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Right of Way Easement Form

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Right of Way Easement Form Powered By Docstoc
					                                                                                                                               Permit Number:______________
                                                                                                                                       (to be provided by DWQ)




                                                 STORMWATER MANAGEMENT PERMIT APPLICATION FORM
                                                       401 CERTIFICATION APPLICATION FORM
                                                               SAND FILTER SUPPLEMENT
                                 This form must be filled out on line, printed and submitted with all of the required information.
                       Make sure to also fill out and submit the Required Items Checklist (Section III) and the I&M Agreement (Section IV)

I. PROJECT INFORMATION
Project name
Contact name
Phone number
Date
Drainage area number

II. DESIGN INFORMATION
Site Characteristics
Drainage area (AD)                                                                            ft2
Impervious area                                                                               ft2
% Impervious (IA)                                                                             %
Design rainfall depth (RD)                                                                    in
Peak Flow Calculations
1-yr, 24-hr runoff depth                                                                      in
1-yr, 24-hr intensity                                                                         in/hr
Pre-development 1-yr, 24-hr runoff                                                            ft3/sec
Post-development 1-yr, 24-hr runoff                                                           ft3/sec
Pre/Post 1-yr, 24-hr peak control                                                             ft3/sec
Storage Volume
                                                                                               3
Design volume (WQV)                                                                           ft
Adjusted water quality volume (WQVAdj)                                                   0.00 ft3
Volume contained in the sedimentation basin and on top of the sand filter                0.00
Maximum head on the sedimentation basin and sand filter (hMaxFilter)                          ft
Average head on the sedimentation basin and sand filter (hA)                                  ft
Runoff Coefficient (RV)                                                                       (unitless)
Type of Sand Filter
Open sand filter?                                                                                   Y or N
  If this is an open sand filter: The clearance between the bottom of the sand
                                                                                              ft
  filter and the SHWT (dSHWT)
Closed/pre-cast sand filter?                                                                        Y or N
  If this is a closed sand filter: The clearance between the bottom of the sand
                                                                                              ft
  filter and the SHWT (dSHWT)
  If this is a closed, underground closed sand filter: The clearance between
  the surface of the sand filter and the bottom of the roof of the underground                ft
  structure (dSpace)




       Form SW401-Sand Filter-Rev.4                                                                          Parts I and II. Project Design Summary, Page 1 of 4
                                                                                                                       Permit Number:______________
                                                                                                                               (to be provided by DWQ)

Sedimentation Basin

Surface area of sedimentation basin (AS)                                              ft2

Sand Filter

                                                                                       2
Surface area of sand filter (AF)                                                      ft

Depth of the sand media filter bed (dF)                                               ft
Coefficient of permeability for the sand filter (k)                                   (ft/day)
Time to drain the sand filter (t)                                                     hours
Time to drain the sand filter (t)                                                0.00 days

Additional Information
Does volume in excess of the design volume bypass the sand filter?                          Y or N
Is an off-line flow-splitting device used?                                                  Y or N
Does volume in excess of the design volume flow evenly distributed through a
                                                                                            Y or N
vegetated filter?
   What is the length of the vegetated filter?                                        ft
   Does the design use a level spreader to evenly distribute flow?                          Y or N
Is the BMP located at least 30ft from surface waters (50ft if SA waters)?                   Y or N
If not a closed bottom, is BMP located at least 100ft from water supply wells?              Y or N
Are the vegetated side slopes equal to or less than 3:1                                     Y or N
Is the BMP located in a recorded drainage easement with a recorded access
                                                                                            Y or N
easement to a public Right of Way (ROW)?
What is the width of the sedimentation chamber/forebay (WSed)?                        ft
What is the depth of sand over the outlet pipe?                                       ft

                                             Figure 1: Open Sand Filter




        Form SW401-Sand Filter-Rev.4                                                                 Parts I and II. Project Design Summary, Page 2 of 4
                                                                                Permit Number:______________
                                                                                        (to be provided by DWQ)

                               Figure 2: Closed Sand Filter




Form SW401-Sand Filter-Rev.4                                  Parts I and II. Project Design Summary, Page 3 of 4
                                                                                                             Permit No.______________
                                                                                                               (to be provided by DWQ)


III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal
package will result in a request for additional information. This will delay final review and approval of the project. Initial
in the space provided to indicate the following design requirements have been met. If the applicant has designated an agent,
the agent may initial below. If a requirement has not been met, attach justification.


 Initials   Page/ Plan
            Sheet No.


  _____       _____      1. Plans (1" - 50' or larger) of the entire site with labeled drainage area boundaries
                         - System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
                         chamber
                         - Maintenance access,
                         - Flow splitting device,
                         - Proposed drainage easement and public right of way (ROW),
                         - Design at ultimate build-out,
                         - Off-site drainage (if applicable), and
                         - Boundaries of drainage easement.
  _____       _____      2. Plan details (1" = 50' or larger) for the sand filter showing:
                         - System dimensions (length, width, and depth) for both the sedimentation chamber and the filter
                         chamber
                         - Maintenance access,
                         - Flow splitting device,
                         - Proposed drainage easement and public right of way (ROW),
                         - Design at ultimate build-out,
                         - Off-site drainage (if applicable), and
                         - Boundaries of drainage easement.
  _____       _____      3. Section view of the sand filter (1" = 20' or larger) showing:
                         - Depth(s) of the sedimentation chamber and sand filter chamber,
                         - Depth of sand filter media
                         - Connection between the sedimentation chamber and the sand filter chamber,
                         - SHWT level(s)
                         - Outlet pipe, and
                         - Clearance from the surface of the sand filter to the bottom of the roof of the underground structure (if
                         applicable)
  _____       _____      4. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
                         results of the soils report must be verified in the field by DWQ, by completing & submitting the soils
                         investigation request form. County soil maps are not an acceptable source of soils information.

  _____       _____      5. Supporting calculations (including drainage calculations)
  _____       _____      6. Signed and notarized operation and maintenance (O&M) agreement
  _____       _____      7. A copy of the deed restrictions (if required).




Form SW401-Sand Filter-Rev.4                                                                                          Part III, Page 4 of 4

				
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Description: Right of Way Easement Form document sample