Rev. 2-25-20 YORK COUNTY CONSERVATION DISTRICT OFFICIAL USE ONLY NPDES # YCCD File# 2401 Pleasant Valley Road, Ste. 101, Room 139 Fee $ Date recd. York PA 17402 Check # Fee paid $ Ph. (717) 840-7430 FAX: (717) 755-0301 Date Complete: Check #

www.yorkccd.org APPLICATION FOR DISTRICT SERVICES

I. PROJECT INFORMATION: New: Revised: (Please Check and Complete) Project Name: Project Location: Project Total Disturbed Acres: Municipality: Acres: (Round to nearest whole acre) (The total acreage of the planned project or parcel including support areas such as: access, utility right-of- way, offsite staging, borrow or spoil areas) Project Description: II. APPLICANT 1. Owner/Developer/Company Name 2. Plan preparer's Name

Address Address

Phone: Fax: Phone: Fax:

Responsible Official Responsible Official

Email: Email:

III. FEE SCHEDULE: Make check payable to: “York County Conservation District”  $200 for the following E&S plans (circle all that apply): All Other Land Development Activities* o Single Family Residential unit (< 1 acre) (Round to nearest whole disturbed acre) Total o Timber harvests 0.1 - 1 acre $ 1,050 = o Chapter 105 general permits 2 – 5 acres $ 1,050 + ($315/acre) = o Spoil & borrow sites (< 1 acre) 6 – 25 acres = o Clearing & grubbing (not assoc. w/ future land $ 2,100 + ($210/acre) development) 26 – 100 acres $ 6,300 + ($105/acre) = o Non-Ag Chapter 102 E&S complaints 101 + acres $ 12,600 + ($65/acre) =  $200 for Agricultural E&S & Manure Management No. of Stream/ + $400 X ______= Plans Wetland Crossings # of crossings  $350 for Green Infrastructure Projects for Linear projects =  $350 for Stream Restoration Projects Total Other: NPDES Permit: Make a separate check payable to “York Make a separate check payable to “Commonwealth of County Conservation District Clean Water Fund” for Pennsylvania Clean Water Fund” Fee per Disturbed Acre base fee (Round to nearest whole disturbed acre) Notice of Intent for General Permit = $500 $100 X ______disturbed acres = ______Notice of Intent for Individual Permit = $1,500 $100 X ______disturbed acres = ______District Use Only E&S Plan Dated: ______Approved: ______PCSM Plan Dated: ______Letter Needed: ______ES APPROVE ______PAC APPROVE ______PAC MAJOR AMEND APPROVE ______PAC RENEW Other ______

(Please Complete the Back) IV. LAND USE DATA Utilize Table A below to complete Blocks 1 and 2 1. Existing Land Use Code: ______2. Proposed Land Use Code: ______TABLE A: Existing & Proposed Land Use and Codes Existing Land Use Code Proposed Land Use Code Agricultural A1 Residential B1 Idle Ag. Land A2 Commercial B2 Forest A3 Industrial B3 Residential A4 Professional B4 Urban (Comm./Indust.) A5 Recreational B5 Impervious A6 Semi-Public B6 Utility A7 Utility B7 Mining/Quarry A8 Agricultural B8 Other A9 Other B9 V. WATERSHED INFORMATION Utilize Table B below to complete Blocks 1, 2, and 3 1. Stream Name: 2. Stream Designation: 3. Wild Trout Stream: ______4. Distance to Stream:

Table B: 1. Stream Name, 2. Stream Designation, 3. PFBC Wild Trout Stream = WT #1 Stream Name #2 #3 #1 Stream Name #2 #3 #1 Stream Name #2 #3 Yellow Breeches CWF Trout Run (Shrewsbury) WWF WT Hartman Run WWF - main stem LR 21012 Foust Run WWF Mahala Run WWF to mouth Centerville Creek - Basin CWF Cuffs Run WWF WT Stoney Run CWF Centerville Creek – Pierceville CWF WT Wilson Run WWF WT Fishers Run CWF Rn to Mouth Boyds Run WWF Pippins Run CWF Pierceville Run CWF Otter Creek - main stem, CWF Marsh Run WWF Cherry Run WWF source to upstream Fishing Creek-Basin TSF WT Fishel Creek WWF boundary of State Game UNT to Fishing Creek CWF WT EB Codorus Creek Basin HQ-CWF Lands 83 (near Old York Rd) - source to PA 214 Mill Branch CWF WT Big Springs Run TSF Seaks Run HW-unt DS of I-83 HQ-CWF WT South Fork Otter Creek CWF WT Conewago Creek WWF EB Codorus Creek - HW to 1st HQ-CWF WT Otter Creek- Hake Rd to mouth CWF WT Long Arm Creek WWF UNT dnst cnty park S. bndy Otter Creek – upstream HQ-CWF WT Davidsburg Run WWF Blymire Hollow Run (UNT to HQ-CWF WT boundary of State Game Bermudian Creek – headwaters WWF WT EB along Blymire Hollow Rd) Lands 83 to mouth Dnst to wireman’s Mill Road EB Codorus Creek CWF Sawmill Run WWF WT (SR 1009) Bridge - PA 214 to inlet of Lake Redman Furnace Run CWF WT Bermudian Creek WWF EB Codorus Creek WWF Counselman Run WWF Wolf Run WWF - main stem, inlet Duncan Run WWF Mud Run WWF of Lake Redman Oakland Run CWF WT Doe Run WWF to mouth Wallace Run CWF WT Red Run UNTs to EB CWF Anderson Run WWF WT Latimore Creek WWF Codorus Creek UNTs to West Bank of WWF Beaver Creek CWF Barshinger Creek CWF Susq.R. - 5,000 ft DS 372 bridge Stony Run CWF Inners Creek CWF to state border Laurel Run WWF Willis Run WWF UNT (Atom Rd.) to Susq. R. WWF WT Bennet Run WWF Mill Creek – basin, source to CWF WT UNT (Cold Cabin Rd) to Susq. R. WWF WT Little Conewago Creek TSF UNT 8066 (400m DWS Muddy Creek TSF Billion Run TSF of RT 124 Bridge) UNTs to – Headwaters to Mouth CWF WT Fox Run TSF Mill Creek- Basin, 400 m DWS WWF Bald Eagle Creek TSF WT Hickory Run TSF of RT 124 Bridge to mouth Neill Run CWF WT Honey Run TSF Dee Run WWF Fishing Creek CWF WT Locust Run TSF HW -1st Private Ln from T956 WWF WT NB Muddy Creek CWF WT Oak Run TSF Trout Run – source to HQ-CWF Bear Branch CWF Paradise Creek TSF UNT at RM 0.3 Carter Creek CWF Poplar Run TSF UNT to Trout Run at CWF Pine Run CWF WT Musser Run WWF RM 0.3 UNT to PR – HW to mouth CWF WT Hartman Run WWF Trout Run - UNT at CWF Rambo Run EV WT SB Conewago Creek WWF RM 0.3 to mouth UNT to RR – HW to Mouth EV WT India Run WWF Wildcat Run WWF SB Muddy Creek HQ-CWF WT Plum Creek WWF Dugan Run WWF UNT to SB – HW to mouth HQ-CWF WT Codorus Crk - source to WB TSF Kreutz Creek WWF Alum Rock HQ-CWF WB Codorus Creek WWF Kreutz Creek (HW to Ducktown WWF WT Leibs Creek HQ-CWF WT WB Codorus Creek WWF WT Rd. Bridge) Toms Run TSF (Lake Marburg UNT to Kreutz Creek (HW at WWF WT Toms Run East Branch TSF Downstream 0.6 mi) Highmount) Toms Run West branch TSF Furnace Creek WWF Klines Run WWF Orson Run TSF WT Long Run WWF Canadochly Creek WWF Robinson Run WWF WT Codorus Creek - main stem, HQ-CWF WT Cabin Creek WWF WT Scott Creek- Basin CWF WT WB to Oil Creek Cabin Creek HW-Willow Crk RB WWF WT Michael Run WWF UNTs to Codorus Creek WWF Bull Run WWF WT Michael Run- 1st UNT dnst HW Porters Creek WWF Fishing Creek - source to TSF to mouth WWF WT Oil Creek WWF Mouth (L. Windsor & Windsor UNTs to W. Bank of Susquehana WWF WT Codorus Creek - main stem, WWF Twps) Atom Rd, Cold Cabin Rd. up frmAR Oil Creek to mouth UNTs to Fishing Creek CWF Broad Creek CWF Bunch Creek WWF - PA 624 bridge to mouth Bee Tree Run CWF Stoverstown Branch WWF Beaver Creek – HW dnst to CWF WT Deer Creek CWF SB Codorus Creek WWF WT Red Lion Water Auth. dam Deer Creek- HW to Five Forks rd CWF WT (headwaters to Granary Rd brdg UNT to Beaver Crk- HW to CWF WT Ebaughs Creek CWF Near Seitzville) Mouth at Rockey Rd Little Deer Creek CWF UNT to SB Codorus Creek EV WT UNT to UNT to Beaver Crk CWF WT Little Falls Creek CWF (Shaeffer Hollow) Green Branch WWF WT Gunpowder Falls WWF UNT to SB Codorus Creek CWF through Glen Rock Valley

Note: Application will not be considered complete without the correct fee and proper information. ROLLED PLANS WILL NOT BE ACCEPTED. The applicant agrees to comply with all requirements of Title 25 – Chapter 102 Erosion and Sediment Pollution Control Rules and Regulations as set forth by the Pennsylvania Department of Environmental Protection and further agrees to obtain all necessary permits in connection with the above referenced project Applicant’s Signature ______