Office Use Only
Fee Paid _________________ Date Approved _______________ Permit Number _____________
Public Hearing: YES NO Agent Approval: YES NO
TOWN OF EAST HAMPTON
INLAND WETLANDS & WATERCOURSES AGENCY (Revised 1/27/2012)
Date: ____________________
1. Name of Applicant* ________________________________
Phone Numbers: Home __________________, Business __________________, Cell ________________
Home Address: Street ___________________________ Town ________________ State/Zip __________
Business Address: Street ______________ __________ Town ________________ State/Zip __________
* All applications MUST list contact phone numbers. If the applicant is a Limited Liability Corporation or a Corporation,
provide the managing member’s or responsible corporate officer’s name, address, and telephone number.
2. Name of Property Owner (if different from Applicant): _____________________ Phone _____________
Address: Street _____________________________ Town __________________ State/Zip ____________
As the legal owner of the property listed on this application I hereby consent to the proposed activities.
I hereby authorize the members and agents of the Agency to inspect the subject land, at reasonable times,
during the pendency of the application and for the life of the permit.
Printed Name: _________________________, Signature: _______________________, Date:___________
3. Provide the applicant’s interest in the land. _________________________________________________
______________________________________________________________________________________
4. Site Location and Description: Assessor’s Map ____________, Block ____________, Lot ____________
Address: Street _____________________________ Town __________________ State/Zip _____________
Note: It is the applicant’s responsibility to provide the correct site address, map, block, and lot number for the legal notice.
Provide a description of the land in sufficient detail to allow identification of the inland wetlands and watercourses,
the area(s) (in acres or square feet) of wetlands or watercourses to be disturbed, soil type(s), and wetland vegetation.
Area of Wetland to be disturbed: ____________ acres or sq. ft.
Area of Watercourse to be disturbed ____________ acres or sq. ft.
Area of Upland Review Area to be disturbed: ____________ acres or sq. ft.(Area within 100’ of wetland)
TOTAL AREA OF DISTURBANCE ____________ acres or sq. ft.
Will fill be needed on site? Yes No If yes, how much fill is needed? ____________ cubic yards
The property contains (circle one or more)
WETLANDS, BROOK, RIVER, INTERMITTANT STREAM, VERNAL POOL, SWAMP, OTHER ____________
Description of soil types on site: ______________________________________________________________
Description of wetland vegetation: ____________________________________________________________
Name of Soil Scientist and date of survey: ______________________________________________________
5. Attach a written narrative of the purpose and description of the proposed activity and proposed erosion and
sedimentation controls, best management practices, and mitigation measures which may be considered as a
condition of issuing a permit for the proposed regulated activity including but not limited to; measures to:
(1) prevent or minimize pollution or other environmental damage, (2) maintain or enhance existing environmental
quality, or (3) in the following order of priority: restore, enhance or create productive wetland or watercourse resources.
Depending on the complexity of the project, include the following: construction schedule, sequence of operations,
drainage computations with pre and post construction runoff quantities and runoff rates, plans clearly showing the
drainage areas corresponding to the drainage computations, existing wetland inventory and functional assessment,
soils report, construction plans signed by a certified soils scientist, licensed surveyor, and licensed professional engineer. Include a construction schedule, impacts to vegetation, and pictures that clearly show the existing conditions of all areas to be distrubed and/or cleared of vegetation.
6. Provide information of all alternatives considered. List all alternatives which would cause less or no environmental
impact to wetlands or watercourses and state why the alternative as set forth in the application was chosen. All such
alternatives shall be diagramed on a site plan or drawing.
(Attach plans showing all alternatives considered.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________________
7. Attach a site plan showing the proposed activity and existing and proposed conditions in relation to wetlands and
watercourses and identifying any further activities associated with, or reasonably related to, the proposed regulated activity which are made inevitable by the proposed regulated activity and which may have an impact on wetlands or watercourses. Include a colored grading plan showing areas to be filled (green) and areas to be excavated (brown) that clearly shows existing and proposed contours and proposed limits of disturbance.
8. Attach the names and mailing addresses of adjacent landowners. Attach additional sheets if necessary.
Name ___________________________ Address _____________________________________________
Name ___________________________ Address _____________________________________________
Name ___________________________ Address _____________________________________________
9. Attach a completed DEP reporting form.
The Agency shall revise or correct the information provided by the applicant and submit the form to the Commissioner of
Environmental Protection in accordance with section 22a-39-14 of the Regulations of Connecticut State Agencies.
10. Attach the appropriate filing fee based on the fee schedule in Section 19 of the regulations.
Fee: _______________________ (Make check payable to “The Town of East Hampton”)
11. Name of Erosion Control Agent (Person Responsible for Compliance): __________________________
Phone Numbers: Home __________________, Business __________________, Cell ________________
Address: Street ______________________________ Town ___________________ State/Zip __________
12. Are you aware of any wetland violations (past or present) on this property? YES NO
If yes, explain ___________________________________________________________________________
13. Are you aware of any vernal pools located on or adjacent (within 500’)to the property? YES NO
14. For projects that do not fall under the ACOE Category 1 general permit – Have you contacted the Army Corps of Engineers? YES NO
15. Is this project within a public water supply aquifer protection area or a public water supply watershed area?
YES NO
If so, have you notified the Commissioner of the Connecticut Department of Public Health and the East Hampton WPCA? YES NO
(Proof of notification must be submitted with your application.)
16. PUBLIC HEARINGS ONLY. The applicant must provide proof of mailing notices to the abutters prior to the hearing date.
17. As the applicant I am familiar with all the information provided in the application and I am aware of the penalties for
obtaining a permit through deception or through inaccurate or misleading information.
