PF is the Peaking Factor

P is the population in thousands

It is unlawful to connect to the public sanitary sewer without payment of the prescribed fee and without a permit. If such a sewer

connection is made, a current sewer tap fee, the fee at the time the connection was discovered, will be assessed; back sewer use

charges will be made and interest at the rate specified in Section 2-112 will be charged. (Code 1976, § 6-2059)

he above equation yields a peaking factor that is intended to cover normal infiltration and inflow for a well-maintained sewer

system and/or those built with modern materials and construction methods. The peaking factor shall not be less than two and

one-half (2.5). Where P is not known or cannot be reasonably assumed, PE (Population Equivalence) may be used. PE is Q (flow

in GPM) divided by one hundred (100)

GPD for new systems and one hundred and twenty-five (125) GPD for existing systems.

ec. 25-220. - Maintenance and repair responsibility for building sewer service connections to public sanitary sewer system.

The property owner shall be responsible for maintenance and repair of building sewer service connections to the public sanitary

sewer system on private property. DeKalb County shall be responsible for maintenance and repair of building sewer service

connections within county street rights-of-way and sanitary sewer easements. (Ord. No. 90-09, § 1, 5-30-90)

Please submit completed/signed and sealed forms to:

Appendix - A

Sec. 25-219. - Connecting to public sewer without paying fees or obtaining permit.

a) General: Gravity Sanitary Sewer Lines: Gravity sanitary sewer lines shall be sized to accommodate the peak design flow

subject to the following limitations:

(1) The maximum depth of flow to diameter of pipe ratio (d/D ratio) for gravity sewer pipes shall not be greater than 0.8 at

he peak flow condition.

(2) The minimum size for a sanitary sewer collection line is eight (8) inches. The minimum size for a sanitary sewer service

line is six (6) inches

b) Design Basis: Gravity Sanitary Sewer Line: Gravity sanitary sewer systems shall be designed on the basis of per capita flows

for the design period in conjunction with a peaking factor, or approved alternative methods. Design calculations for trunk and

interceptor sewers shall be submitted to the DeKalb County Department of Watershed Management (DC DWM) for approval.

(3) Infiltration/Inflow: Use of the per capita flows and the peaking factor is intended to cover normal infiltration and inflow

of water (I/I) for systems built with modern construction techniques. However, an additional allowance should be made for

I/I with existing conditions such as high ground water, older systems, or a number of illicit connections. I/I for existin

stems should be made from actual flow data to the greatest extent possible.

(1) Average Daily Flow: The Average Daily Flow (ADF) that a site will generate is calculated based on the particular use of the

site. The Table 1 (shown below) shows sanitary flow generation factors, in gallons per day (GPD), which can be used to

estimate sanitary flows from proposed and existing developments.

(2) Peak Flow (GPD): Generally, the sewers shall be designed to carry at least the peak hourly flow when operating at

DeKalb County - Department of Watershed Management

Planning and Development

Appendix - B

Table 1: Sanitary Flow Contributions from Site Specific Sources

Dental Office

Fitness Center/Spa

Food Service – Restaurants Open 24 Hours/day

Car Wash (non-recycling)

Church

Campgrounds without Sewer Connections

Campgrounds with Sewer Connections

Country Club

Bar/Lounge

Barber Shop/Beauty Salon

Bath House for Swimming Pool

Boarding Houses

Bowling Alley

100/Space

150/Space

25/Member

20/Person

15/Person

5/Sanctuary Seat

Airports, Railroads, Bus Terminals

Stadiums, Racetracks, Assembly Halls

Veterinary Office

5/Passenger + 10/Employee

Schools – Day, Toilets, Cafeteria

Schools – Day, Toilets, Cafeteria, Gym

Service Station

Shopping Center/Mall

Theaters

Prison

Resident Camps

Residential Homes/Apartments

Retail Stores

Schools – Day, Toilets Only

Hotel/Motel

Laundry

Medical Offices

Nursing Home

Office

Food Service – Restaurants Open Less than 24 Hours/day

Food Service Catering

Funeral Home

Grocery Store

Hospital

Day Camp

Day Care Center

20/Person

150/Bed + 100/Resident Staff

175 GPD/1000 SF

125/Bed + 20/Employee

60/Person

150/Bedroom

200/1000-ft2 Floor Space

300/Bed + 100/Resident Staff

100/Room

500/Machine

200/Exam Room

100 GPD/1000 SF

12/Person

16/Person

300/Embalming + 100/Employee

*Flow Estimating Factors based upon Georgia Environmental Protection Division Large Community Design Guidance, Appendix A,

GPD = gallons per day

= square feet

Mar-05

100/1000-ft2 Enclosure Space

5/Seat

100/Run + 10/Cage + 20/Employee

Contributor

Sanitary Flow, GPD

20/Employee + 100/Chair

50/Person

75/Seat + 20/Employee

50/Seat + 20/Employee

50/100--ft2 Floor Space

5/Seat

30/Seat

125/Chair +20/Employee

10/Swimmer

75/Resident

75/Lane+20/Employee

75/Car

Soil Erosion & Sedimentation Control Bond

Bond No. _____________________ Amount $_____________________

KNOW ALL MEN BY THESE PRESENTS, That __________________________________________

(hereinafter called the "Principal"), as Principal, and _________________________________________,

a corporation duly organized under the laws of the State of _______________ and duly licensed to

transact business in the State of Georgia (hereinafter called the "Surety"), as Surety, are held and firmly

bound unto City of Chamblee, Georgia, in the sum of _______________________________________

_____________________________________________________________________________ for the

payment of which sum well and truly to be made, we the said Principal and the said Surety, bind

ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by

these presents.

WHEREAS, the said Principal has heretofore received authorization from the Obligee for development

and construction for City of Chamblee, Georgia - Land Disturbance Permit Criteria for

_________________________________________________________ Chamblee, Georgia 30341.

WHEREAS, as a condition precedent to the approval, the Principal is required to undertake on-site and

erosion control improvements, in a manner which is set forth and specified in the approval as executed

by the Obligee.

NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if the bounded Principal

shall well and truly keep, do and perform each and every, all and singular, the matters and things in said

approvals, then this obligation shall be null and void; otherwise to remain in full force and effect.

IT IS HEREBY UNDERSTOOD AND AGREED that the penal sum of this bond shall not exceed the

sum as stated above.

IN WITNESS WHEREOF, this instrument has been executed by the duly authorized representatives of

the Principal and Surety.

