Post on 27-May-2020
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BROWARD COUNTY PUBLIC WORKS DEPARTMENT HIGHWAY CONSTRUCTION & ENGINEERING DIVISION
APPLICATION FOR INITIAL PLAN REVIEWFOR PAVING, GRADING, DRAINAGE, WATER, SEWER,
IRRIGATION, LANDSCAPING, UTILITIES, ETC.
Project Name : ___________________________________________________________________________________(Project name as shown on the plan being submitted)
APPLICATION SUBMITTED FOR THE FOLLOWING REVIEW(S) (Check as applicable) Paving & Drainage
Water/Sewer Irrigation Landscape Utility Misc
It is the express intent of this application to summarize and quantify exactly what work is proposed by this project submittal, what facilities currently exist for this project and what impact this project will have on those facilities.
To submit an application to the Broward County Highway Construction & Engineering Division, Paving & Drainage Section for processing you must:
1 Complete this application for these types of projects: Paving & Drainage (P&D), Paving & Drainage with Water Distribution and/or Sewage Collection (P&D and W/S), Bridge Plans (P&D), Gas Transmission & Distribution Plans (Utility), Telephone, CATV or Other Signal System Plans (Utility), Landscape Irrigation & Planting Plans (Irrigation & Landscape) or Monitoring Well Installation (Misc); and
2 Affix your signature and seal to the last page of the completed application. If any information requested is not applicable, please identify it as such. Please print legibly in ink or type. Please do not leave any items unanswered. All information in the Application must be completed; and
3 Submit two (2) complete sets of plans (including survey), signed and sealed by a Registered Professional Engineer,registered in the State of Florida unless specified otherwise, a cd/pdf of plans (unlocked version); and
4 Submit a 100% Engineer=s Estimate for Paving & Drainage plan work in the right of way. 100% Engineer Estimate Forms for P&D plans are available on the Internet at ; and
5 Complete P&D Plan Review Checklist Application to meet General Requirements. The form is available on the Internet at
1 Complete this application for these types of projects: Water Distribution and/or Sewage Collection only (P&D not required), Electric Power Installations; and
2 Affix your signature and seal to the last page of the completed application. If any information requested is not applicable please identify it as such. Please print legibly in ink or type. Please do not leave any items unanswered. All information
in the Application must be completed; and 3 Submit two (2) complete sets of plans (including survey) approved by the Operating Utility and signed and sealed by
a Registered Professional Engineer, registered in the State of Florida unless specified otherwise, and a cd/pdf of plans (unlocked version).
Upon receipt of this information, the Broward County Highway Construction & Engineering Division, Paving & Drainage Section will review the submitted application package to determine acceptability. If the application package is acceptable, the Broward County Highway Construction & Engineering Division, Paving & Drainage Section will calculate the application fee amount, if applicable, and notify the owner/agent as indicated in Section II on Page Two (2) of this document of the applicable application fee. Upon receipt of the applicable application fee, which must be paid for in cash or by check made payable to Broward County Highway Construction and Engineering Services Division, the submitted package will be considered complete.
All completed application packages received will be reviewed and responded to within fourteen (14) calendar days.
If the application package is not considered complete, the submitted package will be rejected. Reasons for rejection will be sent in writing to the owner/agent as indicated in Section II on Page Two (2) of this document. NOTE: If the project does not include an indication of existing or proposed potable water and/or wastewater service any modifications to accommodate these in the future may result in major delays for your client due to redesign and resubmission, which could result in significant costs to your client(s).
Internal Processing Information (Office Use Only)
Date Plan Received : _______________________ Plans Received By : ____________________
Review Meeting Date : _______________________ Plan File Number : ____________________
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I PROJECT INFORMATION AND APPLICATION STATUS
Plan submitted for conformity with Plat/Site Plan required improvement(s) : ____ NVAL required improvement(s) : ____ Delegation Request required improvement(s) : ____ Other : ____
DOES THIS PLAN ADDRESS ALL CONDITIONS OF APPROVAL? Yes : _____ No : _____ N/A : _____Please complete all information on this and the applicable Sections on the following pages.
