Wrc Form Dc 430 – Fill Out and Use This PDF

Form DC–430	SOIL EROSION APPLICATION FORM – RESIDENTIAL/SINGLE LOT

SOIL EROSION PERMIT APPLICATION

EFFECTIVE OCTOBER 1, 2012 TO SEPTEMBER 30, 2013

OAKLAND COUNTY WATER RESOURCES COMMISSIONER

ONE PUBLIC WORKS DRIVE

WATERFORD, MI 48328-1907

SOIL EROSION OFFICE: 248-858-5389

SOIL EROSION OFFICE FAX: 248-858-2054

RESIDENTIAL/SINGLE LOT

DATE: _______________________

SITE CLASSIFICATION: ________________________ APPLICATION NO.: ______________________________________

PLEASE TYPE OR PRINT IN INK AND DO NOT WRITE ABOVE THIS LINE

1.GENERAL INFORMATION PROPERTY ADDRESS:

PROPERTY IS LOCATED N S E W OF WHAT CLOSEST PROPERTY ADDRESS:

(CIRCLE ONE)

CITY/VLG/TWP:

LOT/PARCEL#:

SIDWELL NUMBER (TAX I.D.):

-

-

-

(REQUIRED)

NEAREST MAJOR CROSSROADS:

2.NAMES, ADDRESSES AND PHONE NUMBERS

CONTACT NAME OF LAND OWNER(S) OF RECORD:

(REQUIRED)

COMPANY:

ADDRESS:

(APPLICATIONS WITH P.O. BOX NUMBERS WILL NOT BE ACCEPTED)

CITY:

STATE:

ZIP CODE:

PHONE:

MOBILE PHONE:

FAX:

E-MAIL ADDRESS:

CONTACT NAME FOR BUILDER:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE:

MOBILE PHONE:

FAX:

E-MAIL ADDRESS:

ON-SITE PROJECT CONTACT NAME:

ADDRESS:

CITY:						STATE:			ZIP CODE:
PHONE:				MOBILE PHONE:		FAX:
E-MAIL ADDRESS:

3.TYPE OF CONSTRUCTION (CHECK ONE)

SINGLE FAMILY RESIDENCE

ADDITION TO A RESIDENCE

FILL, LAND BALANCING OR GRADING OPERATION

OTHER (SPECIFY) _____________________________________________________________

JOHN P. MCCULLOCH
OAKLAND COUNTY WATER RESOURCES COMMISSIONER
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Form DC–430

SOIL EROSION APPLICATION FORM – RESIDENTIAL/SINGLE LOT

4.ANSWER "YES" OR "NO" TO THE FOLLOWING QUESTIONS

A.Will any soil be removed from the site?

B.Will any "fill" material be brought into the site? If yes, state amount and type of fill:

C.Will vegetative re-stabilization (sod, seed and mulch, landscaping, etc.) be provided by the builder?

D.Does the lot abut a lake, stream, open drain, pond, detention/retention pond or wetland?

E.Does the project require a MDEQ permit? Attach a copy of the MDEQ permits for Part 31(Floodplain Occupancy Authority), Part 301 (Inland Lakes and Streams), and/or Part 303 (Wetland Protection)

F.Do you own any of the surrounding lots? If yes, which ones?

5.Area of earth disruption in acres or square feet: _______________________

6.Distance from earth disruption to nearest open drain, lake, stream, pond, detention/retention pond or wetland in feet: Name of body of water:

7.Soil Erosion Permit Duration (Circle one or fill in the blank): 3 months, 6 months, 9 months, 12 months, or

8.Type of soil or attach a soils survey map of the property:

9.Fill in the sequence of construction chart:

SEQUENCE OF CONSTRUCTION

OPERATION TIME SCHEDULE - BEGINNING: ________________

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

ASoil Erosion Control Measures B Excavate Basement

C Backfill Basement D Stone Access Drive

E Complete All Earth Movement F Seed & Mulch As Required

10.INCLUDE ONE (1) SITE PLAN SHOWING THE FOLLOWING:

A.Legal description of property

B.Location map with north arrow and distance to nearest open drain, lake, stream, pond, detention/retention pond or wetland

(must be drawn on a separate sheet of 8 ½” x 11” paper)

C.Topographical map, counters or grades shots which accurately shows the existing and proposed drainage patterns. (maps are available at Oakland County’s One Stop Shop )

D.Lakes, streams, wetlands, drains, etc., must be shown on the plans

E.For site Classes 4 and 5, the site plan must drawn by an architect, surveyor or civil engineer

F.Show the location of the house, garage, road, driveway, swales, lakes, streams, wetlands, ponds, ditches and catch basins. Include a subdivision map (if applicable)

G.Stone access drive of 1” x 3” stone into the project site (minimum 12’ x 50’ or to building envelope)

H.Graphic location of temporary soil erosion controls (silt fence, stone access drive, etc.)

