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For Office Use Only <br /> Erosion Control Permit <br /> Simplified Application Checklist Permit Number: 6C—c-9-01 S -- 04 s <br /> Date: a/F,1 S <br /> Project Name: Copus Driveway <br /> Plan Requirements X Location of Information: <br /> Page Number or Attachment <br /> 1. Narrative describing the proposed project 1. Install silt fence, stone check and tracking <br /> pad <br /> 2. Excavating driveway <br /> 3. House site <br /> • 4. Foundation, framing, SFR construction <br /> • 5. Restoration of disturbed areas <br /> 2. * Site plan(of known scale that includes:property lines,disturbed area limits, Attached <br /> impervious area limits(existing and proposed),natural and artificial water <br /> features, 100-yr flood plain,delineated wetland boundaries,location of all <br /> proposed erosion control practices) <br /> NOTE: Grading within 5'of the property line requires department approval <br /> 3. * Contours(existing and proposed) Attached <br /> 4. * Watershed size for each drainage area 12.5 Ac <br /> (include area draining to the site and within project boundaries) ✓ <br /> 5. Tracking control Tracking pad 50' 1 x 12" d width of driveway <br /> (provisions to prevent mud-tracking onto public streets and roads during ✓ <br /> construction,e.g.tracking pad or existing gravel drive) <br /> 6. Sediment control practices to protect stormwater facilities or Stone weeper at outfall of culvert <br /> storm sewer inlets,existing and proposed,on or adjacent to the 1 <br /> site(e.g. inlet protection or stone weeper) <br /> 7. Proposed erosion control practices Silt fence, stone check, tracking pad <br /> (list of erosion control practices) <br /> 8. Proposed start date 12/9/15 <br /> (date for installation of all erosion control practices and start of land disturbing 7 <br /> activity) <br /> 9. Proposed stabilization date 6/9/16 <br /> (date for placement of seed&mulch,sod or permanent surfacing) 1 <br /> 10. Culvert sizes 18" CMP x 24' long <br /> (existing and proposed culverts on or adjacent to the site) ✓ <br /> 11. Any other information necessary to reasonably determine the N/A <br /> location, nature and condition of any physical or environmental 1 <br /> features of the site <br /> Note: Any proposed changes to the erosion control plan must be submitted and approved prior to <br /> implementation. The permit will expire on the stabilization date indicated in the plan (see checklist item#9). <br /> *Information to address the items above is available on the following Dane County websites: <br /> http://accessdane.co.dane.wi.us/html/public.asp <br /> http://www.co.dane.wi.us/lwrd/permit/ <br /> Revised 01.08.2014 <br />