A Project Name : _____________________________________________________________________________ (Project name as shown on the plan being submitted)
Sec. _____ Twp. _____ Rge. _____ Quad. _____ Sec. _____ Twp. _____ Rge. _____ Quad. _____ Sec. _____ Twp. _____ Rge. _____ Quad. _____ Sec. _____ Twp. _____ Rge. _____ Quad. _____
B Plat/Site Plan Name : ____________________________________________________________________ Plat Book & Page : _____________________ County Commission Approval Date : ________________________________
Broward County Environmental Protection and Growth Management Department – Development and Environmental Regulation Division Number : _______________________________
C Project Jurisdiction Unincorporated : _____ Municipality : _____ Municipality Name : ______________________________
D Project Classification Onsite/Offsite : _____ Offsite only : _____ Onsite only : _____
II OWNER/AGENT INFORMATION
A Owner's Name : ______________________________________________________________________
Address : ______________________________________________________________________
______________________________________________________________________
Contact Person : ______________________________________________________________________
Telephone Number : ___________________________ B Consultant/
Agent's Name : ______________________________________________________________________
Address : ______________________________________________________________________
______________________________________________________________________
Contact Person : ______________________________________________________________________
Telephone Number : ___________________________
All correspondence will be addressed to the Consultant/Agent with a copy to the Owner.
III General Plan and Specification Requirements for all Reviews NOTE: Where Water Distribution and/or Sewage Collection System Improvements may or may not be required - If
Water Distribution and/or Sewage Collection System Improvements are required and they are not shown or submitted with this review, failure to show these features as a part of this plan submission may result in revocation of plan and permit approval, which may result in major delays due to redesign and resubmission, which could result in significant costs to your client(s).
A What existing utilities (aerial and underground) were considered in the design of this project? _________________________________________________________________________________________
_________________________________________________________________________________________
B Is this project to be served by an existing or proposed approved water distribution system? If yes also complete Section IV Water Distribution and/or Sewage Collection Systems General Plan and Specification Requirements of this application.
Yes : _____ No : _____ N/A : _____
1 If No, how will potable water be provided? ____________________________________________________
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III General Plan and Specification Requirements for all Reviews - continued 2 If Yes, complete the following:
Owner : ___________________________________________________________________________ Name : ___________________________________________________________________________ Address : ___________________________________________________________________________
___________________________________________________________________________ Telephone Number : _________________________ Email : ____________________________________
3 If yes from which road(s) will the water distribution/potable water service be provided?
______________________________________________________________________________________
4 Do the potable water service lines currently exist to the property line?
Yes : _____ No : _____ N/A : _____
Indicate the existing and/or proposed water distribution/potable water connection(s) on the plan.
C Is this project to be served by an existing or proposed approved wastewater treatment plant? If yes also complete Section IV Water Distribution and/or Sewage Collection Systems General Plan and Specification Requirements of this application.
Yes : _____ No : _____ N/A : _____
1 If No, how will wastewater treatment/sewage collection be provided?
______________________________________________________________________________________
2 If Yes, complete the following:
Owner : ___________________________________________________________________________ Name : ___________________________________________________________________________ Address : ___________________________________________________________________________
___________________________________________________________________________ Telephone Number : _________________________ Email : ____________________________________
3 If yes from which road(s) will the wastewater treatment/sewage collection service be provided?
______________________________________________________________________________________
4 Do the wastewater service/sewage collection lines currently exist to the property line?
Yes : _____ No : _____ N/A : _____
Indicate the existing and/or proposed wastewater/sewage collection connection(s) on the plan.
D Are plans signed and sealed by a Professional Engineer registered in the State of Florida? Landscape plans may be signed and sealed by a Professional Landscape Architect registered in the State of Florida.
Yes : _____ No : _____ N/A : _____
E Are all existing facilities as well as all other proposed facilities, including bus stops and related facilities, are shown adequately to permit assessment of compatibility of proposed work with existing facilities, etc.?
Yes : _____ No : _____ N/A : _____
F Is plan sheet size 24"x 36"? Legal size sheets okay for small jobs provided scale requirements are met and only one (1) sheet is required.
Yes : _____ No : _____ N/A : _____
G Is location sketch (general area layout) scale 300' or less to the inch?
