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Home My WebLink AboutFDOT Permit 2018-D-490-025RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 1 of 8 To be completed by DOT Drainage Connection Permit No. Date Received By Maintenance Unit State Road No. Work Program Project No. Section No. Construction Project No. Milepost Station Instructions for Drainage Connection Permit Pursuant to 14-86.004(6), F.A.C. “The Drainage Connection Permit form serves as the application. Once approved by the Department, the form and supporting documents become the Drainage Connection Permit.” The applicant shall submit four completed permit packages with original signatures. Each package shall include all required attachments. All required signed and sealed plans and supporting documentation shall be submitted on no larger than (11” X 17”) multipurpose paper, unless larger plan sheets are requested by the reviewer. The package will include the following items. If an item does not apply to your project, indicate “Not Applicable” or “N/A.” Included Part Title Completed by: Special Instructions 1 Permit Information Sheet Applicant 2 Certification by a Licensed Professional Licensed Professional Signed and Sealed 3 Certification Applicant Signature 4 Owner’s Authorization of a Representative Owner Signature 5 Affidavit of Ownership or Control and Statement of Contiguous Interest Owner Signature 6 Permit General Conditions FDOT 7 Permit Special Conditions FDOT 8 As-Built Certification Licensed Professional Signed and Sealed – Submit within 15 working days of completion of construction Attachment Legal Description Attachment Photographs of Existing Conditions Attachment Location Map Attachment Grading Plan Licensed Professional Signed and Sealed Attachment Soil Borings Attachment Water Table / Percolation Attachment Calculations Attachment CD with Electronic Files of all Submittal Items Scanned Images in pdf format Note: Different Licensed Professionals may complete parts of the permit package. For example the Licensed Professional signing and sealing the as-built certification may be different from the Licensed Professional who signed and sealed the calculations for the permit package. EXCEPTIONS: Activities that qualify for an Exception are listed in Rule 14-86, F.A.C. A permit application to the Department is NOT required. However, if you desire verification whether the work qualifies for an exception, send a completed copy of this permit package with its requested information to the applicable FDOT District Office. 2018-D-490-025 20.000 4 5 4 4 4 4 4 4 4 4 4 7/3/2018 010 4 490Felicia Thompson Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 2 of 8 PART 1 – Permit Information Sheet Select one: Permit Exception Pursuant to 14-86.002(2), F.A.C. “Applicant means the owner of the adjacent property or the owner’s authorized representative.” Applicant Select one: Property Owner Owner’s Representative (Complete Part 4) Name: Title and Company: Address: City: State: Zip: Telephone: FAX: Email: Property Owner (If not applicant) Name: Title and Company: Address: City: State: Zip: Telephone: FAX: Email: Applicant's Licensed Professional Name: Florida License Number: Title and Company: Address: City: State: Zip: Telephone: FAX: Email: Project Information: Project Name: Location: STREET SR. NO. US HWY NO. CITY COUNTY SECTION(S) TOWNSHIP(S) RANGE(S) *Geographic Coordinates: Latitude (DMS.SSS): Longitude (DMS.SSS): Horizontal Datum: (NAD 83 / Adj.) * State Plane Coordinates: Northing Easting: Projection Zone: Florida North Florida East Florida West Coordinate shall be the center of the driveway intersection with FDOT R/W, or, if there is no driveway connection, near the center of the property line nearest the state highway. *Check with the FDOT Office for requirement. 32958 1835 20th Street (772) 778-3617 ext. ______ Sebastian City Manager, City Of Sebastian -80.4722858753693 32958 SR 5 27.8214517702977 (772) 569-0035 ext. ______ Oyster Pointe Drainage Improvement (772) 388-8203 ext. ______ Paul Carlisle Florida 1225 Main Street Florida Professional Engineer, MBVEngineering, Inc Paul Carlisle 0 4 55313 0 PCarlisle@cityofsebastian.org Indian River City Manager, City Of Sebastian 32960 Sebastian Florida Vero Beach PCarlisle@cityofsebastian.org (772) 388-8203 ext. ______ 010 1225 Main Street aaronb@mbveng.com 4 Aaron Bowles Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 3 of 8 Brief description of facility and proposed connection: Briefly describe why this activity requires a Drainage Connection Permit (Include where the stormwater will discharge to FDOT right of way): The proposed installation of a storm inlet will combine flows from FDOT US Highway 1 and Indian River Drive, ultimately discharging to the Indian River Lagoon. These improvements are being proposed to provide erosion control along Indian River Drive and adjacent private properties, and to address public safety concerns with the open ditch. The proposed project consists of the installation of a new storm ditch bottom inlet to combine multiple storm water pipes currently out falling to an open ditch located along Indian River Drive. Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 6 of 8 PART 6 – Permit General Conditions 1. This permit is a license for permissive use only and does not convey any property rights either in real estate or material, or any exclusive privilege and it does not authorize any injury to private property or invasion of private rights, or any infringement of Federal, State or local laws, rules or regulations; nor does it obviate the necessity of obtaining any required state or local approvals. 