SEALED and dated this ____ day of ________________, _______.

__________________________________

Name of General Contractor

____________________________________ ___________________________________

Witness By

___________________________________

Name of Bond Company

____________________________________ __________________________________

Witness Attorney-in-Fact

330 W. Ponce De Leon Avenue, Suite 600  Decatur, GA 30030  Phone: 404.371.2257  Fax: 404.371.3211

www.dekalbcountyga.gov

DeKalb County

Geographic Information Systems Department

GIS CHECK LIST

PROJECT: ________________________________

GIS FILE LOCATOR/AP #: __________________

DATE: ___________________________________

The following items marked (X) need to be shown or addressed on site plan. GIS

review and is not limited to the following items; additional comments may be

provided as warranted.

1. ( ) Project name must be approved by GIS Addressing Coordinator

2. ( ) Street name(s) must be submitted for both private streets located in the

rear of Lots 1-5 & 6-8 for approval by GIS Addressing Coordinator

3. ( ) GIS will assign street addresses : Contact GIS for street addresses

4. ( ) Show names of adjoining property owner with deed book and page

numbers, parcel ID, and addresses: please cad all items onto plan set

5. ( ) Show North Arrow

6. ( ) Please add the Sheets Index of Drawings for:

( ) Existing Conditions Sheet

( ) Demolition Sheet (if applicable)

( ) Site Plan Sheet (include each parcel dimensions)

7. ( ) Label all open spaces as “common areas/open spaces”

8. ( ) Show name, address and phone number of developer on Sketch Plat and/or

coversheet

9. ( ) Show name, address and phone number of owner on Sketch Plat and/or

coversheet

10. ( ) DeKalb County Records show ownership in: City of Chamblee All

parcels must be in the same exact name prior to any map changes

11. ( ) Provide Site Plan for a residential combination/separation/re-parcel of

existing parcels. Site Plan Sheet should include the

330 W. Ponce De Leon Avenue, Suite 600  Decatur, GA 30030  Phone: 404.371.2257  Fax: 404.371.3211

www.dekalbcountyga.gov

( ) Please add coversheet to plans

( ) Show name, address and phone number of owner(s) on plat

( ) Show all parcel id number of existing parcel on Existing

Conditions Sheet

( ) Show dimensions and legal description(s) of proposed parcel

( ) Record plat after final stamped approval with original signatures.

12. ( ) Provide recorded digitized site plan on diskette to Development

Department; to the attention of Director, Stacy Grear. Diskette should be in

AutoCAD or Microstation platform (Subdivisions, Condos & Townhomes).

GIS prefers the digital file containing separate layers of the following:

Lot Boundaries, Right of Way Boundaries, Legal Lot/Unit #’s, Address #’s,

Street Centerline, & Dimensions

13. ( ) Provide a copy of the recorded plan to GIS Department. Note: GIS

Department must receive stamped/written approval plans from the designated

municipality. At that time, a combination/separation/Reparcel form will be

completed by customer. Note: If customer is not the owner of the parcel(s);

land owner must submit an Agent Authorization Form granting the

customer permission to serve as owner’s agent.

Both GIS Mapping Form

and Agent Authorization must have original signatures.

14. ( ) If applicable, Complete Final/Commercial Plat Mapping Form when

requesting model homes. Provide brief description for model home, i.e. legal

lot number and the number of model homes requested.

15. ( ) Have Engineer to provide preliminary plat with addresses for each lot.

(Condos/Townhomes only)

Cassandra Odom

Cassandra Odom | Addressing Coordinator | Email: codom@DeKalbCountyga.gov

Kalb County | Geographical Information Systems Department

Clark Harrison Bldg. | 330 W. Ponce de Leon Ave., 6

Fl | Decatur, GA 30030

Main: 404.371.2257 | Direct: 404.371.2914 | Fax: 404.371.3211

“Al

ways Gaining In Sight” – DeKalb County GIS - Web: www.DeKalbCountyga.gov

This file includes all three checklists and guidance documents as well as Appendix 1.

To access the desired checklist and guidance document, go to the bottom of this page

and click on the appropriate tab.

Use the arrows on the botttom left hand corner of this page to advance the tabs for

the 2017 checklists.

EROSION, SEDIMENTATION & POLLUTION CONTROL PLAN CHECKLIST

STAND ALONE CONSTRUCTION PROJECTS

SWCD:_________________________________________________________

Project Name:______________________________________

Address:______________________________________

City/County:__________________________________

Date on Plans:_________________________________

Name & email of person filling out checklist:____________________________________________

Plan Included

Page # Y/N

1 The applicable Erosion, Sedimentation and Pollution Control Plan Checklist established by the Commission

as of January 1 of the year in which the land-disturbing activity was permitted.

(The completed Checklist must be submitted with the ES&PC Plan or the Plan will not be reviewed)

2 Level II certification number issued by the Commission, signature and seal of the certified design professional.

(Signature, seal and Level II number must be on each sheet pertaining to ES&PC plan or the Plan will not be

reviewed)

3 Limits of disturbance shall be no greater than 50 acres at any one time without prior written authorization from

the EPD District Office. If EPD approves the request to disturb 50 acres or more at any one time, the Plan must

include at least 4 of the BMPs listed in Appendix 1 of this checklist.*

(A copy of the written approval by EPD must be attached to the plan for the Plan to be reviewed.)

4 The name and phone number of the 24-hour local contact responsible for erosion, sedimentation and pollution controls.

Provide the name, address, email address, and phone number of primary permittee.

6 Note total and disturbed acreage of the project or phase under construction.

7 Provide the GPS location of the construction exit for the site. Give the Latitude and Longitude in decimal degrees.

8 Initial date of the Plan and the dates of any revisions made to the Plan including the entity who requested the revisions.

9 Description of the nature of construction activity.

10 Provide vicinity map showing site’s relation to surrounding areas. Include designation of specific phase, if necessary.

11 Identify the project receiving waters and describe all sensitive adjacent areas including streams, lakes,

residential areas, wetlands, marshlands, etc. which may be affected.

12 Design professional's certification statement and signature that the site was visited prior to development of the

ES&PC Plan as stated on Part IV page 19 of the permit.