Yes : _____ No : _____ N/A : _____
H Is plan scale 1" = 20' minimum for Arterial & Collector Roads and for Subdivision Roads within the trafficway corridor?
Yes : _____ No : _____ N/A : _____
J Is plan scale 1" = 40' minimum for Subdivision Roads outside of the trafficway corridor?
Yes : _____ No : _____ N/A : _____
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III General Plan and Specification Requirements for all Reviews - continued
K Do design drawings for Arterial & Collector Roads include both plans and profiles? Profiles shall be to the same horizontal scale as the plan.
Yes : _____ No : _____ N/A : _____
L Do design drawings for Local Roads provide sufficient elevations? If not roadway profiles are required.
Yes : _____ No : _____ N/A : _____
M Elevations shown on the plans based on National Geodetic Vertical Datum (N.G.V.D.)?
NGVD29 : _____ NAVD88 : _____ N/A : _____
N Has sufficient roadway geometry been shown on this plan to determine proper design/construction aspects of the project?
Yes : _____ No : _____ N/A : _____
O Are names and boundaries of abutting subdivision(s) shown, including plat book/page? If in an unplatted area, acreage and Section, Township & Range information must be shown.
Yes : _____ No : _____ N/A : _____
P Are dimensions of all right of way widths & easements indicated on the plan?
Yes : _____ No : _____ N/A : _____
Q Has a suitable legend been shown on the plans?
Yes : _____ No : _____ N/A : _____
R Are all streets clearly identified?
Yes : _____ No : _____ N/A : _____
S Is proposed pavement clearly indicated on plans and dimensionally located within the right of way?
Yes : _____ No : _____ N/A : _____
T Have all existing and proposed utilities, (Water, Sewer, Gas, Electric, Cable, Telephone, etc.) in the public right of way been shown on the plan? All utilities shall be identified and located by dimension, horizontally and by elevation and their materials of construction are noted to the extent possible without excavation.
Yes : _____ No : _____ N/A : _____
U Are there water & sewer plans available and/or applicable to this project? If yes, please be sure to include them with this submission and complete Section IV Water Distribution and/or Sewage Collection Systems General Plan and Specification Requirements of this application.
Yes : _____ No : _____ N/A : _____
V Do the cross section(s) and/or typical section(s) of proposed road and drainage construction, show dimensions, materials and purposes of all existing (to remain) facilities as well as all proposed facilities within the right of way?
Yes : _____ No : _____ N/A : _____
W Does the title sheet bear the following note? The public roadway(s) indicated in these plans have been designed in accordance with the "Manual of Uniform Minimum Standards for Design, Construction and Maintenance for Streets & Highways - State of Florida."
Yes : _____ No : _____ N/A : _____
X Does this plan provide for sleeving for all future utility crossings to the extent that needs can reasonably be anticipated?
Yes : _____ No : _____ N/A : _____
Y Has a legal description of the property been included as a part of the plans?
Yes : _____ No : _____ N/A : _____
Z Does this property owner have any financial interest in properties near or adjacent to this project? If yes, use separate sheet to fully describe.
Yes : _____ No : _____ N/A : _____
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III General Plan and Specification Requirements for all Reviews - continued
AA Are there any bridges proposed for construction by these plans? If the answer is yes, bridge design shall be in accordance with AASHTO Standard Specifications for Highway and Bridge Construction and applicable F.D.O.T. Design Manuals. Design loading shall be HS-25-44.
Yes : _____ No : _____ N/A : _____
AB Has any contact been made with FP&L and/or Southern Bell regarding service availability for this project? If yes, state name and title of persons contacted.
Yes : _____ No : _____ N/A : _____
FP&L Name/Title : ____________________________________________________________________
S. Bell Name/ Title : ____________________________________________________________________
How will service be provided? Above ground : _____ Underground : _____
AC Is this project located within an existing or proposed Development of Regional Impact(D.R.I.)?
Yes : _____ No : _____ N/A : _____
If yes, indicate the project name and attach a copy of the approved development order.
D.R.I. Name : ______________________________________________________________________________
AD Is this project subject to any existing or proposed agreements with Broward County or a municipality?
