EROSION AND SEDIMENT POLLUTION CONTROL PLAN REVIEW APPLICATION

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2 Effective DAUPHIN COUNTY CONSERVATION DISTRICT 1451 PETER S MOUNTAIN ROAD DAUPHIN, PA EROSION AND SEDIMENT POLLUTION CONTROL PLAN REVIEW APPLICATION This application must be completed by the project owner or the owner s agent and submitted with the required plans, information, narratives and applicable fees. Fees must be submitted with the initial review application. The application will not be considered complete for review without the correct fees. See Applicant Resources for information on fees and checks. 1. PROJECT INFORMATION PROJECT NAME MUNICIPALITY DCCD PROJECT NUMBER IF ASSIGNED ANTICIPATED START DATE TOTAL ACRES OF ENTIRE PROJECT SITE TOTAL DISTURBED ACRES IF PROJECT IS PHASED, TOTAL DISTURBED ACRES OF ENTIRE SUBMITTED PHASE 2. SUBMISSION REQUIREMENTS AND FEES NO NPDES PERMIT REQUIRED 2 COPIES ESPC PLAN AND NARRATIVE ESPC PLAN REVIEW FEE 3 COPIES ESPC PLAN AND NARRATIVE ESPC PLAN REVIEW FEE NPDES PERMIT REQUIRED 3 COPIES NPDES PERMIT APPLICATION PACKAGE $ PER DISTURBED ACRE FEE 3 COPIES PCSM PLAN AND NARRATIVE $ PERMIT FILING FEE PNDI SEARCH IF REQUESTING DCCD TO CONDUCT SEARCH $ PROJECT OWNER OF RECORD NAME ADDRESS CITY STATE ZIP RESPONSIBLE OFFICIAL TELEPHONE 4. PROJECT DESIGNER NAME ADDRESS CITY STATE ZIP RESPONSIBLE OFFICIAL TELEPHONE 5. PROJECT CONTRACTOR /DEVELOPER NAME ADDRESS CITY STATE ZIP RESPONSIBLE OFFICIAL TELEPHONE 6. LAND USES SEE APPLICANT RESOURCES EXISTING CODE PROPOSED CODE 7. NEAREST RECEIVING STREAM SEE APPLICANT RESOURCES NEAREST NAMED STREAM CODE DISTANCE TO NEAREST NAMED OR UNNAMED STREAM IN FEET Members of the DCCD Board and staff are authorized to enter project site for site inspection, if necessary. SIGNATURE OF APPLICANT OR AGENT DATE DCCD USE ONLY: DCCD File Number: Date Received: ESPC Plan Review Fee Paid: Check Number NPDES Admin. Fee Paid: Check Number NPDES Per Acre fee Paid: Check Number PNDI Search fee Paid: Check Number

3 Dauphin County Receiving Waters Stream Name County Township Chapter 93 Designated Use (Existing Use - if applicable) Chapter 93 Code Siltation Impaired Susquehanna River Dauphin Lower Swatara WARM WATER FISHES WWF No UNT to Lisa Lake (9) Dauphin Lower Swatara WARM WATER FISHES WWF No UNT to Susquehanna River (2) Dauphin Lower Swatara WARM WATER FISHES WWF No UNT to Swatara Creek (11) Dauphin Lower Swatara WARM WATER FISHES WWF Yes Swatara Creek Dauphin Londonderry WARM WATER FISHES WWF No UNT to Iron Run (3) Dauphin Londonderry WARM WATER FISHES WWF Yes UNT to Iron Run (13) Dauphin Derry WARM WATER FISHES WWF Yes Iron Run Dauphin Derry WARM WATER FISHES WWF Yes UNT to Spring Creek (10) Dauphin Derry WARM WATER FISHES WWF Yes UNT to Spring Creek (15) Dauphin Conewago WARM WATER FISHES WWF Yes