13 Design professional's certification statement and signature that the permittee’s ES&PC Plan provides for an appropriate

and comprehensive system of BMPs and sampling to meet permit requirements as stated on Part IV page 19 of the permit.*

14 Clearly note the statement that "The design professional who prepared the ES&PC Plan is to inspect the installation of the

initial sediment storage requirements and perimeter control BMPs within 7 days after installation."

in accordance with Part IV.A.5 page 25 of the permit.*

15 Clearly note the statement that "Non-exempt activities shall not be conducted within the 25 or 50-foot

undisturbed stream buffers as measured from the point of wrested vegetation or within 25-feet of the coastal

marshland buffer as measured from the Jurisdictional Determination Line without first acquiring the necessary

variances and permits."

16 Provide a description of any buffer encroachments and indicate whether a buffer variance is required.

17 Clearly note the statement that "Amendments/revisions to the ES&PC Plan which have a significant effect on

BMPs with a hydraulic component must be certified by the design professional."*

TO BE SHOWN ON ES&PC PLAN

18 Clearly note the statement that "Waste materials shall not be discharged to waters of the State, except as

authorized by a Section 404 permit."*

19 Clearly note statement that "The escape of sediment from the site shall be prevented by the installation of

erosion and sediment control measures and practices prior to land disturbing activities."

20 Clearly note statement that "Erosion control measures will be maintained at all times. If full implementation of the

approved Plan does not provide for effective erosion control, additional erosion and sediment control measures

shall be implemented to control or treat the sediment source."

21 Clearly note the statement "Any disturbed area left exposed for a period greater than 14 days shall be

stabilized with mulch or temporary seeding."

22 Any construction activity which discharges storm water into an Impaired Stream Segment, or within 1 linear mile

upstream of and within the same watershed as, any portion of an Biota Impaired Stream Segment must comply

with Part III. C. of the permit. Include the completed Appendix 1 listing all the BMPs that will be used for those

areas of the site which discharge to the Impaired Stream Segment.*

23 If a TMDL Implementation Plan for sediment has been finalized for the Impaired Stream Segment (identified in

Item 22 above) at least six months prior to submittal of NOI, the ES&PC Plan must address any site-specific

conditions or requirements included in the TMDL Implementation Plan.*

24 BMPs for concrete washdown of tools, concrete mixer chutes, hoppers and the rear of the vehicles. Washout

of the drum at the construction site is prohibited.*

25 Provide BMPs for the remediation of all petroleum spills and leaks.

26 Description of the measures that will be installed during the construction process to control pollutants in storm

water that will occur after construction operations have been completed.*

27 Description of practices to provide cover for building materials and building products on site.*

28 Description of the practices that will be used to reduce the pollutants in storm water discharges.*

29 Description and chart or timeline of the intended sequence of major activities which disturb soils for the major

portions of the site (i.e., initial perimeter and sediment storage BMPs, clearing and grubbing activities,

excavation activities, utility activities, temporary and final stabilization).

30 Provide complete requirements of inspections and record keeping by the primary permittee.*

31 Provide complete requirements of sampling frequency and reporting of sampling results.*

32 Provide complete details for retention of records as per Part IV.F. of the permit.*

33 Description of analytical methods to be used to collect and analyze the samples from each location.*

34 Appendix B rationale for NTU values at all outfall sampling points where applicable.*

35 Delineate all sampling locations, perennial and intermittent streams and other water bodies into which

storm water is discharged.*

36 A description of appropriate controls and measures that will be implemented at the construction site including:

(1) initial sediment storage requirements and perimeter control BMPs, (2) intermediate grading and drainage

BMPs, and (3) final BMPs. For construction sites where there will be no mass grading and the initial perimeter

control BMPs, intermediate grading and drainage BMPs, and final BMPs are the same, the Plan may combine

all of the BMPs into a single phase.*

37 Graphic scale and North arrow.

38 Existing and proposed contour lines with contour lines drawn at an interval in accordance with the following:

Map Scale Ground Slope Contour Intervals, ft.

1 inch = 100ft or Flat 0 - 2% 0.5 or 1

larger scale Rolling 2 - 8% 1 or 2

Steep 8% + 2,5 or 10

39 Use of alternative BMPs whose performance has been documented to be equivalent to or superior to

conventional BMPs as certified by a Design Professional (unless disapproved by EPD or the Georgia Soil

and Water Conservation Commission). Please refer to the Alternative BMP Guidance Document found at

www.gaswcc.org.

40 Use of alternative BMP for application to the Equivalent BMP List. Please refer to Appendix A-2 of the Manual

for Erosion & Sediment Control in Georgia 2016 Edition.*

41 Delineation of the applicable 25-foot or 50-foot undisturbed buffers adjacent to state waters and any additional

buffers required by the Local Issuing Authority. Clearly note and delineate all areas of impact.

42 Delineation of on-site wetlands and all state waters located on and within 200 feet of the project site.

43 Delineation and acreage of contributing drainage basins on the project site.

44 Provide hydrology study and maps of drainage basins for both the pre- and post-developed conditions.*

45 An estimate of the runoff coefficient or peak discharge flow of the site prior to and after construction activities are

completed.

46 Storm-drain pipe and weir velocities with appropriate outlet protection to accommodate discharges without

erosion. Identify/Delineate all storm water discharge points.

47 Soil series for the project site and their delineation.

The limits of disturbance for each phase of construction.

49 Provide a minimum of 67 cubic yards of sediment storage per acre drained using a temporary sediment basin,

retrofitted detention pond, and/or excavated inlet sediment traps for each common drainage location. Sediment

storage volume must be in place prior to and during all land disturbance activities until final stabilization of the

site has been achieved. A written justification explaining the decision to use equivalent controls when a

sediment basin is not attainable must be included in the Plan for each common drainage location in which a

sediment basin is not provided. A written justification as to why 67 cubic yards of storage is not attainable must

also be given. Worksheets from the Manual included for structural BMPs and all calculations used by the

storage design professional to obtain the required sediment when using equivalent controls. When discharging

from sediment basins and impoundments, permittees are required to utilize outlet structures that withdraw water

from the surface, unless infeasible. If outlet structures that withdraw water from the surface are not feasible,

a written justification explaining this decision must be included in the Plan.

50 Location of Best Management Practices that are consistent with and no less stringent than the Manual for

Erosion and Sediment Control in Georgia. Use uniform coding symbols from the Manual, Chapter 6, with

legend.

51 Provide detailed drawings for all structural practices. Specifications must, at a minimum, meet the guidelines set

forth in the Manual for Erosion and Sediment Control in Georgia.

52 Provide vegetative plan, noting all temporary and permanent vegetative practices. Include species, planting

dates and seeding, fertilizer, lime and mulching rates. Vegetative plan shall be site specific for appropriate time

of the year that seeding will take place and for the appropriate geographic region of Georgia.

