HomeMy WebLinkAboutM_Appendix_A_TIR_Worksheet_210420_v1CITY OF RENTON SURFACE WATER DESIGN MANUAL
2017 City of Renton Surface Water Design Manual 12/12/2016 8-A-1
REFERENCE 8-A
TECHNICAL INFORMATION REPORT (TIR)
WORKSHEET
Part 1 PROJECT OWNER AND
PROJECT ENGINEER Part 2 PROJECT LOCATION AND
DESCRIPTION
Project Owner _____________________________
Phone ___________________________________
Address __________________________________
_________________________________________
Project Engineer ___________________________
Company _________________________________
Phone ___________________________________
Project Name __________________________
CED Permit # ________________________
Location Township ________________
Range __________________
Section _________________
Site Address __________________________
_____________________________________
Part 3 TYPE OF PERMIT APPLICATION Part 4 OTHER REVIEWS AND PERMITS
Land Use (e.g., Subdivision / Short Subd.)
Building (e.g., M/F / Commercial / SFR)
Grading
Right-of-Way Use
Other _______________________
DFW HPA
COE 404
DOE Dam Safety
FEMA Floodplain
COE Wetlands
Other ________
Shoreline
Management
Structural
Rockery/Vault/_____
ESA Section 7
Part 5 PLAN AND REPORT INFORMATION
Technical Information Report Site Improvement Plan (Engr. Plans)
Type of Drainage Review
(check one):
Date (include revision
dates):
Date of Final:
Full
Targeted
Simplified
Large Project
Directed
__________________
__________________
__________________
Plan Type (check
one):
Date (include revision
dates):
Date of Final:
Full
Modified
Simplified
__________________
__________________
__________________
REFERENCE 8: PLAN REVIEW FORMS AND WORKSHEET
TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
12/12/2016 2017 City of Renton Surface Water Design Manual 8-A-2
Part 6 SWDM ADJUSTMENT APPROVALS
Type (circle one): Standard / Blanket
Description: (include conditions in TIR Section 2)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Approved Adjustment No. ______________________ Date of Approval: _______________________
Part 7 MONITORING REQUIREMENTS
Monitoring Required: Yes / No
Start Date: _______________________
Completion Date: _______________________
Describe: _________________________________
_________________________________________
_________________________________________
Re: SWDM Adjustment No. ________________
Part 8 SITE COMMUNITY AND DRAINAGE BASIN
Community Plan: ____________________________________________________________________
Special District Overlays: ______________________________________________________________
Drainage Basin: _____________________________________________________________________
Stormwater Requirements: _____________________________________________________________
Part 9 ONSITE AND ADJACENT SENSITIVE AREAS
River/Stream ________________________
Lake ______________________________
Wetlands ____________________________
Closed Depression ____________________
Floodplain ___________________________
Other _______________________________
_______________________________
Steep Slope __________________________
Erosion Hazard _______________________
Landslide Hazard ______________________
Coal Mine Hazard ______________________
Seismic Hazard _______________________
Habitat Protection ______________________
_____________________________________
REFERENCE 8-A: TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
2017 City of Renton Surface Water Design Manual 12/12/2016 Ref 8-A-3
Part 10 SOILS
Soil Type
______________________
______________________
______________________
______________________
Slopes
________________________
________________________
________________________
________________________
Erosion Potential
_________________________
_________________________
_________________________
_________________________
High Groundwater Table (within 5 feet)
Other ________________________________
Sole Source Aquifer
Seeps/Springs
Additional Sheets Attached
Part 11 DRAINAGE DESIGN LIMITATIONS
REFERENCE
Core 2 – Offsite Analysis_________________
Sensitive/Critical Areas__________________
SEPA________________________________
LID Infeasibility________________________
Other________________________________
_____________________________________
LIMITATION / SITE CONSTRAINT