Printed name: ________________________, Signature: _________________________, Date: ___________
Please Note: You or a representative must attend the Inland Wetlands meeting to present you application.
CHECKLIST FOR A COMPLETE APPLICATION
completed application form including Department of Environmental Protection reporting form (green copy)
A narrative of the purpose and description and methodology of all proposed activities;
Alternatives considered by the applicant, reasons for leaving less than a 10’ buffer between clearing and the wetlands.
Such alternatives to be diagrammed on a site plan or drawing and submitted to the commission as part of the application;
Names and mailing addresses of abutting property owners;
Three copies of approximately l"=40' scale plans
Locations of existing and proposed land uses
Locations of existing and proposed buildings
Locations of existing and proposed subsurface sewage disposal systems, and test hole descriptions
Existing and proposed topographical and man-made features including roads and driveways, on and adjacent to the site. Include a colored grading plan showing areas to be filled (green) and areas to be excavated (brown) that clearly shows existing and proposed contours and proposed limits of disturbance.
Location and diagrams of proposed erosion control structures
Pictures of existing conditions clearly showing all areas to be disturbed, and/or cleared of vegetation.
Assessor map, block and lot number
Key or inset map
North arrow
Flood zone classification and delineation
Use of wetland and watercourse markers where appropriate.
Soil types classification and boundary delineation (flagged and numbered boundary), Soil Scientist's original signature and certification on plans
Soil Scientist's (or other wetland scientist) report on the function of the wetlands
Watercourse channel location and flow direction, where appropriate
100 ft. regulated area depicted on plans
Conservation easements where appropriate
A detailed erosion and sediment control plan which meets requirements set forth in the most recent revision of the Connecticut Guidelines for Soil Erosion and Sediment Control, published by the Connecticut Council on Soil and Water Conservation, including:
Location of areas to be stripped of vegetation and other unprotected areas
Schedule of operations including starting and completion dates for major development phases
Seeding, sodding, or re-vegetation plans for all unprotected or un-vegetated areas
Location and design of structural sediment control measures
Timing of planned sediment control measures
Use of wetland and watercourse markers
Proper certification on the application documents and plans
In the case of filling in wetlands, watercourses, or regulated upland areas, the following items are necessary:
Area to be filled
Volume of requested fill
Finished slopes of filled areas
Containment and stabilization measures
Proposed finished contours
Evaluation of the effect of filling the wetlands with respect to storage volume and its impact downstream showing before and after development flows, and the evaluation of storm water detention including the existing need for flood control downstream
Other required items:
Proof of adjoining Town notification, where required;
All application fees required by Section 19 of these regulations;
A written narrative detailing how the effects of the applicant's proposed activities upon wetlands and watercourses shall be mitigated.
A written description of any and all future plans which may be linked to the activities proposed in the current application.
Address the potential to enhance the current buffer area.
Review drainage information with Town Engineering
Mailing requirements for abutters (public hearing only)
SECTION 19
APPLICATION FEES
19.5 Fee Schedule. Application fees will be based on the following schedule:
19.5.1 Application Fee** plus fee from Schedule A
19.5.1.1 Residential Uses. $50.00 Plus *$50.00/lot
*Each additional lot with regulated activities.
**$60.00 DEP fee required by C.G.S. 22a-27j will be added to the base fee.
19.5.1.2 Commercial/Industrial/Other Uses. $400.00
19.5.2 Approval by Authorized Agent $30.00
19.5.3 Public Hearing Fee
19.5.3.1 Single Residential $100.00
19.5.3.2 Subdivision $300.00
19.5.3.2 Commercial, Industrial, Other $300.00
19.5.4 Complex Application Fee Actual Cost
The Inland Wetland Agency may charge an additional fee sufficient to cover the cost of reviewing and acting on complex applications.
Such fee may include, but not be limited to, the cost of retaining experts, to advise, review, and report on issues requiring such experts.
The Agency shall estimate the complex application fee, which shall be paid pursuant to section 19 of these regulations within 10 days
of the applicant’s receipt or notice of such estimate. Any portion of the complex application fee in excess of the actual cost shall be
refunded to the applicant no later than 30 days after publication of the Agency’s decision.
19.5.5 Permitted and Nonregulated Uses:
19.5.5.1 Permitted Uses as of Right $0.00
19.5.5.2 Nonregulated $0.00
19.5.6 Regulation Amendment Petitions $100.00
(Does not include Notices or Regulation Advisories from DEP.)
19.5.6.1 Map Amendment Petitions $10.00
Plus fee from Schedule B
19.5.7 Modification of Previous Approval
19.5.7.1 Residential $25.00
19.5.7.2 Subdivision $50.00
19.5.7.3 Commercial/Industrial/Other $75.00
19.5.8 Renewal of Previous Approval $50.00
19.5.9 SCHEDULE A. For the purposes of calculating the permit application fee, the area in schedule A is the total area of wetlands and
watercourses and upland review area upon which a regulated activity is proposed.
SQUARE FEET OF AREA
19.5.9.1 Less than 1,000 $0.00
19.5.9.2 1,000 to 5,000 $200.00
19.5.9.3 More than 5,000 $400.00
19.5.10 SCHEDULE B. For the purposed of calculating the map amendment petition fee, the linear feet in schedule B is the total length
of wetlands and watercourses boundary subject to the proposed boundary change.
LINEAR FEET
19.5.10.1 Less than 500 $0.00
19.5.10.2 500 to 1,000 $100.00
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