Checklist for An application is complete and will be reviewed by the Narragansett Bay Commission only if the following items are submitted: 1. Complete the attached application form in its entirety (pages 1 through 4) along with the appropriate signatures. Please Note: The Applicant information listed in item 1, should name the person responsible for the stormwater connection permit, not an engineering consulting agency or other parties providing the service. 2. Submit a Stormwater Management Plan that evaluates all onsite stormwater management measures to reduce or eliminate stormwater flow to the NBC combined system. Include supporting engineering documentation of method(s) and calculations used for estimating the flows of pre-construction/post construction stormwater of the site as well as all green infrastructure opportunities used. (See NBC s Rules & Regulations, Article 4.4 for complete requirements for developing a Stormwater Management Plan.) 3. Submit a location plan of the property (plat & lot) with a North arrow that points up or to the right. This plan should show the street location with the public sewer/stormwater line, as well as a detailed plan of the proposed stormwater connection. If plans are produced on CAD, an electronic copy shall be submitted. 4. Submit a utility site plan identifying all utilities on/around the property. This utility site plan should show any stormwater drainage systems, LID use and any alternative options available to discharge stormwater into natural waterways. 5. Submit building layout plans. These plans should include plumbing plans showing any measures taken to separate sewer and stormwater and incorporate water reuse. 6. Submit plan(s) showing special stormwater design methods that will be used on site to reduce or eliminate stormwater flow to the NBC combined sewage system. Indicate the size/capacity of the equipment and the piping/plumbing connection arrangements. Submit a minimum of 2 copies of each of the Stormwater Management Plan, location plan, utility plan, building layout plan, and any plans for stormwater reduction along with the completed stormwater connection permit application. If plans are produced on CAD, one electronic copy shall be submitted. 4. Submit the stormwater connection permit application fee payable by check or money order to the Narragansett Bay Commission. This fee is applicable to all applications for a new stormwater connection, either connecting directly or indirectly to NBC facilities. The fee is payable at the time of application. RESIDENTIAL $260 per building connection COMMERCIAL/INDUSTRIAL $779 per building connection All residential condominiums will be charged under residential tariffs regardless of the number of dwelling units. No stormwater connection permit application will be processed without the appropriate fees. Any questions regarding this application, please call the Narragansett Bay Commission Permitting Section at (401) 461-8848 or visit our website at www.narrabay.com. Applications can be mailed to Narragansett Bay Commission, Permit Section, One Service Road, Providence, RI 02905.
PERMIT NUMBER: F APPROVED I N REJECTED A L INACTIVE INTERNAL USE ONLY 1. Applicant: Company (if applicable) Address (Permit will be mailed to this address): City/Town: State: Zip: Telephone: (Cell) (Bus.) (Fax) E-mail: 2. Property Owner: (if other than applicant) Company (if applicable) Address: City/Town: State: Zip: Telephone: (Cell) (Bus.) (Fax) E-mail: 3. Name of Project (if applicable) Project 4. Property Location: Is the property part of a new subdivision? YES NO Provide a sketch or map identifying the property location with street names and/or plat & lot number(s). Property Address*: City/Town: Plat No.(s): Lot No.(s): *If a street address has not been assigned, the Applicant will be required to submit the street address prior to discharging from the connection. Revised 1/2016 Page 1 of 4
5. Building Description: Attach floor plan(s), site plan(s), and plans for special equipment to be used on site. Please check ( ) the appropriate building type. Residential (Up to and including two (2) dwelling units per building) Commercial/ Residential (Three (3) or more dwelling units per building) Commercial (Offices, Restaurants, Salons, Retail Stores, Hotels/Motels, Nursing Homes) Industrial/ Commercial (Retail/ Wholesale Factories, Multi-use Buildings) Industrial (Jewelry Companies, Machine Shops, Printing Companies) If the building is Residential, please supply the following: No. of Building(s) If the building is Commercial/Residential, please supply the following: If the building is Commercial, please supply the following: Describe the commercial operation and any special equipment to be used on site. If the building is Industrial, please supply the following: Will there be site remediation/dewatering associated with this project that will be discharged to the public combined sewer system? YES NO 6. Stormwater Sources: What is the source of stormwater on the premises? (please check the appropriate boxes) Shed Flow Areaway Drains Roof Down Spouts Others Sources Revised 1/2016 Page 2 of 4
7. Stormwater Mitigation Measures: Please indicate the types of Low Impact Development (LID) technology that will be installed at the project site. Dry Wells Green Roofs Catch Basins Reuse Sand Filters Filter Strips Swales Separated Storm Drain Permeable Paving Bioretention Areas Infiltration Systems Underground Storage Devices Stormwater Basins Oil & Grit Separator Landscape Areas Rainwater Harvesting What is the approximate cost of construction mitigation methods? $ Other: 8. Discharge Method: Please indicate the method(s) to be used to discharge stormwater from the project site. Recharge Discharged to River Public combined sewer facility 9. Stormwater Generation: Please indicate the total quantity of flow for the following questions. Pre-Construction Post-Construction 24 hr. Storm Duration (CFS) 24 hr. Storm Duration (CFS) 2 yr. 2 yr. 10 yr. 10 yr. 25 yr. 25 yr. 50 yr. 50 yr. 100 yr. 100 yr. *Please document and attach calculations for the method used for estimating stormwater flow. Revised 1/2016 Page 3 of 4
10. Construction: What are the approximate starting and finishing dates of construction? Starting : Finishing : Please provide information about the Drain Layer. License Number: Company: Address: City/Town: State: Zip: Telephone: (Bus.) (Fax) Please provide information about the Drain Layer s Bond Company. Company: Address: City/Town: State: Zip: Amount of Bond: Telephone (Bus.) (FAX) Will the proposed stormwater connection(s) require an extension to the public combined sewer system? YES NO If YES, this application must be signed below by an authorized representative of the City or Town confirming that the proposed sewer extension will conform to the City or Town RI DEM approved Facility Plan. Signature of Authorized City or Town Agent If this Stormwater Connection Permit Application is approved, the undersigned applicant agrees to accept and abide by all provisions of the Narragansett Bay Commission's Rules and Regulations for the Use of Wastewater Facilities within the Narragansett Bay Water Quality Management District, as amended, and shall in every respect conform to the terms of this application. Any changes to the information of this Stormwater Connection Permit Application must be reported to the Narragansett Bay Commission. Signature of Property Owner Signature of Drain Layer Revised 1/2016 Page 4 of 4