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Additional Sheets Attached
Part 12 TIR SUMMARY SHEET (provide one TIR Summary Sheet
per Threshold Discharge Area)
Threshold Discharge Area:
(name or description)
Core Requirements (all 8 apply):
Discharge at Natural Location Number of Natural Discharge Locations:
Offsite Analysis Level: 1 / 2 / 3 dated:__________________
Flow Control (include facility
summary sheet)
Standard: _______________________________
or Exemption Number: ____________
On-site BMPs: _______________________________
Conveyance System Spill containment located at: _____________________________
Erosion and Sediment Control /
Construction Stormwater Pollution
Prevention
CSWPP/CESCL/ESC Site Supervisor: _____________________
Contact Phone: _________________________
After Hours Phone: _________________________
REFERENCE 8: PLAN REVIEW FORMS AND WORKSHEET
TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
12/12/2016 2017 City of Renton Surface Water Design Manual 8-A-4
Part 12 TIR SUMMARY SHEET (provide one TIR Summary Sheet
per Threshold Discharge Area)
Maintenance and Operation Responsibility (circle one): Private / Public
If Private, Maintenance Log Required: Yes / No
Financial Guarantees and Liability Provided: Yes / No
Water Quality (include facility
summary sheet)
Type (circle one): Basic / Sens. Lake / Enhanced Basic / Bog
or Exemption No. _______________________
Special Requirements (as applicable):
Area Specific Drainage
Requirements
Type: SDO / MDP / BP / Shared Fac. / None
Name: ________________________
Floodplain/Floodway Delineation Type (circle one): Major / Minor / Exemption / None
100-year Base Flood Elevation (or range): _______________
Datum:
Flood Protection Facilities Describe:
Source Control
(commercial / industrial land use)
Describe land use:
Describe any structural controls:
Oil Control High-Use Site: Yes / No
Treatment BMP: _________________________________
Maintenance Agreement: Yes / No
with whom? _____________________________________
Other Drainage Structures
Describe:
REFERENCE 8-A: TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
2017 City of Renton Surface Water Design Manual 12/12/2016 Ref 8-A-5
Part 13 EROSION AND SEDIMENT CONTROL REQUIREMENTS
MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION
Clearing Limits
Cover Measures
Perimeter Protection
Traffic Area Stabilization
Sediment Retention
Surface Water Collection
Dewatering Control
Dust Control
Flow Control
Control Pollutants
Protect Existing and Proposed
BMPs/Facilities
Maintain Protective BMPs / Manage
Project
MINIMUM ESC REQUIREMENTS
AFTER CONSTRUCTION
Stabilize exposed surfaces
Remove and restore Temporary ESC Facilities
Clean and remove all silt and debris, ensure
operation of Permanent BMPs/Facilities, restore
operation of BMPs/Facilities as necessary
Flag limits of sensitive areas and open space
preservation areas
Other _______________________
Part 14 STORMWATER FACILITY DESCRIPTIONS (Note: Include Facility Summary and Sketch)
Flow Control Type/Description Water Quality Type/Description
Detention
Infiltration
Regional Facility
Shared Facility
On-site BMPs
Other
________________
________________
________________
________________
________________
________________
Vegetated Flowpath
Wetpool
Filtration
Oil Control
Spill Control
On-site BMPs
Other
________________
________________
________________
________________
________________
________________
________________
Part 15 EASEMENTS/TRACTS Part 16 STRUCTURAL ANALYSIS
Drainage Easement
Covenant
Native Growth Protection Covenant
Tract
Other ____________________________
Cast in Place Vault
Retaining Wall
Rockery > 4′ High
Structural on Steep Slope
Other _______________________________
REFERENCE 8: PLAN REVIEW FORMS AND WORKSHEET
TECHNICAL INFORMATION REPORT (TIR) WORKSHEET
12/12/2016 2017 City of Renton Surface Water Design Manual 8-A-6
Part 17 SIGNATURE OF PROFESSIONAL ENGINEER
I, or a civil engineer under my supervision, have visited the site. Actual site conditions as observed were
incorporated into this worksheet and the attached Technical Information Report. To the best of my
knowledge the information provided here is accurate.
____________________________________________________________________________________
Signed/Date