Instructions Regarding Application to Affect Vanderburgh County Legal Drain

APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN

PART 1a- MUST BE COMPLETED BY ALL APPLICANTS Name of Drain: Date: APPLICANT DATA Applicant Name: Applicant Mailing Address: Work Phone: Ext: Cell Phone: City: State: Zip: PROPERY OWNER DATA (if different from applicant) Property Owners Name: Property Owners Mailing Address:

Work Phone: Ext: City: Cell Phone: State: Zip: CONTRACTOR DATA (if applicable) Contractors Name: Contractors Mailing Address: Work Phone: Cell Phone: City: Contractors License Number: State: Zip: Location of Request/work (Section, road location, or other description):

Part 1b-Application is for (check all that apply) Request to Connect/Discharge to Legal Drain-Check this box and complete Part 2 of the application, if the request is to connect by open channel, tile or storm sewer to an open or enclosed regulated drain. Request to Permanently Encroach (including underground crossing) - Check this box and complete Part 3 of the application, if the request is to permanently encroach upon the right-of-way of a regulated drain for the purposes of construction of a parking lot, sign, access drive, road, or other structure or to cross the right-of-way of a regulated drain with a utility (either underground or above ground). Notice of Maintenance- Check this box and complete Part 4 of the application, if the applicant is giving notice of work that is in conjunction with maintenance/construction work of existing road and/or bridge or other work that is to be temporarily performed within the right- of-way of a regulated drain. Request for Permanent Relaxation of Regulated Drain Right of Way- Check this box and complete Part 5 of the application, if the request is for a Permanent Relaxation of Vanderbrugh County regulated drain right of way.

of 5 APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN Applicant understands that any approval granted by the Vanderburgh County Drainage Board does not preclude the applicant from obtaining approvals and/or permits from other county, state or federal agencies.

Applicant agrees to pay any fees or post any letter of credit or bond that may be required by the Vanderburgh County Drainage Board prior to commencing any work.

Applicant agrees that if required, certified post construction drawings will be supplied to the Vanderburgh County Surveyors Office.

Applicant agrees to provide any required insurance and to list Vanderburgh County as additionally insured on the required insurance.

Applicant agrees to restore any disturbed/affected land, ditches or other surfaces per the submitted plans and perform any remedial work that may result from applicant’s activities for a period of six months after completion of work.

Applicant agrees to notify Surveyors Office in advance of any significant work activities

Signature of Applicant

Applicant______Date ______Title

Reserved for Surveyors Office Received: GPS or State Plane Coordinates N E

Comments

of 5 APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN Part 2 Request to Connect/Discharge to Regulated Drain Complete this section, if the request is to connect by open channel, tile or storm sewer to an open or enclosed regulated drain. Purpose of Outlet: Outlet will (choose one) Connect to regulated drain through an open channel or other open conveyance Connect to regulated drain via storm sewer or drain tile Connect into enclosed regulated drain through a storm sewer Tile Description: Size: Length: Type: Estimated Start Date of Construction Est. Completion Date of Construction Yes No Is outlet request part of planned commercial development or subdivision? If answered yes please list development: Provide brief description of work; if any drawings are required please reference drawing number and date of drawings. Outlet requests for storm water from proposed developments should include calculations of stormwater quantities for required design storms. Description and/or drawings shall also include proposed methods to permanently stabilize any areas disturbed by Applicant’s actions.

This request is made under IC 36-9-27-17, “Private and mutual drains; connection with regulated drains; procedure.” All connections will be made according to submitted plans and be in accordance with Vanderburgh County Drainage Code. Part 3 Request to Permanently Encroach (including underground crossing) Purpose of encroachment within right of way of a regulated drain: Parking lot Sign Access drive or road Construction of structure Underground Utility Above ground utility Other (describe) Yes No Is encroachment request part of planned commercial development or subdivision? If answered yes list development Yes No As part of the encroachment, will a culvert or bridge be required? If yes provide drawings and calculations Estimated Start Date of Construction Est. Completion Date of Construction Any underground utility work will be utilizing Trench Bore N/A Provide brief description of work; if any drawings are required please reference drawing number and date of drawings. Description and/or drawings shall also include proposed methods to permanently stabilize any areas disturbed by Applicant’s actions.

Under IC 36-9-27-33 “Right of entry over private land; extension of spoil banks beyond right-of- way” subsection d states that “Permanent structures may not be placed on any right-of-way without the written consent of the board” This application serves as a written request to approve placement of a permanent structure within said right-of-way. Approval of the application by the Drainage Board will serve as written consent of the Board.

of 5 APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN Part 4-Notice of Maintenance of Activity Yes No Is proposed maintenance work to be part of a larger project (bridge/road construction and/or rehabilitation) Yes No Is proposed maintenance work being performed by state, county, city, town or other legal jurisdiction? Yes No Is the applicant making any request for funding from the Vanderburgh County Drainage Board for any portion of work under this application? Estimated Start Date of Construction Est. Completion Date of Construction Provide brief description of work; if any drawings are required please reference drawing number and date of drawings.

Provide brief description of plans to reduce erosion during maintenance activity and any seeding and other measures to be done once maintenance activities are completed.

Request for approval of maintenance of regulated drain is made under the provisions IC 36-9-27- 15, “Jurisdiction over regulated drains”

Part 5-Request for Permanent Relaxation of Regulated Drain Right of Way Current right of way width: Requested width: List all parcel and subdivisions which permanent relaxation will affect:

Provide with this request a letter to the Drainage Board containing the following information:  Reason why Applicant is requesting relaxation of Regulated Drain Right of Way  Information regarding previous Relaxation of Regulated Drain Right of Way of any adjoining properties on the Regulated Drain  How relaxation of the Regulated Drain Right of Way will benefit Vanderburgh County  How relaxation of the Regulated Drain Right of Way will not cause undo hardship to the Vanderburgh County Drainage Board in the Boards efforts to maintain the Drain Letter Request is attached to this application Yes Right of Entry for Regulated Drains is established under IC 36-9-27-33,” Right of entry over private land; extension of spoil banks beyond right-of-way” Under this section the drainage board may reduce the right of way requirements to regulated drains established after September 1, 1984 and to urban drains. Any approved permanent relaxation of right of way will require applicant to record information on affected parcels or subdivision plat.

of 5 APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN Instructions regarding Application to Affect Vanderburgh County Regulated Drain

Part 1a and Part 1b must be filled out completely by all applicants. In addition to completing Part 1a and Part 1b of the application, applicant must also complete all appropriate parts of the application that correspond to the boxes that the applicant checked in Part 1b.

Application must be filed with the Vanderburgh County Surveyors Office 2 weeks prior to the next scheduled Drainage Board Meeting.

All design work submitted as part of the application must be signed, sealed and dated in accordance with 864 IAC 1.1-7-3.

of 5 APPLICATION TO AFFECT VANDERBURGH COUNTY REGULATED DRAIN