Yes : _____ No : _____ N/A : _____
If yes, please indicate the title of said agreement. If the agreement has been approved please attach a copy.
Agreement Title : ___________________________________________________________________________
AE Has any contact been made with anyone in Broward County government concerning the design of this project? If yes, state name of person(s) and agency affiliation.
Yes : _____ No : _____ N/A : _____
Name/Agency Affiliation : _____________________________________________________________________
AF Does this project abut or contain a trafficway as depicted on the Broward County Trafficways Plan?
Yes : _____ No : _____ N/A : _____
If yes, does adequate right of way exist to conform with the trafficways plan?
Yes : _____ No : _____ N/A : _____
If no, please explain _________________________________________________________________________
_________________________________________________________________________________________
AG Is this project located on or adjacent to a roadway that is functionally classified as a state road?
Yes : _____ No : _____ N/A : _____
If yes, has application been made to the Florida Department of Transportation for public right of way construction?
Yes : _____ No : _____ N/A : _____
If yes, provide copy of the permit and plan approved by the Florida Department of Transportation.
AH Does any public right of way adjacent to or within this project abut any existing or proposed water bodies such as lakes, canals, etc.?
Yes : _____ No : _____ N/A : _____
AI Has this project taken into consideration all conditions of plat approval and/or developer's agreement(s)?
Yes : _____ No : _____ N/A : _____
If no, please explain _________________________________________________________________________
_________________________________________________________________________________________
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III General Plan and Specification Requirements for all Reviews - continued
AJ Are plans based on aerial photographs?
Yes : _____ No : _____ N/A : _____
Plans based on trial photographs shall not be considered adequate for review.
AK Is plan information accurate? Plan information must be accurate.
Yes : _____ No : _____ N/A : _____
AL Have the landscape plans been designed for conformance with : Florida D.O.T. Manual of Uniform Minimum Standards for Design, Construction and Maintenance for Streets and Highways, rev. 9/98; Broward County Land Development Code, Winter 2001; Broward County Highway Construction & Engineering Division Minimum Standards, April 1995 edition.
Yes : _____ No : _____ N/A : _____
AM Will there be any tree removal as part of construction?
Yes : _____ No : _____ N/A : _____
If so, a tree removal/relocation permit from Broward County Department of Planning and Environmental Protection will be required.
AN Are exfiltration trenches part of the proposed construction?
Yes : _____ No : _____ N/A : _____
No tree may be closer than its mature height to any exfiltration trench.
AO Has a Beautification Agreement or Revocable License Agreement been executed?
Yes : _____ No : _____ N/A : _____
If yes provide a copy of the agreement with submission of this package.
AP Do the plant selection and installation conform to the following : xeriscape principles in accordance with guidelines established by the South Florida Water Management District, Florida Division of Forestry publication 'Guidelines to South Florida Plants', Florida Power and Light publication 'Plant the Right tree in the right place' rev. 5/95, Broward County Ordinance No. 1999-07 'Broward County Preservation and Abuse Ordinance' and Article VIII 'Functional Landscaping and Xeriscaping' of the Broward County Zoning Code.
Yes : _____ No : _____ N/A : _____
AQ Will there be any landscaping and/or irrigation installation with this project?
Yes : _____ No : _____ N/A : _____
If yes, please be sure to include them with this submission and complete Section IV Water Distribution and/or Sewage Collection Systems General Plan and Specification Requirements of this application.
AR What design speed was used in the design of this project? ___ mph
AS What is the existing posted speed for the roadways adjacent to this project? ___ mph
AT What design storm was used to establish the road crown elevation for residential? ___ year storm
AU What design storm was used to establish the edge of ultimate through travel lane elevation for the arterial road? ___ year storm
This application package is being submitted for :
___ Paving & Drainage Go to Page 12 - Section IX Agent Signature ___ Paving & Drainage with Water Distribution and/or Sewage Collection Go to Page 7 - Section IV ___ Bridge Plans Go to Page 12 - Section IX Agent Signature ___ Gas Transmission & Distribution Go to Page 9 - Section V ___ Telephone, CATV or Other Signal System Go to Page 10 - Section VI ___ Monitoring Well Installation Go to Page 12 - Section VIII ___ Water Distribution and/or Sewage Collection only (P&D not required) Go to Page 7 - Section IV ___ Electric Power Installations Go to Page 11 - Section VII
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IV Water Distribution and/or Sewage Collection Systems, General Plan and Specification Requirements Where Paving & Drainage Plan Improvements are not required
NOTE: If Paving & Drainage Plan Improvements are required and they are not shown or submitted with this review, failure to show these features as a part of this plan submission may result in revocation of plan and permit approval, which may result in major delays due to redesign and resubmission, which could result in significant costs to your client(s).