*If using this checklist for a project that is less than 1 acre and not part of a common development

but within 200 ft of a perennial stream the * checklist items would be N/A.

Effective January 1, 2019

EROSION, SEDIMENTATION & POLLUTION CONTROL PLAN CHECKLIST

STAND ALONE CONSTRUCTION PROJECTS

SWCD:_________________________________________________________

Project Name:_________________________________ Address:____________________________________________

City/County:__________________________________ Date on Plans:_______________________________________

Name & email of person filling out checklist:_____________________________________________________

Plan Included

Page # Y/N

1 The applicable Erosion, Sedimentation and Pollution Control Plan Checklist established by the Commission as of January 1

of the year in which the land-disturbing activity was permitted.

(The completed Checklist must be submitted with the ES&PC Plan or the Plan will not be reviewed) Permit IV.D.1 pg 26

2 Level II certification number issued by the Commission, signature and seal of the certified design professional.

(Signature, seal and Level II number must be on each sheet pertaining to ES&PC Plan or the Plan will not be reviewed)

The Level II certification must be issued to the Design Professional whose signature and seal are on the Plan.

3 Limits of disturbance shall be no greater than 50 acres at any one time without prior written authorization from the EPD

District Office. If EPD approves the request to disturb 50 acres or more at any one time, the Plan must include at least 4 of

the BMPs listed in Appendix 1 of this checklist.*

(A copy of the written approval by EPD must be attached to the plan for the Plan to be reviewed.) Permit IV.D.3 pg 27

4 The name and phone number of the 24-hour local contact responsible for erosion, sedimentation and pollution controls.

May be shown on ES&PC Plan sheets and/or ES&PC notes. Permit II.B.1.c pg 12

Provide the name, address, email address, and phone number of primary permittee.

May be shown on cover sheet, ES&PC Plan or under ES&PC notes. Permit II.B.1.b pg 12

6 Note total and disturbed acreage of the project or phase under construction.

Must be shown on ES&PC Plan or under ES&PC notes. Permit IV.D.2.c pg 27

7 Provide the GPS location of the construction exit for the site. Give the Latitude and Longitude in decimal degrees.

GPS location of the construction exit must be shown on cover sheet and may also be shown on ES&PC Plan sheets and

ES&PC notes. It must match the NOI. Permit II.B.1.a pg 12

8 Initial date of the Plan and the dates of any revisions made to the Plan including the entity who requested the revisions.

The initial Plan date should be shown on all pages. With each resubmittal, the revision date and entity requesting revisions

should be shown on cover sheet and each sheet that has been revised.

9 Description of the nature of construction activity.

Provide a description of the existing site and a description of the proposed project. These must be shown on ES&PC Plan

or under ES&PC notes. Permit IV.D.2.a pg 27

10 Provide vicinity map showing site’s relation to surrounding areas. Include designation of specific phase, if necessary.

Site location must be delineated showing surrounding area roads and highways. If the project is being done in phases,

each individual phase must be delineated and labeled. This information is important for Plan Reviewers if a site visit is

needed, or if the site needs to be located on another map. Permit IV.D.2.e pg 27

11 Identify the project receiving waters and describe all sensitive adjacent areas including streams, lakes, residential areas,

wetlands, marshlands, etc. which may be affected.

The name of the initial receiving water(s) or if unnamed, the first named blue line stream indicated on the appropriate

USGS Topographic map, and when the discharge is through a municipal separate storm sewer system (MS4), the name

of the local government operating the municipal separate storm sewer system and the name of the receiving water(s)

which receives the discharge from the MS4, and the permittee's determination of whether the receiving water(s)

TO BE SHOWN ON ES&PC PLAN

supports warm water fisheries or is a trout stream. Describe any neighboring area which could be affected by the

post-developed runoff from the site. Permit IV.D.2.f pg 27

12 Design professional's certification statement and signature that the site was visited prior to development of the ES&PC

Plan as stated on Part IV page 19 of the permit.

The following statement and the signature of the design professional must be shown on the ES&PC Plan or under ES&PC

notes. "I certify under penalty of law that this Plan was prepared after a site visit to the locations described herein by myself

or my authorized agent, under my supervision."

13 Design professional's certification statement and signature that the permittee’s ES&PC Plan provides for an appropriate

and comprehensive system of BMPs and sampling to meet permit requirements as stated on Part IV page 19 of the permit.*

The following statement and the signature of the design professional must be shown on the ES&PC Plan or under ES&PC

notes. "I certify that the permittee's Erosion, Sedimentation and Pollution Control Plan provides for an appropriate and

comprehensive system of Best Management Practices required by the Georgia Water Quality Control Act and the document

"Manual for Erosion and Sediment Control in Georgia" (Manual) published by the Georgia Soil and Water Conservation

Commission as of January 1 of the year in which the land-disturbing activity was permitted, provides for the sampling of

the receiving water(s) or the sampling of the storm water outfalls and that the designed system of Best Management Practices

and sampling methods is expected to meet the requirements contained in the General NPDES Permit No. GAR 100001."

14 Clearly note the statement that "The design professional who prepared the ES&PC Plan is to inspect the installation of the

initial sediment storage requirements and perimeter control BMPs within 7 days after installation." *

The Plan must include a statement indicating that the primary permittee must retain the design professional who prepared

the Plan, except when the primary permittee has requested in writing and EPD has agreed to an alternate design

professional, to inspect the installation of the initial sediment storage requirements and perimeter control BMPs which the

design professional designed within seven (7) days after installation. The design professional shall determine if these

BMPs have been installed and are being maintained as designed. The design professional shall report the results of the

inspection to the primary permittee within seven (7) days and the permittee must correct all deficiencies within two (2)

business days of receipt of the inspection report from the design professional unless weather related site conditions are

such that additional time is required. Permit IV.A.5 pg 25

15 Clearly note the statement that "Non-exempt activities shall not be conducted within the 25 or 50-foot undisturbed stream

buffers as measured from the point of wrested vegetation or within 25-feet of the coastal marshland buffer as measured

from the Jurisdictional Determination Line without first acquiring the necessary variances and permits."

See Part IV.(i) - (iv) on pages 19-24 of the permit and show under ES&PC notes.

16 Provide a description of any buffer encroachments and indicate whether a buffer variance is required.

When the project requires an approved buffer variance from the GA EPD, an indication shall be shown on the ES&PC

Plan. A description of the encroachment activity must be shown on the ES&PC Plan or under ES&PC notes.