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5 BERKS COUNTY CONSERVATION DISTRICT 1238 COUNTY WELFARE ROAD, SUITE 200 LEESPORT, PA (610) FAX (610) PROJECT APPLICATION APPLICATION TYPE(check all that apply) New Initial Revision Subsequent Revision Expedited Review Project Name: Site Location/Address: Municipality: Tax Parcel Total Project Area (Acres): Total Disturbed Area (Acres): Lat Long Receiving Water/Watershed Name: Chapter 93 Classification: APPLICANT INFORMATION Applicant's Last Name First Name Phone Organization Name or Registered Fictitious Name Phone Mailing Address City State ZIP + 4 FAX CONSULTANT INFORMATION Last Name (license, certifications) First Name Consulting Firm Mailing Address City State ZIP+4 Phone Ext FAX PLAN INFORMATION **ALL PLANS MUST BE FOLDED. ROLLED PLANS WILL BE RETURNED** Have you included the following: Permits Required: Type of Submission: Attached Fees NPDES General Residential Written Narrative NPDES Individual Commercial/Industrial Plan Drawings 105 Water Encroachment (GP) Government Calculations Review Fee $ (see NOTE below) 2 nd Revision Fee $ (50% of initial fee) E&SC Permit (only for 25 acres of disturbance for Timber Harvests) Timber Harvest Agricultural Other Enclosed Fees (All Checks Payable to BCCD Unless Otherwise Stated) NPDES Base Fee $ (payable to Berks County Clean Water Fund) NPDES Disturbed Acre Fee $ (payable to DEP/Commonwealth Clean Water Fund) 105 Permit Fee $ (payable to Berks County Clean Water Fund) NOTE: The initial project fee includes the initial review, one subsequent review, site inspections, technical assistance, complaint response, and administrative support. Each fee must be on a separate check DO NOT COMBINE fees. For District Use Only: Application# Date: Project Review Fee $ Ck# _ NPDES Base Fee $ Ck# _ Disturbed Acre Fee $ Ck# _ 105 Permit Fee $ Ck# _ Expedited Fee $ Ck# _ Revised 06/01/2012, 06/2013 Page 1 of 5

6 Berks County Receiving Waters Stream Name County Township Chapter 93 Designated Use (Existing Use, if applicable) Chapter 93 Code Siltation Impaired UNT to Little Cocalico Creek (5) Berks South Heidelberg TROUT STOCKING TSF No UNT to Cacoosing Creek (8) Berks South Heidelberg COLD WATER FISHES CWF No Cacoosing Creek Berks South Heidelberg COLD WATER FISHES CWF No UNT to Cacoosing Creek (15) Berks Spring COLD WATER FISHES CWF No Little Muddy Creek Berks Spring TROUT STOCKING TSF No UNT to Wyomissing Creek (13) Berks Cumru HIGH QUALITY-COLD WATER FISHES HQ No Wyomissing Creek Berks Cumru HIGH QUALITY-COLD WATER FISHES HQ No UNT to Allegheny Creek (19) Berks Brecknock COLD WATER FISHES CWF No Allegheny Creek Berks Brecknock COLD WATER FISHES CWF No UNT to Muddy Creek (8) Berks Brecknock HIGH QUALITY-TROUT STOCKING HQ No Muddy Creek Berks Brecknock HIGH QUALITY-TROUT STOCKING HQ No Hay Creek Berks New Morgan EXCEPTIONAL VALUE EV No Hay Creek Berks New Morgan HIGH QUALITY-COLD WATER FISHES CWF No UNT to Hay Creek (12) Berks New Morgan HIGH QUALITY-COLD WATER FISHES CWF No UNT to Hay Creek (12) Berks New Morgan EXCEPTIONAL VALUE EV No UNT to Hay Creek Berks New Morgan COLD WATER FISHES CWF No UNT to Conestoga River (1) Berks New Morgan WARM WATER FISHES WWF No UNT to East Branch Conestoga River (12) Berks New Morgan WARM WATER FISHES WWF No East Branch Conestoga River Berks Caernarvon WARM WATER FISHES WWF No

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8 County Blair Huntingdon Perry Juniata Cumberland York Dauphin Lebanon Lancaster Berks South Central Region ESCGP-2 Fees LOD (Acres) - In Addition to LOD from March 2016 Submission Fee Determination Total Fee Payable to 0 $500 Base Fee + $200 per disturbed acre $0.00 Blair County Conservation District $100 per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 0 $300 Base Fee + $50 per acre $0.00 Huntingdon County Conservation District $ per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 0 $400 per linear mile (0.3mi additional) $0.00 Perry County Conservation District $100 per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 0 >1 acre= $500 + $150 per disturbed acre $0.00 Juniata County Conservation District $ per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund acres= $1000+ $150/acre $0.00 Cumberland County Conservation District $ per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 0 2nd Submission = 25% of original ($19,050) $4, York County Conservation District $ per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 5 1 to 5 acres= $1,140+ $340/acre $2, Dauphin County Conservation District $100 per disturbed acre $ Commonwealth of Pennsylvania Clean Water Fund 0 >25 acres= $8,800 + $90/acre $0.00 Lebanon County Conservation District $100 per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 0 5+ acres= $1,500+ $100/acre over 5 $0.00 Lancaster County Conservation District $100 per disturbed acre $0.00 Commonwealth of Pennsylvania Clean Water Fund 5 $750 per acre $3, Berks County Conservation District $100 per disturbed acre $ Commonwealth of Pennsylvania Clean Water Fund PA Clean Water Fund: Disturbed Acreage Total $1, PA Clean Water Fund: Review Fee $500.00

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