A Are plans signed and sealed by a Professional Engineer registered in the State of Florida?
Yes : _____ No : _____ N/A : _____
B Have these plans been approved by the operating utility?
Yes : _____ No : _____ N/A : _____
C Have accessible benchmarks been listed on the plans?
Yes : _____ No : _____ N/A : _____
D Do the plans show all existing adjacent utilities as well as all other know planned utilities sufficiently to permit judging of the compatibility of the proposed work with the existing and planned systems?
Yes : _____ No : _____ N/A : _____
E Do the plans show water and/or sewer main materials, sizes, and their dimensioned locations?
Yes : _____ No : _____ N/A : _____
F Do the plans show the locations of valves, hydrants, manholes, tees, wyes and approximate locations of house connections?
Yes : _____ No : _____ N/A : _____
G Are existing and proposed pavements clearly indicated on the plans and dimensionally located within the public right of way?
Yes : _____ No : _____ N/A : _____
H Are proposed cuts in pavement shown and noted on the plan?
Yes : _____ No : _____ N/A : _____
I Are all utilities located dimensionally from the existing edge of pavement or the right of way line? When locations of existing utilities cannot be determined, this shall be so noted.
Yes : _____ No : _____ N/A : _____
J Have the locations of bus stops and related facilities been shown on the plan?
Yes : _____ No : _____ N/A : _____
K Have service laterals which are to be installed during the original installation of main(s) been indicated on the plans?
Yes : _____ No : _____ N/A : _____
Note: Dimensioned locations for the service laterals are not required on the original plans. Plans for services to be installed as a separate project, after installation of main(s), shall be noted and explained.
L Are specifications for the proposed work included with the plans? Specifications may be omitted in connection with plans for minor extensions of existing systems provided that the extensions are to be constructed in accordance with the requirements of the Broward County Highway Construction & Engineering Division "Minimum Standards".
Yes : _____ No : _____ N/A : _____
If no, has a notation been made on the plans that all installations within Broward County jurisdiction rights of way are in conformity with the Broward County Highway Construction & Engineering Division "Minimum Standards".
Yes : _____ No : _____ N/A : _____
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IV Water Distribution and/or Sewage Collection Systems, General Plan and Specification Requirements - continued
M Does the plan identify the operating or maintaining utility company?
Yes : _____ No : _____ N/A : _____
N Are all existing and proposed above and underground utilities, referenced in IVA above, shown on this plan?
Yes : _____ No : _____ N/A : _____
O Has HRS (Broward County Health Department) approval been obtained? If yes include copy of the approval.
Yes : _____ No : _____ N/A : _____
P Has DNRP (Broward County Department of Natural Resource Protection) approval been obtained? If yes include copy of the approval.
Yes : _____ No : _____ N/A : _____
Q For irrigation purposes is the minimum pipe specification for laterals downstream of valves, PVC meeting ASTM Standard D-2241, Type 1120, SDR 26, minimum Class 200, solvent weld type.
Yes : _____ No : _____ No irrigation included as a part of this project : _____
This application package is being submitted for :
___ Paving & Drainage with Water Distribution and/or Sewage Collection Go to Page 12 - Section IX Agent Signature
___ Water Distribution and/or Sewage Collection only (P&D not required) Go to Page 12 - Section IX Agent Signature
(THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK)
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V Gas Transmission and Distribution Systems, General Plan and Specification Requirements
A Are plans signed and sealed by a Professional Engineer registered in the State of Florida?
Yes : _____ No : _____ N/A : _____
B Do the plans show and locate by dimension the proposed project facilities and all existing and other planned facilities sufficiently to permit assessment of the compatibility of the proposed work with the existing planned systems?