17 Clearly note the statement that "Amendments/revisions to the ES&PC Plan which have a significant effect on BMPs with a

hydraulic component must be certified by the design professional."*

See Part IV.C. on page 26 of the permit. This can be clarified in a narrative and shown under ES&PC notes. Revisions

or amendments should be submitted to the Local Issuing Authority for review.

18 Clearly note the statement that "Waste materials shall not be discharged to waters of the State, except as authorized by a

Section 404 permit."*

The Plan must include a description of how waste materials, including waste building materials, construction and demolition

debris, concrete washout, excavated sediment, etc., will be properly disposed of. Any disposal of solid waste to waters of

the State is prohibited unless authorized by a Section 404 permit. Permit IV.D.3.c.(1) pg 30

19 Clearly note statement that "The escape of sediment from the site shall be prevented by the installation of erosion and

sediment control measures and practices prior to land disturbing activities."

Must be shown on ES&PC Plan or under ES&PC notes.

20 Clearly note statement that "Erosion control measures will be maintained at all times. If full implementation of the approved

Plan does not provide for effective erosion control, additional erosion and sediment control measures shall be implemented

to control or treat the sediment source."

Must be shown on ES&PC Plan or under ES&PC notes.

21 Clearly note the statement "Any disturbed area left exposed for a period greater than 14 days shall be stabilized with mulch

or temporary seeding."

Must be shown on ES&PC Plan or under ES&PC notes. Permit IV.D.3.a.(1) pg 28

22 Any construction activity which discharges storm water into an Impaired Stream Segment, or within 1 linear mile upstream

of and within the same watershed as, any portion of an Biota Impaired Stream Segment must comply with Part III.C. of the

permit. Include the completed Appendix 1 listing all the BMPs that will be used for those areas of the site which discharge

to the Impaired Stream Segment.*

If any storm water associated with construction activities discharges into an Impaired Stream Segment that has been listed

for the criteria violated, "Bio F" (Impaired Fish Community) and/or "Bio M" (Impaired Macroinvertebrate Community),

within Category 4a, 4b or 5, and the potential cause is either "NP" (nonpoint source) or "UR" (urban runoff), the ES&PC

Plan must include at least four (4) of the BMPs listed in Part III.C.2.a. - v. of the permit. The Impaired Stream Segment(s)

should be delineated on the ES&PC Plan. Georgia's most current and subsequent "305(b)/303(d) List Documents (Approved)'

can be viewed on the GAEPD website (www.gaepd.org/Documents/305b.html) Permit III.C.2.a. - v. pg 15-17

23 If a TMDL Implementation Plan for sediment has been finalized for the Impaired Stream Segment (identified in Item 22

above) at least six months prior to submittal of NOI, the ES&PC Plan must address any site-specific conditions or

requirements included in the TMDL Implementation Plan.*

List of TMDL Implementation Plans can be viewed on the GAEPD website, www.gaepd.org. The TMDL Implementation

Plan for sediment should be delineated on the ES&PC Plan. Permit III.C.1 pg 15

24 BMPs for concrete washdown of tools, concrete mixer chutes, hoppers and the rear of the vehicles. Washout of the drum

at the construction site is prohibited.*

When the project allows the concrete washdown of tools, concrete mixer chutes, hoppers and rear of the vehicles on the

project site delineate the location of the area provided for washing and provide detail of BMPs that will be used. If the

project does not allow the concrete washdown on the project site, note that on the Plan. Permit IV.D.3.c.(6) pg 31

25 Provide BMPs for the remediation of all petroleum spills and leaks.

The Plan must provide BMPs and guidance for the prevention of spills and leaks of petroleum products from any areas

where such products are stored or used as well as guidance for the proper remediation of any spills and leaks that do

occur. This information can be in the form of a separate Spill Prevention/Spill Response document so long as that

information accompanies the Plan. Permit IV.D.3.c.(5) pg 31

26 Description of the measures that will be installed during the construction process to control pollutants in storm water that

will occur after construction operations have been completed.*

The Plan must contain a description of the measures that will be installed during the construction process to control pollutants

in storm water that will occur after construction operations have been completed. These may include storm water detention

and retention structures, use of vegetated swales and natural depressions for flow attenuation or a combination of these

practices (sequential systems). The Plan must also include a technical explanation of the basis used to select these

practices where flows will exceed pre-development levels. The Plan must indicate that velocity dissipation devices will be

placed at discharge locations and along the length of any outflow channel in order to provide a non-erosive flow so that the

natural physical and biological characteristics and functions of the water course are maintained and protected. The

installation of these devices may be subject to Section 404 of the Federal Clean Water Act.

Note: The permittee is only responsible for the installation and maintenance of storm water management devices prior to

final stabilization of the site and not the operation and maintenance of such structures after construction activities have been

completed. Permit IV.D.3.b pg 29

27 Description of practices to provide cover for building materials and building products on site.*

The Plan must contain a description of measures, such as plastic sheeting or temporary roofs, to cover building materials,

building products, construction wastes, trash, landscape materials, fertilizers, pesticides, herbicides, detergents, sanitary waste,

and other materials in order to minimize exposure to precipitation and to stormwater. Permit IV.D.3.c.(2) pg 30

28 Description of the practices that will be used to reduce the pollutants in storm water discharges.*

The Plan must identify all potential sources of storm water pollution expected to be present on the site and provide a

narrative explaining how the pollutants will be minimized in the storm water discharges. Permit IV pg 24

29 Description and chart or timeline of the intended sequence of major activities which disturb soils for the major portions of

the site (i.e., initial perimeter and sediment storage BMPs, clearing and grubbing activities, excavation activities, utility

activities, temporary and final stabilization).

Activity schedule must be site specific. The narrative description and timeline for each phase of construction may be shown

on ES&PC Plan sheet or under ES&PC notes. Permit IV.D.2.b pg 27

30 Provide complete requirements of Inspections and record keeping by the primary permittee.*

The Plan must include all of the Inspections and record keeping requirements of the primary permittee as stated in

Part IV.D.4.a. on pages 31-33 of the permit. The complete Inspection and record keeping requirements shall be

shown on the Plan under ES&PS notes.

31 Provide complete requirements of Sampling Frequency and Reporting of sampling results.*

See Part IV.D.6.d pages 35-37 Sampling Frequency and Part IV.E page 37 Reporting in the permit. Complete Sampling

Frequency and Reporting requirements are to be shown on the Plan under ES&PC notes.

