HomeMy WebLinkAbout22SITE1 OSTA form page 011922- 9 - AD
Guidelines 10/19/16
OFFICE OF THE STATE TRAFFIC ADMINISTRATION (OSTA) - ADMINISTRATIVE DECISION REQUEST - DRAINAGE
Name of Facility Town State Route(s)
Location (complete street address; if none, provide map/block/lot information)
Stormwater Runoff (at least one of the following must be checked to qualify):
The proposed project will not increase impervious area at the site.
Stormwater runoff from the site does not drain nor is directed to State property or State owned/maintained drainage
facilities.
Diversions (the following must be checked to qualify):
Proposed drainage patterns on the site are maintained as closely as possible to the existing site conditions. No diversion
of stormwater or stream flow is proposed that will potentially affect State or private property.
State Drainage System Modifications (the following must be checked to qualify):
There are no new connections or modifications to State owned/maintained drainage systems.
There are no modifications to the development drainage system that a State drainage connects or discharges to.
Drainage Rights/Easements (Check all that apply. Response will be used to determine if new/additional ROW is required):
State drainage facilities are not located on the subject site.
Runoff from any adjacent State highway or railroad facility does not discharge onto the subject site.
Existing and /or proposed site drainage does not connect to a State owned/maintained drainage facility.
Existing site drainage connects to a State owned/ maintained drainage facility. A record of the connection
exists - does not exist at the DOT District office.
Land records were searched and no State drainage rights/easements were found for the subject site.
A State “ drainage right of way ” or “ easement ” is recorded on the land records for the property.
Description of State drainage right of way or easement ( type & location )
The proposed project will not affect an existing State drainage right of way or easement on the subject property.
Flood History (the following must be checked to qualify):
The subject site does not have a history of flooding or known drainage problems. The applicant has consulted with the
municipality and the DOT District Drainage office regarding any flood history or known drainage problems at the site. A
copy of the meeting/telephone report is attached.
Other Approvals
Has the drainage design and stormwater management for the project been approved at the local
level?
Yes No
Name PE Number
Signature Date Affix P.E. Stamp Here
A record of the connection -
Professional Engineer Certification
I have conducted a site investigation and reviewed the proposed project plans relative to the
information required for this document. Based on my review and reasonable investigation,
including my inquiry of those individuals responsible for obtaining the in formation, I hereby
certify that the information provided on this document is complete and true.