Coordination with ODNR - In Stream Work Waiver Request.docx



ODOT Specific In-stream Work Restriction Waiver Request General Project InformationODOT Contact:Request Date:County, Route, Section:Project PID:County:Township:Lat (DD.dddd):Lon (-DD.dddd):USACE Project #:USACE Contact:Ohio EPA Permit #:Ohio EPA Contact:Project Description:Stream InformationStream Name:Drainage Area:Ohio EPA Aquatic Life Use:(Choose)Stream designation for in-water work restrictions: (Choose)Known listed aquatic species potentially impacted by proposed project (include listed species from ESR and discuss potential impacts and coordination efforts): Types and quality of instream habitat features that will be impacted within the specific area for which the waiver is being requested:Project Construction and Timing InformationLinear Feet of Stream Impact:Construction Description and Timing of In-Water Work: Waiver Request InformationEstimated Dates for construction involving In-stream work:Waiver(s) Requested From:? Division of Wildlife? Scenic RiversApplicable In-stream Work Restriction Period(s) (without waiver):(Choose) (Choose)Portion of the restricted dates that waiver is being requested for:? Full? Partial? N/A? Full? Partial? N/AInclude month/Date range of requested waiver:Include number of construction seasons:Previous Waiver Requests:Justification for Waiver Request: Best Management PracticesEarth Disturbed Area Acreage:NOI Required?(Choose)Appropriate BMPs for all earth disturbing activities could include any or all of the items listed in ODOT Supplemental Specification 832.05 A-N as appropriate. list of BMPs below include those commonly used, however, additional BMPs or combinations of BMPs may be appropriate within a project area.? Appropriate site specific BMPs will be determined following the process outlined in ODOT Supplemental Specification 832. Please check all that apply.?Temporary Access Fills – For all fill and surface material placed in the channel, around the culverts, or on the surface of the causeway and access fills furnish clean, non-erodible, nontoxic dumped rock fill, Type B, C, or D, as specified in C&MS 703.19.B. Extend rock fill up the slope from original stream bank for 50 feet (10 m) to catch and remove erodible material from equipment. All portions of the causeway (including all rock and culverts) and access fills will be removed in its entirety. The material will not be disposed in other waters of the US or isolated wetland. The stream bottom affected by the causeway and access fills will be restored to its pre-construction elevations. ?Perimeter Controls - Perimeter filter fabric fence will be used to capture construction related sediment carried in sheet flow runoff.?Seeding and Mulching - Commercial fertilizer, seed, and mulch materials conforming to ODOT Construction and Materials Specifications Item 659 will be used to provide sufficient durable protective cover that provides OEPA NPDES Permit compliant erosion control.?Project fueling and refueling BMP locations - BMP to prevent and respond to spills or leaks as required by the OEPA NPDES Permit.?Inlet Protection - Constructing the inlet protection for existing inlets at the beginning of construction and for new inlets immediately after completing the sump.?Slope protection – The placement of dikes, the installation of slope drains, and the construction of ditches to divert water from bare non-vegetated areas and to protect cut and fill slopes. The side slopes will be protected from erosion by placing dikes at the top of fill slopes prior to construction of the slope. Ditches and dikes will be constructed prior to construction of cut slopes to divert runoff away from the slope. All sediment-laden discharges from slope protection will be directed into an appropriate sediment control BMP.?Ditch Checks and Ditch Protection – The construction of filter fabric ditch checks or rock checks across a ditch and perpendicular to the flow. Rock checks will be used to protect the ditch from erosion. Filter fabric ditch checks will be used to filter sediment from the flowing water only when appropriate and when sediment dams/basins are considered a safety hazard or infeasible as determined by the Engineer. Ditch checks will be placed as soon as the ditch is cut. If working on a ditch, ditch checks will be replaced by the end of the workday.?Sediment Basins and Dams - Sediment Basins and Dams will be designed and constructed in accordance with and as described in the OEPA NPDES Permit for “sediment settling ponds”. Sediment Basins and Dams will be designed and constructed at concentrated and critical flow locations to settle out sediment before the water leaves the EDA area and will not be constructed in any jurisdictional waterways.? All sediment basins requiring a dewatering device (riser and outlet pipe) shall incorporate a surface water dewatering device as described in the OEPA NPDES Permit.Other BMPs: Best Management Practices Monitoring?Sediment and erosion control measures be monitored during construction activity?Seeding and mulching will be monitored for establishmentAssociated Stream Improvements1. Is this a stream restoration project? (if yes, answer 1a and 1b. If no, skip to 2)(Choose)1(a). Is this a dam removal project?(Choose)1(b). Will a conservation easement be placed on the stream channel?(Choose)2. Will bioengineering be used to design channel protection or other features?(Choose)3. Will natural channel design be used for this project?(Choose)4. Will trees or shrubs be planted along the stream as part of the project?(Choose)5. Will the project stabilize erosion or other bank instabilities using rock channel protection?(Choose)Additional Information on Stream Improvements:Attachments?Topographic Map (required)?Other:?Aerial Photo (required)?Other:?Plans?Other: ................
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