32 Provide complete details for Retention of Records as per Part IV.F. of the permit.*

See Part IV.F page 38 Retention of Records in the permit. Complete details of Retention of Records are to be shown on the

Plan under ES&PC notes.

33 Description of analytical methods to be used to collect and analyze the samples from each location.*

This narrative must is to be shown on the Plan under ES&PC notes and shall include quality control/assurance procedures

and precise sampling methodology for each sampling location. Permit IV.D.6.a. - c. pg 33-35

34 Appendix B rationale for NTU values at all outfall sampling points where applicable.*

When the permittee has determined that some or all outfalls will be monitored, a rationale must be shown on the Plan under

ES&PC notes which includes the NTU limit(s) selected from Appendix B. This rationale must include the size of the

construction site, the calculation of the size of the surface water drainage area, and the type of receiving water(s) (i.e.,

trout stream or supporting warm water fisheries). Permit IV.D.6.a.(3) pg 33

35 Delineate all sampling locations, perennial and intermittent streams and other water bodies into which storm water is

discharged.*

The Plan shall include a USGS topographic map, a topographic map or a drawing (referred to as a topographic map) that

is a scale equal to or more detailed than a 1:24000 map showing the locations of the site or the common development. The

map must include (a) the location of all perennial and intermittent streams and other water bodies as shown on a USGS

topographic map, and all other perennial and intermittent streams and other water bodies located during the mandatory field

verification, into which the storm water is discharged and (b) the receiving water and/or outfall sampling locations. When

the permittee has chosen to use a USGS topographic map and the receiving water(s) is not shown on the USGS

topographic map, the location of the receiving water(s) must be hand-drawn on the USGS topographic map from where

the storm water(s) enters the receiving water(s) to the point where the receiving water(s) combines with the first blue line

stream shown on the USGS topographic map. Permit IV.D.6.a.(1) pg 33

36 A description of appropriate controls and measures that will be implemented at the construction site including: (1) initial

sediment storage requirements and perimeter control BMPs, (2) intermediate grading and drainage BMPs, and (3) final

BMPs. For construction sites where there will be no mass grading and the sediment storage requirements and initial

perimeter control BMPs, intermediate grading and drainage BMPs, and final BMPs are the same, the Plan may combine

all of the BMPs into a single phase.*

The Plan must be shown in a minimum of three phases with each phase shown on a separate sheet. Initial phase of the

Plan must include the required 67 cy per acre sediment storage, construction exit, tree-save fence if applicable and any

other BMPs necessary to prevent sediment from leaving the site such as silt fence, inlet protection on existing storm drain

structures, diversions, check dams, temporary ground cover, etc. Limits of disturbance for the initial phase are to be only

the areas needed to install initial BMPs. The intermediate phase should show rough grading and utility construction. BMPs

should include initial inlet protection, additional silt fence as needed, any revised sediment storage needed as drainage

basins are altered, outlet protection, retrofit if applicable, matting with temporary or permanent vegetation as needed,

temporary down drains, filter rings, etc. Final phase of Plan should show finished grade, curbing and paving if applicable,

building construction if applicable, etc. BMPs should include permanent vegetation, appropriate inlet protection, etc.

For construction sites where there will be no mass grading and the initial perimeter control BMPs, intermediate grading and

drainage BMPs, and the final BMPs are the same, the Plan may combine all of the BMPs into a single phase Plan. The

Plan will include appropriate staging and access requirements for construction equipment. Permit IV.D.3 pg 27

37 Graphic scale and North arrow.

The graphic scale and North arrow must be clearly shown on all phases of the ES&PC Plan sheets.

38 Existing and proposed contour lines with contour lines drawn at an interval in accordance with the following:

Map Scale Ground Slope Contour Intervals, ft.

1 inch = 100ft or Flat 0 - 2% 0.5 or 1

larger scale Rolling 2 - 8% 1 or 2

Steep 8% + 2,5 or 10

The initial, intermediate, and final phase sheets of the Plan must show the proposed grade in bold contour lines with the

above intervals overlaying the original contour lines. Elevations of both the existing and proposed contour lines must be

shown.

39 Use of alternative BMPs whose performance has been documented to be equivalent to or superior to conventional BMPs

as certified by a Design Professional (unless disapproved by EPD or the Georgia Soil and Water Conservation

Commission). Please refer to the Alternative BMP Guidance Document found at www.gaswcc.org.

Please refer to the Alternative BMP Guidance Document found at www.gaswcc.georgia.gov Permit IV.D.3.a (4) pg 29

40 Use of alternative BMP for application to the Equivalent BMP List. Please refer to Appendix A-2 of the Manual

for Erosion & Sediment Control in Georgia 2016 Edition.*

Please refer to Appendix A-2 of the Manual for Erosion & Sediment Control in Georgia 2016 Edition.

41 Delineation of the applicable 25-foot or 50-foot undisturbed buffers adjacent to State waters and any additional buffers

required by the Local Issuing Authority. Clearly note and delineate all areas of impact.

The State Law of Georgia mandates these minimum undisturbed buffers, but the Local Issuing Authorities are allowed to

require more stringent buffers of State waters. The minimum undisturbed buffers required by the State and all other buffers

of State waters required by the issuing authority must be delineated. Any undisturbed buffer area that is impacted by the

project site must be noted on the Plan. Permit IV.D.2.e pg 27

42 Delineation of on-site wetlands and all State waters located on and within 200 feet of the project site.

ALL STATE WATERS LOCATED ON AND WITHIN 200 FEET OF THE PROJECT SITE MUST BE DELINEATED ON

ALL PHASES OF THE PLAN. When a project is located in a jurisdiction with a certified Local Issuing Authority and the

LIA must make a determination of State waters that are not delineated on the Plan, the Plan review could be delayed for

beyond the full forty-five day review time allowed to the LIA, or the full thirty-five day review time allowed to the District if the

District is reviewing the Plan. For all projects in a jurisdiction where there is no certified Local Issuing Authority regulating

that project, EPD is responsible for State waters determinations and there are no time limits for reviewing the Plan.

ALL WETLANDS LOCATED WITHIN THE PROJECT SITE ONLY MUST BE DELINEATED.

If the Local Issuing Authority requires an undisturbed buffer of wetlands, delineate required buffer.

