Spreadsheet: 5904cf7d-73d3-4d1c-9f59-da845ef51dd2
Sheet: Sheet1

Red triangles at the upper right hand corner indicate design comments | Unnamed: 1 | Unnamed: 2 | Unnamed: 3
Please complete the yellow shaded items.
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
LEVEL SPREADER - VEGETATED FILTER STRIP (LS-VFS) SUPPLEMENT
This form must be completely filled out, printed, initialed, and submitted.
I.  PROJECT INFORMATION
Project name
Contact name
Phone number
Date
Drainage area number
II.  DESIGN INFORMATION
The purpose of the LS-VFS | Pick one:
Stormwater enters LS-VFS from | Pick one:
Type of VFS | Pick one:
Explanation of any "Other" responses above
If Stormwater Enters the LS-VFS from the Drainage Area
Drainage area |  | ft2
Impervious surface area |  | ft2
Percent impervious |  | %
Rational C coefficient
Peak flow from the 1 in/hr storm |  | cfs
Time of concentration |  | min
Rainfall intensity, 10-yr storm |  | in/hr
Peak flow from the 10-yr storm |  | cfs
Design storm | Pick one:
Maximum amount of flow directed to the LS-VFS |  | cfs
Is a flow bypass system going to be used? |  | (Y or N)
Explanation of any "Other" responses above
If Stormwater Enters the LS-VFS from a BMP
Type of BMP | Pick one:
Peak discharge from the BMP during the design storm |  | cfs
Peak discharge from the BMP during the 10-year storm |  | cfs
Maximum capacity of a 100-foot long LS-VFS |  | cfs
Peak flow directed to the LS-VFS |  | cfs
Is a flow bypass system going to be used? |  | (Y or N)
Explanation of any "Other" responses above
LS-VFS Design
[NAME] surface area |  | sq ft
Depth of forebay at stormwater entry point |  | in
Depth of forebay at stormwater exit point |  | in
Feet of level lip needed per cfs |  | ft/cfs
Computed minimum length of the level lip needed |  | ft
Length of level lip provided |  | ft
[NAME] of VFS |  | ft
Elevation at downslope base of level lip |  | fmsl
Elevation at the end of the VFS that is farthest from the LS |  | fmsl
Slope (from level lip to the end of the VFS) |  | %
Are any draws present in the VFS? |  | (Y or N)
Is there a collector swale at the end of the VFS? |  | (Y or N)
Bypass System Design (if applicable)
Is a bypass system provided? |  | (Y or N)
Is there an engineered flow splitting device? |  | (Y or N)
Dimensions of the channel (see diagram below):
M |  | ft
B |  | ft
W |  | ft
y (flow depth for 10-year storm) |  | ft
freeboard (during the 10-year storm) |  | ft
Peak velocity in the channel during the 10-yr storm |  | ft/sec
Channel lining material | Pick one:
Does the bypass discharge through a wetland? |  | (Y or N)
Does the channel enter the stream at an angle? |  | (Y or N)
Explanation of any "Other" responses above
III.  REQUIRED ITEMS CHECKLIST
EDIT Please indicate the page or plan sheet numbers where the supporting documentation can be found.  An incomplete submittal package will result in a request for additional information.  This will delay final review and approval of the project.  Initial in the space provided to indicate the following design requirements have been met.  If the applicant has designated an agent, the agent may initial below.  If a requirement has not been met, attach justification.
Requried Item: |  | Initials | Page or plan sheet number and any notes:
1.  Plans (1" - 50' or larger) of the entire site showing: - Design at ultimate build-out, - Off-site drainage (if applicable), - Delineated drainage basins (include Rational C coefficient per basin), - Forebay (if applicable),  - High flow bypass system, - Maintenance access,  - Proposed drainage easement and public right of way (ROW), and - Boundaries of drainage easement. |  | _________
2.  Plan details (1" = 30' or larger) for the level spreader showing:      - Forebay (if applicable),  - High flow bypass system, - One foot topo lines between the level lip and top of stream bank,  - Proposed drainage easement, and - Design at ultimate build-out. |  | _________
3.  Section view of the level spreader (1" = 20' or larger) showing:         - Underdrain system (if applicable),  - Level lip, - Upslope channel, and - Downslope filter fabric. |  | _________
4.  Plan details of the flow splitting device and supporting calculations (if applicable).
5.  A construction sequence that shows how the level spreader will be protected from sediment until the entire drainage area is stabilized. |  | _________
6.  If a non-engineered VFS is being used, then provide a photograph of the VFS showing that no draws are present.
7.  The supporting calculations. |  | _________
8.  A copy of the signed and notarized operation and maintenance (O&M) agreement. |  | _________