Yes : _____ No : _____ N/A : _____
C Are specifications for the proposed work included with the plans?
Yes : _____ No : _____ N/A : _____
If no has a notation been made on the plans that all installations within Broward County jurisdiction rights of way are in conformity with the Broward County Highway Construction & Engineering Division "Minimum Standards"?
Yes : _____ No : _____ N/A : _____
D Is the plan scale of sufficient size to show the proposed work and the right of way area clearly?
Yes : _____ No : _____ N/A : _____
E Do the plans show gas main sizes, and their dimensioned location offsets from property lines?
Yes : _____ No : _____ N/A : _____
F Do the plans show the approximate locations of valves and gas service connections?
Yes : _____ No : _____ N/A : _____
G Are existing pavement widths dimensioned on the plans and indicated by notes and light shading and are they located by dimensions within the right of way?
Yes : _____ No : _____ N/A : _____
H Have all locations of other underground utilities been determined and shown on the plan? If locations cannot be determined, this shall be indicated by a note.
Yes : _____ No : _____ N/A : _____
I Have house gas services installed during the original installation of main(s) been indicated on the plans?
Yes : _____ No : _____ N/A : _____
Note: Dimensioned locations for house gas services are not required on the original plans. Plans for connections after installation of main(s), shall be noted and explained.
J Does the plan identify the operating or maintaining utility company?
Yes : _____ No : _____ N/A : _____
K Is this plan for maintenance work? If yes, the drawing must indicate location, right of way layout, proposed work area and nature of work.
Yes : _____ No : _____ N/A : _____
L Is this for emergency work? If yes, the plan must comply with P above and be submitted within ten (10) working days of completion of the work.
Yes : _____ No : _____ N/A : _____
This application package is being submitted for :
___ Gas Transmission & Distribution Go to Page 12 - Section IX Agent Signature
(THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK)
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VI Installations of Telephone, CATV or Other Signal Systems, General Plan and Specification Requirements
A Do the plans show and locate by dimension the proposed project facilities and all existing and other planned facilities sufficiently to permit assessment of the compatibility of the proposed work with the existing systems?
Yes : _____ No : _____ N/A : _____
B Are specifications for the proposed work included with the plans?
Yes : _____ No : _____ N/A : _____
If no has a notation been made on the plans that all installations within Broward County jurisdiction rights of way is in conformity with the Broward County Highway Construction & Engineering Division "Minimum Standards".
Yes : _____ No : _____ N/A : _____
C Is the plan scale of sufficient size to show the proposed work and the right of way area clearly.
Yes : _____ No : _____ N/A : _____
D Are existing pavement widths dimensioned on the plans and indicated by notes and light shading and are they located by dimensions within the right of way?
Yes : _____ No : _____ N/A : _____
E Have all locations of other underground utilities been determined and shown on the plan? If locations cannot be determined, this shall be indicated by a note.
Yes : _____ No : _____ N/A : _____
F Does the plan identify the operating or maintaining utility company?
Yes : _____ No : _____ N/A : _____
G Is this plan for maintenance work? If yes, the drawing must indicate location, right of way layout, proposed work area and nature of work.
Yes : _____ No : _____ N/A : _____
H Is this for emergency work? If yes, the plan must comply with P above and be submitted within ten (10) working days of completion of the work.
Yes : _____ No : _____ N/A : _____
I Do the plans show the number, size, service and location of all underground cables and conduits?
Yes : _____ No : _____ N/A : _____
J Do the plans show the approximate locations of all valves, hydrants, poles, manholes and terminal boxes and the size, service and material of all other piping?
Yes : _____ No : _____ N/A : _____
K Are all utility mains located by dimensioned offsets from the right of way lines and by their elevations as determined by the appropriate utility company as-built drawings?
Yes : _____ No : _____ N/A : _____
L Have service drops proposed to be installed during the original installation of the common cable been indicated on the plans?
Yes : _____ No : _____ N/A : _____
Note: Dimensioned locations for these service drops are not required on the original plans.