43 Delineation and acreage of contributing drainage basins on the project site.

All existing drainage basins on the project site and their acreage must be delineated on the existing conditions and/or on

the initial phase of the Plan. As the basins are altered or new ones created during intermediate and fnal phases, the new

basins and their acreage must be delineated throughout each phase of the Plan. Permit IV.D.2.e pg 27

44 Provide hydrology study and maps of drainage basins for both the pre- and post-developed conditions.*

Hydrology study and drainage maps should be separate from the Plan. Maps should include each individual basin

draining to, through, and from, the project site, with each one delineated, labeled and showing its total acreage.

45 An estimate of the runoff coefficient or peak discharge flow of the site prior to and after construction activities are

completed.

The Plan must provide both pre- and post-construction estimates of the runoff coefficient or peak discharge flow for the site.

This can be in the form of a hydrologic study so long as that study is made a part of the Plan and accompanies the Plan. A

complete hydrologic study is not a required element of the Plan, only the pre and post-construction estimates of the run-off

coefficient or peak discharge flow for the site. Permit IV.D.2.d pg 27

46 Storm-drain pipe and weir velocities with appropriate outlet protection to accommodate discharges without erosion.

Identify/Delineate all storm water discharge points.

The storm-drain pipe and weir velocities must show the flow characteristics of the pipe at full flow including pipe diameter,

flow rate (cfs), velocity (fps), and tailwater conditions. This information should be shown in a chart on the storm-drain

profile sheet, ES&PC intermediate phase sheet, or on the ES&PC detail sheet that shows outlet protection.

The dimensions of the apron must include length (La), width at the headwall (W1), down-stream width (W2), average

stone diameter (d50), and stone depth (D) designed in accordance with Figures 6-34.1 and 6-34.2 in the Manual. These

should be shown in a chart on ES&PC intermediate and/or final phase sheet or ES&PC detail sheet with outlet protection.

Velocity dissipation devices shall be placed at all discharge locations and along the length of any outfall channel for the

purpose of providing a non-erosive velocity flow from the structure to a water course so that the natural physical and

biological functions and characteristics are maintained and protected.

47 Soil series for the project site and their delineation.

Soil series delineations are required for the Plan review and can be found on the NRCS web site. The highest level of soil

survey required for the project site, such as a level three or level four survey for projects that will be using septic systems,

must be delineated on the Plan. The soil series delineation should be shown on the existing site Plan or the initial phase

Plan. A chart listing the soils located on the project should be shown on the sheet with their delineation.

48 The limits of disturbance for each phase of construction.

The limits of disturbance for the initial phase should delineate only the area required to be disturbed for the installation of

perimeter control and initial sediment storage. The intermediate phase should delineate the entire area to be disturbed for

that phase, such as grading, drainage, utilities installed, etc. The final phase should delineate any additional areas to be

disturbed such as individual lots, etc.

49 Provide a minimum of 67 cubic yards of sediment storage per acre drained using a temporary sediment basin,

retrofitted detention pond, and/or excavated inlet sediment traps for each common drainage location. Sediment storage

volume must be in place prior to and during all land disturbance activities until final stabilization of the site has been

achieved. A written justification explaining the decision to use equivalent controls when a sediment basin is not attainable

must be included in the Plan for each common drainage location in which a sediment basin is not provided. A written

justification as to why 67 cubic yards of storage is not attainable must also be given. Worksheets from the Manual must be

included for structural BMPs and all calculations used by the design professional to obtain the required sediment storage

when using equivalent controls. When discharging from sediment basins and impoundments, permittees are required to

utilize outlet structures that withdraw water from the surface, unless infeasible. If outlet structures that withdraw water from

the surface are not feasible, a written justification explaining this decision must be included in the Plan.

For each common drainage location, a temporary (or Permanent) sediment basin (Sd3, Sd4, Rt, or excavated Sd2) providing

at least 67 cubic yards of storage per acre drained, or equivalent control measures, shall be provided until final stabilization

of the site. The 67cubic yards of storage per acre does not apply to flows from off-site areas and flows from on-site areas

that are either undisturbed or have undergone final stabilization where such flows are diverted around both the disturbed

area and the sediment basin. Sediment basins may not be appropriate for some common drainage locations and a written

justification explaining the decision not to use sediment basins must be included in the Plan. Worksheets from the Manual

must be completed and shown on the Plan or attached to the Plan for each temporary sediment basin designed for the

project. All cross sections and details required per the Manual for Sd3's must be shown on the ES&PC detail section of the

Plan. Completed worksheets from the Manual must be shown on the Plan for each retrofit and excavated inlet sediment

trap. When the design professional chooses to use equivalent controls the calculations used to obtain the required 67 cubic

yards per acre drained must be included on the Plan. If outlet structures that withdraw water from the surface are not

feasible, a written justification explaining this decision must be included in the Plan. Permit IV.D.3.a.(3) pg 28

50 Location of Best Management Practices that are consistent with, and no less stringent than, the Manual for Erosion and

Sediment Control in Georgia. Use uniform coding symbols from the Manual, Chapter 6, with legend.

BMPs for all phases of the Plan must be consistent with and no less stringent than the Manual and shown using uniform

coding symbols from the Manual. The uniform coding symbols legend from the Manual must be included and may be

shown on detail sheet or any of the ES&PC Plan sheets.

51 Provide detailed drawings for all structural practices. Specifications must, at a minimum, meet the guidelines set forth in

the Manual for Erosion and Sediment Control in Georgia.

The erosion and sediment control detail sheet must show a detailed drawing for each structural BMP shown on the Plan.

All BMPs and details shown must, at a minimum, meet the guidelines given in the Manual. Note that a worksheet is

provided in the Manual for most structural BMPs that must be included on the ES&PC Plan or detail sheet.

52 Provide vegetative plan, noting all temporary and permanent vegetative practices. Include species, planting dates and

seeding, fertilizer, lime and mulching rates. Vegetative plan shall be site specific for appropriate time of year that seeding

will take place and for the appropriate geographic region of Georgia.

Must be shown on ES&PC Plan, on the ES&PC detail sheet or under ES&PC notes.

*If using this checklist for a project that is less than 1 acre and not part of a common development

but within 200 ft of a perennial stream the * checklist items would be N/A.

Effective January 1, 2019

EROSION, SEDIMENTATION & POLLUTION CONTROL PLAN CHECKLIST

INFRASTRUCTURE CONSTRUCTION PROJECTS

SWCD:_________________________________________________________

Project Name:______________________________________

Address:____________________________________________

City/County:__________________________________ Date on Plans:_______________________________________

Name & email of person filling out checklist:_____________________________________________________

Plan Included

Page # Y/N

1 The applicable Erosion, Sedimentation and Pollution Control Plan Checklist established by the Commission as of January 1

of the year in which the land-disturbing activity was permitted.

