RESIDENTIAL BUILDING LOT EROSION PREVENTION
AND SEDIMENT CONTROL CHECKLIST		 Building Permit No.
Owner Name & Phone Number



 Property Address
Owner Address



 Subdivision/Section/Lot No.(s)
Contractor Name & Phone Number



 Tax Map Number
Contractor Address



 Parcel

Pre-Construction Checklist:
Please initial that these have been accomplished before construction begins.

Note:  This permit applies to this site or other sites where materials may be disposed of (dumpsters, etc.) or stored for use for this site or sites in the vicinity.

_______ Silt fence has been installed properly along topographic contours downslope of the area to be disturbed prior to any grading, clearing and/or any other construction activity.  Soil, sand, rock or other debris will be kept off the roads and storm drains and, if for any reason, escapes the construction site, the debris must immediately be physically removed.  Excavated topsoil to be reused must be stockpiled and encircled with silt fencing.

_______ This site shall contain a temporary stone construction entrance (see City of Goodlettsville's Stormwater Ordinance and BMP manual).  The stone shall be 2-3 inches in diameter and shall be kept clean by adding stone as needed.  It shall be at least 6 inches deep and underlain with filter fabric and be 20 feet wide.

_______  Where applicable, inlet protections for nearby storm sewer curb and drop inlets have been installed.

_______ Vegetative buffers or other protection must be provided along streams, rivers, and ponds to avoid erosion of banks.

_______ Stabilization measures must be performed within seven (7) days in portions of the site where construction activities have temporarily or permanently ceased and within fifteen (15) days after final grading.

_______ Designated areas such as non-disturbance forested buffer must be marked off and protected.  Heavy equipment should not be operated or stored, or materials handled or stored within these areas.

_______Sediment must be removed from sediment barriers, ponds and other sediment controls when design capacity has been reduced by 33%.

_______Sediment that has escaped the construction site and has collected in the street or drainage structures must immediately be physically removed.

_______Building and waste materials and non-stormwater discharges, such as concrete, paint wash water or machinery leakage or spillage must be managed to prevent them from entering the stormwater system, ground water or nearby water body.

_______ Erosion prevention and sediment controls must be inspected at least twice very calendar week and at least 72 hours apart.

All correspondence must reference the above-listed permit number.

I certify, under penalty of law, that I have reviewed this document and understand the erosion prevention and sediment control requirements herein.  I agree to implement and follow the provisions of this document for the construction site.  I understand that these requirements will be inspected and enforced by the City of Goodlettsville and failure to comply may result in the issuance of a "stop work order" and/or other penalties until compliance is accomplished.  The undersigned will be responsible for complying with these requirements and any provision of the City of Goodlettsville's Stormwater Management Ordinance that applies.

Print Name

 Signature

 Date


Permit issued by: _______________________________________________Date:___________________
                                  (signature)

RESIDENTIAL BUILDING LOT EROSION PREVENTION AND SEDIMENT CONTROL CHECKLIST INSTRUCTIONS
Purpose of this form:
To eliminate any non-allowable discharges to Goodlettsville's Municipal Separate Storm Sewer System (MS4) that impacts water quality.

Completing this form:
Type or print clearly using ink - no marker or pencil.  Initial each blank item signifying that you have read these sections and will comply with them.  Submitting this Permit does not exempt you from complying with all aspects of the City of Goodlettsville's Stormwater Management Ordinance.  This form does not exempt you from obtaining any other state, local or federal required permits.

A signed copy of this form must be kept on the construction site and be available for inspection.

No site development permit is required for the following activities:
  • Any emergency activity that is immediately necessary for the protection of life, property, or natural resources.
  • Agricultural land management activities (except where the clearing of the land, forest or other agriculture activity results in activities other than further agriculture or forest use).
  • Additions or modifications to existing detached single-family dwellings.
  • Developments that do not disturb more than 5,000 square feet of land use.  NOTE:  This exception may not be applied for contiguous properties that may have been subdivided and/or are attributed to multiple separate owners.  This exemption does not apply to any discharge of sediment or other form of water pollution that may leave a small site.
Permits:
An ARAP permit may be required.  If your work will disturb or cause alterations of a stream or wetland, you must obtain an appropriate Aquatic Resource Alteration Permit (ARAP).  If you have a question about the ARAP program or permits, contact your local Tennessee Department of Environment and conservation Environmental Assistance Center at (888) 891-8332 or visit them online at www.state.tn.us/environment/eac