This application package is being submitted for :
___ Telephone, CATV or Other Signal Systems Go to Page 12 - Section IX Agent Signature
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VII Electric Power Installations, General Plan and Specification Requirements
A Do the plans show and locate by dimension the proposed project facilities and all existing and other planned facilities sufficiently to permit assessment of the compatibility of the proposed work with the existing planned systems?
Yes : _____ No : _____ N/A : _____
B Are specifications for the proposed work included with the plans?
Yes : _____ No : _____ N/A : _____
If no has a notation been made on the plans that all installations within Broward County jurisdiction rights of way is in conformity with the Broward County Highway Construction & Engineering Services Division "Minimum Standards".
Yes : _____ No : _____ N/A : _____
C Is the plan scale of sufficient size to show the proposed work and the right of way area clearly.
Yes : _____ No : _____ N/A : _____
D Are existing pavement widths dimensioned on the plans and indicated by notes and light shading and are they located by dimensions within the right of way?
Yes : _____ No : _____ N/A : _____
E Have all locations of other underground utilities been determined and shown on the plan? If locations cannot be determined, this shall be indicated by a note.
Yes : _____ No : _____ N/A : _____
F Does the plan identify the operating or maintaining utility company?
Yes : _____ No : _____ N/A : _____
G Is this plan for maintenance work? If yes, the drawing must indicate location, right of way layout, proposed work area and nature of work.
Yes : _____ No : _____ N/A : _____
H Is this for emergency work? If yes, the plan must comply with P above and be submitted within ten (10) working days of completion of the work.
Yes : _____ No : _____ N/A : _____
I Do the plans show all proposed cable, conduit and duct sizes, manhole and pole locations, right of way lines and widths, all existing utilities and the dimensioned offsets of the proposed facilities from the right of way lines?
Yes : _____ No : _____ N/A : _____
J Have underground service lines been shown and located by dimension from the lot lines of the property they serve?
Yes : _____ No : _____ N/A : _____
Note: Aerial service lines proposed to be installed during the original installation are not required to be dimensioned on the plans.
This application package is being submitted for :
___ Electric Power Installations Go to Page 12 - Section IX Agent Signature
(THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK)
Page 12 of 12
VIII Monitoring Well Installations, General Plan and Specification Requirements NOTE: Construction of a monitoring well in an existing travel lane of any County Jurisdiction road is prohibited, except when
unavoidable.
A Are plans signed and sealed by a Professional Engineer registered in the State of Florida? If they were prepared by a graduate geologist or graduate environmental engineer this is acceptable, but documentation must be provided.
Yes : _____ No : _____ N/A : _____
B Are all existing facilities as well as all other planned facilities sufficiently shown to permit assessment of the compatibility of the proposed work with existing systems?
Yes : _____ No : _____ N/A : _____
C Do the plans as submitted on legal size paper, meet the scale requirements?
Yes : _____ No : _____ N/A : _____
D Do the plans show the proposed monitoring well location with dimensioned offset of the monitoring well from the right of way lines, and existing edge of pavement?
Yes : _____ No : _____ N/A : _____
E Are existing pavements indicated by notes and the pavement width and location within the right of way shown by dimensions?
Yes : _____ No : _____ N/A : _____
F Are all proposed wells covered with traffic bearing, flush mounted steel manhole covers and housings, installed at grade?
Yes : _____ No : _____ N/A : _____
G Has a detailed cross section of the monitoring well been included indicating details of the locking cap, depth, pipe diameter, well screening and high water table elevation?
Yes : _____ No : _____ N/A : _____
This application package is being submitted for :
___ Monitoring Well Installations Complete Agent Signature Section
IX AGENT SIGNATURE
ALL APPLICATIONS FOR PLAN REVIEW MUST BE SIGNED, SEALED AND DATED. FAILURE TO DO SO WILL BE
CAUSE FOR REJECTION OF THE APPLICATION.
I hereby certify that the information contained herein to the best of my knowledge and belief is accurate and complete.
By signing this application, the undersigned acknowledges that they have read and understand the contents of this application and the ramifications that may result if incorrect, misleading, or omitted information having a significant bearing on the approvability of the plan has been provided.
__________________________________
Registered Professional Engineer
Seal
Signed this __________ day of _________________________ 20__