(The completed Checklist must be submitted with the ES&PC Plan or the Plan will not be reviewed)

2 Level II certification number issued by the Commission, signature and seal of the certified design professional.

(Signature, seal and Level II number must be on each sheet pertaining to ES&PC Plan or the Plan will not be reviewed)

3 The name and phone number of the 24-hour local contact responsible for erosion, sedimentation and pollution controls.

Provide the name, address, email address, and phone number of primary permittee.

5 Note total and disturbed acreage of the project or phase under construction.

6 Provide the GPS locations of the beginning and end of the Infrastructure project. Give the Latitude and Longitude in

decimal degrees.

7 Initial date of the Plan and the dates of any revisions made to the Plan including the entity who requested the revisions.

8 Description of the nature of construction activity.

9 Provide vicinity map showing site’s relation to surrounding areas. Include designation of specific phase, if necessary.

10 Identify the project receiving waters and describe all sensitive adjacent areas including streams, lakes, residential areas,

wetlands, marshlands, etc. which may be affected.

11 Design professional's certification statement and signature that the site was visited prior to development of the ES&PC

Plan as stated on Part IV page 21 of the permit.

12 Design professional's certification statement and signature that the permittee’s ES&PC Plan provides for an appropriate

and comprehensive system of BMPs and sampling to meet permit requirements as stated on Part IV page 20 of the permit.*

13 Design professional certification statement and signature that the permittee's ES&PC Plan provides for representative

sampling as stated on Part IV.D.6.c.(3) page 37 of the permit as applicable.*

14 Clearly note the statement that "The design professional who prepared the ES&PC Plan is to inspect the installation of the

initial sediment storage requirements, perimeter control BMPs, and sediment basins within 7 days after installation."

in accordance with Part IV.A.5 page 26 of the permit *

15 Clearly note the statement that "Non-exempt activities shall not be conducted within the 25 or 50-foot undisturbed stream

buffers as measured from the point of wrested vegetation or within 25-feet of the coastal marshland buffer as measured

from the Jurisdictional Determination Line without first acquiring the necessary variances and permits."

16 Provide a description of any buffer encroachments and indicate whether a buffer variance is required.

17 Clearly note the statement that "Amendments/revisions to the ES&PC Plan which have a significant effect on BMPs with a

hydraulic component must be certified by the design professional."*

18 Clearly note the statement that "Waste materials shall not be discharged to waters of the State, except as authorized by a

Section 404 permit."*

TO BE SHOWN ON ES&PC PLAN

19 Clearly note statement that "The escape of sediment from the site shall be prevented by the installation of erosion and

sediment control measures and practices prior to land disturbing activities."

20 Clearly note statement that "Erosion control measures will be maintained at all times. If full implementation of the approved

Plan does not provide for effective erosion control, additional erosion and sediment control measures shall be implemented

to control or treat the sediment source."

21 Clearly note the statement "Any disturbed area left exposed for a period greater than 14 days shall be stabilized with mulch

or temporary seeding."

22 Any construction activity which discharges storm water into an Impaired Stream Segment, or within 1 linear mile upstream

of and within the same watershed as, any portion of an Biota Impaired Stream Segment must comply with Part III. C. of the

permit. Include the completed Appendix 1 listing all the BMPs that will be used for those areas of the site which discharge

to the Impaired Stream Segment.*

23 If a TMDL Implementation Plan for sediment has been finalized for the Impaired Stream Segment (identified in item 22

above) at least six months prior to submittal of NOI, the ES&PC Plan must address any site-specific conditions or

requirements included in the TMDL Implementation Plan.*

24 BMPs for concrete washdown of tools, concrete mixer chutes, hoppers and the rear of the vehicles. Washout of the drum

at the construction site is prohibited.*

25 Provide BMPs for the remediation of all petroleum spills and leaks.

26 Description of the measures that will be installed during the construction process to control pollutants in storm water that

will occur after construction operations have been completed.*

27 Description of practices to provide cover for building materials and building products on site.*

28 Description of the practices that will be used to reduce the pollutants in storm water discharges.*

29 Description and chart or timeline of the intended sequence of major activities which disturb soils for the major portions of

the site (i.e., initial perimeter and sediment storage BMPs, clearing and grubbing activities, excavation activities, utility

activities, temporary and final stabilization).

30 Provide complete requirements of inspections and record keeping by the primary permittee.*

31 Provide complete requirements of sampling frequency and reporting of sampling results.*

32 Provide complete details for retention of records as per Part IV.F. of the permit.*

33 Description of analytical methods to be used to collect and analyze the samples from each location.*

Appendix B rationale for NTU values at all outfall sampling points where applicable.*

35 Delineate all sampling locations, perennial and intermittent streams and other water bodies into which storm water is

discharged also provide a summary chart of the justification and analysis for the representative sampling as applicable.*

36 A description of appropriate controls and measures that will be implemented at the construction site including: (1) initial

sediment storage requirements and perimeter control BMPs, (2) intermediate grading and drainage BMPs, and (3) final

BMPs. For construction sites where there will be no mass grading and the initial perimeter control BMPs,

intermediate grading and drainage BMPs, and final BMPs are the same, the Plan may combine all of the BMPs into a single

phase.*

37 Graphic scale and North arrow.

38 Existing and proposed contour lines with contour lines drawn at an interval in accordance with the following:

Existing Contours USGS 1": 2000' Topographical Sheets

Proposed Contours 1" : 400' Centerline Profile

39 Use of alternative BMPs whose performance has been documented to be equivalent to or superior to conventional BMPs

as certified by a Design Professional (unless disapproved by EPD or the Georgia Soil and Water Conservation

Commission). Please refer to the Alternative BMP Guidance Document found at www.gaswcc.org.

Use of alternative BMP for application to the Equivalent BMP List. Please refer to Appendix A-2 of the Manual for

Erosion & Sediment Control in Georgia 2016 Edition.*

41 Delineation of the applicable 25-foot or 50-foot undisturbed buffers adjacent to State waters and any additional buffers

required by the Local Issuing Authority. Clearly note and delineate all areas of impact.

42 Delineation of on-site wetlands and all State waters located on and within 200 feet of the project site.

43 Delineation and acreage of contributing drainage basins on the project site.

44 Delineate on-site drainage and off-site watersheds using USGS 1" :2000' topographical sheets.