2. The drainage connection as authorized herein shall be constructed and thereafter maintained in accordance with the documents attached hereto and incorporated by reference herein. All work performed in the Department's right of way shall be done in accordance with the most current Department standards, specifications and the permit provisions. Such construction shall be subject to the inspection and approval of the Department, and the Department may at any time make such inspections as it deems necessary to assure that the drainage connection is in compliance with this permit. 3. The entire expense of construction within the Department right of way, including replacement of existing pavement or other existing features, shall be borne by the permittee. 4. The permittee shall maintain that portion of the drainage connection authorized herein located on permittee’s property in good condition. The Department shall maintain that portion of the drainage connection authorized herein located within its right of way. 5. If the drainage connection is not constructed, operated or maintained in accordance with this permit, the permit may be suspended or revoked. In this event modification or removal of any portion of the drainage connection from the Department's right of way shall be at the permittee's expense. 6. The Department reserves the right to modify or remove the drainage connection to prevent damage or in conjunction with road improvements. 7. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the Department's right, title, and interest in the land to be entered upon and used by the permittee, and the permittee will, at all times, assume all risk of and indemnify, defend and save harmless the Department from and against any and all loss, damage, cost or expense arising in any manner on account of the exercise or attempted exercises by said permittee of these rights and privileges, regardless of the respective degrees of fault of the parties. 8. Utilities, including gas lines, may exist within the right of way. Prior to beginning work the permittee shall contact Sunshine State One Call of Florida, Inc at 811 or 800-432-4770, who will notify all utility owners near the scheduled project. The utility owners have two (2) full business days to provide locations of their respective facilities. The permittee shall be solely responsible for any damage to or conflicts with gas lines, utilities and/or third persons. 9. The permittee shall notify the Department of Transportation Maintenance Office located at Phone 48 hours in advance of starting any work on the drainage connection authorized by this permit and also 24 hours prior to any work within the Department’s right of way. Construction of any work on the right of way shall be completed within days after such notification. If such construction is not completed within days after such notification, the permittee shall notify the Department of the anticipated completion date. 10. This permit shall expire if construction on the drainage connection is not begun within one year from the date of approval and if construction on the drainage connection is not completed by (Date) . 11. A permittee may request an extension of the Drainage Connection Permit expiration date by filing a written request for a permit time extension. All requests for time extensions must be received by the Department 15 working days prior to the expiration date. 12. All the provisions of this permit shall be binding on any assignee or successor in interest of the permittee. (772) 429-4923 ext. ______ 365 Treasure Coast Operations (Paul Brege) 7/19/2019 365 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 7 of 8 PART 7 – Permit Special Conditions – To be completed by FDOT The above request has been reviewed and has been found to meet the regulations as prescribed in Rule 14-86, F.A.C., and is hereby approved, subject to the following special conditions: Department of Transportation: Signature Title Date Olivia Bonilla 7/19/2018DRAINAGE DESIGNER III There is an authorized drainage connection to FDOT right of way. This permit authorizes drainage structures in the right of way. This Drainage Connection Permit authorizes construction of the drainage structures shown in the approved plans. This Drainage Connection Permit does NOT authorize any other work inside FDOT right of way. Any other work inside FDOT right of way must be authorized by another permit type such as an Access Permit. Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DRAINAGE CONNECTION PERMIT 850-040-06 ROADWAY DESIGN 10/08 Page 8 of 8 PART 8 – As-Built Certification Within 15 working days of completion of construction, you must send this certification to the Department office in which you filed your DOT Drainage Permit. 1. STORM WATER FACILITY INFORMATION Permit No.: Source (Project) Name: Source Location: Street City: County: Source Owner: Owner Address: 2. AS-BUILT CERTIFICATION I hereby certify that this storm water facility has been built substantially in accordance with the certified design plans, and that any substantial deviations (noted below) will not prevent the facility from functioning in compliance with the requirements of Chapter 14-86 F.A.C. when properly maintained and operated. These determinations have been based upon on-site observation of construction, scheduled and conducted by me or by a project representative under my direct supervision. Name of Licensed Professional: Florida License Number: Company Name (if applicable): Certificate of Authorization Number (if applicable): Address: City: State: Zip: Telephone: Fax: Email: Signature of Licensed Professional Date (Affix Seal) Substantial deviations from the approved plans and specifications (attach additional sheets if required). Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved 2018-D-490-025 Olivia Bonilla 7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018 Approved2018-D-490-025Olivia Bonilla7/19/2018