CONNECTICUT DEPARTMENT OF TRANSPORTATION
Permit Need Determination Form
A location map and detailed project description must accompany Part 1 of this request. Submittals are to be sent to the OEP.
Town (s): Click here to enter town.
State Project #: Click here to enter project number.
CORE Project #: Click here to enter CORE number.
Funding Source (if Municipal): Click here to enter funding.
Federal Funding in any phase (ROW/ PE/ CN): Select item.
-Funding Agency: Click here to enter agency.
DOT Design contact: Click here to enter contact.
Phone: Click here to enter phone number.
FDP Date: Click here to enter date.
Anticipated Construction Start Date: Click here to enter date.
Bridge Number: Click here to enter bridge number.
Town or State Initiated: Select item.
Waterway(s): Click here to enter name.
Construction Oversite: Select item.
Target Part 2 Meeting Date (4-6 weeks before PD): Click here to enter date.
Project Description:
PART 1 (To be completed by OEP based on project location map and project description provided.)
Permit/Resource Coordination Requirements and BMPs for State Projects
Water Resources Natural Resources
No Concerns Noted Choose an item. No Concerns Noted Choose an item.
DEEP Boating Concerns Choose an item. DEEP Property Acquisition Required Choose an item.
Impaired Waterbody Choose an item. Wild and Scenic River Designation Choose an item.
Watershed/Water Co. Land/Reservoir Choose an item. Prime Farmland Choose an item.
Public Wells Choose an item. DEEP Fisheries Coordination Choose an item.
Aquifer Protection Area Choose an item. NDDB Coordination Choose an item.
Sole Source Aquifer Protection Area* Choose an item. NDDB Coord. (for Stormwater Permit)** Choose an item.
Coast Guard Coordination needed Choose an item. Federally Listed Species Coordination Choose an item.
Potential LEAN candidate Choose an item.
Potential FEMA Floodplain Involvement*** Choose an item.
*EPA Coordination to be made in conjunction with FHWA.
**If a stormwater permit is required, NDDB coordination must occur if species are located within 1/4mile of the project site.
*** Coordination with the DOT Hydraulic and Drainage Unit will be required to finalize Flood Management permitting requirements. Use attached review request form to initiate H&D review.
Initial Review by: Choose reviewer. Date: Click here to enter a date.
CONCURRENCE DOCUMENTATION:
Part 1 Resource/Coordination Completion:
Staff: ______Date ______Supervisor: ______Date ______
Permit/Resource Coordination Requirements and BMPs for Municipal Projects
This is the only section that will be responded by OEP for Municipal Projects. State and Federal Permit Requirements are to be determined by the Municipality. Flood Management permitting will need to be approved prior to submission of any State and/or Federal Permits required for a municipal project.
Flood Management Certification Natural Resources
Not Required Choose an item. No Concerns Noted Choose an item.
Additional Information Required Choose an item. DEEP Fisheries Coordination Choose an item.
Flood Management General (H&D) Choose an item. NDDB Coordination Choose an item.
Flood Management MOU (H&D, OEP & Town) Choose an item. Federally Listed Species Coordination Choose an item.
Individual Flood Management (DEEP-IWRD) Choose an item. Sole Source Aquifer Protection Area Choose an item.
Ind. Flood Management Exemption (DEEP-IWRD) Choose an item. Potential LEAN candidate Choose an item.
Part 1 Comment:Click here to enter text.
______
PART 2 (EPC will work with the Designer to set up a PNDF Part 2 meeting, prior to 30% design progress.)
The designer should plan to bring the following to the meeting, at a minimum:· Latest design plans
· Estimated tree clearing area ( Click here to enter number. acres)
· Estimated overall erodible surface area disturbance ( Click here to enter number. acres)
· Approximate wetland and watercourse impact totals ( Click here to enter number. sq. feet)
· Approximate floodplain impact totals ( Click here to enter number. sq. feet)
· Drainage area (for bridge/cross culvert work only); drainage area to the structure ( Click here to enter number. sq. miles)
· Site photographs
· If the project is coastal and the consultant completed a tidal wetland delineation, please bring a copy of the consultant’s wetland delineation report which will include a list of identified tidal wetland vegetation.
Please see PNDF Instruction Guide on OEP’s Water & Natural Resources website.
The following will be completed by OEP at the time of the meeting or immediately following.
Section 1: State Permitting Requirements
Flood Management Certification Dam Permits
Not Required Choose an item. Not Required Choose an item.
Additional Information Required Choose an item. Gen. Dam Safety Repair (DEEP-IWRD) Choose an item.
Flood Management General (H&D) Choose an item. Ind. Dam Construction (DEEP-IWRD) Choose an item.
Individual Flood Management (DEEP-IWRD) Choose an item.
Ind. Flood Management Exemption (DEEP-IWRD) Choose an item. Department of Public Health (DPH) Permits
Not Required Choose an item.
401 Water Quality Certification Water Company Land General Permit Choose an item.
Not Required Choose an item. Water Company Land Change in Use Choose an item.
Automatic (USACE Self-Verification) Choose an item.
Connecticut Addendum Army Corps of Engineers General Permit (CT GP) Choose an item.
Individual 401 WQC (DEEP-IWRD) Choose an item.
401 via DEEP-OLISP Choose an item.
Inland Wetlands/Watercourses Permits
Not Required Choose an item.
General Water Resource Construction Activities (DEEP-IWRD) Choose an item.
Individual Inland Wetlands & Watercourses (DEEP-IWRD) Choose an item.
Temporary Authorization (DEEP-IWRD) Choose an item.
Emergency Authorization (DEEP-IWRD) Choose an item.
Stormwater Permit
Not Required Choose an item.
General Stormwater and Dewatering from Construction Activities (DEEP-WPED) Choose an item.
Coastal Permits
Not Required Choose an item.
Additional Information Required Choose an item.
Coastal Consistency Review (OEP Internal Sign-off) Choose an item.
Coastal Consistency Review (DEEP-OLISP) Choose an item.
General Coastal Maintenance (DEEP-OLISP) Choose an item.
Certificate of Permission (DEEP-OLISP) Choose an item.
Structures, Dredging & Fill (DEEP-OLISP) Choose an item.
Structures, Dredging, Fill and Tidal Wetlands (DEEP-OLISP) Choose an item.
Temporary Authorization (DEEP-OLISP) Choose an item.
Emergency Authorization (DEEP-OLISP) Choose an item.
PART 2 (con’t)
Section 2: Federal Permitting Requirements
Section 404/Section 10 Permits (USACE)
Not Required Choose an item.
Additional Information Required Choose an item.
Self-Verification Form (SV) Choose an item.
Pre-Construction Notification (PCN) - Eng. Form 4345 Choose an item.
Individual Permit - Eng. Form 4345 Choose an item.
Emergency Authorization Choose an item.
United States Coast Guard (USCG)*
(If identified in Part 1)
Not Required Choose an item.
Construction Letter Choose an item.
Coast Guard Bridge Permit Choose an item.
Exempt from Permit under STURRA by FHWA Choose an item.
*Coordination with FHWA will be required to determine USCG permitting requirements (OEP will coordinate).
Part 2 Comment:Click here to enter text.
Part 2 Determination of Permits for the Project:
Staff: ______Date ______Supervisor: ______Date ______
Determination based on plans dated: Click here to enter a date.
Comment:Click here to enter text.
NOTE: If project scope or project limits change, permit needs may change and must be coordinated with the OEP.
Revised 8/19/2016 Office of Environmental Planning