Stormwater Management Application(PDF, 136KB)

OUTAGAMIE COUNTY DRAINAGE BOARD LEGAL DRAIN CONNECTION (DIRECT AND IN-DIRECT) APPLICATION (Page 1 of this form completed by applicant) DRAINAGE DISTRICT & # ____________________________________________________________________________ APPLICATION DATE: ________________ PARCEL #: ______________________ MUNICIPALITY: ____________________ SITE ADDRESS: _____________________________________________________________________________________ PROJECT DESCRIPTION _______________________________________________________________________________ __________________________________________________________________________________________________ AREA OF PARCEL: _______________acres/sf DISTURBED AREA: _____________sf COST OF PROJECT: $_____________ PARCEL OWNER NAME: ______________________________________ TELEPHONE: _____________________________ EMAIL: ________________________________ MAILING ADDRESS: ___________________________________________ STREET CITY, STATE, ZIP CODE ENGINEER/NAME: ___________________________________________________________________________________ (must be qualified under 88.21(5)) TELEPHONE: ________________________ EMAIL: ________________________________________________________ The undersigned agrees to conduct the above described activities in accordance with the Outagamie County Drainage Board policies, and in compliance with all the standards in the drainage rule (Ch. ATCP 48, WI Admin Code) and statute (Ch. 88, WI Statutes) and to grant permission for reasonable inspections as a condition of this approval. OWNER’S STATEMENT: I request that plans be reviewed for compliance with Outagamie County Drainage Board Storm- water Management Guidance and applicable State codes. I am also responsible for compliance with all code requirements and any conditions of plan approval. 1. Owner is responsible for the costs for review of the submitted plans by the Drainage Board’s consultant/engineer on a time/material charge. 2. Application filing fee of $400.00. Fee must be paid prior to scheduling of a public hearing date. Allow a minimum of 60 to 90 days for DATCP approval and public hearings. Make check payable to: Outagamie County Drainage Board. Mail to: Outagamie County Drainage Board, 320 S Walnut Street, Appleton WI 54911. _______________________________________________ _____________________________________________ Owner’s Printed Name Owner’s Signature Date ENGINEER’S STATEMENT: I attest that: The design specifications for the proposed action were prepared by myself as a qualified engineer under s. 88.21(5), Stats. The design specifications comply with applicable standards under ATCP 48, Subchapter IV, District Maps, Drains and Corridors and Subchapter V, Construction Projects and Drainage Alterations; Department Approval. As project engineer, in my judgement, the proposed action as designed will be effective in achieving the county drainage board’s objectives. ___________________________________________ _______________________________________________ Engineer’s Printed Name Engineer’s Signature Date ATCP 48.34 CONSTRUCTION PROJECT & DRAINAGE ALTERATIONS DATCP APPROVAL APPLICATION (Page 2 completed by the County Drainage Board) District Name & Number: _______________________________________________________________ Proposed Action: ______________________________________________________________________ Objectives: ___________________________________________________________________________ Persons Requesting Action: ______________________________________________________________ Estimated Cost: _________________________ (Cost of proposed action including any damage awards to landowners who will be adversely affected) ____ Design specifications were prepared by a qualified engineer under s.88.21 (5) ____ Lands & Waters Effected. A map/site plan as defined in ATCP 48.36 (1) (g) is included in submittal ____ Hydrology Analysis, prepared by a qualified engineer under s.88.21 (5), meeting ATCP 48.36 (1)(h) ____ Construction plan (including a plan, if applicable, for controlling construction site erosion; and of material, if any, that will be removed): Were formal changes to the cross-section, grade profile or alignment made? Yes_____ No_____ If yes, the required information under ATCP 48.36 (1)(k) must be included. Assessment of benefits to landowners: ________________________________________________________ Financing Plan: The Board’s plan for financing the proposed action, including any proposed cost assessment to lands within the district. __________________________________________________________________ Environmental effects (How the proposed action may affect the human and natural environment on lands and land uses as defined in ATCP 48.36 (1)(n)) ________________________________________________________ Alternatives. Assessment of alternatives to the proposed action, including the alternative of doing nothing. ATCP 48.36 (1)(o)___________________________________________________________________________ Notice of Public Hearing: The Notice of Public Hearing was published on ________________ in the _________ ____________; applicable property owners were provided notice by mail on ______________________ ____ Copies were filed with other agencies as specified in ATCP 48.36 (1)(3) Upon review of the above documents by the Board, this project was approved at a regular Board meeting on: ______________________. We hereby submit the plans and specifications for review and approval by the Department of Agricultural, Trade and Consumer Protection (DATCP). ____________________________________________ Drainage Board President Date