I.Graphic location of limits of earth disruption

J.Soil erosion and sedimentation controls details

K.Maintenance notes for soil erosion and sedimentation controls must include the following statement: “The soil erosion controls will be maintained weekly and after every storm event by (whom)”

L.All items must be drawn to scale (No larger then 1” = 200’)

M.Proof of land ownership – current tax bill, recorded warranty deed, closing statement or land contract

JOHN P. MCCULLOCH
OAKLAND COUNTY WATER RESOURCES COMMISSIONER
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Form DC–430

SOIL EROSION APPLICATION FORM – RESIDENTIAL/SINGLE LOT

11.PERMIT FEE CALCULATION IS DONE BY THE WATER RESOURCES COMMISSIONER’S SOIL EROSION UNIT SITE CLASSIFICATIONS:

	Class 5			Project is on a lake/stream/wetland/open water of any kind and has a slope of 2% or greater or discharges
				to these waters
	Class 4			Project is on a lake/stream/wetland/open water of any kind and has a slope of less than 2%
	Class 3			Project is on a dry/wet detention basin with a sediment filter or on a retention pond
	Class 2			Project is more than 225 square feet and does not meet the requirements found in Class 3, 4 or 5
	Class 1			Minor changes less than 225 square feet of disturbance: additions, decks, etc.
INSPECTION FEES:
			Classification		Annual inspection fee:	Quarterly inspection fee:
				Class 5	$510.00	$	127.50
				Class 4	$265.00	$	66.25
				Class 3	$205.00	$	51.25
				Class 2	$140.00	$	35.00
				Class 1	$110.00	$	27.50

A review fee of $70 is due with the permit application. The inspection fee is due when the permit is issued.

Make checks payable to: Water Resources Commissioner or WRC

Cash, Check, Visa, MasterCard and Discover are accepted

Refunds will be sent to the property owner identified in item No. 2

12.The permit may be renewed for a maximum of one (1) year from the date of application if there is no activity on the site.

13.A permit not picked up within 30 days after notification of approval will be terminated. No refunds will be issued.

14.To transfer a permit, a permit transfer information form, or a similar form created by the landowner, must be completed and signed, then mailed or delivered to the WRC soil erosion unit offices. A permit cannot be transferred if there are any outstanding balances or violations against the permit.

15.This permit will be renewed every three (3) months after it expires until the site has all permanent soil erosion controls in place.

Final vegetation is specified as having every square foot of ground covered with a density of 90% and at least 1” in height.

16.ENFORCEMENT ACKNOWLEDGEMENT

A.Failure to comply with the applicable requirements of Part 91, Soil Erosion and Sedimentation Control of the Natural Resources and Environmental Protection Act, Act 451 of the Public Acts of 1994, as Amended (“Part 91”), is a civil infraction and will result in one or more of the following actions taken by this office: (1) a fine up to $2,500; (2) installation of soil erosion and sedimentation controls by county enforcing agency with all costs related to the administration, legal costs, permit or renewal fees and implementation of controls to be assessed against the landowner which may become a lien on the property if not paid; (3) a temporary restraining order will be filed in court to restrain any and all further construction at the property site, and to recover damages to the natural resources of the state; and (4) any other legal action necessary to ensure compliance with Michigan law.

B.A person who knowingly violates Part 91 or knowingly makes a false statement in an application for a permit or in a soil and sedimentation control plan may be ordered to pay a fine of up to $10,000 for each day of violation.

C.If corrective action is not taken within five (5) days of the date of a Notice of Determination of Violation letter, the permit holder will be responsible for a payment of a civil fine of not less than $2,500 or more than $25,000 for each day of violation. MCL 324.9121(1); 9121(2); and 9121(3).

D.By applying for and accepting this permit, the landowner hereby consents to the following: (1) the authority of the Michigan Department of Environmental Quality, or the county enforcing agency to enter upon the property at all reasonable times for the purpose of inspecting and investigating conditions or practices that may be in violation of

JOHN P. MCCULLOCH
OAKLAND COUNTY WATER RESOURCES COMMISSIONER
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Form DC–430

SOIL EROSION APPLICATION FORM – RESIDENTIAL/SINGLE LOT

part 91; (2) installation of soil erosion and sedimentation controls by the county enforcing agency with all costs related to the administration, legal costs, permit or renewal fees and implementation of controls to be assessed against the landowner which may become a lien on the property.

E.No earth disruption can occur on this site before the issuance of the soil erosion permit.

F.A violation re-inspection fee of $55 will be assessed if the violations are not corrected within the five (5) day period.

17.LANDOWNERS SIGNATURE

Ihereby acknowledge that I have read, understand and accept the terms and conditions of this application.

I understand that an application and site plans that are incomplete and/or incorrect shall be returned which may result in delay in issuing a permit. WRC has 30 days from the date of receipt of a complete and correct application and site plan to complete the review and issue this permit.

I (we) affirm that the above information is accurate and that I (we) will conduct the above described earth change in accordance with Part 91, Soil Erosion and Sedimentation Control, of the Natural Resource and Environmental Protection Act, Act 451 of the Public Acts of 1994, as amended, applicable local ordinances, and the documents accompanying this application.

LANDOWNER’S SIGNATURE

PRINT NAME

DATE

*The designated agent must sign the application along with the landowner or have an original written and notarized statement from the landowner authorizing the designated agent to sign the application and the permit in the landowner’s name.

JOHN P. MCCULLOCH
OAKLAND COUNTY WATER RESOURCES COMMISSIONER
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